Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style?

Article Abstract:

Treatment of gestational diabetes mellitus (GDM) may help reduce the excessive birth weights associated with the disorder, but may not reduce the high rate of cesarean deliveries associated with it. There is disagreement on the necessity of treatment for GDM, which varies in severity and causes pregnant women to have glucose intolerance. Researchers analyzed glucose tolerance tests and delivery outcomes in 3,778 pregnant women. Compared to women with normal glucose metabolism, those with borderline GDM that was not treated were more likely to have infants with excessive weight and to have cesarean delivery. Among the untreated women with borderline GDM, cesarean delivery was directly related to birth weight. On the other hand, treatment of women with definite GDM led to more normal birth weights, but such weight reduction did not appear to affect delivery. The rate of cesarean deliveries was 33% in women with treated GDM, regardless of the weight of their infants.

Care and treatment, Usage, Complications and side effects, Cesarean section, Fetal macrosomia

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Screening for gestational diabetes mellitus

Article Abstract:

Several professional groups have recommended screening only pregnant women at high risk of diabetes for gestational diabetes but many physicians may find the complex protocol hard to follow. Gestational diabetes is glucose intolerance that develops during pregnancy. It can result in serious outcomes for mother and infant and consequently, many physicians believe all pregnant women should be screened. A 1997 study recommended that only older women with obesity and a family history of diabetes or gestational diabetes be screened. This is supported by the American Diabetes Association and the American College of Obstetricians and Gynecologists.

Editorial, Methods

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Selective screening for gestational diabetes mellitus

Article Abstract:

A policy of screening only those pregnant women who have a high risk for gestational diabetes may be as effective as universal screening. Researchers ranked 3,131 pregnant women according to their risk of gestational diabetes based on age, race and body mass. Only the high-risk women were given a glucose tolerance test and the blood glucose level diagnostic of gestational diabetes was lowered from 140 milligrams per deciliter (mg/dL) to 130 mg/dL. The number of screening tests was reduced by 35% compared to traditional screening policies and about 82% of the women with gestational diabetes were identified.

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