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Her parents Sonja and Eddie, from Homestead,Florida, were visiting friends in Miami when MrsTaylor went into labour at just over 19 weeks pregnant, having conceived by IVF. William Smalling, neo-natologist at Baptist Children's Hospital in Miami, said: "She's truly a miracle baby. Two criteria based on a 2 h 75 g OGTT are being used for the diagnosis of gestational diabetes (GDM), those recommended over the years by the World Health Organization (WHO), and those recently recommended by the International Association for Diabetes in Pregnancy Study Group (IADPSG), the latter generated in the HAPO study and based on pregnancy outcomes. We searched relevant studies in MEDLINE, EMBASE, LILACS, the Cochrane Library, CINHAL, WHO-Afro library, IMSEAR, EMCAT, IMEMR and WPRIM.
The WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes. BackgroundThe definition of gestational diabetes mellitus (GDM) as any degree of glucose intolerance with onset or first recognition during pregnancy is largely accepted. ResultsResults of the literature searchFigure 1 (flow chart) describes the process of study identification and inclusion, and the reasons for exclusions. Included studiesData on the adverse outcomes associated with diagnostic criteria were extracted from 8 studies (9 publications) [7, 12a€“19], all of which were published in full in peer reviewed journals (Table 1).
Perinatal outcomesAs seen in Figure 2, a total of five studies allowed evaluation of the association between GDM diagnosed through WHO criteria and fetal macrosomia (defined by authors as birth weight > 4000 g, except Aberg et al [12]). Relative incidence (RR) of macrosomia among those with and without gestational diabetes as defined by WHO and IADPSG diagnostic criteria. Relative incidence (RR) of large for gestational age infants among those with and without gestational diabetes as defined by WHO and IADPSG diagnostic criteria. With regard to perinatal mortality (Figure 4), only two studies provided sufficient data for the evaluation of the WHO criteria.
Association between perinatal mortality and gestational diabetes as defined by WHO and IADPSG diagnostic criteria.
Maternal outcomesFour studies [13, 16, 18, 19] provided data on preeclampsia, one of which included cases of transient hypertension or unspecified hypertension in the same group as preeclampsia [13].
Association between preeclampsia and gestational diabetes as defined by WHO and IADPSG diagnostic criteria. Figure 6 presents data pertaining to studies with sufficient information to evaluate diagnostic criteria as predictors for cesarean delivery.
Association between cesarean delivery and gestational diabetes as defined by WHO and IADPSG diagnostic criteria. Sensitivity analyses and assessment of publication biasBecause the HAPO study was used to generate the IADPSG criteria, we performed post hoc subgroup analysis excluding the HAPO study (Figure 7) for all outcomes for which it contributed data.
As the EBDG study was used in all analysis, sometimes using individual patient data from the original database, we also performed post hoc sensitivity analyses excluding this study (Figure 8). It was not possible to assess the influence of the HAPO study on macrosomia, as no HAPO data were available for this outcome. DiscussionThis is the first systematic review to assess the magnitude of the associations between different GDM diagnostic criteria and several clinically relevant outcomes. ConclusionsIn conclusion, the meta-analyses of studies examining the WHO and IADPSG criteria demonstrate small increased risk for adverse pregnancy outcomes, with generally similar magnitudes of associations for each criteria.
Additional file 1: Description of the electronic search strategy used to perform the literature search.
Additional file 3: Meta-analyses performed with different variance estimators to generate pooled relative risks for the IADSPG and WHO criteria for gestational diabetes in the prediction of pregnancy outcomes. Competing interestsAll authors have completed the Unified Competing Interest form, declaring the absence of financial interests that may be relevant to the submitted work.Authors' contributionsMIS participated in all the aspects of the project and was the overall supervisor. The story of adolescent pregnancy in Mexico is the overall reduction in fertility among girls and young women in Mexico from the 1960s through 2010. Constitucion Politica de los Estados Unidos Mexicanos Titulo Primero articulo 4 De Los Derechos Humanos Y Sus Garantias (Reformada la denominacion por decreto publicado en el Diario Oficial de la Federacion el 10 de Junio de 2011). JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. Tel Aviv  - A brain dead Palestinian woman in her sixth month of pregnancy is being kept on life support in an Israeli hospital until doctors can deliver her unborn baby, a hospital spokeswoman said Thursday. The baby may have to spend the full three months in the womb of his dead mother, said Leah Malul, the spokeswoman of Barzilia hospital. The hospital is located in the southern Israeli coastal city of Ashekelon, at some 12 kilometres from the Gaza Strip.
The Israeli doctors were keeping the woman on life support at her husband's request, she told Deutsche Presse-Agentur dpa.
She pointed out that continuing the pregnancy was highly risky and the unborn baby may have been harmed by the stroke as well, but added "it is too early to know. Doctors attempted to delay the birth but eventually were forced to carry out an emergency caesarean.
We didn't even know what a normalblood pressure is for a baby this small."Amillia's incredible story will reignite the debate over Britain's abortion laws, which campaigners say must be updated in the light of recent medical advances. It is intended for general informational purposes only and does not address individual circumstances.
Our aim is to systematically review the evidence for the associations between GDM (according to these criteria) and adverse outcomes. We included cohort studies permitting the evaluation of GDM diagnosed by WHO and or IADPSG criteria against adverse maternal and perinatal outcomes in untreated women. Of the 8 included studies, three were retrospective and information was gathered through data linkage or chart review [15, 17, 18]. Because of the ethical need to offer treatment to women identified as having GDM by the diagnostic criteria in use at the moment of the testing, some studies excluded such women and others presented results permitting the separation of those who received treatment. For the analyses of the IADPSG criteria, the pooled RRs after exclusion were always somewhat smaller than the RR for the HAPO study alone. For the analyses of the IADPSG criteria, this exclusion led to somewhat increased pooled RRs, statistically different from the RRs for the EBDG study for large for gestational age and cesarean delivery; after the exclusion of the EBDG study, the pooled RRs remained statistically significant. At the beginning of the twentieth century, the fertility rate in Mexico was six children per female. She suffered a stroke and was transferred to Israel when the Gaza hospital she had been brought to was unable to treat her. As long as the mother's body continues to function as normal, there is no reason to get him out before, because that could lead to future complications," he told the Israeli Yediot Ahronot daily. During two months in an incubator, she even had plastic surgery after her left ear was partially torn off during the delivery."I'm still in amazement," said Mrs Taylor, 37, ateacher.
Are you curious how big your developing baby is, what your baby looks like as it grows inside you, and when you'll feel it move? Take a peek inside the womb to see how a baby develops from month to month.

It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. National Diabetes Data Group (NDDG) [1] and the World Health Organization (WHO) [2] established that the 2 h 75 g oral glucose tolerance test (OGTT) should be the main diagnostic test for glucose intolerance outside of pregnancy.Regarding glucose intolerance during pregnancy, two different approaches were taken.
One study was performed in the United States [13], one in Asia [18], two in the Middle East [17], one in Europe [12], two in Latin America [14, 16] and one was a multi country study [7, 19]. As seen in Table 1 in some cases, this resulted in study samples with a very narrow glucose range.Quality assessment of the studies included is summarized in Table 2.
We did not identify any published study allowing evaluation of macrosomia according to the IADSPG diagnostic criteria. No studies were available to evaluate the IADSPG diagnostic criteria with regard to perinatal mortality. The associations were consistent across the four studies analyzed according to the WHO criteria (I2 = 29%), but were inconsistent across the three studies that used the IADSPG criteria (I2 = 93%).
After exclusion, the pooled RRs remained statistically significant for preeclampsia (p = 0.006), but not for large for gestational age and cesarean delivery. For the analyses of the WHO criteria, pooled RRs were generally smaller after exclusion of the EBDG study, but remained statistically significant. In addition to providing estimates for the magnitude of the increased risk predicted by these two criteria, we also evaluated the application of the IADPSG criteria to settings other than that of the HAPO study.Our summary estimates of relative risk demonstrate that GDM diagnostic criteria based on both the WHO and the IADPSG criteria predict perinatal and maternal adverse outcomes. For the IADPSG criteria, additional studies will be needed to adequately estimate the magnitude of associations when applied to non-HAPO settings. Perfil de las Usuarias que han Realizado Interrupcion Legal del Embarazo en la Ciudad de Mexico Abril de 2007–31 de Mayo De 2013 (Profile of Users Who have done Legal Interruption of Pregnancy in the City of Mexico April 2007–31 May 2013).
Mortalidad: Principales Causas de Mortalidad por Residencia Habitual, Grupos de Edad y Sexo del Fallecido. Salud Sexual y Reproductiva para Adolescentes (Sexual and reproductive health for adolescents). Jovenes protestan en la Ssa por desabasto de condones (Youth protest in the SSA by shortages of condoms). Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I2 a‰? 73%). The NDDG opted, in pregnancy, to maintain the 3 h 100 g OGTT test, largely used and evaluated in the USA. Studies based on capillary glucose measurements were included.Types of outcome measuresWe decided to analyze, as perinatal outcomes, large for gestational age births and macrosomia (as defined by the authors), as well as perinatal mortality (fetal death and early neonatal death). After revising all titles and abstracts, 202 potentially relevant citations were identified and full papers were obtained for all. All but one study [12] used venous plasma glucose based on the oral glucose tolerance test to diagnose GDM. For the analyses of the WHO criteria, the pooled RRs excluding HAPO were generally greater than the RR for the HAPO study alone, although not statistically significantly so; and remained statistically significant after the exclusion.
The American Diabetes Association (ADA) and many other medical associations around the world adopted over the years this 3 h 100 g OGTT test.
A total of 9 publications pertaining to 8 studies met the selection criteria and were included in this systematic review.
For the three outcomes for which meta-analyses were possible for both criteria (large for gestational age, preeclampsia and cesarean delivery), the magnitude of the effects were similar for the WHO and the IADPSG criteria (1.53 vs.
This spectacular decline in fertility is even more remarkable when the context in which it occurred is considered. Poblacion, Desarrollo y Crecimiento (Change and persistence of intergenerational mobility in Mexico. Paul Fassbach, who has cared for Amillia since her second day.Amillia was conceived in vitro and has been in an incubator since birth. Excluding either the HAPO or the EBDG studies minimally altered these associations, but the RRs seen for the IADPSG criteria were reduced after excluding HAPO.
In so doing, different cutoffs for the diagnosis of GDM were chosen, one of the issues being the difficulty in converting blood glucose values from the original studies done in the 1960s and 1970s [1, 3a€“5] to their plasma equivalents analyzed using new analytic methods.The WHO adopted the 2 h 75 g OGTT in pregnancy, recommending the same diagnostic cut points established for the diagnosis of impaired glucose tolerance outside of pregnancy [2, 3].
The history of post-Columbian Mexico is in part the history of a burden imposed upon women and girls by Roman Catholic Church doctrine.
Within about three days after conception, the fertilized egg is dividing very fast into many cells.
The full database for the EBDG study was available which allowed analysis for both criteria for all outcomes. As both, a formal and informal member of the Mexican-ruling Governments, over the years, the Church has sanctioned large families and forbid contraception and abortion.
It passes through the fallopian tube into the uterus, where it attaches to the uterine wall.
Thus, the purpose of this study is to summarize, through a systematic review, the association of GDM, as diagnosed by the WHO and the IADPSG criteria, with adverse pregnancy outcomes, in untreated women. 1.23, respectively), although the inconsistency across studies limited aggregate estimation for the IADPSG criteria.
Like most developing countries, despite much progress, Mexico is a nation still sharply divided by income and education. In so doing, the applicability of the IADPSG criteria to non-HAPO settings is also evaluated.
The reference lists of all articles selected for full text reading were reviewed for additional potentially eligible studies.Data collection and analysisSelection of studiesAll citations identified were entered into an electronic database and duplicates were deleted. Sensitivity analyses excluding either the HAPO or the EBDG study did not materially change the magnitude of these associations (changes varying between 1 and 13%).It is important to note that these crude associations are very small within a diagnostic context. While a growing middle class continues to emerge in the urban areas, there remains widespread poverty and sharp divisions between the wealthy educated elite and the poor. Development at 4 WeeksAt this point the baby is developing the structures that will eventually form his face and neck. The heart and blood vessels continue to develop. Initially, two investigators independently screened the titles and abstracts of potentially relevant studies for eligibility. The major changes in sexual behavior among adolescent girls in Mexico are much the same as among adolescent girls in developing countries worldwide. And the lungs, stomach, and liver start to develop. A home pregnancy test would show positive. When the information was not sufficient to determine if the article was eligible for inclusion, the article's full text was obtained for further evaluation.

First, both GDM criteria, especially the IADPSG criteria, identify lesser degrees of hyperglycemia when compared to other ones, such as those previously recommended by the ADA [20]. The overall reduction in fertility among girls and young women in Mexico since the 1960 has been profound. Discrepancies were discussed until consensus was reached.Data extraction and managementTwo independent investigators reviewed the eligible studies and extracted data using a standardized form prepared for this review. Second, as all the studies analyzed in this review excluded women receiving specific treatments for GDM (see Table 1), the range of hyperglycemia classified as GDM represents a mild degree of hyperglycemia.
Given the continuum of risk in the association between plasma glucose and pregnancy outcomes [7], if both criteria were applied to a broader spectrum, such as the one seen in the usual clinical setting, which includes women at greater risk given their higher glucose level, the association should be stronger.
When raw quantitative data were not reported, approximate values were obtained from the figures or calculated from percentages.Assessment of methodological qualityThe methodological quality of the included studies was assessed by examining factors which might affect the strength of the association between glucose levels and outcomes.
Nevertheless, even if GDM diagnostic criteria were to reach relative risks close to 3 for these adverse outcomes in such settings, the relative risks would still be unlikely to reflect major diagnostic discrimination in terms of post test probabilities [21]. This fact suggests the importance of investigating the contribution to risk discrimination of other factors, besides glycaemia, for these outcomes.It is also important to interpret the heterogeneity found across studies, most seen for the IADPSG criteria. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Development at 12 WeeksThe baby measures about 2 inches and starts to make its own movements. Meta-analysis data were combined using random-effect models, with restricted maximum-likelihood (REML) estimation.
Potential reasons for heterogeneity include different population characteristics, study design and nature of the diagnostic criteria. As sensitivity analyses examining the influence of the EBDG and the HAPO studies did reveal some changes in the heterogeneity found, particularities about each of these study settings need to be considered.
As our aim was to investigate diagnostic criteria based on their capacity to predict GDM-related outcomes for classification purposes rather than for etiological investigation, all statistical analyses were crude, without adjustment for potential confounders.Assessment of heterogeneityOverall results were calculated based on the random effects model.
The HAPO study is a large multi-country study conducted from 2000 to 2006 with a strict research protocol. We assessed heterogeneity using the Cochrane's I‡2 statistics with a significance level of 0.10.
The EBDG study is a multicenter study conducted in Brazil in the 1990's with a less strict protocol, in a scenario of less intervention, following women with a wider range of hyperglycemia. Inconsistency indexes (I2) were also calculated, and a value greater than 50% was considered an indicator of high inconsistency between studies [10].Sensitivity analysis and assessment of publication biasWe did sensitivity analyses in order to examine the influence of the HAPO study and Brazilian Study of Gestational Diabetes (EBDG) on the magnitude and consistency of associations with outcomes.
A more strict protocol, with more control over incomplete fasting, such as that seen in the HAPO study, could produce larger associations with the IADPSG criteria, which diagnoses an appreciable fraction of cases on the basis of the fasting value.
In fact, the application of the IADPSG criteria in two published studies [13, 22] and in the EBDG database showed that the fasting value identified over 70% of all cases of GDM so defined, while when these criteria were applied to the HAPO study as a whole, the fasting value identified only about 50% of cases. Development at 20 WeeksThe baby weighs about 10 ounces and is a little more than 6 inches long.
The EBDG study was approved by local institutional review boards and informed consent was obtained from all participants. However, as this rate in HAPO varied from 24% (Thailand) to 74% (Barbados)[23], whether these differences resulted from incomplete fasting or from other specific study or population particularity cannot be concluded from current information. Data from the other studies were obtained from published articles cited in the list of references. The lack of blinding to glucose levels in most studies (except HAPO) could lead to GDM treatment, and thus reduce the magnitude of the associations; so we excluded such women.
Politicas para la infancia: Programa de Prevencion y Atencion del Embarazo en Adolescentes (PAIDEA). Although undetected intervention may still be present even after these exclusions, for example, diet, it is unlikely that this would cause more heterogeneity in the IADPSG than in the WHO analyses.One hypothesis is that the IADPSG criteria are more vulnerable to heterogeneity across different settings because they allow that diagnosis be made on the basis of only one out of three possible measures (fasting, 1 h and 2 h). Soon -- if you haven't already -- you'll feel your baby move, which is called "quickening." Time for an UltrasoundAn ultrasound is usually done for all pregnant women at 20 weeks. Given population variability in terms of the probability of being positive by fasting and post load values, as well as in terms of the possibility of having incomplete fasting (drank coffee or tea with sugar; for example), more heterogeneity could be found for the IADPSG criteria.
During this ultrasound, the doctor will make sure that the placenta is healthy and attached normally and that your baby is growing properly.
Another possibility, worth exploring in future studies, is whether the heterogeneity stems from differences in the prevalence or characteristics of obesity in the underlying populations.Additionally, since the IADPSG criteria were derived from the HAPO study, lower performance of these criteria in non-HAPO settings is to be expected. You can see the baby's heartbeat and movement of its body, arms, and legs on the ultrasound. For large for gestational age and for cesarean delivery, results remained inconsistent across studies after excluding HAPO, which makes questionable the estimates of pooled RRs generated for these outcomes (the pooled RRs found were lower and not statistically significant).
You can usually find out whether it's a boy or a girl at 20 weeks.Shown here is a 2D ultrasound (inset) contrasted with a 4D ultrasound, both at 20 weeks.
Development at 24 WeeksThe baby weighs about 1.4 pounds now and responds to sounds by moving or increasing his pulse.
First, few studies were available to evaluate important outcomes such as perinatal mortality and long-term outcomes in offspring. Yet, positive associations were found for macrosomia and pregnancy related hypertension, two clinically relevant outcomes. With the inner ear fully developed, the baby may be able to sense being upside down in the womb. Second, as we excluded studies conducted with selective screening and studies not allowing analysis of untreated women, we eliminated several otherwise good studies which were included in other reviews on GDM screening [24].
Development at 28 WeeksThe baby weighs about 2 pounds, 6 ounces, and changes position often at this point in pregnancy.
Publication bias could not be excluded because of the small number of studies examined.Our study also has several strong points, including its originality, extensive search strategy, inclusion of studies independent of language, strict methodological rigor, assessment of study quality, and sensitivity and subgroup analyses to investigate the applicability of the IADPSG criteria in settings other than the HAPO study.
Birthing classes prepare you for many aspects of childbirth, including labor and delivery and taking care of your newborn.    Development at 32 WeeksThe baby weighs almost 4 pounds and is moving around often. Development at 36 WeeksBabies differ in size, depending on many factors, such as gender, the number of babies being carried, and size of the parents.
He is an early term baby if born between 37-39 weeks, at term, if he's 39-40 weeks and late term if he's 41-42 weeks, Birth!A mother's due date marks the end of her 40th week. The delivery date is calculated using the first day of her last period. Based on this, pregnancy can last between 38 and 42 weeks with a full-term delivery happening around 40 weeks.

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