The effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in gestational diabetes Contribution of first trimester fasting plasma insulin levels to the incidence of glucose intolerance in later pregnancy: Tanaka women's clinic study. Prediction of gestational diabetes mellitus in the first trimester, comparison of fasting plasma glucose, two-step and one-step methods: a prospective randomized controlled trial Breast-feeding is associated with reduced postpartum maternal glucose intolerance after gestational diabetes. Insulin and glyburide therapy: dosage, severity level of gestational diabetes, and pregnancy outcome. Early pregnancy probiotic supplementation with Lactobacillus rhamnosus HN001 may reduce the prevalence of gestational diabetes mellitus: a randomised controlled trial A two-step screening algorithm including fasting plasma glucose measurement and a risk estimation model is an accurate strategy for detecting gestational diabetes mellitus Effects of a Multispecies Probiotic Mixture on Glycemic Control and Inflammatory Status in Women with Gestational Diabetes: A Randomized Controlled Clinical Trial The Impact of Vitamin D Supplementation on Post-Partum Glucose Tolerance and Insulin Resistance in Gestational Diabetes: A Randomized Controlled Trial An evaluation of Croí MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): study protocol for a randomised controlled trial Favorable effects of vitamin D supplementation on pregnancy outcomes in gestational diabetes: a double blind randomized controlled clinical trial. Probiotics for the Prevention of Gestational Diabetes Mellitus in Overweight and Obese Women: Findings From the SPRING Double-Blind Randomized Controlled Trial A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Effect of probiotic yoghurt on plasma glucose in overweight and obese pregnant women: a randomized controlled clinical trial The effects of vitamin D and probiotic co-supplementation on glucose homeostasis, inflammation, oxidative stress and pregnancy outcomes in gestational diabetes: A randomized, double-blind, placebo-controlled trial. Lifestyle intervention for gestational diabetes mellitus prevention: A cluster-randomized controlled study Comparison of risk factors and pregnancy outcomes of gestational diabetes mellitus diagnosed during early and late pregnancy. A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. Tele-Mum: A Feasibility Study for a Randomized Controlled Trial Exploring the Potential for Telemedicine in the Diabetes Care of Those with Gestational Diabetes. Screening for gestational diabetes mellitus: the Sri Lankan experience. Probiotics in obese pregnancy do not reduce maternal fasting glucose: a double-blind, placebo-controlled, randomized trial (Probiotics in Pregnancy Study). Use of glyburide for the treatment of gestational diabetes: the San Antonio experience. Executive Summary: Standards of Medical Care in Diabetes—2009
Abstract Objective : This study was design ed to evaluate the effects of probiotic supplementation on biomarkers of inflammation , oxidative stress and pregnancy outcomes  among subjects with gestational diabetes ( GDM ) . Methods : This r and omized , double-blind , placebo-controlled clinical trial was done among 60 subjects with GDM who were not on oral hypoglycemic agents . Patients were r and omly allocated to intake either probiotic capsule containing Lactobacillus acidophilus , Lactobacillus casei and Bifidobacterium bifidum ( 2 × 109 CFU/g each ) ( n = 30 ) or placebo ( n = 30 ) for six weeks . Results : Compared with the placebo , probiotic supplementation result ed in significant decreases in fasting plasma glucose ( FPG ) ( −5.3 ± 6.7 vs. + 0.03 ± 9.0 mg/dL , p = .01 ) , serum high-sensitivity C-reactive protein ( hs-CRP ) ( −2.2 ± 2.7 vs. + 0.5 ± 2.4 μg/mL , p < .001 ) , plasma malondialdehyde ( MDA ) concentrations ( −0.1 ± 0.8 vs. + 0.5 ± 1.5 μmol/L , p = .03 ) and MDA/TAC ratio ( −0.0003 ± 0.0008 vs. + 0.0009 ± 0.002 , p = .004 ) , and a significant increase in total antioxidant capacity ( TAC ) levels ( + 65.4 ± 103.3 vs. −37.2 ± 143.7 mmol/L , p = .002 ) . Probiotic supplementation did not affect pregnancy outcomes . Conclusions : Overall , probiotic supplementation among women with GDM for six weeks had beneficial effects on FPG , serum hs-CRP , plasma TAC , MDA and oxidative stress index , but did not affect pregnancy outcomes AIMS To clarify risk factors predictive of glucose intolerance in later pregnancy . METHODS We prospect ively studied 509 pregnant women who visited the obstetrics clinic in Tokyo prior to week 13 of gestation , between September 2008 and January 2010 .  Biochemical parameters were measured in fasting plasma sample s collected at week 8.0 ± 2.0 of gestation . A 50 g glucose challenge test ( GCT ) was performed between weeks 26 and 29 : plasma glucose levels ≥ 7.8 mmol/l 1h after ingestion indicated a positive GCT . Logistic regression was performed , adjusting for relevant covariates . RESULTS We identified 114 patients with positive GCTs , including 8 with gestational diabetes mellitus ( GDM ) . After correcting for baseline body mass index , only the homeostasis model assessment of insulin resistance value remained a significant predictor of GCT positivity ( OR 2.07 ; 1.21 - 3.55 ) . We identified threshold values of fasting plasma glucose ( FPG ) ≥ 3.66 mmol/l and fasting plasma insulin ( FPI ) ≥ 36.69 pmol/l as indicative of a higher risk of positive GCT ( OR 2.38 ; 1.49 - 3.80 ) . CONCLUSIONS First trimester FPI levels improve the predictive ability of FPG level on subsequent GCT positivity Our aim was to evaluate and compare the diagnostic performance of three methods commonly used for GDM screening : fasting plasma glucose ( FPG ) , two-step 50 g glucose challenge test ( GCT ) , and 75 g glucose tolerance test ( GTT ) in a r and omized study design to predict GDM in the first trimester and determine the best approach in predicting GDM . In a non-blind , parallel-group prospect i ve r and omized controlled study ; 736 singleton pregnant women underwent FPG testing in the first trimester and r and omly assigned to two groups ; two-step 50 g GCT and 75 g GTT . GDM diagnosis was made according to Carpenter – Coustan or ADA ( American Diabetes Association ) criteria in two-step 50 g GCT and 75 g GTT groups , respectively . Subsequent testing was performed by two-step 50 g GCT at 24–28 weeks for screen negatives . After excluding the women who were lost to follow-up or withdrawn as a result of pregnancy loss , 486 pregnant women were recruited in the study . The FPG , two-step GCT , and one-step GTT methods identified GDM in 25/486 ( 5.1 % ) , 15/248 ( 6.0 % ) , and 27/238 ( 11.3 % ) women , respectively . Area under ROC curves were 0.623 , 0.708 , and 0.792 , respectively . Sensitivities were 47.17 , 68.18 , and 87.1 % , respectively . Specificities were 77.37 , 100 , and 100 % , respectively . Positive predictive values were 20.33 , 100 , and 100 % , respectively . Negative predictive values were 92.29 , 97 , and 98.1 % , respectively . Until superior screening alternatives become available , the 75 g GTT may be preferred for GDM screening in the first trimester Gestational diabetes mellitus ( GDM ) is associated with adverse foetal and maternal outcomes , and identifies women at risk of future Type 2 Diabetes Mellitus ( T2DM ) . Breast-feeding may improve postpartum maternal glucose tolerance . We prospect ively examined the prevalence of postpartum dysglycaemia after GDM and examined the effect of lactation on postpartum glucose tolerance . We compared postpartum 75 g oral glucose tolerance test ( OGTT ) results from 300 women with GDM and 220 controls with normal gestational glucose tolerance ( NGT ) .  Breast-feeding data was collected at time of OGTT . Postpartum OGTT results were classified as normal [ fasting plasma glucose ( FPG ) < 5.6mmol/l , 2-h < 7.8 mmol/l ] and abnormal [ impaired fasting glucose ( IFG ) , FPG 5.6 - 6.9 mmol/l ; impaired glucose tolerance ( IGT ) , 2-h glucose 7.8 - 11 mmol/l ; IFG+IGT ; T2DM , FPG > or = 7 mmol/l + /- 2h glucose > or = 11.1 mmol/l ] . 6 ( 2.7 % ) with NGT in pregnancy had postpartum dysglycaemia compared to 57 ( 19 % ) with GDM in index pregnancy ( p < 0.001 ) . Non-European ethnicity ( OR 3.40 , 95 % CI 1.45 - 8.02 , p = 0.005 ) , family history of T2DM ( OR 2.14 , 95 % CI 1.06 - 4.32 , p = 0.034 ) and gestational insulin use ( OR 2.62 , 95 % CI 1.17 - 5.87 p = 0.019 ) were associated with persistent dysglycaemia . The prevalence of persistent hyperglycaemia was significantly lower in women who breast-fed versus bottle-fed postpartum ( 8.2 % v 18.4 % , p < 0.001 ) . Breast-feeding may confer beneficial metabolic effects after GDM and should be encouraged OBJECTIVE We sought to investigate the association between glyburide dose , degree of severity in  gestational diabetes mellitus ( GDM ) ,  level of glycemic control , and  pregnancy outcome in insulin- and glyburide-treated patients . STUDY DESIGN In a secondary analysis of our previous r and omized study , 404 women were analyzed . The association among glyburide dose , severity of GDM , and selected maternal and neonatal factors was evaluated . Severity levels of GDM were stratified by fasting plasma glucose ( FPG ) from the oral glucose tolerance test ( OGTT ) . Infants with birth weight at or above the 90th percentile were considered large-for-gestational age ( LGA ) . Macrosomia was defined as birth weight > or = 4000 g. Well-controlled was defined as mean blood glucose < or = 95 mg/dL. The association between glyburide- and insulin-treated patients by severity of GDM and neonatal outcome was evaluated . RESULTS The dose received for the glyburide-treated patients was 2.5 mg-32 % ; 5 mg-23 % ; 10 mg-17 % ; 15 mg-8 % ; and 20 mg-20 % . Patients were grouped into low ( < or = 10 mg ) and high ( > 10 mg ) daily dose of glyburide . A comparison between severity of the disease ( fasting plasma glucose categories ) and highest dose of glyburide revealed a significant difference between the low-95 FPG and the other severity categories ( P = .02 ) . Of patients in the well-controlled glycemic group , only 6 % required the high dose of glyburide ( > 10 mg ) . In patients with poor glycemic control ( mean blood glucose > 95 mg/dL ) , 38 % received the high dose of glyburide ( P = .0001 ) . Comparison between the high glyburide ( > 10 mg ) and the low glyburide dosages ( < or = 10 mg ) revealed that the rate of macrosomia was 16 % vs 5 % and LGA 22 % vs 8 % , ( P = .01 ) , respectively . No significant difference was found in composite outcome , metabolic complications , and Ponderal Index between the 2 dose groups . Stratification by disease severity revealed a significantly lower rate of LGA for both the glyburide- and insulin-treated subjects . No significant difference was found between metabolic , respiratory , and neonatal intensive care unit ( NICU ) for patients within each fasting plasma glucose severity category . CONCLUSION Glyburide and insulin are equally efficient for treatment of GDM in all levels of disease severity . Achieving the established level of glycemic control , not the mode of pharmacologic therapy , is the key to improving the outcome in GDM The study aims to assess whether supplementation with the probiotic Lactobacillus rhamnosus HN001 ( HN001 ) can reduce the  prevalence of gestational diabetes mellitus ( GDM ) . A double-blind , r and omised , placebo-controlled parallel trial was conducted in New Zeal and ( NZ ) ( Wellington and Auckl and ) . Pregnant women with a personal or partner history of atopic disease were r and omised at 14–16 weeks ’ gestation to receive HN001 ( 6 × 109 colony-forming units ) ( n 212 ) or placebo ( n 211 ) daily . GDM at 24–30 weeks was assessed using the definition of the International Association of Diabetes and Pregnancy Study Groups ( IADPSG ) ( fasting plasma glucose ≥5·1 mmol/l , or 1 h post 75 g glucose level at ≥10 mmol/l or at 2 h ≥8·5 mmol/l ) and NZ definition ( fasting plasma glucose ≥5·5 mmol/l or 2 h post 75 g glucose at ≥9 mmol/l ) . All analyses were intention-to-treat . A total of 184 ( 87 % ) women took HN001 and 189 ( 90 % ) women took placebo .  There was a trend towards lower relative rates ( RR ) of GDM ( IADPSG definition ) in the HN001 group , 0·59 ( 95 % CI 0·32 , 1·08 ) ( P=0·08 ) . HN001 was associated with lower rates of GDM in women aged ≥35 years ( RR 0·31 ; 95 % CI 0·12 , 0·81 , P=0·009 ) and women with a history of GDM ( RR 0·00 ; 95 % CI 0·00 , 0·66 , P=0·004 ) . These rates did not differ significantly from those of women without these characteristics . Using the NZ definition , GDM prevalence was significantly lower in the HN001 group , 2·1 % ( 95 % CI 0·6 , 5·2 ) , v. 6·5 % ( 95 % CI 3·5 , 10·9 ) in the placebo group ( P=0·03 ) . HN001 supplementation from 14 to 16 weeks ’ gestation may reduce GDM prevalence , particularly among older women and those with previous GDM Aims /hypothesisIt is currently not clear how to construct a time- and cost-effective screening strategy for gestational diabetes mellitus ( GDM ) . Thus , we elaborated a simple screening algorithm combining ( 1 ) fasting plasma glucose ( FPG ) measurement ; and ( 2 ) a multivariable risk estimation model focused on individuals with normal FPG levels to decide if a further OGTT is indicated . Methods A total of 1,336 women were prospect ively screened for several risk factors for GDM within a multicentre study conducted in Austria . Of 714 women ( 53.4 % ) who developed GDM using recent diagnostic guidelines , 461 were sufficiently screened with FPG .  A risk prediction score was finally developed using data from the remaining 253 women with GDM and 622 healthy women . The screening algorithm was vali date d with a further 258 pregnant women . Results A risk estimation model including history of GDM , glycosuria , family history of diabetes , age , preconception dyslipidaemia and ethnic origin , in addition to FPG , was accurate for detecting GDM  in participants with normal FPG . Including an FPG pretest , the receiver operating characteristic AUC of the screening algorithm was 0.90 ( 95 % CI 0.88 , 0.91 ) . A cut-off value of 0.20 was able to differentiate between low and intermediate risk for GDM with a high sensitivity . Comparable results were seen with the validation cohort . Moreover , we demonstrated an independent association between values derived from the risk estimation and macrosomia in offspring ( OR 3.03 , 95 % CI 1.79 , 5.19 , p < 0.001 ) . Conclusions /interpretationThis study demonstrates a new concept for accurate but cheap GDM screening . This approach should be further evaluated in different population s to ensure an optimised diagnostic algorithm Objective . This trial aims to examine the effects of a Probiotic Mixture ( VSL#3 ) on glycemic status and inflammatory markers , in women with GDM . Material s and Methods . Over a period of 8 weeks , 82 women with gestational diabetes were r and omly assigned to either an intervention group ( n = 41 ) which were given VSL#3 capsule or to a control group which were given placebo capsule ( n = 41 ) . Fasting plasma glucose , homeostatic model assessment of insulin resistance , glycosylated hemoglobin , high-sensitivity C-reactive protein , tumor necrosis factor-α , interleukin-6 , Interferon gamma , and interleukin-10 were measured before and after the intervention . Results . After 8 wk of supplementation FPG , HbA1c , HOMA-IR , and insulin levels remained unchanged in the probiotic and placebo groups . The comparison between the two groups showed no significant differences with FPG and HbA1c , but there were significant differences in insulin levels and HOMA-IR ( 16.6 ± 5.9 ; 3.7 ± 1.5 , resp . ) . Unlike the levels of IFN-g ( 19.21 ± 16.6 ) , there was a significant decrease in levels of IL-6 ( 3.81 ± 0.7 ) , TNF-α ( 3.10 ± 1.1 ) , and hs-CRP ( 4927.4 ± 924.6 ) . No significant increase was observed in IL-10 ( 3.11 ± 5.7 ) in the intervention group as compared with the control group . Conclusions . In women with GDM , supplementation with probiotics ( VSL#3 ) may help to modulate some inflammatory markers and may have benefits on glycemic control Background Hypovitaminosis D has been associated with the development of gestational diabetes mellitus ( GDM ) in many observational studies . Objectives We report the first study of the impact of prenatal vitamin D supplementation on postpartum dysglycemia in GDM patients in a r and omized clinical trial . Patients and Methods Women with GDM at 12 - 32 weeks of gestation were assigned r and omly to either the intervention group ( in which serum 25-hydroxy vitamin D [ 25OHD ] levels were measured immediately , n = 48 ) or the control group ( in which the serum was stored and assayed at 6 - 12 weeks post-partum , n = 48 ) . Participants with initial serum 25OHD < 30 ng/mL in the intervention group were instructed to take a total of 700,000 IU vitamin D3 during pregnancy . The primary outcomes were fasting plasma glucose ( FPG ) , insulin , 2-h post 75 g glucose load plasma glucose ( 2-hPLG ) , homeostasis model assessment of insulin resistance ( HOMA-IR ) , HbA1C , and 25 OHD at 6 - 12 weeks after delivery . Results The mean ± SD of serum 25OHD in the intervention group raised dramatically from 14.6 ± 6.3 to 32.4 ± 14.4 ng/mL , whereas no significant change occurred in the control group ( from 17.7 ± 6.1 to 19.3 ± 9.6 ng/mL , P < 0.001 ) . Thirteen participants developed dysglycemia in each group . Mean FPG , 2-hPLG , and HOMA-IR were not significantly different between the groups . There was no significant difference between the groups for maternal and neonatal outcomes . Conclusions Although the high vitamin D supplementation dose in the present study ( compared to the 400 IU/day dose usually recommended for pregnancy ) safely increases the serum 25OHD , in GDM cases , the higher dose does not affect the plasma glucose level or insulin resistance at short term follow-up after delivery Background Universal screening using the International Association of Diabetes and Pregnancy Study Groups ( IADPSG ) criteria has identified a prevalence of gestational diabetes mellitus ( GDM ) of 12.4 % in women living in Irel and . Women with prior GDM are at increased risk of developing type 2 diabetes later in life . A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes , and medical management . No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM . Through a two-group , parallel r and omised controlled trial ( RCT ) , this study aims to assess the clinical impact , cost-effectiveness and psychological experience of the Croí MyAction intensive lifestyle modification programme for women with prior GDM . Methods / Design A total of 54 women with a history of GDM and persistent post-partum glucose dysfunction ( impaired glucose tolerance ( IGT ) or impaired fasting glucose ( IFG ) ) , are r and omly assigned to a  control arm ( n = 27 ) or to the Croí MyAction intervention group ( n = 27 ) . The control arm receives usual health care advice - written information on diet and lifestyle changes for reducing diabetes risks and visits with general practitioners as required . The intervention group receives usual health care as per the control group in addition to attending a 12-week intensive lifestyle modification programme known as Croí MyAction . Croí MyAction involves 2.5 hour sessions once per week ( for 12 weeks ) comprising a group exercise programme , group health promotion or education seminars , and one-to-one meetings with a multidisciplinary health care team to personalise risk factor reductions . R and omisation and allocation to the intervention arms is carried out by an independent research er , ensuring that the allocation sequence is concealed from study research ers until the interventions are assigned . The primary analysis is based on glucose dysfunction , comparing a mean reduction in fasting plasma glucose ( FPG ) levels on a 75 gram oral glucose tolerance test ( OGTT ) in the two groups at a one-year , post-intervention follow-up . The trial is funded by the Irish Health Research Board ( HRB ) . Ethics approval was obtained on 27 March 2012 from the Clinical Research Ethics Committee , Galway University Hospitals , Health Service Executive of Irel and ( Ref : C.A.691).Trial registration Current Controlled Trials IS RCT N41202110 Gestational diabetes mellitus ( GDM ) has been recognized as a significant risk factor for unfavorable pregnancy outcomes . Prevalence of vitamin D deficiency is highly prevalent among women with GDM . This study was design ed to assess the effect of vitamin D supplementation on pregnancy outcomes of pregnant women with GDM who were not on oral hypoglycemic agents . This r and omized controlled clinical trial was performed among 45 pregnant women diagnosed with GDM at 24 - 28 weeks ' gestation . Subjects were r and omly assigned to consume either vitamin D supplements ( cholecalciferol ) or placebo . Individuals in the vitamin D group ( n=22 ) received 50 000 IU vitamin D3 pearl 2 times during the study : at study baseline and day 21 of intervention and those in placebo group ( n=23 ) received 2 placebos at the mentioned times . Fasting blood sample s were taken at baseline to measure fasting plasma glucose . Participants underwent a 3-h oral glucose tolerance tests ( OGTT ) and the blood sample s were collected at time 60 , 120 , and 180 min to measure plasma glucose levels . Newborn 's weight , height , head circumference , Apgar score , and hyperbilirubinemia were determined . Taking vitamin D supplements , compared with placebo , result ed in improved pregnancy outcomes ; such that those in the vitamin D group had no case of polyhydramnios , while 17.4 % of subjects in placebo group had this condition ( p=0.04 ) . In addition , newborn 's hyperbilirubinemia was significantly lower in vitamin D group than that in placebo group ( 27.3 % vs. 60.9 % , p=0.02 ) . In conclusion , vitamin D supplementation for 6 weeks among pregnant women with GDM result ed in decreased maternal polyhydramnios and infant hyperbilirubinemia compared with placebo . Clinical trial registration number www.i rct .ir : I RCT 201305115623N7 OBJECTIVE Given the role of gut microbiota in regulating metabolism , probiotics administered during pregnancy might prevent gestational diabetes mellitus ( GDM ) . This question has not previously been studied in high-risk overweight and obese pregnant women . We aim ed to determine whether probiotics ( Lactobacillus rhamnosus and Bifidobacterium animalis subspecies lactis ) administered from the second trimester in overweight and obese women prevent GDM as assessed by an oral glucose tolerance test ( OGTT ) at 28 weeks ’ gestation . Secondary outcomes included maternal and neonatal complications , maternal blood pressure and BMI , and infant body composition . RESEARCH DESIGN AND METHODS This was a double-blind r and omized controlled trial of probiotic versus placebo in overweight and obese pregnant women in Brisbane , Australia . RESULTS The study was completed in 411 women .  GDM occurred in 12.3 % ( 25 of 204 ) in the placebo arm and 18.4 % ( 38 of 207 ) in the probiotics arm ( P = 0.10 ) . At OGTT , mean fasting glucose was higher in women r and omized to probiotics ( 79.3 mg/dL ) compared with placebo ( 77.5 mg/dL ) ( P = 0.049 ) . One- and two-hour glucose measures were similar . Preeclampsia occurred in 9.2 % of women r and omized to probiotics compared with 4.9 % in the placebo arm ( P = 0.09 ) . Excessive weight gain occurred in 32.5 % of women in the probiotics arm ( 55 of 169 ) compared with 46 % in the placebo arm ( 81 of 176 ) ( P = 0.01 ) . Rates of small for gestational age ( < 10th percentile ) were 2.4 % in the probiotics arm ( 5 of 205 ) and 6.5 % in the placebo arm ( 13 of 199 ) ( P = 0.042 ) . There were no differences in other secondary outcomes . CONCLUSIONS The probiotics used in this study did not prevent GDM in overweight and obese pregnant women OBJECTIVE To compare management based on maternal glycemic criteria with management based on relaxed glycemic criteria and fetal abdominal circumference ( AC ) measurements in order to select patients for insulin treatment of gestational diabetes mellitus ( GDM ) with fasting hyperglycemia . RESEARCH DESIGN AND METHODS In a pilot study , 98 women with fasting plasma glucose ( FPG ) concentrations of 105 - 120 mg/dl were r and omized . The st and ard group received insulin treatment . The experimental group received insulin if the AC , measured monthly , was > or = 70th percentile and /or if any venous FPG measurement was > 120 mg/dl . Power was projected to detect a 250-g difference in birth weights . RESULTS Gestational ages , maternal glycemia , and AC percentiles were similar at r and omization . After initiation of protocol , venous FPG ( P = 0.003 ) and capillary blood glucose levels ( P = 0.049 ) were significantly lower in the st and ard group . Birth weights ( 3,271 + /- 458 vs. 3,369 + /- 461 g ) , frequencies of birth weights > 90th percentile ( 6.3 vs 8.3 % ) , and neonatal morbidity ( 25 vs. 25 % ) did not differ significantly between the st and ard and experimental groups , respectively . The cesarean delivery rate was significantly lower ( 14.6 vs. 33.3 % , P = 0.03 ) in the st and ard group ; this difference was not explained by birth weights . In the experimental group , infants of women who did not receive insulin had lower birth weights than infants of mothers treated with insulin ( 3,180 + /- 425 vs. 3,482 + /- 451 g , P = 0.03 ) . CONCLUSIONS In women with GDM and fasting hyperglycemia , glucose plus fetal AC measurements identified pregnancies at low risk for macrosomia and result ed in the avoidance of insulin therapy in 38 % of patients without increasing rates of neonatal morbidity Introduction There is only some evidence about effectiveness of probiotics for preventing gestational hyperglycaemia . This trial examined the effects of probiotic yoghurts containing Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 on maternal plasma glucose ( primary outcome ) and on some maternal and infant complications ( secondary outcomes ) in overweight and obese women with no diabetes in pregnancy . Methods Using stratified block r and omization , women with pre- or early-pregnancy BMI ≥ 25 and fasting plasma glucose < 92 mg/dl at 22 weeks of gestation were assigned into probiotic or conventional yoghurt group , consuming 100 g/day from 24 weeks of gestation until delivery . The women and their infants were followed up until 1 month after birth . Results In each group , one out of 65 women  had intra-uterine foetal death and were not analysed for other outcomes . The mean BMI was 29.2 ( SD 3.3 ) in probiotic and 30.3 ( SD 4.1 ) in conventional yoghurt group . Four weeks after initiation of the treatment , plasma glucose levels were significantly lower in the probiotic than in conventional yoghurt group at fasting ( mean difference adjusted for the BMI category ) and baseline FPG ( − 4.0 mg/dl ; 95 % confidence interval − 6.9 , − 1.1 ) and 2-h OGTT ( − 13.9 ; − 22.8 , − 5.0 ) . At the 1-h OGTT , however , the difference was not statistically significant ( − 9.8 ; − 20.6 , 0.9 ) . Further , there was a significantly lower infant bilirubin level in the probiotic group on days 3–5 after birth ( − 2.2 mg/dl ; − 3.3 , − 1.2 ) . There were not statistically significant differences between the groups regarding the risk of gestational diabetes ( 6 vs 11 ; odds ratio 0.5 ; 0.2 , 1.5 ) , preterm delivery ( 3 vs 8 ; 0.3 ; 0.1 , 1.2 ) , and other maternal and infant outcomes . Conclusion The probiotics supplementation has some beneficial effects on glucose metabolism of overweight and obese pregnant women . Nevertheless , further studies are required to judge the clinical significance of such effects BACKGROUND AND AIMS This study was design ed to assess the effects of combined vitamin D and probiotic supplementation on metabolic status and pregnancy outcomes in women with gestational diabetes ( GDM ) . METHODS This r and omized , double-blind , placebo-controlled clinical trial was performed in 87 women with GDM . Patients were r and omly assigned three groups to receive either vitamin D ( 50,000 IU/every 2 weeks ) plus probiotic ( 8 × 109 CFU/day ) ( n = 30 ) , probiotic ( 8 × 109 CFU/day ) ( n = 29 ) or placebo ( n = 28 ) for 6 weeks . RESULTS Vitamin D and probiotic co-supplementation significantly reduced fasting plasma glucose ( β -10.99 mg/dL ; 95 % CI , -14.26 , -7.73 ; P < 0.001 ) , serum insulin levels ( β -1.95 μIU/mL ; 95 % CI , -3.05 , -0.84 ; P = 0.001 ) and homeostasis model of assessment -insulin resistance ( β -0.76 ; 95 % CI , -1.06 , -0.45 ; P < 0.001 ) , and significantly increased the quantitative insulin sensitivity check index ( β 0.01 ; 95 % CI , 0.008 , 0.03 ; P = 0.001 ) compared with the placebo . In addition , vitamin D and probiotic co-supplementation result ed in a significant reduction in triglycerides ( β -37.56 mg/dL ; 95 % CI , -51.55 , -23.56 ; P < 0.001 ) , VLDL- ( β -7.51 mg/dL ; 95 % CI , -10.31 , -4.71 ; P < 0.001 ) , HDL-/total cholesterol ratio ( β -0.52 ; 95 % CI , -0.79 , -0.24 ; P < 0.001 ) , high sensitivity C-reactive protein ( β -1.80 mg/L ; 95 % CI , -2.53 , -1.08 ; P < 0.001 ) and malondialdehyde ( β -0.43 μmol/L ; 95 % CI , -0.77 , -0.09 ; P = 0.01 ) ; also , a significant rise in HDL-cholesterol ( β 4.09 mg/dL ; 95 % CI , 1.11 , 7.08 ; P = 0.008 ) and total antioxidant capacity ( TAC ) levels ( β 97.77 mmol/L ; 95 % CI , 52.34 , 143.19 ; P < 0.001 ) were observed compared with the placebo . Vitamin D and probiotic co-supplementation did not change other metabolic parameters  . Vitamin D and probiotic co-supplementation  significantly decreased triglycerides ( P = 0.02 ) , VLDL-cholesterol ( P = 0.02 ) and hs-CRP ( P = 0.01 ) , and significantly increased TAC ( P = 0.006 ) and total glutathione levels ( P = 0.04 ) compared with only probiotic group . CONCLUSIONS In conclusion , vitamin D and probiotic co-supplementation  in women with GDM had beneficial effects on metabolic status . This trial was registered at www.i rct .ir as I RCT 201706075623N119 Objective The study was to examine whether gestational diabetes mellitus ( GDM ) can be prevented by early trimester lifestyle counseling in a high-risk population . Methods From September 2012 to January 2013 , 1664 pregnancies in the Department of Obstetrics and Gynecology of First Hospital of Peking University were enrolled in the study during their first prenatal care visit before the 8 gestational weeks visit and asked to fill out a question naire on GDM risk evaluation . According to the question naire and medical records , those with at least one risk factor of GDM were included in the intervention study and r and omly allocated to two groups , intervention group and control group . Routine prenatal care was offered , while st and ardized two-step lifestyle intervention was provided to the intervention group during 6–8 gestational weeks , and at 12–13 gestational weeks , enforcement intervention based on maternal anthropometrics were offered . Both groups were followed until 75 g oral glucose tolerance test ( OGTT ) testing at 24–28 gestational weeks . The weight gain after intervention and the prevalence of GDM were used to evaluate the effect . Results ( 1 ) According to the International Association of Diabetes and Pregnancy Study Groups ( IADPSG ) criteria , the positive rate of GDM for the intervention group was 17.16 % ( 23/134 ) , lower than the control group which was 23.91 % ( 33/138 ) , P = 0.168 . ( 2 ) The weight gain during the first and second trimester for the intervention group was ( 1.38 ± 2.34 ) kg and ( 5.51 ± 2.18 ) kg , lower than in the control group which was ( 1.41 ± 2.58 ) kg and ( 5.66 ± 2.25 ) kg , ( P = 0.905 , P = 0.567 ) . ( 3 ) Positive rate of GDM for those fasting plasma glucose ( FPG ) ≥5.1 mmol/L during early pregnancy was 11/36 ( 30.55 % ) for the intervention group that was lower than 17/37 ( 45.95 % ) for the control group , but the statistical difference was not significant ( P = 0.076 ) . Conclusion The positive rate of GDM could be reduced by a certain amount lifestyle intervention from the beginning of pregnancy . More vali date d effective intervention should be explored in the high-risk pregnant women OBJECTIVE To compare risk factors and pregnancy outcomes of gestational diabetes mellitus ( GDM ) diagnosed during early and late pregnancy . DESIGN Prospect i ve population -based cohort study . SETTING Community health care centers of Isfahan , Iran . PARTICIPANTS AND MEASUREMENTS 1000 pregnant women who were eligible and consented to participate underwent fasting plasma glucose testing at the first prenatal visit ( 6 - 14 weeks ) . The women free from GDM or overt diabetes were screened at 24 - 28 weeks of gestation using a 75-g , 2-hour oral glucose tolerance test . The diagnosis of GDM was reached through the International Association of the Diabetes and Pregnancy Study Groups . Early-onset GDM was defined as the diagnosis of GDM at the first prenatal visit . Late-onset GDM was defined as the diagnosis of GDM later at 24 - 28 weeks . FINDINGS Prevalence of GDM was 10 % ( 95 % CI : 8.1 - 11.9 ) at the first prenatal visit . GDM incidence was 9.3 % ( 95 % CI : 7.4 - 11.2 ) at 24 - 28 weeks of gestation . Family history of diabetes , and previous gestational diabetes and maternal age were the independent risk factors for GDM during early and late diagnosis . GDM was associated with increased risk of macrosomia , large for gestational age , and cesarean section in both periods while , neonates of women with early-onset GDM were more likely to have an apgar score at 1-min < 7 , and neonatal respiratory distress syndrome and were more admitted to the neonatal intensive care unit . KEY CONCLUSION AND IMPLICATION FOR PRACTICE Despite early screening and current practice management , early-onset GDM was associated with poorer pregnancy outcomes compared to the late-onset group . Women with early-onset GDM would benefit from more strict surveillance and management strategies to improve pregnancy outcomes . Further studies are needed to evaluate the efficacy of alternative management approaches in these high risk women OBJECTIVE To our knowledge , no reports are available indicating the effects of the dietary approaches to stop hypertension ( DASH ) eating plan on insulin resistance , inflammation , and oxidative stress among pregnant women with gestational diabetes mellitus ( GDM ) . This study was design ed to investigate the effects of the DASH diet on insulin resistance , serum high-sensitivity C-reactive protein ( hs-CRP ) and biomarkers of oxidative stress among pregnant women with GDM . METHODS This r and omized controlled clinical trial was performed with 32 pregnant women diagnosed with GDM at 24 to 28 wk gestation . Participants were r and omly assigned to consume either the control ( n = 16 ) or DASH diet ( n = 16 ) for 4 wk . The DASH diet was rich in fruits , vegetables , whole grains , and low-fat dairy products and was low in saturated fats , total fats , cholesterol , refined grains , and sweets , with a total of 2400 mg/d of sodium . The control diet contained 40 % to 55 % of its energy as carbohydrates , 10 % to 20 % as proteins , and 25 % to 30 % as total fats . Fasting blood sample s were taken at baseline and after 4 wk of intervention to measure fasting plasma glucose ( FPG ) , serum insulin , and hs-CRP , homeostasis model of assessment -insulin resistance ( HOMA-IR ) , plasma total antioxidant capacity ( TAC ) , and total glutathione levels ( GSH ) . RESULTS Consumption of the DASH diet compared with the control diet result ed in decreased FPG ( -7.62 versus 3.68 mg/dL ; P = 0.02 ) , serum insulin levels ( -2.62 versus 4.32 μIU/mL , P = 0.03 ) , and HOMA-IR score ( -0.8 versus 1.1 ; P = 0.03 ) . Increased concentrations of plasma TAC ( 45.2 versus -159.2 mmol/L ; P < 0.0001 ) and GSH ( 108.1 versus -150.9 μmol/L ; P < 0.0001 ) also were seen in the DASH group compared with control group . We failed to find a significant difference in mean changes of serum hs-CRP levels between the two diets . Within-group comparisons revealed significant reductions in plasma TAC and GSH levels in the control diet , while a significant increase in these biomarkers in the DASH diet . CONCLUSION Consumption of the DASH diet in pregnant women with GDM had beneficial effects on FPG , serum insulin levels , HOMA-IR score , plasma TAC , and total GSH levels . The effects of this dietary pattern on pregnancy outcomes need to be investigated in future studies BACKGROUND The incidence of gestational diabetes mellitus (GDM)--hyperglycemia with onset or first recognition during pregnancy -- is increasing and will have a significant impact on diabetes services . This study aim ed to determine the feasibility and acceptability of using telemedicine in the diabetes care of women with GDM and the possibility of replacing alternate ( one in every two ) diabetes review appointments with telemedicine . SUBJECTS AND METHODS A feasibility study for a r and omized controlled trial was conducted across two sites . Fifty women with GDM were r and omized to usual care ( n = 26 ) or usual care plus telemedicine ( n = 24 ) . Telemedicine entailed weekly blood pressure and weight measurements and transmission of these data , along with blood glucose readings , for review by the healthcare team . Patients were contacted about these results as necessary . Patients completed question naires to measure their satisfaction with telemedicine or blood glucose monitoring .  The intervention group and healthcare providers also took part in qualitative interviews . Analysis involved descriptive statistics for the satisfaction question naires and framework analysis for the qualitative interviews . RESULTS Eighty-nine percent of patients were satisfied with telemedicine and would use it again . Both HCPs and patients found the equipment easy to use and were positive about using it to replace alternate diabetes review appointments in the future . If used in this way , healthcare providers felt that protected time in which to perform the telemedicine review would be necessary . CONCLUSIONS Telemedicine may help meet the growing dem and on diabetes services due to increasing numbers of women being diagnosed with GDM OBJECTIVE To evaluate tests used for screening and confirmation of gestational diabetes mellitus ( GDM ) in Sri Lanka . METHODS FIELD BASED Consecutive pregnant women in Homagama DDHS area ( n = 853 ) , were assessed for risk factors and subjected to r and om and postpr and ial urinary Benedict 's and Dipstick tests , fasting and 2 hour post 75 g glucose capillary blood glucose ( FBG and 2hBG ) which were vali date d against 75 g oral glucose tolerance test ( OGTT ) performed at 24 - 28 weeks ( WHO criteria ) . HOSPITAL BASED Retrospective analysis of consecutive high-risk women ( n = 999 ) and prospect i ve study of r and omly selected GDM women ( n = 66 ) to assess predictive value of the OGTT . RESULTS FIELD BASED Sensitivity and specificity respectively of r and om urine Benedict 's , 10 % , 99.2 % ; postpr and ial urine Benedict 's , 52.2 % , 94.5 % ; postpr and ial urine Dipstick , 68.7 % , 90 % ; capillary FBG threshold 4.1 mmol/l , 62.6 % , 73 % ; capillary 2hBG threshold 7.2 mmol/l , 98.5 % , 95.2 % ; risk factors , 93.1 % , 22.2 % . HOSPITAL BASED OGTT-11.6 % lag curves , 16.3 % abnormal , FPG accuracy at 4.7mmol/l ; predictive value of 2 hPG > or = 8.9 mmol/l for insulin treatment-sensitivity 97.2 % , specificity 71.4 % . CONCLUSIONS Current practice of r and om urine testing in community screening for gestational diabetes is unreliable , and glucose specific postpr and ial urine test improves sensitivity . FPG is unsuitable for screening , the 2 hour post 75 g blood glucose at a threshold of > 7.2 mmol/l is sensitive and specific . In laboratory confirmation using 75 g OGTT the fasting plasma glucose has low predictive value , 2 hour test performed alone is liable to false positives and 2 hour glucose > 8.9 mmol/l following a peak at 1 hour suggests the need for insulin treatment BACKGROUND Recent studies have reported beneficial effects of probiotics on maternal glycemia in healthy pregnant women . Obesity significantly increases risk of impaired glucose tolerance in pregnancy , but glycemic effects of probiotics in this specific obstetric group require additional investigation . OBJECTIVE The aim of the Probiotics in Pregnancy Study was to investigate the effect of a probiotic capsule on maternal fasting glucose in obese pregnant women . DESIGN In this placebo-controlled , double-blind , r and omized trial , 175 pregnant women with an early pregnancy body mass index ( BMI ; in kg/m² ) from 30.0 to 39.9 were recruited from antenatal clinics at the National Maternity Hospital , Dublin , Irel and . Exclusion criteria were BMI < 30.0 or > 39.9 , prepregnancy or gestational diabetes , age < 18 y , multiple pregnancy , and fetal anomaly . Women were r and omly assigned to receive either a daily probiotic or a placebo capsule from 24 to 28 wk of gestation in addition to routine antenatal care . The primary outcome was the change in fasting glucose between groups from preintervention to postintervention . Secondary outcomes were the incidence of gestational diabetes and neonatal anthropometric measures . RESULTS In 138 women who completed the study ( 63 women in the probiotic group ; 75 women in the placebo group ) , mean ( ±SD ) early pregnancy BMI was 33.6 ± 2.6 , which differed significantly between probiotic ( 32.9 ± 2.4 ) and placebo ( 34.1 ± 2.7 ) groups . With adjustment for BMI , the change in maternal fasting glucose did not differ significantly between treated and control groups [ -0.09 ± 0.27 compared with -0.07 ± 0.39 mmol/L ; P = 0.391 ; B = -0.05 ( 95 % CI : -0.17 , 0.07 ) ] . There were also no differences in the incidence of impaired glycemia ( 16 % in the probiotic group compared with 15 % in the placebo group ; P = 0.561 ) , birth weight ( 3.70 kg in the probiotic group compared with 3.68 kg in the placebo group ; P = 0.723 ) , or other metabolic variables or pregnancy outcomes . A secondary analysis of 110 women , excluding antibiotic users and poor compliers , also revealed no differences in maternal glucose or other outcomes between groups . CONCLUSION Probiotic treatment of 4 wk during pregnancy did not influence maternal fasting glucose , the metabolic profile , or pregnancy outcomes in obese women OBJECTIVES Equivalent efficacy of glyburide and insulin for treatment of gestational diabetes ( GDM ) was demonstrated in a recent r and omized trial . We describe our experience with glyburide in practice , and suggest factors that predict failure of glyburide treatment . METHODS Women with GDM treated with glyburide were studied . They were divided into two groups : those who achieved adequate glycemic control with glyburide , and those who did not . The groups were compared in terms of baseline characteristics , including diabetes risk factors and glucose testing values . Receiver operating characteristics ( ROC ) curves were generated to identify thresholds for fasting plasma glucose and body mass index ( BMI ) that would predict glyburide failure . RESULTS Seventy-five women were analyzed : 63 ( 84 % ) were successfully treated with glyburide , and 12 ( 16 % ) were not . Baseline characteristics were similar between the groups , except that failures had higher 3-h glucose tolerance test ( GTT ) values at all time points . ROC curves for fasting plasma glucose , pre-pregnancy BMI and BMI at diagnosis revealed no cut-off points for predicting failure of glyburide therapy . However , when fasting plasma glucose value on the GTT was > or = 110 mg/dl , 24 % of women failed to respond to glyburide , compared to 12 % at < 110 mg/dl ( p = 0.15 ) . CONCLUSIONS In treatment of GDM , glyburide is successful in achieving good glycemic control in most women . Women with high fasting plasma glucose levels , however , may not respond adequately to glyburide therapy Current Criteria for the Diagnosis of Diabetes ● Fasting plasma glucose ( FPG ) Ն126 mg/dl ( 7.0 mmol/l ) . Fasting is defined as no caloric intake for at least 8 h ● Symptoms of hyperglycemia and a casual ( r and om ) plasma glucose Ն200 mg/dl ( 11.1 mmol/l ) . Casual ( r and om ) is defined as any time of day without regard to time since last meal . The classic symptoms of hyperglycemia include polyuria , polydipsia , and unexplained weight loss . ● 2-h plasma glucose Ն200 mg/dl ( 11.1 mmol/l ) during an oral glucose tolerance test ( OGTT ) . The test should be performed as described by the World Health Organization , using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water . Testing for Pre-Diabetes and Diabetes in Asymptomatic Patients ● Testing to detect pre-diabetes and type 2 diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese ( BMI Ն25 kg/m 2 ) and who have one or more additional risk factors for diabetes ) . In those without these risk factors , testing should begin at age 45 years . ( B ) ● If tests are normal , repeat testing should be carried out at least at 3-year intervals . ( E ) ● To test for pre-diabetes or diabetes , an FPG test or 2-h OGTT ( 75-g glucose load ) or both are appropriate . ( B ) ● An OGTT may be considered in patients with impaired fasting glucose ( IFG ) to better define the risk of diabetes . ( E ) ● In those identified with pre-diabetes , identify and , if appropriate , treat other cardiovascular disease ( CVD ) risk factors . ( B ) Testing for Type 2 Diabetes in Children ● Test children who are overweight ( BMI Ͼ85th percentile for age and sex , weight for height Ͼ85th percentile , or weight Ͼ120 % of ideal for height ) and have any two of the following risk factors : ● Family history of type 2 diabetes in first-or second-degree relative ● Signs of insulin resistance or conditions associated with insulin resist a n c e ( a c a n t h o s i s n i g r i c a n s , hypertension , dyslipidemia , polycys-tic ovary syndrome , or small-for-gestational-age birth weight ) ● Maternal history of diabetes or gesta-tional diabetes mellitus ( GDM ) during the child 's gestation ( E ) ● Testing should begin at age 10 years or at onset of puberty , if puberty occurs at a younger age , and be repeated every 3 years . ( E ) ● FPG is the preferred test . ( E ) Detection and Diagnosis of
Among secondary endpoints , a significant reduction of maternal insulin ( both in women with or without diabetes ) was observed in the probiotics group .
INTERPRETATION Probiotics during pregnancy do not reduce the incidence of GDM , with a very little ( statistically but not clinical ly significant ) reduction of fasting plasma glucose
AIM To perform a systematic review and meta- analysis of r and omized controlled trials ( RCTs ) to evaluate the effect of  probiotics in pregnancy on the  incidence of gestational diabetes ( GDM ) and fasting plasma glucose ( FPG ) .