***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 
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    Input: AIMS To describe the prevalence of impaired glucose tolerance and obesity in offspring of mothers whose pregnancies were complicated by gestational diabetes mellitus ( GDM ) in a low-risk population and to investigate the effect on these outcomes of minimal intervention compared with tight control for management of GDM . METHODS Eighty-nine children ( mean age 9.1 years , 93 % Caucasian ) were recruited through a follow-up study of women previously involved in a r and omized controlled trial of minimal intervention ( control group ) vs. tight glycaemic control ( treatment group ) for GDM . Fasting blood glucose ( FBG ) and 2-h glucose tolerance tests ( 2hGTT ) were performed on offspring and body mass index ( BMI ) calculated . Glucose tolerance and BMI of treatment groups were compared using non-inferiority tests ( non-inferiority margin -15 % ) . RESULTS Of those offspring , 6.9 % ( 5/72 ) had abnormal glucose metabolism [ four children had impaired glucose tolerance ( IGT ) and one had Type 2 diabetes mellitus ( DM ) ( all Caucasian ) ] . Of the four children with IGT , three were male , three had normal BMI , and three had a family history of Type 2 diabetes . Of the 71 offspring who underwent 2hGTT , 25/25 ( 100 % ) of the control offspring and 46/46 ( 100 % ) of the treatment offspring had normal FBG ( FBG < 5.7 mmol/l ) . Twenty-five of 25 ( 100 % ) of control and 42/46 ( 91.3 % ) of the treatment offspring had normal glucose tolerance ( 2hGTT < 7.8 mmol/l ) ( % difference 8.7 , 95 % CI -5.6 , 20.3 ) . BMI < 85th percentile was found in 25/33 ( 75.8 % ) of the treatment group and 44/52 ( 84.6 % ) of the control group ( difference in percentage -8.9 , 95 % CI -27.2 , 7.8 ) . CONCLUSIONS School-age children of mothers with GDM are at risk of IGT and overweight , even if from a low-risk ethnic population . FBG was not adequate for screening this population . Minimal intervention for glycaemic control in GDM pregnancies appears to be as effective as tight control for preventing IGT in childhood but not for preventing obesity 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 Background In conjunction with the growing prevalence of obesity and the older age of pregnant women gestational diabetes ( GDM ) is a major health problem . The aim of the study was to evaluate if a lifestyle intervention since early pregnancy is feasible in improving the glucose tolerance of women at a high-risk for GDM in Finl and . Methods A 75-g oral glucose tolerance test ( OGTT ) was performed in early pregnancy ( n = 102 ) . Women at high risk for GDM ( n = 54 ) were r and omized at weeks 8 - 12 from Apr 2005 to May 2006 to a lifestyle intervention group ( n = 27 ) or to a close follow-up group ( n = 27 ) . An OGTT was performed again at weeks 26 - 28 for the lifestyle intervention and close follow-up groups . Results The values of the OGTT during the second trimester did not differ between the lifestyle intervention and close follow-up groups . In the lifestyle intervention group three women had GDM in the second trimester and respectively one woman in the close follow up group . Insulin therapy was not required in both groups . The intervention result ed in somewhat lower weight gain 11.4 ± 6.0 kg vs. 13.9 ± 5.1 kg , p = 0.062 , adjusted by the prepregnancy weight . Conclusions Early intervention with an OGTT and simple lifestyle advice is feasible . A more intensive lifestyle intervention did not offer additional benefits with respect to glucose tolerance , although it tended to ameliorate the weight gain . Trial Registration Clinical Trials.gov : Please cite this paper as : Ijäs H , Vääräsmäki M , Morin‐Papunen L , Keravuo R , Ebeling T , Saarela T , Raudaskoski T. Metformin should be considered in the treatment of gestational diabetes : a prospect i ve r and omised study . BJOG 2011;118:880–885 Emerging evidence suggests that fetal environmental exposures impact on future development of obesity . The objectives of this study were to assess the relationships between ( i ) maternal insulin sensitivity  and glucose tolerance status in pregnancy and ( ii ) early infant weight gain and adiposity in the first year of life . In this prospect i ve cohort study , 301 women underwent oral glucose tolerance testing for assessment of glucose tolerance status and insulin sensitivity ( IS(OGTT ) ) in pregnancy . Their infants underwent anthropometric assessment at 12 months of age , including determination of weight gain in the first year of life and sum of skinfold thickness ( SFT ) , a measure of infant adiposity . Infant weight gain and sum of SFT at 12 months did not differ according to maternal glucose tolerance status . On univariate analyses , weight gain from 0 to 12 months and sum of SFT were negatively associated with maternal IS(OGTT ) during pregnancy . On multiple linear regression analysis , negative independent predictors of weight gain from 0 to 12 months were maternal IS(OGTT ) during pregnancy ( t = -2.73 ; P = 0.007 ) , infant female gender ( t = -3.16 ; P = 0.002 ) , and parental education ( t = -1.98 ; P = 0.05 ) , whereas white ethnicity was a positive independent predictor ( t = 2.68 ; P = 0.008 ) . Maternal IS(OGTT ) ( t = -2.7 ; P = 0.008 ) and parental education ( t = -2.58 ; P = 0.01 ) were independent negative predictors of sum of SFT at 12 months . Independent of maternal glucose tolerance status , maternal insulin resistance during pregnancy is associated with increased infant weight gain and adiposity over the first year of life . Further longitudinal study to evaluate obesity in this group of children will increase our underst and ing of the contribution of the intrauterine environment to their long-term health Aims /hypothesisNew diagnostic criteria for gestational diabetes mellitus ( GDM ) have recently been published . We wished to evaluate what impact these new criteria would have on GDM prevalence and outcomes in a predominantly European population . Methods The Atlantic Diabetes In Pregnancy ( DIP ) programme performed screening for GDM in 5,500 women with an oral glucose tolerance test at 24–28 weeks . GDM was defined according to the new International Association of Diabetes and Pregnancy Study Groups ( IADPSG ) criteria and compared with previous WHO criteria ; maternal and neonatal adverse outcomes were prospect ively recorded . Results Of the participants , 12.4 % and 9.4 % were diagnosed with GDM using IADPSG and WHO criteria , respectively . IADPSG GDM pregnancies were associated with a statistically significant increased incidence of adverse maternal outcomes ( gestational hypertension , polyhydramnios and Caesarean section ) and neonatal outcomes ( prematurity , large for gestational age , neonatal unit admission , neonatal hypoglycaemia and respiratory distress ) . The odds ratio for the development of these adverse outcomes remained significant after adjustment for maternal age , body mass index and non-European ethnicity . Those women who were classified as having normal glucose tolerance by WHO criteria but as having GDM by IADPSG criteria also had significant adverse pregnancy outcomes . Conclusions /interpretationGDM prevalence is higher when using newer IADPSG , compared with WHO , criteria , and these women and their offspring experience significant adverse pregnancy outcomes . Higher rates of GDM pose a challenge to healthcare systems , but improved screening provides an opportunity to attempt to reduce the associated morbidity for mother and child 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 
    Output:
    
The 50 g oral glucose challenge test with a glucose threshold of 130 mg/dL versus 140 mg/dL improves sensitivity and reduces specificity .
Method ologically strong studies showed a continuous positive relationship between increasing glucose levels and the incidence of primary cesarean section and macrosomia .
There was more childhood obesity for Carpenter and Coustan GDM versus patient groups with no GDM .
Moderate evidence found less shoulder dystocia with treatment for GDM .
Low evidence showed no difference for neonatal hypoglycemia between treated and untreated GDM .
Moderate evidence showed benefits of treatment for reduction of macrosomia ( > 4,000 g ) .
While evidence supports a positive association with increasing plasma glucose on a 75 g or 100 g oral glucose tolerance test and macrosomia and primary cesarean section , clear thresholds for increased risk were not found .
The 50 g oral glucose challenge test has high NPV but variable PPV .
Treatment of GDM results in less preeclampsia and macrosomia .
Current evidence does not show that treatment of GDM has an effect on neonatal hypoglycemia or future poor metabolic outcomes .
There is little evidence of short-term harm from treating GDM other than an increased dem and for services .