American Journal Of Obstetrics And Gynecology

Pregravid Cardiometabolic Risk Factors Linked to GDM

FRIDAY, July 1 (HealthDay News) -- Women with pregravid cardiometabolic risk factors are at significantly higher risk of developing gestational diabetes mellitus (GDM), according to a study published in the July issue of the American Journal of Obstetrics & Gynecology .

Monique M. Hedderson, Ph.D., from Kaiser Permanente Northern California in Oakland, and colleagues investigated whether pregravid cardiometabolic risk-factor profile was associated with subsequent risk of GDM. A total of 199 women with GDM and 381 controls who underwent a multiphasic health checkup examination between 1984 and 1996 and subsequently got pregnant, were included in the analysis. Cases and controls were matched by year and age at checkup examination and age at delivery.

The investigators found that pregravid serum glucose levels of 100 to 140 mg/dL, body mass index (BMI) of 25.0 kg/m² or more, and prehypertension/hypertension levels correlated independently with the risk for GDM (odds ratio 4.8, 2.7, and 1.5, respectively). Patients with more pregravid cardiometabolic risk factors had a significantly higher risk of developing GDM. High BMI and adverse glucose levels were associated with a 4.6-fold increased risk of GDM compared with normal levels.

"We found that the presence of cardiometabolic risk factors before pregnancy increases the risk of the development of GDM and may help to identify women who are at high risk for GDM to target for prevention strategies," the authors write.

The study was funded by Kaiser Permanente.

Unbound MEDLINE | Outcomes associated with introduction of a ...

The objective of this study was to assess outcomes that are associated with the implementation of a shoulder dystocia protocol that is focused on team response. We identified women who had a shoulder dystocia during 3 time periods: 6 months before (period A), 6 months during (period B), and 6 months after (period C) the institution of a shoulder dystocia protocol. Documentation and health outcomes were compared among the time periods. During the study period, 254 women (77, 100, and 77 in periods A, B, and C, respectively) had a shoulder dystocia. There were no differences among study periods in patient characteristics. However, complete and consistent documentation increased (14% to 50% to 92%; P < .001), and brachial plexus palsy that was diagnosed at delivery (10.1% to 4.0% to 2.6%; P = .03) and at neonatal discharge (7.6% to 3.0% to 1.3%; P = .04) declined.

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