***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In this study , we assessed maternal-fetal outcomes in untreated patients with increasing carbohydrate intolerance not meeting the current criteria for the diagnosis of gestational diabetes mellitus ( GDM ) , examined the relationship between birth weight and mode of delivery among women with untreated borderline GDM , treated overt GDM , and normoglycemia , and established more efficient screening strategies for detection of GDM . This was a prospect i ve analytic cohort study in which nondiabetic women aged > or = 24 years were eligible for enrollment . A 50-g glucose challenge test ( GCT ) and a 100-g oral glucose tolerance test ( OGTT ) were administered at 26 and 28 weeks gestational age , respectively . Risk factors for unfavorable maternal-fetal outcomes were recorded . Time since the last meal  prior to the screening test was recorded , as well . Caregivers and patients were blinded to glucose values except when test results met the National Diabetes Data Group criteria for GDM . Maternal and fetal outcomes , including the mode of the delivery , were recorded in the postpartum period . Of 4,274 patients screened , 3,836 ( 90 % ) continued to the diagnostic oral glucose tolerance test . GDM was seen in 145 women . Increasing carbohydrate intolerance in women without overt gestational diabetes was associated with a significantly increased incidence of cesarean section , preeclampsia , macrosomia , and need for phototherapy , as well as an increased length of maternal and neonatal hospital stay . Multivariate analysis showed that increasing carbohydrate intolerance remained an independent predictor for various unfavorable outcomes , but the strength of the associations was diminished . Compared with normoglycemic control subjects , the untreated borderline GDM group had increased rates of macrosomia ( 28.7 vs. 13.7 % , P < 0.001 ) and cesarean delivery ( 29.6 vs. 20.2 % , P = 0.03 ) . Usual care of known GDM patients normalized birth weights , but the cesarean delivery rate was about 33 % , whether macrosomia was present or absent . An increased risk of cesarean delivery among treated patients compared with normoglycemic control subjects persisted after adjustment for multiple maternal risk factors . As for the screening tests , time since the last meal had a marked effect on mean plasma glucose . Receiver operating characteristic curve analysis allowed the selection of the most efficient cut points for the GCT based on the time since the last meal . These cut points were 8.2 , 7.9 , and 8.3 mmol/l ( 1 mmol/l = 18.015 mg/dl ) for elapsed postpr and ial time of < 2 , 2 - 3 , and > 3 h , respectively . With this change from the current threshold of 7.8 mmol/l , the number of patients with a positive screening test dropped from 18.5 to 13.7 % . There was an increase in positive predictive value from 14.4 to 18.7 % . The overall rate of patient misclassification fell from 18.0 to 13.1 % . In conclusion , increasing maternal carbohydrate intolerance in pregnant women without GDM is associated with a grade d increase in adverse maternal and fetal outcomes . Infant macrosomia is an important factor in high cesarean delivery rates for women with untreated borderline GDM . Although detection and treatment of GDM normalizes birth weights , rates of cesarean delivery remain inexplicably high . Recognition of GDM may lead to a lower threshold for surgical delivery . The efficiency of screening for GDM can be enhanced by adjusting the current GCT threshold of 7.8 mmol/l to new values related to time since the last meal before screening . Further analyses are underway to eluci date whether maternal risk factors can be used to achieve additional efficiency gains in screening OBJECTIVE Our purpose was to assess maternal-fetal outcomes in patients with increasing carbohydrate intolerance not meeting the current criteria for the diagnosis of gestational diabetes . STUDY DESIGN We conducted a prospect i ve analytic cohort study in which nondiabetic women aged > or = 24 years , receiving prenatal care in three Toronto teaching hospitals , were eligible for enrollment . A glucose challenge test and an oral glucose tolerance test were administered at 26 and 28 weeks ' gestation , respectively ; risk factors for unfavorable maternal-fetal outcomes were recorded . Caregivers and patients were blinded to glucose values except when test results met the current criteria for gestational diabetes . RESULTS Of 4274 patients screened , 3836 ( 90 % ) continued to the diagnostic oral glucose tolerance test . The study cohort was formed by the 3637 ( 95 % ) patients without gestational diabetes , carrying singleton fetuses . Increasing carbohydrate intolerance in women without overt gestational diabetes was associated with a significantly increased incidence of cesarean sections , preeclampsia , macrosomia , and need for phototherapy , as well as an increased length of maternal and neonatal hospital stay . Multivariate analysis showed that increasing carbohydrate intolerance is an independent predictor for various unfavorable outcomes . CONCLUSION Increasing maternal carbohydrate intolerance in pregnant women without gestational diabetes is associated with a grade d increase in adverse maternal-fetal outcomes CONTEXT AND OBJECTIVE Lack of consensus about which screening tests to use for gestational diabetes mellitus ( GDM ) and difficulties in performing the gold-st and ard diagnostic test , the 100-g glucose tolerance test ( 100-g GTT ) , justify comparison with alternatives . The aim was to compare this with two other screening tests : combined fasting glucose with risk factors ( FG + RF ) and 50-g GTT . DESIGN AND SETTING Prospect i ve longitudinal cohort study in the Hospital School of Universidade Federal de Mato Grosso do Sul . METHODS The three tests were performed independently on 341 pregnant women .  Sensitivity ( S ) , specificity ( Sp ) , positive ( PPV ) and negative ( NPV ) predictive values , positive ( PLR ) and negative ( NLR ) likelihood ratios , and false-positive ( FP ) and false-negative ( FR ) rates obtained with FG + RF and 50-g GTT were compared with values from 100-g GTT . The average one-hour post-intake glucose levels ( 1hPG ) with 50-g and 100-g were compared . Students t test was used in the statistical analysis . RESULTS FG + RF led more pregnant women ( 53.9 % ) to diagnostic confirmation than did 50-g GTT ( 14.4 % ) . The tests were equivalent for S ( 86.4 and 76.9 % ) , PPV ( 98.7 and 98.9 % ) , NLR ( 0.3 and 0.27 ) and FR ( 15.4 and 23.1 % ) . Average 1hPG values were similar : 50-g GTT = 106.8 mg/dl and 100-g GTT = 107.5 mg/dl . CONCLUSION Diagnostic efficiency with simplicity , practicality and low cost make FG + RF more appropriate for screening for GDM . The equivalence of 1hPG allows a new , cheaper and less uncomfortable protocol to be proposed for screening and diagnosing GDM BACKGROUND We conducted a r and omized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications . METHODS We r and omly assigned women between 24 and 34 weeks ' gestation who had gestational diabetes to receive dietary advice , blood glucose monitoring , and insulin therapy as needed ( the intervention group ) or routine care . Primary outcomes included serious perinatal complications ( defined as death , shoulder dystocia , bone fracture , and nerve palsy ) , admission to the neonatal nursery , jaundice requiring phototherapy , induction of labor , cesarean birth , and maternal anxiety , depression , and health status . RESULTS The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group ( 1 percent vs. 4 percent ; relative risk adjusted for maternal age , race or ethnic group , and parity , 0.33 ; 95 percent confidence interval , 0.14 to 0.75 ; P=0.01 ) . However , more infants of women in the intervention group were admitted to the neonatal nursery ( 71 percent vs. 61 percent ; adjusted relative risk , 1.13 ; 95 percent confidence interval , 1.03 to 1.23 ; P=0.01 ) . Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group ( 39 percent vs. 29 percent ; adjusted relative risk , 1.36 ; 95 percent confidence interval , 1.15 to 1.62 ; P<0.001 ) , although the rates of cesarean delivery were similar ( 31 percent and 32 percent , respectively ; adjusted relative risk , 0.97 ; 95 percent confidence interval , 0.81 to 1.16 ; P=0.73 ) . At three months post partum , data on the women 's mood and quality of life , available for 573 women , revealed lower rates of depression and higher scores , consistent with improved health status , in the intervention group . CONCLUSIONS Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman 's health-related quality of life OBJECTIVE The International Association of Diabetes and Pregnancy Study Groups ( IADPSG ) has proposed new criteria for the diagnosis of gestational diabetes mellitus ( GDM ) . The aim of this study was to compare the prevalence of GDM when IADPSG criteria were used with the prevalence when the current Australasian Diabetes in Pregnancy Society ( ADIPS ) criteria were used . DESIGN , SETTING AND PARTICIPANTS This was a prospect i ve study over a 6-month period , examining the results of all glucose tolerance tests ( GTTs )  conducted for the diagnosis of GDM in Wollongong , a city using the public and private sectors . MAIN OUTCOME MEASURES The prevalence of GDM using the existing ( ADIPS ) and the proposed ( IADPSG ) criteria . RESULTS There were 1275 evaluable GTTs ( 571 public and 704 private ) . Using the current ADIPS diagnostic criteria , the prevalence of GDM was 8.6 % ( public ) , 10.5 % ( private ) and 9.6 % ( overall ) . Using the proposed IADPSG criteria , the prevalence of GDM was 9.1 % ( public ) , 16.2 % ( private ) and 13.0 % ( overall ) . CONCLUSIONS The proposed IADPSG criteria would increase the prevalence of GDM from 9.6 % to 13.0 % ( P < 0.001 ) . In our study in the Wollongong area , which has a population with a predominantly white background , this increase came mainly from older women attending a private pathology provider . Data from both the public and private sectors need to be included in any discussion on the change in prevalence of GDM OBJECTIVE The objective of this study was to compare 2-hour postpr and ial glucose measurements with the st and ard 1-hour , 50 gm glucola screen as a predictor of gestational diabetes . STUDY DESIGN In this prospect i ve study , 448 patients were screened for gestational diabetes mellitus after 20 weeks ' gestation . Each patient was instructed to ingest a meal containing at least 100 gm of carbohydrate , and 2 hours later a plasma glucose level was obtained . Shortly after , each patient was given 50 gm glucola followed by a 1-hour glucose measurement . If either screen showed a result of 140 mg/dl or more , a formal 3-hour glucose tolerance test was done . Data were analyzed with use of the receiver operating characteristic curve . RESULTS Of the 448 patients screened , 39 ( 8.7 % ) had a screening result of 140 mg/dl or greater and 16 ( 3.6 % ) of these had gestational diabetes mellitus . The receiver operating characteristic curve showed that the 1-hour glucose screen was more predictive of gestational diabetes than the postmeal assessment . The area under the receiver operating characteristic curve ( plus or minus the SEM ) for the 1-hour glucose test was 0.746 + /- 0.086 ( p < 0.005 ) whereas the 2-hour postpr and ial test produced an area of 0.524 + /- 0.097 ( p = NS ) . The range of optimal 1-hour glucola discriminatory values was 182 to 190 mg/dl . Thus the critical cutoff value of the 1-hour glucola test that minimizes false-positive results and maximizes true-positive screening for gestational diabetes is 182 mg/dl or greater . CONCLUSIONS The 1-hour glucola test is a reliable screening test for gestational diabetes mellitus whereas the 2-hour post-pr and ial test is not OBJECTIVES To vali date a diagnostic test for gestational diabetes which predicts the risk of macrosomia . METHODS A prospect i ve study was carried out among  
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Glycated hemoglobin level had poorer test characteristics than fasting plasma glucose level or the OGCT .
The OGCT and fasting plasma glucose level ( at a threshold of 4.7 mmol/L [ 85 mg/dL ] ) by 24 weeks ' gestation are good at identifying women who do not have GDM .
The OGCT is better at identifying women who have GDM .