Are the current ACOG glucose tolerance test criteria sensitive enough?

Article Abstract:

Some pregnant women develop pregnancy-related diabetes, or gestational diabetes, and require insulin therapy. Most pregnant women are screened for possible gestational diabetes using a glucose tolerance test that is based on criteria developed by O'Sullivan and Mahan; this method is sanctioned by the American College of Obstetricians and Gynecologists (ACOG). Recent research has indicated that this method underevaluates glucose levels, and thus a number of women with possible gestational diabetes are not referred for further testing. In this study, an alternative method of screening for gestational diabetes was compared with the ACOG-approved test. Pregnant women were screened using both tests. With the alternative hospital test, 103 women were identified as having gestational diabetes and in possible need of insulin. Of these 103 women, only 64 met the criteria of the ACOG test for gestational diabetes. There were no demographic differences between the 39 women who met only the hospital criteria and the 64 who met both sets of criteria. Upon further evaluation, 29 of the 103 women were determined to need insulin therapy. Of the 39 women in the hospital test group, 10 (26 percent) needed insulin. Of the 64 women in the ACOG test group, 19 (30 percent) needed insulin. The difference between the two groups was not significant. Infant outcomes were similar for both groups of women. For the women meeting the criteria for gestational diabetes, the ultimate need for insulin was not related to how abnormal the screening test result was. These results indicate that the ACOG-approved glucose tolerance test most widely used in screening for gestational diabetes may not be adequately sensitive. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Insulin

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The resolution of preeclampsia-related thrombocytopenia

Article Abstract:

Pregnancy may be complicated by hypertensive conditions such as preeclampsia, which is characterized by abnormally high blood pressure; headaches; urinary excretion of the blood protein albumin; and accumulation of tissue fluid in the lower extremities. If untreated, preeclampsia may lead to eclampsia, a serious condition characterized by the development of coma and seizures in the second half of pregnancy. Preeclampsia may be complicated by thrombocytopenia, or a decrease in platelets, which are cells involved in blood coagulation. Studies show that platelet numbers are slightly decreased in 20 to 50 percent of patients with preeclampsia. This decrease in circulating platelets may result from the adherence of the platelets to damaged blood vessels, or it may be due to immune mechanisms. Four to 16 percent of patients with preeclampsia-eclampsia develop a condition referred to as the HELLP syndrome, characterized by hemolysis, or the rupture of red blood cells; elevated liver enzymes; and low platelet count. The duration of recovery from thrombocytopenia after childbirth was assessed by monitoring platelet numbers in 25 patients with severe preeclampsia; fewer than 100,000 platelets per microliter (uL), and elevated liver enzymes. Platelet numbers recovered to above 100,000 platelets per uL by 95 hours in all patients. Seven patients showed a rebound effect, in which platelet numbers exceeded the upper normal limit of 340,000 platelets per uL, reaching values between 413,000 and 871,000 platelets per uL. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Causes of, Complications and side effects, Preeclampsia, Blood platelets, Thrombocytopenia

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The role of repeat glucose tolerance tests in the diagnosis of gestational diabetes

Article Abstract:

To learn more about the development of gestational diabetes mellitus (carbohydrate intolerance that develops or is first identified during pregnancy), 106 patients were studied. These women had been screened for gestational diabetes when they were between 24 and 28 weeks pregnant. Testing was performed using an oral glucose tolerance test (GTT) in which the patient consumes carbohydrates and then measurements of glucose levels are taken. All patients had at least one abnormal result. Subsequently, two abnormal results on a GTT given approximately one month later occurred in 36 cases (34 percent of the sample). This indicates that one abnormal result on an early GTT is a good predictor of gestational diabetes. A brief review of the medical literature concerning the diagnostic criteria for this disorder is presented. Because early diagnosis and treatment of gestational diabetes can significantly reduce later complications, which can be very serious, the authors recommend repeating a GTT three to four weeks after an initial abnormal result. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression

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