Iranian Journal of

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Background: Estimation of cost effectiveness and cost benefit are intrinsic to the design and evaluation of healthcare systems. The aim of most studies of gestational diabetes screening has been to modulate screening parameters to reduce the eligible population and therefore costs. We analysed the findings of a cross-sectional study of gestational diabetes mellitus carried out in Tehran to determine the screening method best suited to the socio-economic profile of our population.
Methods: 2416 pregnant women were universally screened in Tehran teaching hospitals. Each patient’s risk factors and laboratory results were recorded. The 50gGCT was used to screen and the 100gOGTT to confirm a diagnosis of GDM.
Results: Switching from the 130mg/dl to the 140mg/dl threshold, case-detection sensitivity declined by 12% (to 88%), with the per-pregnancy cost dropping from 30,410 to 25,641 Rials (from US$3.80 to 3.20) [-15.6%], and the cost per detected case from 644,488 to 619,500 Rials (from US$80.56 to 77.43) [-3.87%].
Conclusion: We recommend adoption of the universal screening approach in Iran for 4 reasons: (1) The high prevalence of gestational diabetes in the low-risk group (2) The poor level of healthcare provided in Iran compared with societies that have opted for the selective approach (3) The lower cost of screening and diagnostic tests in Iran compared with the aforementioned and (4) The high cost of treating the complications of diabetes.

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Introduction: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance occurring or detected for the first time during pregnancy. Hypertension occurring as a result of pregnancy is called pregnancy-induced hypertension (PIH), which is itself divided into two groups: gestational hypertension and pre-eclampsia. The aim of this study is to compare the incidence of hypertensive disorders in patients with GDM and controls.
Methods: This is a case-control study of 2416 pregnant women attending 5 antenatal clinics attached to Tehran University of Medical Sciences. The universal two-step screening approach was used: first, all women underwent a 50-gram 1-hour glucose challenge test second, all women with a 1-hour blood glucose concentration higher than 130mg/dl underwent a 100-gram, 3 hour oral glucose tolerance test. Carpenter and Coustan’s criteria were used to diagnose GDM. 220 women with a normal glucose challenge test were chosen as controls. GDM cases and controls were matched for age, body mass index, parity, and gestational age.
Results: 114 women overall were diagnosed with GDM. Mean age, BMI, and parity in GDM and control groups were 29.09±6.13 and 28.64±6.00 years, 27.43±4.33 and 26.64±1.8 kg/m2, and 1.79 and 1.52 births, respectively. Women with GDM had a higher prevalence of essential hypertension, PIH, and pre-eclampsia than matched controls.
Conclusion: Our results show that hypertensive disorders are more common in women with GDM than in normoglycaemic controls of similar age, parity and BMI.

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Background: Early detection of carbohydrate intolerance is important to prevent maternal and perinatal complications. This study aims to determine association of symptoms and clinical feature with different degree of carbohydrate intolerance in comparison with healthy pregnant women.
Methods: Two thousand four hundred sixteen pregnant women referred to five university hospital clinics were followed up until delivery. Previously known diabetic patients were excluded from the study. The universal screening was performed with a 50-g 1-hour glucose challenge test (GCT). Those with plasma glucose 130mg/dl underwent a 100-g 3-hour glucose tolerance test (GTT) to diagnose gestational diabetes mellitus (GDM) according to Carpenter and Coustan criteria. Also based on result of GCT and GTT all pregnancy divided to four groups GDM, impaired GCT (IGCT), impaired GTT (IGT) and normal pregnancy. Family and obstetric histories were taken followed by a complete physical examination included: BMI and blood pressure measurements, excess weight gain during pregnancy, proteinuria, glycosuria, polyhydramnios, and edema. Symptoms were considered were as followed: polyuria, polydipsia.
Results: Among the 2416 pregnant women, 114(4.7) were diagnosed with GDM. Of the 114, 42(36.8%) were obese, 39 (34.2%) had glycosuria, 5 (4.3%) had pre-eclampsia, , 22 (19.2%) had abnormal excess weight gain during pregnancy. The most important symptoms were polyuria (14.9%), polydipsia (12.6%). In comparison with healthy group, GDM patients had a significantly higher BMI, glycosuria, polyhydramnios, proteinuria, and excess weight gain. Association of these symptoms in GDM patients was significantly different from that in healthy pregnant women. Out of 114 GDM patients 59 (51.7%) did not have any symptoms or any abnormal clinical features.
Conclusion: The rate of asymptomatic patients in different level of carbohydrat intolerance indicates that symptom – based screening would miss many subjects. Despite clinical feature is not a reliable basis for screening GDM patients, it maybe used to improve maternal surveillance.

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There are controversies on the effects of diabetes and lifestyle of affected patients on their bone mineral densities (BMDs). This study has investigated the effects of lifestyle of type 2 diabetics on BMD at the lumbar spine and proximal femur in pre and postmenopausal women.
Methods: In a historical cohort study, 20 pre-menopausal type 2 diabetics and 57 non-diabetics and 126 type 2 Diabetics and 315 non-diabetics postmenopausal women, were recruited. BMD measurements were also made to the spine and proximal femur (Neck, Wards, and Shaft) by dual energy X-ray absorptiometry (DXA) technique. Exclusion criteria were endocrine, rheumatologic or chronic diseases. Type 2 diabetic cases and non-diabetics were matched for age and body mass index (BMI) in both pre menopausal or postmenopausal groups.
Results: A total of 146 type 2 Diabetic patients without any other endocrine disorder and 372 non-diabetic women, aged 40-81 years were enrolled. No significant differences were found between diabetics and healthy controls in terms of BMD values of spine and femur regions in the pre‌menopausal women. Postmenopausal diabetics, however, had higher BMD at the lumbar spine compared with the healthy postmenopausal controls. An age-related decrease in BMD values (lumbar and femur) was observable in all groups and a significant correlation between BMI and BMD was found. Adjusting for age and BMI, the effect of lifestyle on BMD at all sites was investigated. Occupation was associated with BMD in postmenopausal, but not in premenopausal women. Among the investigated dietary items, milk, yogurt and cheese were all associated with increased BMD in at least one region in diabetic patients. Smoking was not associated with BMD.
Conclusion: Type 2 Diabetes does not seem to be complicated by bone loss and osteoporosis. Physical activity and milk consumption in postmenopausal diabetic women can be a protective factor against bone loss.

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Diabetes mellitus (DM) is the commonest cause of renal failure, blindness and non traumatic amputation. According to ADA, prevention of DM complications is possible through monitoring and control of blood glucose levels.
Methods: The Betachek strip, produced in Australia, is able to determine biood glucose level with no need for electronic glucometer devices.
Results: In this study, we compared venous and capillary blood glucose levels as determined by lest strips with measurements of enzymatic method (the standard laboratory kit). The mean capillary and venous blood glucose measured by the strip test was 21.85 mg/dl (P< 0.0001) and 17.9 mg/dl (P< 0.002) respectively that was 11.13% more than the standard method.
Conclusion: In this study, standard method had higher correlation with venous samples glucose level, than capillary samples (as measured by Betachek) (0.84 vs. 0.824). This difference was statistically significant (P< 0.0001).
Good correlation between the Betachek strip and the standard enzymatic method of blood glucose measurements, advocate its usage in home setting.

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Background: Recurrent GDM are more common in women with previous GDM. Also GDM is an important risk factor for abnormal glucose tolerance and type 2 diabetes during postpartum. This study aims to determine the prevalence of postpartum IGT and T2DM in women with previous GDM.
Methods: A cohort study was conducted on 2416 pregnant women referred to five Tehran university hospital clinics. The universal screening was performed with a GCT-50g and those with plasma glucose level130mg/dl, were diagnosed as having GDM if they had an impaired GTT-100g based on Carpenter and Coustan criteria. All pregnancies were followed up until delivery. Available GDM patients underwent an OGTT-75gr within 6 to 12 weeks after delivery. Postpartum diabetes mellitus was diagnosed according to ADA criteria. Student T test and ANOVA used for comparing means of variables and Chi Square used for comparing of frequency of variables. Value of P less than 0.5 determine as significant different.
Results: the prevalence of GDM was 4.7%. In fallow up 85.9% of women with GDM were screen in postpartum. 16.3% of women required insulin treatment and other patients were managed with diet. Prevalence of postpartum diabetes mellitus and IGT were 8.1% (CI 95%: 3.5-15.4) and 21.4% (CI 95%: 13.7-30.8) respectively, and 70.5% returned to normoglycemy.
Conclusion: Abnormal glucose tolerance is a common disorder in the early postpartum in GDM patients. Because of the high incidence of glucose tolerance disorders in women with previous GDM, screening, diagnosis and management during pregnancy was important for prevention of these disorders. Following up these mothers after delivery is highly recommended.

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Background: Women with gestational diabetes mellitus (GDM) have a reported 3% to 65% risk of developing type 2 diabetes. This study aims to identify the factors in GDM patients which can predict the risk of postpartum impaired glucose tolerance (T2DM+IGT) and T2DM.
Methods: A cohort study was conducted on 2416 pregnant women referred to five university hospital clinics. The universal screening was performed with a GCT- 50g and those with plasma glucose level  130mg/dl, were diagnosed as GDM if they had an impaired GTT-100g based on Carpenter and Coustan criteria. All pregnancies were followed until delivery. Available GDM patients underwent an OGTT-75gr within 6 to 12 weeks after delivery. Postpartum diabetes mellitus was diagnosed according to ADA criteria.
Results: Such factors as FBS105 during pregnancy, insulin requirement during pregnancy and BMI≥27kg/m2 before pregnancy were more prevalent in postpartum diabetic patients as compared with normal controls, significantly. Multivariate analysis suggested that gestational requirement for insulin and BMI≥27kg/m2 were the best predictors for developing postpartum diabetes. Also history of abortion, gestational requirement for insulin and BMI≥27kg/m2 were the best predictors for postpartum IGT.
Conclusion: Women with GDM have a substantially increased risk of developing postpartum IGT or diabetes. High glucose levels, insulin requirement during pregnancy, history of abortion and BMI≥27kg/m2 are the best predictors for postpartum diabetes and IGT.

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Background: Although there is increasing evidences that vitamin D is related to the occurrence of diabetes mellitus, its relation to glucose metabolism in pregnancy is not well studied. This study investigated 25-hydroxyvitamin D deficiency status in GDM pregnant women.
Methods: As a cross sectional study we recruited 741 pregnant women referred to five university educating hospital clinics. The universal screening was performed with a GCT-50g and those with plasma glucose level ≥130mg/dl, were diagnosed as GDM, if they had an impaired GTT-100g based on Carpenter and Coustan criteria. The levels of insulin was studied during OGTT-100g. Serum concentrations of 25-hydroxy vitamin D was measured too.
Results: Univeriate analysis revealed that 25 (OH) vit D concentrations were positively correlated with HOMA and ISOGTT index. Subjects with hypovitaminosis D (<12.5nmol/dl) had greater prevalence of GDM than others.
Conclusion: The results reveal a positive association between 25(OH) vit D concentrations and insulin sensitivity. Vit D deficiency is more prevalent in patients with GDM than normal pregnant women, So vit D supplementation may control glucose levels and improves outcome of pregnancy.

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Background: Adiponectin and leptin are hormones which are related to body fat tissues and body weight. In pregnant women, conflicting associations have been reported between the role of serum concentrations of adiponectin and leptin with infant birth weight. The aim of this study was to determine the association between maternal and cord blood adiponectin and leptin concentrations with birth weight. Methods: As a cross-sectional study 86 pregnant women referred to university hospital clinics were recruited. Maternal and umbilical cord blood samples were obtained in delivery room just after birth. The maternal and umbilical cord serum samples were analyzed for adiponectin and leptin. Their birth weight and height were measured at labor.
Results: The mean of maternal BMI, birth weight, and gestational age was 23.8±4.8 kg/m2, 3.13±0.14 kg, and 38.15±2.6 week, respectively. No correlation between adiponectin and birth weight were found. Birth weight positively correlates with leptin.
Conclusion: leptin concentrations in cord blood may be reflected the alternation of body fat tissue in infant and independently associated with infant birth weight.