Objective: The objective of the study was to determine the effectiveness of myoinositol (MI) supplementation in the prevention of gestational diabetes mellitus (GDM) among high-risk patients. Materials and Methods: Comprehensive and systemic online searches were performed on PubMed, MEDLINE, Ovid, and Cochrane. Cross-referencing from related articles was also done. Only studies published in English were included in the study. We selected all randomized controlled trials on MI and singleton pregnant women with high risk for GDM. Data Collection and Analysis: Five randomized controlled trials were evaluated by two independent reviewers. For each comparison, the quality of evidence was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Cochrane Collaboration tool. Review Manager 5.3 was used to generate the risk of bias evaluation and the analysis of the results. Main Results: The present study identified five randomized controlled trials involving 871 participants. The comparison of the studies showed a statistically significant reduction in the incidence of GDM in MI supplementation versus the control group (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.19–0.53, P = 0.0001, Z = 4.36) by 68%. Similarly, there is a greater reduction in the incidence of fetal macrosomia among patients in the MI group than the controlled group (OR = 0.24, 95% CI = 0.07–0.78; P = 0.02, Z = 2.36) by 78%. However, there was no difference in terms of incidence of gestational hypertension (OR = 0.61, 95% CI = 0.19–2.01; P = 0.42, Z = −0.81), cesarean section (OR = 0.89, 95% CI = 0.65–1.22; P = 0.47, Z = 0.72), and neonatal hypoglycemia (OR = 0.35, 95% CI = 0.01–8.80; P = 0.53, Z = 0.63) outcomes. Conclusion MI supplementation taken at 4 g daily would decrease the incidence of GDM and fetal macrosomia. There was no statistically significant reduction in the risk of gestational hypertension, cesarean section, and neonatal hypoglycemia in the supplementation of MI.
Cesarean section ; fetal macrosomia ; gestational diabetes mellitus ; gestational hypertension ; myoinositol ; neonatal hypoglycemia

Maternai diabetes is the most important known risk factor for development of fetal macrosomia. An attempt to study macrosomia and gestational diabetes was made using oral glucose tolerance test (OGTT) in early puerperium. Patients were divided into two groups: The macrosomia group was mothers who delivered largc fetuses over 4Kg. The control group was mothers who delivered normal weight fetuses (3.5-3.9Kg). The 75g OGTI' was done within 48 hours after delivery. The results were that 12% of the macrosomia group had abnormal glucose intolerance but only 2% of controi group showed an abnomal glucose level. Definite diabetes were not seen in either groups. In conclusion, if a glucose tolerance test has not been performed prenatally, the 75g oral glucose toleranre test has some usefulness within 48 hours postpartum in the macrosomia group which has the possibility of gestational diabetes.
Diabetes, Gestational ; Female ; Fetal Macrosomia ; Fetus ; Glucose ; Glucose Intolerance ; Glucose Tolerance Test* ; Humans ; Mothers ; Postpartum Period* ; Pregnancy ; Risk Factors

Objective To explore the performance of mobile health platform for standardized management of pregnant women with gestational diabetes mellitus(GDM). Methods A randomized controlled trial was conducted,in which 295 women with GDM were randomized into two groups(traditional management group and mobile health management group)by a computer-generated sequence.The traditional management group accepted standardized GDM management,and the mobile health management group was supplemented by mobile health management based on the standardized management.The glycemic control rate and the incidences of low birth weight,macrosomia,preterm birth,premature rupture of membranes,postpartum hemorrhage after cesarean section,neonatal asphyxia,malformation,and admission to the neonatal intensive care unit were compared between the two groups. Results The glycemic control rate in mobile health management group was significantly higher than that in the traditional management group [(67.22±22.76)%
Cesarean Section ; Diabetes, Gestational/therapy* ; Female ; Fetal Macrosomia ; Humans ; Infant, Newborn ; Pregnancy ; Pregnancy Outcome ; Premature Birth ; Telemedicine

BACKGROUND: Weight gain during pregnancy reflects the mother's nutritional status. However, it may be affected by nutritional therapy and exercise interventions used to control blood sugar in gestational diabetes mellitus (GDM). This study aimed to evaluate weight gain during gestation and pregnancy outcomes among women with GDM. METHODS: A retrospective study involving 1523 women with GDM was conducted between July 2013 and July 2016. Demographic data, gestational weight gain (GWG), blood glucose, glycated-hemoglobin level, and maternal and fetal outcomes were extracted from medical records. Relationships between GWG and pregnancy outcomes were investigated using multivariate logistic regression. RESULTS: In total, 451 (29.6%) women showed insufficient GWG and 484 (31.8%) showed excessive GWG. Excessive GWG was independently associated with macrosomia (adjusted odds ratio [aOR] 2.20, 95% confidence interval [CI] 1.50-3.52, P < 0.001), large for gestational age (aOR 2.06, 95% CI 1.44-2.93, P < 0.001), small for gestational age (aOR 0.49, 95% CI 0.25-0.97, P = 0.040), neonatal hypoglycemia (aOR 3.80, 95% CI 1.20-12.00, P = 0.023), preterm birth (aOR 0.45, 95% CI 0.21-0.96, P = 0.040), and cesarean delivery (aOR 1.45, 95% CI 1.13-1.87, P = 0.004). Insufficient GWG increased the incidence of preterm birth (aOR 3.53, 95% CI 1.96-6.37, P < 0.001). CONCLUSIONS Both excessive and insufficient weight gain require attention in women with GDM. Nutritional therapy and exercise interventions to control blood glucose should also be used to control reasonable weight gain during pregnancy to decrease adverse pregnancy outcomes.
Adult ; Body Mass Index ; Diabetes, Gestational ; pathology ; physiopathology ; Female ; Fetal Macrosomia ; pathology ; physiopathology ; Gestational Age ; Humans ; Logistic Models ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Retrospective Studies ; Weight Gain ; physiology

BACKGROUND: Gestational diabetes mellitus (GDM) brings health issues for both mothers and offspring, and GDM prevention is as important as GDM management. It was shown that a history of GDM was significantly associated with a higher maternal risk for GDM recurrence. The incidence of GDM recurrence was unclear because of the incidence of second-child was low before 2016 in China. We aim to investigate the prevalence of GDM recurrence and its associated high-risk factors which may be useful for the prediction of GDM recurrence in China. METHODS: A retrospective study was conducted which enrolled participants who underwent regular prenatal examination and delivered twice in the same hospital of 18 research centers. All participants were enrolled from January 2018 to October 2018, where they delivered the second baby during this period. A total of 6204 women were enrolled in this study, and 1002 women with a history of GDM were analyzed further. All participants enrolled in the study had an oral glucose tolerance test (OGTT) result at 24 to 28 weeks and were diagnosed as GDM in the first pregnancy according to the OGTT value (when any one of the following values is met or exceeded to the 75-g OGTT: 0 h [fasting], ≥5.10 mmol/L; 1 h, ≥10.00 mmol/L; and 2 h, ≥8.50 mmol/L). The prevalence of GDM recurrence and development of type 2 diabetes mellitus were calculated, and its related risk factors were analyzed. RESULTS: In 6204 participants, there are 1002 women (1002/6204,16.15%) with a history of GDM and 5202 women (5202/6204, 83.85%) without a history of GDM. There are significant differences in age (32.43 ± 4.03 years vs. 33.00 ± 3.34 years vs. 32.19 ± 3.37 years, P  < 0.001), pregnancy interval (4.06 ± 1.44 years vs. 3.52 ± 1.43 years vs. 3.38 ± 1.35 years, P  = 0.004), prepregnancy body mass index (BMI) (27.40 ± 4.62 kg/m2vs. 23.50 ± 3.52 kg/m2vs. 22.55 ± 3.47 kg/m2, P < 0.001), history of delivered macrosomia (22.7% vs. 11.0% vs. 6.2%, P < 0.001) among the development of diabetes mellitus (DM), recurrence of GDM, and normal women. Moreover, it seems so important in the degree of abnormal glucose metabolism in the first pregnancy to the recurrence of GDM and the development of DM. There are significant differences in OGTT levels of the first pregnancy such as area under the curve of OGTT value (18.31 ± 1.90 mmol/L vs. 16.27 ± 1.93 mmol/L vs. 15.55 ± 1.92 mmol/L, P < 0.001), OGTT fasting value (5.43 ± 0.48 mmol/L vs. 5.16 ± 0.49 mmol/L vs. 5.02 ± 0.47 mmol/L, P < 0.001), OGTT 1-hour value (10.93 ± 1.34 mmol/L vs. 9.69 ± 1.53 mmol/L vs. 9.15 ± 1.58 mmol/L, P < 0.001), OGTT 2-hour value (9.30 ± 1.66 mmol/L vs. 8.01 ± 1.32 mmol/L vs. 7.79 ± 1.38 mmol/L, P < 0.001), incidence of impaired fasting glucose (IFG) (fasting plasma glucose ≥5.6 mmol/L) (31.3% vs. 14.6% vs. 8.8%, P < 0.001), and incidence of two or more abnormal OGTT values (68.8% vs. 39.7% vs. 23.9%, P < 0.001) among the three groups. Using multivariate analysis, the factors, such as age (1.07 [1.02-1.12], P = 0.006), prepregnancy BMI (1.07 [1.02, 1.12], P  = 0.003), and area under the curve of OGTT in the first pregnancy (1.14 [1.02, 1.26], P  = 0.02), have an effect on maternal GDM recurrence; the factors, such as age (1.28 [1.01-1.61], P  = 0.04), pre-pregnancy BMI (1.26 [1.04, 1.53], P = 0.02), and area under the curve of OGTT in the first pregnancy (1.65 [1.04, 2.62], P = 0.03), have an effect on maternal DM developed further. CONCLUSIONS The history of GDM was significantly associated with a higher maternal risk for GDM recurrence during follow-up after the first pregnancy. The associated risk factors for GDM recurrence or development of DM include age, high pre-pregnancy BMI, history of delivered macrosomia, the OGTT level in the first pregnancy, such as the high area under the curve of OGTT, IFG, and two or more abnormal OGTT values. To prevent GDM recurrence, women with a history of GDM should do the preconception counseling before preparing next pregnancy.
Adult ; Blood Glucose/metabolism* ; China/epidemiology* ; Diabetes Mellitus, Type 2/epidemiology* ; Diabetes, Gestational ; Female ; Fetal Macrosomia ; Glucose Intolerance ; Humans ; Male ; Pregnancy ; Retrospective Studies

Background: Gestational diabetes is a special form of diabetes mellitus, which is initially diagnosed during gestation. In Vietnam, routine screens for gestational diabetes are not performed. The risk factors of the disease are not taken into account during early screening. Many pregnancies are later diagnosed when complications present themselves. Objective: To determine the prevalence and discover the risk factors for Gestational Diabetes (GD) among pregnant women, who followed up at the Department of Obstetrics and Gynecology, Bach Mai Hospital. Subject and methods: A cross-sectional, prospective study was conducted on 415 pregnant women, who had 24-28 weeks of gestation, followed up at the Department of Obstetrics and Gynecology, Bach Mai Hospital from December, 2006 to April, 2007. All were asked about the risk factors and given an oral glucose tolerance test with 75g of glucose. Results: The prevalence of GD in general population accounted for 7.9%. The prevalence of GD, who had BMI \u226523, family history with 1st degree relative of diabetes and positive glycosuria at gestational age under 24 weeks in subgroups were 25.8%, 37.8% and 55.6%, respectively. None of the pregnant women who had a child weighed \u22654.000g at the previous delivery was diagnosed as GD. However, all thepregnant women, who had history of abnormal glucose tolerance, were GD. Conclusion: Prevalence of GD is increasing. BMI\u226523, family history with 1st degree relative of diabetes and positive glycosuria at age of gestation <24 weeks are considered as high risk factors of GD.
gestational diabetes

Diabetes, Gestational

Introduction: Gestational diabetes (GDM) has significant maternal and foetal implications. screening allows active interventions which significantly improves pregnancy outcomes. Despite World Health Organization (WHO), FIGO and National Institute of clinical Excellence (NIcE) recommendations for universal screening especially among high risk population; Malaysia currently adopts a selective risk based screening for GDM. Objective: the objective is to audit the effectiveness of the current practice of selective risk based screening in detection of GDM in Malaysia. Methodology: this is a retrospective cohort study based on the National Obstetric Registry (NOR) which comprises of 14 major tertiary hospitals in Malaysia. the study period was from 1st January 2011 till 31st December 2012 and a total of 22,044 patients with GDM were analysed. Logistic regression analysis was used to calculate the crude odd ratio. Results: the incidence of GDM in Malaysia is 8.4%. Maternal age of ≥25, booking bMI ≥27kg/m2, booking weight ≥80kg and previous hypertension are non-significant risk of developing GDM in Malaysia. Parity 5 and more was only associated with an odds-ratio of 1.02 (95% confidence Interval: 0.90-1.17) as compared to parity below 5. the association of women with previous stillbirth with GDM was not significant. conclusion: current risk based screening for GDM based on maternal age, booking bMI, weight and hypertension is inappropriate. An ideal screening tool should precede disease complications, which is the novel objective of screening. Universal screening for GDM in Malaysia may be a more accurate measure, especially with regards to reducing maternal and foetal complications.
Diabetes, Gestational

Introduction: Proper gestational diabetes mellitus (GDM) care is essential for optimal control and thus prevents adverse perinatal outcomes. This audit aimed to determine the quality of GDM care provided by a public polyclinic. Methods: The audit was performed on the clinic-based medical record of GDM patients who had undergone at least three prenatal follow-ups and one postnatal follow-up between January and November 2012. Patients with pre-existing diabetes mellitus were excluded. Results: A total of 74 medical records were audited and it showed that 94.6% of patients were of age 25 and above, 91.9% were Malays, 71.6% were multigravida and 98.6% had risk factors of GDM. 54.1% of diagnoses were made during the second trimester, while 25.7% and 20.2% of cases were detected during the first and third trimester respectively. All of the GDM patients had their weight and blood pressure monitored, 85.1% had their fundal height checked as scheduled and 85.1% were referred for diet counselling. 81.9% and 100% of GDM patients who were not on treatment and on treatment correspondingly had their blood sugar profile monitoring done as recommended. Only 13.5% of GDM patients were given prenatal family planning counselling and 35.1% were given a six weeks’ postnatal oral glucose tolerance test appointment. Monthly ultrasound screening and HbA1c monitoring was done in merely 51.4% and 58.1% of the GDM patients respectively. Conclusion: The GDM care process in this public polyclinic could be improved further to achieve the standard recommendations
Gestational diabetes

Abstract Maternal hyperglycemia during the peripartum period is highly correlated with fetal hyperinsulinemia and consequent neonatal hypoglycemia. Liberal use of intravenous glucose therapy prior to delivery can potentially cause maternal hyperglycemia, therefore, it is prudent to implement all preventive measures. This study aims to determine the occurrence of neonatal hypoglycemia with intravenous glucose therapy prior to delivery in maternal diabetes mellitus. This was a retrospective cohort study of neonates born from diabetic mothers at the University of Santo Tomas Hospital Clinical and Private Divisions from January 1, 2013 to December 15, 2017. Clinical information gathered was divided into maternal and neonatal characteristics. Maternal intravenous fl uid use, rate, and duration were noted; maternal and neonatal blood glucose results were obtained. There were 109 infants of diabetic mothers, of which 105 were delivered as singleton and 4 from twin pregnancies. Neonatal hypoglycemia was present in 14.68%. Comparing the risk factors, there was a higher amount of glucose infused to the mothers whose offspring developed hypoglycemia compared to those without hypoglycemia. Statistically, this did not demonstrate a signifi cant difference. The rate of glucose infusion and frequency of maternal insulin use were similar between the groups. Linear correlation was not evident when the total glucose infused and the rate of intravenous glucose infusion was compared to the neonatal glucose in the fi rst hour of life. Based on this study, routine administration of glucose-containing intravenous fl uid did not infl uence the incidence of neonatal hypoglycemia. It is recommended that further prospective studies be conducted.
Diabetes, Gestational ;