Diabetes Research and Clinical Practice 106S2 (2014) S288–S290
Contents available at ScienceDirect
Diabetes Research and Clinical Practice journ al h ome pa ge : www .elsevier.co m/lo cate/diabres
Screening and diagnosis of diabetes in children and pregnant women Hung-Yuan Lia, *, Jung-Nan Weib , Lee-Ming Chuanga , En-Tzu Wuc , Chien-Nan Leec a b c
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Chia Nan University of Pharmacy and Science, Tainan, 717, Taiwan Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
ARTICLE INFO
ABSTRACT
Keywords: Screening Diagnosis Diabetes Children Gestational diabetes
The incidence and prevalence of diabetes in children has increased in recent decades. The findings of a nationwide screening program in Taiwan show that type 2 diabetes has replaced type 1 diabetes as the leading cause of diabetes in children and adolescents. Important risk factors for diabetes in children are high or low birth weights, obesity, and a family history of diabetes. The incidence of diabetes reaches plateaus during puberty. Therefore, we have developed a strategy to screen seventh-grade children with diabetes based on urinalysis and a risk score. Gestational diabetes is associated with various adverse perinatal outcomes, particularly macrosomia and birth injury, and a higher rate of Cesarean section. The 100 g oral glucose tolerance test (OGTT) for gestational diabetes was initially designed to predict maternal diabetes after delivery, and was revised by Carpenter and Coustan to predict adverse fetal outcomes. In 2010, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) proposed a 75 g OGTT to define gestational diabetes, resulting in a significant increase in the prevalence of gestational diabetes. Our data suggest that adopting the new IADPSG criteria is reasonable, since they reduce adverse perinatal outcomes and are cost-efficient. © 2014 Elsevier Ireland Ltd. All rights reserved.
1. Screening and diagnosis of diabetes in children In recent years, the incidence of diabetes mellitus (DM) in children has increased dramatically worldwide [1–3]. In Taiwan, the prevalence of DM is approximately 1 per thousand in 10-year-old children and 2.5–3 per thousand in 18-yearolds [4]. According to the results of a nationwide screening program in Taiwan, type 2 DM has become the leading cause of DM in children [5]. Most children with type 2 DM are asymptomatic, in contrast to children with type 1 DM. In addition, children with type 2 DM show a much more aggressive disease course [6], including an earlier and more rapid deterioration of b-cell function than adults with newly
diagnosed type 2 DM [7]. Some of these children develop complications shortly after type 2 DM diagnosis, such as hypertension, dyslipidemia, and microalbuminuria [8,9]. Indeed, the presence of other cardiovascular risk factors in children may predict type 2 DM [10]. Moreover, clustering of these cardiovascular risk factors results in systemic lowgrade inflammation [11,12], which is associated with early development of atherosclerosis, placing these individuals at a higher risk of cardiovascular diseases in the future [13,14]. Therefore, a screening strategy to identify children with type 2 DM is required. Since children find blood sampling painful, and the costs of mass screening through blood testing is high, targeting of high-risk groups is a more practical approach. The American Diabetes Association (ADA) has defined asymptomatic
* Corresponding author at: National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan. Tel: +886-2-23123456 ext. 63540; fax: +886-2-23123456 ext. 63486. E-mail address: E-mail: [email protected] (H.-Y. Li). 0168-8227© 2014 Elsevier Ireland Ltd. All rights reserved.
H.-Y. Li et al. / Diabetes Research and Clinical Practice 106S2 (2014) S288–S290
children with type 2 DM as a high-risk group. Overweight children with any two of the following risk factors should be screened: a family history of type 2 DM, a specific race/ethnicity (Native American, African American, Latino, Asian American, Pacific Islander), signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome, or a small-for-gestational-age birth weight), and a maternal history of diabetes or gestational DM during the child’s gestation [15]. However, there are some limitations to these recommendations. First, the high-risk races only include Americans, and there are no recommendations for other ethnic groups. Second, it is difficult for parents and teachers to recognize the signs or conditions associated with insulin resistance, such as acanthosis nigricans and polycystic ovary syndrome. Usually, these conditions are diagnosed by a doctor. Third, the diagnosis of dyslipidemia requires a blood test, and DM can be diagnosed at the same time. In Taiwan, we performed a nationwide screening program for DM in children and adolescents using urinalysis during 1992–2000 [5]. We found that being overweight, and having hypertension, a family history of DM, and a high or low birth weight were risk factors for DM [10,16,17]. Importantly, these risk factors can be investigated by parents and teachers, but not necessarily by doctors. In addition, the incidence of DM peaks during puberty [5]. Therefore, we have developed a screening strategy that combines these risk factors and urinalysis in seventh-grade students (manuscript in submission). Compared with the ADA criteria (following urinalysis), our screening strategy is easier to perform in schools, misses less children with DM, and may be a better way to screen for asymptomatic Asian children with DM.
2. Screening and diagnosis of diabetes in pregnant women Gestational diabetes mellitus (GDM) is diagnosed when DM is diagnosed for the first time during pregnancy [18]. Women with GDM have an increased risk of adverse perinatal outcomes, including macrosomia, birth trauma, jaundice, respiratory distress syndrome, primary Cesarean section, and maternal hypertensive disorders [19,20]. After delivery, 15–50% of women with GDM develop type 2 DM [18]. In addition, children born to mothers with GDM have an increased risk of obesity and diabetes, partly through the effects of macrosomia [21,22]. Therefore, GDM is sometimes called “a disease of two generations”. The diagnosis of GDM was first proposed by O’Sullivan to predict maternal diabetes after delivery [23]. A 100 g, 3-h oral glucose tolerance test (OGTT) is used. In 1982, Carpenter and Coustan (C&C) revised the cutoffs in order to predict the risk of adverse fetal outcomes [24–26]. The C&C criteria were adopted by the ADA in 1990 [27] and the American College of Obstetrics and Gynecology (ACOG) in 2001 [28]. In clinical practice, the 100 g OGTT is usually preceded by a 50 g glucose challenge test (GCT) as a screening test. In 2008, the Hyperglycemia and Adverse Pregnancy Outcome study used a 75 g, 2-h OGTT to define cutoffs that predict adverse perinatal outcomes [29]. Based on the findings of that study, the IADPSG proposed a new diagnostic strategy using a
S289
75 g OGTT [30], which was adopted by the ADA in 2011 [31]. The implementation of the IADPSG criteria was associated with a significant increase in the prevalence of GDM [32]. In other words, more women with mild hyperglycemia were identified and diagnosed with GDM. Although treatment for women with mild hyperglycemia results in reduced adverse perinatal outcomes [33], there were no studies at the time directly comparing the perinatal outcomes seen with the IADPSG or C&C criteria. Therefore, the ACOG and the National Institutes of Health still recommend a 50 g GCT followed by a 100 g OGTT for diagnosis [19,34]. Recently, we have compared the performance of the IADPSG and the C&C criteria (manuscript in submission). Use of the IADPSG criteria was associated with a reduction in adverse perinatal outcomes and was cost-efficient in identifying women with GDM, in relation to the increased prevalence of GDM. Therefore, the new IADPSG criteria for GDM are reasonable and their use should be considered.
Conflicts of interest The authors have no conflicts of interest to declare.
References 1. Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care 1999;22:345–54. 2. Kitagawa T, Owada M, Urakami T, Tajima N. Epidemiology of type 1 (insulin-dependent) and type 2 (non-insulindependent) diabetes mellitus in Japanese children. Diabetes Res Clin Pract 1994;24(Suppl):S7–13. 3. Pinhas-Hamiel O, Dolan LM, Daniels SR, Standiford D, Khoury PR, Zeitler P. Increased incidence of non-insulindependent diabetes mellitus among adolescents. J Pediatr 1996;128:608–15. 4. Wei JN, Chuang LM, Lin RS, Chao CL, Sung FC. Prevalence and hospitalization rates of diabetes mellitus in Taiwan, 1996–2000. Taiwan J Public Health 2002;21:173–80. 5. Wei JN, Sung FC, Lin CC, Lin RS, Chiang CC, Chuang LM. National surveillance for type 2 diabetes mellitus in Taiwanese children. JAMA 2003;290:1345–50. 6. Group TS, Zeitler P, Hirst K, Pyle L, Linder B, Copeland K, et al. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med 2012;366:2247–56. 7. TODAY Study Group. Effects of metformin, metformin plus rosiglitazone, and metformin plus lifestyle on insulin sensitivity and beta-cell function in TODAY. Diabetes Care 2013;36:1749–57. 8. TODAY Study Group. Rapid rise in hypertension and nephropathy in youth with type 2 diabetes: the TODAY clinical trial. Diabetes Care 2013;36:1735–41. 9. TODAY Study Group. Lipid and inflammatory cardiovascular risk worsens over 3 years in youth with type 2 diabetes: the TODAY clinical trial. Diabetes Care 2013;36:1758–64. 10. Li HY, Wei JN, Sung FC, Chuang LM. Higher rate of obesity and hypertension in adolescents with type 2 diabetes than in those with type 1 diabetes. Diabetes Care 2006;29:2326. 11. King GL. The role of inflammatory cytokines in diabetes and its complications. J Periodontol 2008;79:1527–34.
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12. Wei JN, Li HY, Sung FC, Lin CC, Chiang CC, Carter AM, et al. Obesity and clustering of cardiovascular disease risk factors are associated with elevated plasma complement C3 in children and adolescents. Pediatr Diabetes 2012;13:476–83. 13. McGill HC Jr, McMahan CA, Zieske AW, Tracy RE, Malcom GT, Herderick EE, et al. Association of Coronary Heart Disease Risk Factors with microscopic qualities of coronary atherosclerosis in youth. Circulation 2000;102: 374–9. 14. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998;338:1650–6. 15. American Diabetes Association. Standards of medical care in diabetes – 2012. Diabetes Care 2012;35(Suppl 1):S11–63. 16. Wei JN, Li HY, Wang YC, Chuang LM, Lin MS, Lin CH, et al. Detailed family history of diabetes identified children at risk of type 2 diabetes: a population-based case–control study. Pediatr Diabetes 2010;11:258–64. 17. Wei JN, Sung FC, Li CY, Chang CH, Lin RS, Lin CC, et al. Low birth weight and high birth weight infants are both at an increased risk to have type 2 diabetes among schoolchildren in Taiwan. Diabetes Care 2003;26:343–8. 18. Committee on Practice Bulletins – Obstetrics. Practice Bulletin No. 137: Gestational Diabetes Mellitus. Obstet Gynecol 2013;122:406–16. 19. National Institutes of Health consensus development conference statement: diagnosing gestational diabetes mellitus, March 4–6, 2013. Obstet Gynecol 2013;122:358–69. 20. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352: 2477–86. 21. Wei JN, Li HY, Sung FC, Lin CC, Chiang CC, Li CY, et al. Birth weight correlates differently with cardiovascular risk factor in youth obesity. Obesity (Silver Spring) 2007;15: 1609–16. 22. Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care 2007;30:2287–92.
23. O’Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes 1964;13:278–85. 24. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144:768–73. 25. Cheng YW, Block-Kurbisch I, Caughey AB. Carpenter– Coustan criteria compared with the National Diabetes Data Group thresholds for gestational diabetes mellitus. Obstet Gynecol 2009;114:326–32. 26. Berggren EK, Boggess KA, Stuebe AM, Jonsson Funk M. National Diabetes Data Group vs Carpenter–Coustan criteria to diagnose gestational diabetes. Am J Obstet Gynecol 2011;205:253.e1–7. 27. American Diabetes Association. Gestational diabetes mellitus. Diabetes Care 1990;13(Suppl):5–6. 28. American College of Obstetricians and Gynecologists Committee on Practice Bulletins – Obstetrics. ACOG Practice Bulletin. Clinical Management guidelines for obstetrician–gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational Diabetes. Obstet Gynecol 2001;98:528–38. 29. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991–2002. 30. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676–82. 31. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2010;34:S62–9. 32. Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG Consensus Panel – recommended criteria. Diabetes Care 2012;35:526–8. 33. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009;361: 1339–48. 34. Committee Opinion no. 54: Screening and Diagnosis of Gestational Diabetes Mellitus. Obstet Gynecol 2011;118: 751–3.
Contents available at ScienceDirect
Diabetes Research and Clinical Practice journ al h ome pa ge : www .elsevier.co m/lo cate/diabres
Screening and diagnosis of diabetes in children and pregnant women Hung-Yuan Lia, *, Jung-Nan Weib , Lee-Ming Chuanga , En-Tzu Wuc , Chien-Nan Leec a b c
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Chia Nan University of Pharmacy and Science, Tainan, 717, Taiwan Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
ARTICLE INFO
ABSTRACT
Keywords: Screening Diagnosis Diabetes Children Gestational diabetes
The incidence and prevalence of diabetes in children has increased in recent decades. The findings of a nationwide screening program in Taiwan show that type 2 diabetes has replaced type 1 diabetes as the leading cause of diabetes in children and adolescents. Important risk factors for diabetes in children are high or low birth weights, obesity, and a family history of diabetes. The incidence of diabetes reaches plateaus during puberty. Therefore, we have developed a strategy to screen seventh-grade children with diabetes based on urinalysis and a risk score. Gestational diabetes is associated with various adverse perinatal outcomes, particularly macrosomia and birth injury, and a higher rate of Cesarean section. The 100 g oral glucose tolerance test (OGTT) for gestational diabetes was initially designed to predict maternal diabetes after delivery, and was revised by Carpenter and Coustan to predict adverse fetal outcomes. In 2010, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) proposed a 75 g OGTT to define gestational diabetes, resulting in a significant increase in the prevalence of gestational diabetes. Our data suggest that adopting the new IADPSG criteria is reasonable, since they reduce adverse perinatal outcomes and are cost-efficient. © 2014 Elsevier Ireland Ltd. All rights reserved.
1. Screening and diagnosis of diabetes in children In recent years, the incidence of diabetes mellitus (DM) in children has increased dramatically worldwide [1–3]. In Taiwan, the prevalence of DM is approximately 1 per thousand in 10-year-old children and 2.5–3 per thousand in 18-yearolds [4]. According to the results of a nationwide screening program in Taiwan, type 2 DM has become the leading cause of DM in children [5]. Most children with type 2 DM are asymptomatic, in contrast to children with type 1 DM. In addition, children with type 2 DM show a much more aggressive disease course [6], including an earlier and more rapid deterioration of b-cell function than adults with newly
diagnosed type 2 DM [7]. Some of these children develop complications shortly after type 2 DM diagnosis, such as hypertension, dyslipidemia, and microalbuminuria [8,9]. Indeed, the presence of other cardiovascular risk factors in children may predict type 2 DM [10]. Moreover, clustering of these cardiovascular risk factors results in systemic lowgrade inflammation [11,12], which is associated with early development of atherosclerosis, placing these individuals at a higher risk of cardiovascular diseases in the future [13,14]. Therefore, a screening strategy to identify children with type 2 DM is required. Since children find blood sampling painful, and the costs of mass screening through blood testing is high, targeting of high-risk groups is a more practical approach. The American Diabetes Association (ADA) has defined asymptomatic
* Corresponding author at: National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan. Tel: +886-2-23123456 ext. 63540; fax: +886-2-23123456 ext. 63486. E-mail address: E-mail: [email protected] (H.-Y. Li). 0168-8227© 2014 Elsevier Ireland Ltd. All rights reserved.
H.-Y. Li et al. / Diabetes Research and Clinical Practice 106S2 (2014) S288–S290
children with type 2 DM as a high-risk group. Overweight children with any two of the following risk factors should be screened: a family history of type 2 DM, a specific race/ethnicity (Native American, African American, Latino, Asian American, Pacific Islander), signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome, or a small-for-gestational-age birth weight), and a maternal history of diabetes or gestational DM during the child’s gestation [15]. However, there are some limitations to these recommendations. First, the high-risk races only include Americans, and there are no recommendations for other ethnic groups. Second, it is difficult for parents and teachers to recognize the signs or conditions associated with insulin resistance, such as acanthosis nigricans and polycystic ovary syndrome. Usually, these conditions are diagnosed by a doctor. Third, the diagnosis of dyslipidemia requires a blood test, and DM can be diagnosed at the same time. In Taiwan, we performed a nationwide screening program for DM in children and adolescents using urinalysis during 1992–2000 [5]. We found that being overweight, and having hypertension, a family history of DM, and a high or low birth weight were risk factors for DM [10,16,17]. Importantly, these risk factors can be investigated by parents and teachers, but not necessarily by doctors. In addition, the incidence of DM peaks during puberty [5]. Therefore, we have developed a screening strategy that combines these risk factors and urinalysis in seventh-grade students (manuscript in submission). Compared with the ADA criteria (following urinalysis), our screening strategy is easier to perform in schools, misses less children with DM, and may be a better way to screen for asymptomatic Asian children with DM.
2. Screening and diagnosis of diabetes in pregnant women Gestational diabetes mellitus (GDM) is diagnosed when DM is diagnosed for the first time during pregnancy [18]. Women with GDM have an increased risk of adverse perinatal outcomes, including macrosomia, birth trauma, jaundice, respiratory distress syndrome, primary Cesarean section, and maternal hypertensive disorders [19,20]. After delivery, 15–50% of women with GDM develop type 2 DM [18]. In addition, children born to mothers with GDM have an increased risk of obesity and diabetes, partly through the effects of macrosomia [21,22]. Therefore, GDM is sometimes called “a disease of two generations”. The diagnosis of GDM was first proposed by O’Sullivan to predict maternal diabetes after delivery [23]. A 100 g, 3-h oral glucose tolerance test (OGTT) is used. In 1982, Carpenter and Coustan (C&C) revised the cutoffs in order to predict the risk of adverse fetal outcomes [24–26]. The C&C criteria were adopted by the ADA in 1990 [27] and the American College of Obstetrics and Gynecology (ACOG) in 2001 [28]. In clinical practice, the 100 g OGTT is usually preceded by a 50 g glucose challenge test (GCT) as a screening test. In 2008, the Hyperglycemia and Adverse Pregnancy Outcome study used a 75 g, 2-h OGTT to define cutoffs that predict adverse perinatal outcomes [29]. Based on the findings of that study, the IADPSG proposed a new diagnostic strategy using a
S289
75 g OGTT [30], which was adopted by the ADA in 2011 [31]. The implementation of the IADPSG criteria was associated with a significant increase in the prevalence of GDM [32]. In other words, more women with mild hyperglycemia were identified and diagnosed with GDM. Although treatment for women with mild hyperglycemia results in reduced adverse perinatal outcomes [33], there were no studies at the time directly comparing the perinatal outcomes seen with the IADPSG or C&C criteria. Therefore, the ACOG and the National Institutes of Health still recommend a 50 g GCT followed by a 100 g OGTT for diagnosis [19,34]. Recently, we have compared the performance of the IADPSG and the C&C criteria (manuscript in submission). Use of the IADPSG criteria was associated with a reduction in adverse perinatal outcomes and was cost-efficient in identifying women with GDM, in relation to the increased prevalence of GDM. Therefore, the new IADPSG criteria for GDM are reasonable and their use should be considered.
Conflicts of interest The authors have no conflicts of interest to declare.
References 1. Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care 1999;22:345–54. 2. Kitagawa T, Owada M, Urakami T, Tajima N. Epidemiology of type 1 (insulin-dependent) and type 2 (non-insulindependent) diabetes mellitus in Japanese children. Diabetes Res Clin Pract 1994;24(Suppl):S7–13. 3. Pinhas-Hamiel O, Dolan LM, Daniels SR, Standiford D, Khoury PR, Zeitler P. Increased incidence of non-insulindependent diabetes mellitus among adolescents. J Pediatr 1996;128:608–15. 4. Wei JN, Chuang LM, Lin RS, Chao CL, Sung FC. Prevalence and hospitalization rates of diabetes mellitus in Taiwan, 1996–2000. Taiwan J Public Health 2002;21:173–80. 5. Wei JN, Sung FC, Lin CC, Lin RS, Chiang CC, Chuang LM. National surveillance for type 2 diabetes mellitus in Taiwanese children. JAMA 2003;290:1345–50. 6. Group TS, Zeitler P, Hirst K, Pyle L, Linder B, Copeland K, et al. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med 2012;366:2247–56. 7. TODAY Study Group. Effects of metformin, metformin plus rosiglitazone, and metformin plus lifestyle on insulin sensitivity and beta-cell function in TODAY. Diabetes Care 2013;36:1749–57. 8. TODAY Study Group. Rapid rise in hypertension and nephropathy in youth with type 2 diabetes: the TODAY clinical trial. Diabetes Care 2013;36:1735–41. 9. TODAY Study Group. Lipid and inflammatory cardiovascular risk worsens over 3 years in youth with type 2 diabetes: the TODAY clinical trial. Diabetes Care 2013;36:1758–64. 10. Li HY, Wei JN, Sung FC, Chuang LM. Higher rate of obesity and hypertension in adolescents with type 2 diabetes than in those with type 1 diabetes. Diabetes Care 2006;29:2326. 11. King GL. The role of inflammatory cytokines in diabetes and its complications. J Periodontol 2008;79:1527–34.
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H.-Y. Li et al. / Diabetes Research and Clinical Practice 106S2 (2014) S288–S290
12. Wei JN, Li HY, Sung FC, Lin CC, Chiang CC, Carter AM, et al. Obesity and clustering of cardiovascular disease risk factors are associated with elevated plasma complement C3 in children and adolescents. Pediatr Diabetes 2012;13:476–83. 13. McGill HC Jr, McMahan CA, Zieske AW, Tracy RE, Malcom GT, Herderick EE, et al. Association of Coronary Heart Disease Risk Factors with microscopic qualities of coronary atherosclerosis in youth. Circulation 2000;102: 374–9. 14. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998;338:1650–6. 15. American Diabetes Association. Standards of medical care in diabetes – 2012. Diabetes Care 2012;35(Suppl 1):S11–63. 16. Wei JN, Li HY, Wang YC, Chuang LM, Lin MS, Lin CH, et al. Detailed family history of diabetes identified children at risk of type 2 diabetes: a population-based case–control study. Pediatr Diabetes 2010;11:258–64. 17. Wei JN, Sung FC, Li CY, Chang CH, Lin RS, Lin CC, et al. Low birth weight and high birth weight infants are both at an increased risk to have type 2 diabetes among schoolchildren in Taiwan. Diabetes Care 2003;26:343–8. 18. Committee on Practice Bulletins – Obstetrics. Practice Bulletin No. 137: Gestational Diabetes Mellitus. Obstet Gynecol 2013;122:406–16. 19. National Institutes of Health consensus development conference statement: diagnosing gestational diabetes mellitus, March 4–6, 2013. Obstet Gynecol 2013;122:358–69. 20. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352: 2477–86. 21. Wei JN, Li HY, Sung FC, Lin CC, Chiang CC, Li CY, et al. Birth weight correlates differently with cardiovascular risk factor in youth obesity. Obesity (Silver Spring) 2007;15: 1609–16. 22. Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care 2007;30:2287–92.
23. O’Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes 1964;13:278–85. 24. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144:768–73. 25. Cheng YW, Block-Kurbisch I, Caughey AB. Carpenter– Coustan criteria compared with the National Diabetes Data Group thresholds for gestational diabetes mellitus. Obstet Gynecol 2009;114:326–32. 26. Berggren EK, Boggess KA, Stuebe AM, Jonsson Funk M. National Diabetes Data Group vs Carpenter–Coustan criteria to diagnose gestational diabetes. Am J Obstet Gynecol 2011;205:253.e1–7. 27. American Diabetes Association. Gestational diabetes mellitus. Diabetes Care 1990;13(Suppl):5–6. 28. American College of Obstetricians and Gynecologists Committee on Practice Bulletins – Obstetrics. ACOG Practice Bulletin. Clinical Management guidelines for obstetrician–gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational Diabetes. Obstet Gynecol 2001;98:528–38. 29. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991–2002. 30. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676–82. 31. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2010;34:S62–9. 32. Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG Consensus Panel – recommended criteria. Diabetes Care 2012;35:526–8. 33. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009;361: 1339–48. 34. Committee Opinion no. 54: Screening and Diagnosis of Gestational Diabetes Mellitus. Obstet Gynecol 2011;118: 751–3.
