Gestational Diabetes - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

GESTATIONAL DIABETES A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES ...

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GESTATIONAL DIABETES A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Gestational Diabetes: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83956-5 1. Gestational Diabetes-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on gestational diabetes. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON GESTATIONAL DIABETES .......................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Gestational Diabetes ................................................................... 25 E-Journals: PubMed Central ....................................................................................................... 66 The National Library of Medicine: PubMed ................................................................................ 67 CHAPTER 2. NUTRITION AND GESTATIONAL DIABETES .............................................................. 113 Overview.................................................................................................................................... 113 Finding Nutrition Studies on Gestational Diabetes .................................................................. 113 Federal Resources on Nutrition ................................................................................................. 118 Additional Web Resources ......................................................................................................... 119 CHAPTER 3. ALTERNATIVE MEDICINE AND GESTATIONAL DIABETES ........................................ 121 Overview.................................................................................................................................... 121 National Center for Complementary and Alternative Medicine................................................ 121 Additional Web Resources ......................................................................................................... 125 General References ..................................................................................................................... 126 CHAPTER 4. DISSERTATIONS ON GESTATIONAL DIABETES .......................................................... 127 Overview.................................................................................................................................... 127 Dissertations on Gestational Diabetes ....................................................................................... 127 Keeping Current ........................................................................................................................ 128 CHAPTER 5. CLINICAL TRIALS AND GESTATIONAL DIABETES..................................................... 129 Overview.................................................................................................................................... 129 Recent Trials on Gestational Diabetes ....................................................................................... 129 Keeping Current on Clinical Trials ........................................................................................... 130 CHAPTER 6. PATENTS ON GESTATIONAL DIABETES ..................................................................... 133 Overview.................................................................................................................................... 133 Patents on Gestational Diabetes ................................................................................................ 133 Patent Applications on Gestational Diabetes............................................................................. 137 Keeping Current ........................................................................................................................ 140 CHAPTER 7. BOOKS ON GESTATIONAL DIABETES ........................................................................ 141 Overview.................................................................................................................................... 141 Book Summaries: Federal Agencies............................................................................................ 141 Book Summaries: Online Booksellers......................................................................................... 143 The National Library of Medicine Book Index ........................................................................... 144 Chapters on Gestational Diabetes .............................................................................................. 144 CHAPTER 8. MULTIMEDIA ON GESTATIONAL DIABETES .............................................................. 147 Overview.................................................................................................................................... 147 Video Recordings ....................................................................................................................... 147 Audio Recordings....................................................................................................................... 149 CHAPTER 9. PERIODICALS AND NEWS ON GESTATIONAL DIABETES ........................................... 151 Overview.................................................................................................................................... 151 News Services and Press Releases.............................................................................................. 151 Academic Periodicals covering Gestational Diabetes................................................................. 156 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 157 Overview.................................................................................................................................... 157 U.S. Pharmacopeia..................................................................................................................... 157 Commercial Databases ............................................................................................................... 158 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 161 Overview.................................................................................................................................... 161 NIH Guidelines.......................................................................................................................... 161

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NIH Databases........................................................................................................................... 163 Other Commercial Databases..................................................................................................... 167 APPENDIX B. PATIENT RESOURCES ............................................................................................... 169 Overview.................................................................................................................................... 169 Patient Guideline Sources.......................................................................................................... 169 Finding Associations.................................................................................................................. 178 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 181 Overview.................................................................................................................................... 181 Preparation................................................................................................................................. 181 Finding a Local Medical Library................................................................................................ 181 Medical Libraries in the U.S. and Canada ................................................................................. 181 ONLINE GLOSSARIES................................................................................................................ 187 Online Dictionary Directories ................................................................................................... 189 GESTATIONAL DIABETES DICTIONARY............................................................................ 191 INDEX .............................................................................................................................................. 241

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with gestational diabetes is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about gestational diabetes, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to gestational diabetes, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on gestational diabetes. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to gestational diabetes, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on gestational diabetes. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON GESTATIONAL DIABETES Overview In this chapter, we will show you how to locate peer-reviewed references and studies on gestational diabetes.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and gestational diabetes, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “gestational diabetes” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Impact of Social Support and Stress on Compliance in Women With Gestational Diabetes Source: Diabetes Care. 13(4): 441-443. April 1990. Summary: Adherence to medical recommendations is especially important in gestational diabetes because of the health implications for both the pregnant woman and the fetus. This study examined adherence with two daily self-management tasks, diet and insulin administration, in 98 women with gestational diabetes. The influence of stress and regimen related social support on adherence was also investigated. Results indicate that the level of reported adherence was high for both insulin administration and diet. Fewer minor stressors and greater social support were associated with greater adherence. 2 tables. 8 references. (AA-M).

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Physical and Glycemic Responses of Women with Gestational Diabetes to a Moderately Intense Exercise Program Source: Diabetes Educator. 16(4): 309-312. July-August 1990. Contact: Available from American Association of Diabetes Educators. 100 West Monroe, 4th floor, Chicago, IL 60603. (800) 338-3633 or (312) 424-2426. Fax (312) 424-2427. Summary: Aerobic exercise machines are becoming more popular. Their use by women with gestational diabetes is reported, as well as a substantiation of their benefits in improving blood glucose management and in increasing maternal fitness without undue stress to the fetus. Of equal benefit is the use of an exercise specialist to prescribe an individual exercise program to increase the safety and effectiveness of the workout, to monitor maternal and fetal well-being, to record relevant data, and to provide feedback and information to the patient about the exercise session. The use of exercise specialists in the clinical setting should prove a useful adjunct to medical and dietary regimens for the woman with gestational diabetes. 3 tables. 12 references. (AA).

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Race-Ethnicity and Other Risk Factors for Gestational Diabetes Source: American Journal of Epidemiology. 135(9): 965-973. May 1, 1992. Summary: Although gestational diabetes (GDM) is estimated to complicate between 1 and 5 percent of pregnancies, there are only limited data on the role of race/ethnicity as well as other risk factors in the development of this disorder. This article reports on a study in which the epidemiologic characteristics of gestational diabetes were assessed in an ethnically diverse cohort of 10,187 women who had undergone standardized screening for glucose intolerance and who delivered a singleton infant at the Mount Sinai Medical Center in New York City between January 1987 and December 1989. The overall prevalence of gestational diabetes was 3.2 percent. The data suggests that, after controlling for traditional risk factors (maternal age, prepregnancy weight, and a family history of diabetes), Orientals, first generation Hispanics, women from the Indian subcontinent and the Middle East, those with a history of infertility, and low socioeconomic status women are at an increased risk for gestational diabetes. 5 tables. 24 references.

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Sweet Taste and Intake of Sweet Foods in Normal Pregnancy and Pregnancy Complicated by Gestational Diabetes Mellitus Source: American Journal of Clinical Nutrition. 70(2): 277-284. August 1999. Contact: Available from American Journal of Clinical Nutrition. Production Office, 9650 Rockville Pike, Bethesda, MD 20814. (301) 530-7038. Fax (301) 571-8303. Website: www.ajcn.org. Summary: Dietary compliance in gestational diabetes mellitus (GDM) is poor. Changes in sweet taste perception might alter food preferences in GDM, making dietary compliance difficult to achieve. This study documented changes in sweet taste perception and dietary intakes in pregnancy women with and without GDM and determined whether these differences persisted postpartum (after the pregnancy). Subjects were 30 pregnant women without GDM, 25 pregnancy women with recently diagnosed GDM, and 12 nonpregnancy control subjects. Pregnancy women were tested at 28 to 32 weeks gestations and retested 12 weeks postpartum. Subjects evaluated the taste of strawberry flavored milks with different sucrose (0 to 10 percent) and fat (0 to 10 percent) contents and glucose solutions. Women with GDM showed no differences in liking for the milk samples across test sessions and their liking ratings were not

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significantly different from those of nonpregnant control subjects. Women without GDM liked the 10 percent sucrose sweetened milk samples less during pregnancy that at 12 weeks postpartum, at which time their ratings were not significantly different from those of nonpregnant control subjects. In women with GDM, plasma glucose after a 50 gram glucose load was correlated with both increased liking for the taste of glucose and higher consumption of fruit and fruit juices. The authors summarize that normal pregnancy was associated with a lower preference for 10 percent sucrose sweetened milk samples late in gestation than postpartum, whereas GDM was associated with no such differences. Plasma glucose in women with GDM was related to a higher preference for the sweet taste of glucose and higher dietary sweet food intakes from fruit and fruit juices. These findings have important implications for the dietary management of GDM. 3 figures. 2 tables. 37 references. •

Gestational Diabetes: Clinical Management Guidelines for ObstetricianGynecologists Source: Obstetrics and Gynecology. 98(3): 525-538. September 2001. Contact: Available from Elsevier Science, Inc. 655 Avenue of the Americas, New York, NY 10010. (212) 989-5800. Summary: Gestational diabetes mellitus (GDM) is one of the most common clinical issues facing obstetricians and their patients. A lack of data from well-designed studies has contributed to the controversy surrounding the diagnosis and management of this condition. This document provides a brief overview of the understanding of GDM and then provides management guidelines that have been validated by appropriately conducted clinical research. When outcomes based research is not available, expert opinion is provided to aid the practitioner. The background section covers definition and prevalence, maternal and fetal complications of GDM, and controversies regarding current screening practices and treatment benefits. Clinical considerations and recommendations are provided for: screening for GDM, gestational age at which laboratory screening should be performed, the use of venous versus capillary blood, appropriate threshold values for laboratory screening tests, the diagnosis of GDM, monitoring blood glucose values in women with GDM, the role of diet therapy in the treatment of GDM, the role of insulin in the treatment of GDM, the role of exercise and oral antidiabetic agents in the treatment of GDM, fetal assessment in pregnancies complicated by GDM, childbirth considerations in pregnancies complicated by GDM, and postpartum follow up of women who had GDM during their pregnancy. The article concludes with a summary of recommendations, categorized by those based on research studies and those based on consensus and expert opinion. 2 tables. 105 references.

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Gestational Diabetes: What and Why Source: Living Well with Diabetes. 5(1): 11-12. Winter 1990. Summary: Gestational diabetes occurs in three to five percent of all pregnancies. Early symptoms of the disease primarily consist of a 'strange' feeling after eating foods high in sugar. Screening for gestational diabetes is performed through routine blood tests. When results of several blood tests show higher than normal levels, precise diagnosis is made by administering a glucose tolerance test. After diagnosis, treatment mainly consists of balancing the diet to maintain a blood glucose level of 60 to 120 mg/dl throughout the day. Self monitoring of the blood glucose level is performed using a meter. These measures serve to protect the infant from complications of the disease, including macrosomia, hypoglycemia, respiratory distress syndrome,

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hyperbilirubinemia, and stillbirth, as well as protecting the mother from toxemia. After delivery, the mother's blood glucose level should be monitored, since up to 60 percent of women with gestational diabetes will develop Type II diabetes later in life. •

Prevalence of Gestational Diabetes Mellitus Detected by the National Diabetes Data Group or the Carpenter and Coustan Plasma Glucose Thresholds Source: Diabetes Care. 25(9): 1625-1630. September 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: In 2000, the American Diabetes Association (ADA) proposed the adoption of the Carpenter and Coustan criteria for diagnosis of gestational diabetes mellitus (GDM). The Carpenter and Coustan cutoffs are lower than the previously recommended National Diabetes Data Group (NDDG) values and would result in higher prevalence of GDM. This article describes a study that estimated the magnitude of change in prevalence of GDM using the Carpenter and Coustan thresholds as compared with the NDDG thresholds by age and ethnicity. The cross-sectional study included 28,330 women aged 14 to 49 years who gave birth in 1996 and were members of the Northern California Kaiser Permanente Medical Care Program. Age, ethnicity, screening, and diagnostic test results were assessed from computerized hospitalization and laboratory systems. A total of 26,481 women (94 percent of the original sample) were screened and 4,190 women underwent a diagnostic glucose tolerance tests after an abnormal screening result. Overall, the GDM prevalence among screened women was 3.2 percent by NDDG and 4.8 percent by Carpenter and Coustan criteria, and based on either threshold, it increased with age. The age-adjusted GDM prevalence by NDDG and Carpenter and Coustan criteria, respectively, was 5.0 and 7.4 percent in Asians, 3.9 and 5.6 percent in Hispanics, 3.0 and 4.0 percent in African-Americans, and 2.4 and 3.8 percent in whites. The authors conclude that this information would be useful for clinical settings in predicting cost of GDM based on demographic characteristics of the population. 3 tables. 39 references.

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Gestational Diabetes Mellitus: Is It a Clinical Entity? Source: Diabetes Reviews. 3(4): 602-613. 1995. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: In this article, the authors demonstrate that gestational diabetes mellitus (GDM) is not merely a clinical sign but a disease, a distinct clinical entity, with short-and long-range implications for both mother and offspring. Evidence supports the hypothesis that certain developing tissues and organs in the fetus of the mother with diabetes may receive an imprint that affects fetal neural cells, adipocytes, muscle cells, and pancreatic beta-cells. During the third trimester, the proliferation of these tissues and organs is the basis for the development later in life of obesity or NIDDM. Metabolic alterations during delivery are responsible for transient neonatal metabolic complications, such as hypoglycemia, hypocalcemia, and hypomagnesemia. Fetal hyperinsulinemia leads to a decreased level of arterial oxygen and an increase in plasma erythropoietin concentration. The chronic hypoxemic state in utero may explain some cases of intrauterine fetal death, as well as fetal polycythemia, hyperbilirubinemia, and renal vein thrombosis. These complications, together with the increased rate of labor complications and cesarean sections, contribute to the higher maternal morbidity and

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mortality among patients with diabetes as well as a high risk of diabetes later in life. 2 figures. 9 tables. 99 references. (AA-M). •

Non-Insulin-Dependent Diabetes Mellitus and Gestational Diabetes Mellitus: Same Disease, Another Name? Source: Diabetes Reviews. 3(4): 566-583. 1995. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: In this article, the authors review the evidence that suggests that gestational diabetes mellitus (GDM) and noninsulin-dependent diabetes mellitus (NIDDM) are etiologically indistinct. The authors outline observations that provide a powerful argument that hyperglycemia detected for the first time in pregnancy actually represents an unveiling of preexisting metabolic abnormalities that characteristically precede the development of NIDDM. GDM thus may represent an early stage in the natural history of NIDDM. Diagnosis of GDM therefore assumes importance for two reasons. First, it will identify patients in whom aggressive glycemic control will prevent perinatal complications. Second, diagnosis of GDM also will identify patients who may benefit from early therapeutic intervention to prevent the development of NIDDM and associated complications later in life. 15 figures. 5 tables. 219 references. (AA-M).

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Gestational Diabetes: Ensuring a Successful Outcome Source: Postgraduate Medicine. 99(3): 165-166, 171-172. March 1996. Summary: In this article, the fourth in a series of four articles on diabetes, the authors describe risk factors, methods of diagnosis, and a plan of management. The management plan includes a nutrition program based on American Diabetes Association nutrition guidelines, use of insulin if needed, self-monitoring of glucose levels, and appropriate exercise. The authors note that patients with gestational and pregestational diabetes are among the most ambitious and compliant patients in their resolve to manage their diabetes. Physicians can qualify for continuing medical education credits by taking the posttest following this article. 2 tables. 14 references. (AA-M).

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Diagnosis and Management of Gestational Diabetes Mellitus Source: Clinical Diabetes. 13(2): 32-39. March-April 1995. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: In this review article, the author discusses the diagnosis and management of gestational diabetes mellitus (GDM). The author summarizes the etiology of hyperglycemia during pregnancy; discusses the rationale for normalizing the glucose level if hyperglycemia occurs; and describes one protocol that has proven to be successful in achieving and maintaining normo-glycemia during pregnancy. Specific topics include the role of early pregnancy-related hormones; the development of GDM; the complications of hyperglycemia to the fetus; a diet prescription for pregnant women with diabetes; the screening and diagnosis of GDM; the criteria for initiating insulin therapy in a woman with GDM; exercise as a treatment strategy for GDM; followup visits; the timing of delivery; labor and delivery; neonatal care; and postpartum maternal insulin requirements. 6 tables. 31 references.

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Total Sialic Acid and Associated Elements of the Metabolic Syndrome in Women with and Without Previous Gestational Diabetes Source: Diabetes Care. 25(8): 1331-1335. August 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: Inflammatory markers predict type 2 diabetes and relate to the metabolic syndrome (also known as the insulin resistance syndrome). Gestational diabetes mellitus (GDM) predicts type 2 diabetes and may be part of this syndrome. This article reports on a study undertaken to examine the association of inflammatory markers with GDM, in which the authors investigated total sialic acid (TSA) in women with and without previous GDM. All women with GDM and a random sample of women from one center of the Brazilian Study of Gestation Diabetes were invited to return 7 years after their index pregnancy. After an interview, an oral glucose tolerance test and anthropometry were performed. A total of 46 women with and 50 women without previous GDM completed the protocol. Mean TSA was significantly higher in women with previous GDM than without previous GDM. TSA was strongly correlated with individual components and aggregates of the metabolic syndrome. These findings in young women suggest that a chronic mild systemic inflammatory response is an early feature of the metabolic syndrome and that GDM may be a window for its investigation. 1 figure. 3 tables. 27 references.

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Diagnosis of Gestational Diabetes: Are New Criteria Needed? Source: Diabetes Reviews. 3(4): 614-620. 1995. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: Many different criteria are used for diagnosing gestational diabetes mellitus (GDM) throughout the world. The author of this article calls for the development of new standards of diagnosis that are based upon outcomes directly relevant to the pregnancy and that will be universally accepted. Different populations should be expected to manifest differing prevalence rates, just as for NIDDM and IDDM. Criteria should take into account the changes in glucose metabolism brought about by pregnancy and should be validated by their predictive value for pregnancy outcome. The author discusses existing criteria; the continuum of carbohydrate intolerance; and population-specific criteria. 2 tables. 52 references. (AA-M).

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Association of a Woman's Own Birth Weight with Subsequent Risk for Gestational Diabetes Source: JAMA. Journal of the American Medical Association. 287(19): 2534-2541. May 15, 2002. Summary: Several studies have reported links between reduced fetal growth and subsequent risk for type 2 diabetes among adults, but the association between indices of fetal growth and gestational diabetes mellitus (GDM), a major complication of pregnancy and a strong predictor of type 2 diabetes, remains little explored. This article reports on a study undertaken to test the hypothesis that a woman's own fetal growth is inversely related to her later risk for GDM. The results demonstrated that birth weight showed a U-shaped relationship to a woman's risk of GDM in her first pregnancy, with the highest risks associated with low and high birth weights. After adjustment for potential confounding factors, the odds ratio for low birth weight women was 4.23,

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compared to odds ratio of 0.92 for high birth weight, leaving a strong inverse doseresponse relationship between birth weight and risk of GDM (low birth weight translates into a higher risk of experiencing GDM). The authors briefly discuss how early life factors, including those in utero, may be important in the etiology (cause) of GDM. 2 figures. 3 tables. 60 references. •

Preparing the Woman with Gestational Diabetes for Self-Care: Use of a Structured Teaching Plan by Nursing Staff Source: JOGNN. Journal of Obstetric, Gynecologic and Neonatal Nursing. 20(3): 189-193. May-June 1991. Summary: Staff nurses are expected to teach patients with gestational diabetes (GDM) effectively, but studies indicate that nurses are often uncertain about what information to teach and what teaching methods to use. This article reviews and outlines the components of the Structured Teaching Plan, developed by the authors to guide staff nurses in teaching patients with GDM. The tool provides reinforcement of content and objective evaluation, thereby assisting the patient to overcome learning barriers. The authors focus on the implementation and evaluation of the Teaching Plan, providing a day-by-day curriculum to use with patients. 14 references. (AA-M).

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Maternal Plasma Phospholipid Polyunsaturated Fatty Acids in Pregnancy with and without Gestational Diabetes Mellitus: Relations with Maternal Factors Source: American Journal of Clinical Nutrition. 70(1): 53-61. July 1999. Contact: Available from American Journal of Clinical Nutrition. Production Office, 9650 Rockville Pike, Bethesda, MD 20814. (301) 530-7038. Fax (301) 571-8303. Website: www.ajcn.org. Summary: The fatty acids arachidonic acid (AA) and docosahexaenoic acid (DHA) are essential for fetal grown and development, but their metabolism may be altered in insulin resistance. This article reports on a study of maternal plasma (blood) phospholipid polyunsaturated fatty acid concentrations in pregnancy women receiving diet therapy for gestational diabetes mellitus (GDM, n = 15); the study identified maternal factors associated with plasma phospholipid AA and DHA concentrations in the third trimester. The study included a control group of 15 healthy, pregnancy women without GDM. Maternal plasma phospholipid linoleic acid, AA, and 22:5n-6 (another fatty acid) did not differ significantly between women with GDM and control subjects. The other n-6 long chain polyunsaturated fatty acids were lower in GDM subjects than in control subjects. Plasma phospholipid and summed precursors of DHA were lower and DHA adjusted for dietary DHA intake, was 13 percent higher in GDM subjects than in control subjects. Maternal blood hemoglobin A1c (glycosylated hemoglobin, a measure of blood glucose levels over time) was inversely related to plasma phospholipid AA in control subjects and positively associated with plasma phospholipid AA in women with GDM. Pregravid (before pregnancy) body mass index was negatively associated with plasma phospholipid DHA in control subjects and in women with GDM with a body mass index less than 30. The authors conclude that, in pregnancy women, both with and without GDM, maternal glycemic control and pregravid BMI appear to be significant predictors of plasma phospholipid AA and DHA, respectively, during the third trimester. Additionally, dietary DHA significantly affects phospholipid DHA concentrations. 5 tables. 34 references.

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Is Self-Monitoring of Blood Glucose Necessary in the Management of Gestational Diabetes Mellitus? Source: Diabetes Care. 21(Supplement 2): B118-B122. August 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article addresses the issue of whether self-monitoring of blood glucose (SMBG) is necessary for managing gestational diabetes mellitus (GDM). Controversy continues over the role of blood glucose monitoring in the management of pregnant women with GDM, specifically with regard to the use of capillary versus venous samples, as well as the frequency and timing of blood glucose determinants. At the Third International Workshop Conference, it was noted that self-monitoring has allowed women to participate in their own care but that its utility in mild GDM not requiring the use of insulin has not been formally proved. The article reviews the existing evidence in the literature on the impact of SMBG on outcomes in pregnancies complicated by GDM. This evidence suggests a role for the self-monitoring of capillary blood glucose in pregnancies complicated by even mild GDM. The article also presents data on the optimal timing, accuracy, costs, and psychosocial effects of self-monitored glucose determinations and concludes that SMBG provides important information on guiding and assessing dietary and insulin therapy in pregnancies complicated by GDM. Furthermore, it enhances patient education, facilitates lifestyle modifications, and allows women to actively participate in their own care. SMBG has been shown to improve neonatal outcomes in pregnancies complicated by GDM without apparently causing undue stress for the mother and at a potentially lower cost. However, the optimal management scheme of blood glucose monitoring and the appropriate threshold of glucose values for initiating insulin therapy have yet to be firmly established. 38 references. (AA-M).

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Do Gestational Diabetes Criteria Need Revision? Source: Emergency Medicine. 24(4): 266, 268. March 15, 1992. Summary: This article addresses the need for revision of the gestational diabetes criteria as established by the American College of Obstetricians and Gynecologists (ACOG). Topics include how the guidelines were established in 1964; methods of measuring serum glucose; treatment of gestational diabetes with dietary modification; and selective screening. The article also reports on a research study conducted on 103 pregnant women who had at least two abnormal serum glucose values on the 100-gm glucose challenge; 64 of these women also met the current ACOG criteria for gestational diabetes.

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Hormonal Choices After Gestational Diabetes: Subsequent Pregnancy, Contraception, and Hormone Replacement Source: Diabetes Care. 21(Supplement 2): B50-B55. August 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article assesses the effects of subsequent states of excess hormone exposure, that is, subsequent pregnancy, hormonal contraception, and hormonal replacement therapy, on the development of diabetes in women with prior gestational diabetes mellitus (GDM). The article reviews current literature on the effect of parity, hormonal contraception, and hormonal replacement therapy in healthy women and

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women with previous gestational diabetes and current diabetes. Subsequent pregnancy in women with prior GDM appears to triple the risk of subsequent diabetes, while lowdose progestin and estrogen combination oral contraceptives do not appear to clinically increase risk. Hormonal replacement therapy appears to lead to the greatest reduction in coronary artery disease in women at greatest risk, that is, those who have developed diabetes. Careful followup and metabolic surveillance should be provided when prescribing hormonal contraception or replacement therapy. In women with prior GDM, exposure to repeat pregnancy poses a greater risk for subsequent diabetes than either an exposure to low-dose progestin and estrogen combination oral contraceptives or to postmenopausal hormonal therapy, both of which do not appear to increase the risk of diabetes. Women must be educated about their individual risk of developing diabetes based on their identifiable risk factors. In addition, their general health status, including any cardiovascular risk factors, should be evaluated. 27 references. (AA-M). •

Gestational Diabetes: What are the Implications? Source: Postgraduate Medicine. 91(5): 393-400, 402. April 1992. Summary: This article considers the implications of gestational diabetes, including the merits of screening tests for all pregnant women. Topics discussed include diagnostic testing and screening; the management of gestational diabetes, notably diet monitoring metabolic control, and insulin use; obstetric management issues; metabolic management during labor; postpartum management; and how gestational diabetes develops. The authors note that glucose tolerance must be reevaluated in the postpartum period and periodically thereafter to detect continuing intolerance or diabetes. 3 tables. 41 references.

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Comparison of Glyburide and Insulin in Women with Gestational Diabetes Mellitus Source: New England Journal of Medicine. 343(16): 1134-1138. October 19, 2000. Summary: This article describes a study that compared glyburide and insulin in the treatment of women with gestational diabetes. The study population consisted of 404 women with singleton pregnancies and gestational diabetes that required treatment. The women were randomly assigned between 11 and 33 weeks of gestation to receive glyburide or insulin according to an intensified treatment protocol. The primary end point was achievement of the desired level of glycemic control Secondary end points included maternal and neonatal complications. The study found that the mean pretreatment blood glucose concentration as measured at home for one week was 114 plus or minus 19 milligrams (mg) per deciliter (dl) in the glyburide group and 116 plus or minus 22 mg per dl in the insulin group. The mean concentrations during treatment were 105 plus or minus 16 mg/dl in the glyburide group and 105 plus or minus 18 mg per dl in the insulin group. Eight women in the glyburide group required insulin therapy. There were no significant differences between the glyburide and insulin groups in the percentage of infants who were large for gestational age, who had macrosomia, who had lung complications, who had hypoglycemia, who were admitted to a neonatal intensive care unit, or who had fetal anomalies. The cord serum insulin concentrations were similar in the two groups, and glyburide was not detected in the cord serum of any infant in the glyburide group. The article concludes that, in women with gestational diabetes, glyburide is a clinically effective alternative to insulin therapy. 4 tables. 49 references. (AA-M).

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Exercise as a Treatment Modality to Maintain Normoglycemia in Gestational Diabetes Source: Journal of Perinatal and Neonatal Nursing. 6(1): 14-24. June 1992. Summary: This article discusses a study that used exercise as a treatment modality for gestational diabetes mellitus (GDM). The authors describe the study and then apply Orem's self-care model of nursing to the clinical findings. The authors provide a literature review, a discussion of the research methodology, and the results. They draw two conclusions: diet and exercise, if properly supervised and prescribed, may serve as alternatives to insulin in controlling GDM; and women who are normally sedentary can safely begin an exercise program (supervised) during pregnancy. The article concludes with a discussion of the nursing considerations for helping patients with GDM achieve optimal levels of self-care. 2 figures. 41 references.

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Gestational Diabetes Mellitus: Diagnosis, Treatment, and Beyond Source: Diabetes Educator. 27(1): 69-72, 74. January-February 2001. Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, 4th Floor, Chicago, IL 60603-1901. (312) 424-2426. Summary: This article discusses the diagnosis and treatment of gestational diabetes mellitus (GDM). Early recognition and treatment are critical to a successful outcome for both mother and infant. GDM is defined by the American Diabetes Association (ADA) as any degree of glucose intolerance with onset or first recognition during pregnancy. A risk assessment for GDM during the first prenatal visit is important. The ADA recommends screening and the 100-gram oral glucose tolerance test for diagnosing GDM. Daily self monitoring of blood glucose can be used to determine the effectiveness of diet, exercise, and insulin in maintaining target blood glucose goals. Medical nutrition therapy is used to ensure that the woman is consuming adequate calories and nutrients for maternal and fetal health. An individualized meal plan can be developed by the patient and a registered dietitian. Exercise is vital for maintaining euglycemia because regular exercise enhances insulin sensitivity and glucose utilization. Human insulin is the only pharmacologic treatment recommended to lower blood glucose during pregnancy. Postpartum care is important because approximately 40 percent to 60 percent of women with GDM will develop type 2 diabetes. 4 tables. 4 references.

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Risk and Prevention of Type 2 Diabetes in Women with Gestational Diabetes Source: Diabetes Care. 21(Supplement 2): B43-B49. August 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article discusses the risk and prevention of type 2 diabetes in women with gestational diabetes mellitus (GDM). Women with a history of GDM are at increased risk of future diabetes, predominantly type 2, as are their children. The extent of this risk depends both on the diagnostic criteria used to identify GDM and on maternal risk factors, some of which are potentially modifiable whereas others are not. The unmodifiable risk factors are ethnicity, prepregnancy weight, age, parity, family history of diabetes, and degree of hyperglycemia in pregnancy and immediately postpartum. The modifiable risk factors are persistent obesity, future weight gain, and subsequent pregnancies. Additional modifiable risk factors in these women are likely to be levels of physical activity, dietary fat, and avoidance of other lifestyle factors that adversely influence insulin resistance, such as smoking and certain drugs. Strategies to

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prevent diabetes need to address the modifiable risk factors and use the unmodifiable risk factors to identify women most at risk. In addition, women need to understand the potential benefits to be gained from complying with the lifestyle changes likely to be required to prevent type 2 diabetes. This can occur only through education, which must be both comprehensible and culturally relevant. 1 figure. 87 references. (AA-M). •

Stress and Intervention in Gestational Diabetes Source: Diabetes Professional. p. 28, 32, 34. Spring 1990. Summary: This article emphasizes skills that can be used in teaching and counselin g women with gestational diabetes. It includes results and insights gained from a study in which 25 patients with gestational diabetes completed the Psychosocial Adjustment to Illness Scale (PAIS). The PAIS yields information regarding patients' anxiety levels, coping mechanisms, family support, and perception of their medical treatment since the onset of illness. The author stresses the importance of immediate intervention to ease the fears of the patient and her family and to provide the best possible outcome for the pregnancy. 1 table.

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Epidemiology of Glucose Intolerance and Gestational Diabetes in Women of Childbearing Age Source: Diabetes Care. 21(Supplement 2): B9-B13. August 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article examines epidemiological data on gestational diabetes mellitus (GDM) from several sources. Available data suggest that the frequency of diabetes in pregnancy is highly variable, generally reflecting the underlying pattern of type 2 diabetes in the particular population. Different ethnic groups in the same environmental setting experience widely variable risk. Impaired glucose tolerance is usually more prevalent than diabetes in women of childbearing age. Maternal age, overweight, parity, and family history of diabetes all predispose to GDM. Incidence is low in the absence of risk factors, suggesting that selective screening programs may be cost-effective. Adverse outcome may be more frequent in women with impaired glucose tolerance than in women with normal tolerance. Programs to reduce the incidence of subsequent type 2 diabetes in women who have GDM may be cost effective to health services and improve the quality of life for those concerned. The worldwide epidemic of glucose intolerance predicted by the latest World Health Organization studies will undoubtedly increase the burden of GDM, especially in developing countries. 3 figures. 6 tables. 24 references. (AA-M).

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Etiology and Pathogenesis of Gestational Diabetes Source: Diabetes Care. 21(Supplement 2): B19-B26. August 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article focuses on the knowledge that has been generated on the pathogenesis of gestational diabetes mellitus (GDM) since the Third WorkshopConference on GDM. Although a significant amount of information has been gathered, it is still not known why GDM develops in 2 to 3 percent of all pregnant women. Similar frequencies of HLA-DR2, the-DR3, and-DR4 antigens in healthy pregnant women and women with GDM and the low prevalence of markers for autoimmune destruction of

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beta cells in GDM pregnancy rule out the possibility that GDM is a disease of autoimmune origin. Insulin secretion during an oral glucose tolerance test (OGTT) or a meal is substantially increased in women with GDM compared with the same women postpartum. However, insulin secretion increases less in women with GDM than in pregnant women who retain normal glucose tolerance. Peak insulin concentrations during an OGTT occur later in women with GDM, and following intravenous glucose, a reduced first-phase insulin response is also seen in these women. Second-phase insulin responses are similar in pregnant women with normal glucose tolerance and GDM. Excessive secretion of proinsulin, which does not always return to normal postpartum, is often observed in women with GDM. This might reflect beta cells that are stressed because they are trying to counter the decreased insulin sensitivity that develops during pregnancy. Thus, insulin sensitivity decreases by 50 to 70 percent in both normal and GDM pregnancy, but whereas insulin sensitivity returns to normal postpartum in pregnant women with normal glucose tolerance, this is not always the case in patients with GDM. Insulin receptor binding to target tissues is largely unaffected by normal and GDM pregnancy, as is basal and insulin-stimulated insulin receptor-bound tyrosine kinase activity. Although there is indication that certain post-insulin receptor binding events are altered in tissues from women with GDM, data are still scarce. In addition, the impact of various pregnancy-related hormones on beta cell function or peripheral tissue sensitivity to insulin remains to be investigated. 3 tables. 105 references. (AA-M). •

Gestational and Pre-Gestational Diabetes: Comparison of Maternal and Fetal Characteristics and Outcome Source: International Journal of Gynecology and Obstetrics. 58(2): 203-209. August 1997. Contact: Available from Elsevier Science. P.O. Box 945, New York, NY 10159-0945. (888) 437-4636 or (212) 633-3730. Fax (212) 633-3680. E-mail: [email protected]. Summary: This article is based on a study designed to determine the incidence of maternal and fetal complications of gestational diabetes mellitus (GDM) and compare such pregnancies with pre-gestational diabetes mellitus (pre-GDM) and non-diabetic pregnancies. Researchers analyzed the prenatal and intrapartum complications of 972 women with GDM, 71 women with pre-GDM, 8,904 women in the control group, and the offspring of all participants. Maternal complications included higher incidences of cesarean section and perineal lacerations in GDM and pre-GDM patients than in the non-diabetic pregnancies. In addition, there were higher rates of macrosomia and hypoglycemic episodes in the offspring of GDM and pre-GDM offspring. The authors conclude that because GDM and pre-GDM have a similar incidence of maternal, fetal, and neonatal complications, they should be monitored and managed identically. 3 tables. 24 references. (AA-M).

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Gestational Diabetes: A Triage Model of Care for Rural Perinatal Providers Source: American Journal of Obstetrics and Gynecology. 174(6): 1719-1724. June 1996. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146-3318. (800) 453-4351 or (314) 453-4351. Fax (415) 259-5019. E-mail: [email protected]. Summary: This article is based on an effort to develop a protocol for surveillance, diagnosis, and management of diet-controlled gestational diabetes for rural care providers. While the California Diabetes and Pregnancy ('Sweet Success') Program (CDAPP) provides outpatient-based comprehensive educational, psychosocial, and medical services to pregnant women, the majority of women in California do not have

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access to a CDAPP affiliate clinic. Researchers developed protocols for medical, nutritional, educational, and psychosocial education and treatment. After a diabetes educator, registered dietitian, and social worker provided on-site protocol training to rural providers, researchers collected data on maternal-fetal outcome, birth weight, and provider time specific to diabetes. The control group had multidisciplinary care according to California Diabetes and Pregnancy Program protocols. With the exception of time spent for diabetes care, there was no significant difference in outcome between the 39 protocol patients and 48 controls. The pilot providers averaged 4.3 hours and control providers 5.6 hours. The results of the study suggest that rural providers who have appropriate training and protocol guidelines can effectively supply comprehensive care to women with diet-controlled gestational diabetes. Patients with transportation restrictions would have improved access to care, and the need for referral of approximately 78 percent of all women with gestational diabetes would be reduced. A discussion section concludes the article. 4 figures. 14 references. (AA-M). •

Nutritional Management of Gestational Diabetes and Nutritional Management of Women with a History of Gestational Diabetes: Two Different Therapies or the Same? Source: Clinical Diabetes. 17(4): 170-176. 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article offers practical suggestions for the nutritional management of gestational diabetes mellitus (GDM) and nutritional management of women with a history of GDM. GDM, which is the most common medical complication of pregnancy, is defined as carbohydrate intolerance of varying degrees of severity with onset or first recognition during pregnancy. Women who have GDM have a significant risk of developing GDM with a subsequent pregnancy and of developing type 2 diabetes later in life. Nutritional management is the cornerstone of treatment for GDM. Medical nutrition therapy for GDM is discussed in terms of optimal maternal weight gain; ideal caloric intake; and amount, timing, and distribution of carbohydrate intake. Other topics include self monitoring of blood glucose, testing for ketones, keeping records of all food and caloric beverages consumed, exercising, breastfeeding, and following up 6 to 12 weeks postpartum. In addition, the article addresses the issues of caring for women with a history of GDM and identifying nutritional factors influencing recurrence of GDM and progression to type 2 diabetes. The article recommends that nutrition therapy start with a modest carbohydrate level distributed among three meals and three snacks, exercise be used as an adjunct to treatment if possible to help maintain maternal euglycemia, and insulin be added to the treatment regimen if necessary. In addition, the article advises that practitioners who have chosen to use a carbohydrate level of less than 45 percent of kcal be sure to educate and evaluate postpartum whether the woman has switched to a low fat diet and has maintained the low fat diet. 1 figure. 4 tables. 37 references.

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Euglycemic Control of Gestational Diabetes Mellitus by Specific Dietary Manipulation: A Case Study Presentation Source: Diabetes Educator. 17(6): 460-465. November/December 1991. Summary: This article presents a case review of a 32-year-old white woman with gestational diabetes whose condition was complicated by her blood glucose intolerance to lactose in milk. Topics include dietary treatment for gestational diabetes; the role of the nurse educator; the role of the registered dietitian; and ongoing management and

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delivery issues. The authors note that, by following a carefully monitored regimen using specific dietary manipulation to maintain normoglycemia, the woman was able to deliver a normal, healthy baby by spontaneous vaginal delivery. A form on which to record daily blood glucose and ketone tests is included. 1 figure. 4 tables. 11 references. (AA-M). •

Historical Perspective on Gestational Diabetes Source: Diabetes Care. 21(Supplement 2): B3-B4. August 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article presents a historical perspective on gestational diabetes. Extreme fetal macrosomia occurred in the first recorded case of diabetes in pregnancy in November 1823. A German woman was admitted to a Berlin hospital at 7 months into her fifth pregnancy with unquenchable thirst, excessive urination, weakness, dry skin, cold face, and back pain. From about 32 to 36 weeks, she had a recurrent sore throat and increased abdominal distention. In late December, the woman had an obstructed labor, and the child, who weighed 12 pounds, died intrapartum. Postpartum, the woman's strength improved daily, and sugar disappeared from her urine. The belief that the diabetic condition was in some way a symptom of the pregnancy, which dates to this first report, has led to the more recent concept of gestational diabetes. Lesser degrees of maternal hyperglycemia were also recognized to be a risk to the baby, and early studies of carbohydrate intolerance in pregnancy in Boston, MA, and Los Angeles, CA, have set the stage for the worldwide interest in this interaction between mother and fetus. 18 references. (AA-M).

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Harmony and Health: A Workshop on Gestational Diabetes for Native Health Workers Source: Beta Release. 14(4): 101-104. December 1990. Summary: This article reports on a one and a half day workshop held in La Ronge, Saskatchewan, on gestational diabetes in the native population. The learners were Community Health Workers (CHWs) and Community Health Representatives (CHRs) who act as a liaison between the people in their community and various health professionals. The educators focused on three topics: meal planning, blood testing, and regular check-ups. The integration of teaching principles and the use of various teaching aids enhanced the learning sessions. The authors give both background information about diabetes in the native population as well as a description of the northern communities and the available health resources. They also discuss the program goals for the workshop, the principles used to meet these goals, and the specific teaching strategies used. 4 figures. 9 references. (AA-M).

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Comparison of an Insulin Analog, Insulin Aspart, and Regular Human Insulin With No Insulin in Gestational Diabetes Mellitus Source: Diabetes Care. 26(1): 183-186. January 2003. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reports on a study that assessed the short-term efficacy of insulin aspart in comparison with regular human insulin in women with gestational diabetes mellitus (GDM) during standardized meal tests. The study included 15 women with

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GDM who had inadequate diabetes control with diet alone. On 3 consecutive days, breakfast meal tests were performed: the first with no exogenous insulin and the other two after the injection of either regular insulin or insulin aspart. The peak insulin concentration was higher and the peak glucose and C-peptide concentrations were lower with both insulin preparations than with no exogenous insulin. The authors conclude that this study demonstrates that effective postprandial glycemic control in women with GDM who required insulin was brought about by insulin aspart through higher insulin peak and lower demand on endogenous insulin secretion. 2 figures. 3 tables. 17 references. •

Effects of a Partially Home-Based Exercise Program for Women With Gestational Diabetes Source: Obstetrics and Gynecology. 89(1): 10-15. January 1997. Summary: This article reports on a study to examine the effectiveness of a partially home-based, moderate intensity aerobic exercise program for women with gestational diabetes (GDM). Thirty-three women with GDM were randomly assigned to the exercise or the no-exercise group. Subjects underwent hemoglobin A1c assay and submaximal cycle ergometer fitness tests at baseline and at study conclusion. Subjects kept diaries of home fasting and 2-hour postprandial blood glucose determinations. Exercise subjects were asked to exercise for 30 minutes three to four times weekly at 70 percent of estimated maximal heart rate for the weeks of study participation. Two exercise sessions weekly were supervised by the investigator, and two were unsupervised at home. Control group subjects were asked to maintain their current activity level. Results showed that daily fasting and postprandial blood glucose levels, hemoglobin A1c, incidence of exogenous insulin therapy, and incidence of newborn hypoglycemia were not different between the groups. There was a training effect in the exercise group, but not in the control group. A significant decline in the daily grams of carbohydrate consumed was observed in the control group, but not in the exercise group. No complications were found in the subjects who exercised. The authors conclude that this partially home-based exercise program did not reduce blood glucose levels, but did result in a modest increase in cardiorespiratory fitness. The intervention appeared safe. 3 tables. 38 references. (AA-M).

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Did Publication of a Clinical Practice Guideline Recommendation to Screen for Type 2 Diabetes in Women with Gestational Diabetes Change Practice? Source: Diabetes Care. 26(2): 265-268. February 2003. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reports on a study undertaken to determine whether women with previous gestational diabetes mellitus (GDM) were screened postpartum for type 2 diabetes according to the Canadian Diabetes Association (CDA) guidelines. The 1998 CDA guidelines recommend that all women diagnosed with GDM be screened postpartum for type 2 diabetes using a 2 hour, 75-gram oral glucose tolerance test (OGTT). There were 131 women in 1997 and 123 women in 2000 with confirmed GDM. Of these, only 69 women in 1997 and 52 women in 2000 had blood work recorded in the database. None of these women had an OGTT performed in either period. The authors found a significant increase in the measurement of serum glucose (50 women preguideline or 72.1 percent versus 48 women or 92.3 percent post-guideline) and glycosylated hemoglobin (HbA1c, a measure of blood glucose over time). The authors

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conclude that, in the region studied, physicians are not following the CDA recommendations to screen women with GDM postpartum with an OGTT. However, they did find a significant increase in the measurement of serum glucose and HbA1c. Publication of expert opinion-based guidelines did not change the postpartum use of an OGTT in these women but may have increased the use of less reliable screening tests for type 2 diabetes. 1 figure. 2 tables. 22 references. •

Gestational Diabetes and the Incidence of Type 2 Diabetes Source: Diabetes Care. 25(10): 1862-1868. October 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reports the results of a study that examined factors associated with variation in the risk for type 2 diabetes in women with prior gestational diabetes mellitus (GDM). The authors reviewed articles published between January 1965 and August 2001, in which subjects underwent testing for GDM and then testing for type 2 diabetes after delivery. A total of 28 studies were examined. After the index pregnancy, the cumulative incidence of diabetes ranged from 2.6 percent to over 70 percent in studies that examined women 6 weeks postpartum to 28 years postpartum. Differences in rates of progression between ethnic groups was reduced by adjustment for various lengths of follow up and testing rates, so that women appeared to progress to type 2 diabetes at similar rates after a diagnosis of GDM. Cumulative incidence of type 2 diabetes increased markedly in the first 5 years after delivery and appeared to plateau after 10 years. An elevated fasting glucose level during pregnancy was the risk factor most commonly associated with future risk of type 2 diabetes. The authors conclude that targeting women with elevated fasting glucose levels during pregnancy may prove to have the greatest effect for the effort required. 2 figures. 1 table. 55 references.

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Carbohydrate and Lipid Metabolism in Pregnancy: Normal Compared with Gestational Diabetes Mellitus Source: American Journal of Clinical Nutrition. 71(5 Supplement): 1256S-1261S. May 2000. Contact: Available from American Journal of Clinical Nutrition. Production Office, 9650 Rockville Pike, Bethesda, MD 20814. (301) 530-7038. Fax (301) 571-8303. Website: www.ajcn.org. Summary: This article reviews maternal metabolic strategies for accommodating fetal nutrient requirements in normal pregnancy and in gestational diabetes mellitus (GDM). Pregnancy is characterized by a progressive increase in nutrient stimulated insulin responses despite an only minor deterioration in glucose (sugar) tolerance, consistent with progressive insulin resistance. The hyperinsulinemic (too much insulin in the blood) euglycemic (ideal levels of blood glucose) glucose clamp technique and intravenous glucose tolerance test have indicated that insulin action in late normal pregnancy is 50 to 70 percent lower than in nonpregnant women. Metabolic adaptations do not fully compensate in GDM and glucose intolerance ensures. GDM may reflect a predisposition to type 2 diabetes or may be an extreme manifestation of metabolic alterations that normally occur in pregnancy. Recent advances in understanding carbohydrate metabolism during pregnancy suggest that preventive measures should be aimed at improving insulin sensitivity in women predisposed to GDM. Further research is needed to elucidate the mechanisms and consequences of alterations in lipid (fats) metabolism during pregnancy. 49 references.

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Gestational Diabetes: When the Pregnant Woman Becomes Diabetic Source: Joslin Magazine. 6(3): 3-7. Winter 1991. Contact: Available from Joslin Diabetes Center. One Joslin Place, Boston, MA 02215. (617) 732-2560. Summary: This article reviews the condition of gestational diabetes. Topics include a definition of gestational diabetes; risk factors for developing gestational diabetes; how the health care provider tests for gestational diabetes, including a glucose tolerance test; how gestational diabetes is treated; the role of self-monitoring of blood glucose (SMBG) and the use of insulin in women with gestational diabetes; other tests performed on the woman with gestational diabetes; delivery problems; the risk of subsequently developing noninsulin-dependent diabetes; the risks of poorly controlled gestational diabetes for the mother; and the effects of gestational diabetes on the unborn child.

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Gestational Diabetes Mellitus Screening Tests: A Review of Current Recommendations Source: Journal of Perinatal and Neonatal Nursing. 6(1): 37-42. June 1992. Summary: This article reviews the current recommendations for gestational diabetes mellitus (GDM) screening tests. Topics include patient selection for screening; preconceptional testing; the role of screening in early pregnancy; the 3-hour glucose tolerance test; the role of glycosylated hemoglobin; the significance of glycosuria; and follow-up of women with GDM. The author stresses that early recognition and management of gestational diabetes decreases the incidence of macrosomia and infant morbidity and mortality. 17 references.

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From Diagnosis to Home Management: Nutritional Considerations for Women With Gestational Diabetes Source: Diabetes Educator. 17(6): 455-459. November/December 1991. Summary: This article reviews the nutritional considerations for women with gestational diabetes (GD). Topics include the psychosocial aspects of a diagnosis with GD; learning the self-care and management concepts; follow-up patient education for meal planning and nutrition, including teaching about portion control, hidden sugars in foods and medicine, and how to deal with special occasions such as holiday meals, travel, and illness; and special educational opportunities, including home videos, telephone support networks, special childbirth classes for women with gestational diabetes, and luncheon meetings at which nutritionally correct meals are served. 1 figure. 16 references. (AA-M).

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Maternal Glycemic Criteria for Insulin Therapy in Gestational Diabetes Mellitus Source: Diabetes Care. 21(Supplement 2): B91-B98. August 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reviews the results of 58 original studies addressing criteria for insulin management in gestational diabetes mellitus (GDM). In the past decade, it has become clear that GDM is a clinical entity associated with perinatal mortality and morbidity. The level of glycemic control and its evaluation through self-monitoring of blood glucose are the foundation for ascertaining optimal pregnancy outcome. The article addresses the criteria for insulin initiation, including insulin requirements for the

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GDM patient, identification of the patient who will benefit from insulin therapy, the timing of insulin initiation, and the patient's behavioral adjustment and compliance during insulin therapy. The article recommends that patients whose fasting plasma glucose on the oral glucose tolerance test (OGTT) is less than 96 milligrams (mg) per deciliter (dL) be assigned to diet therapy. Obese women or those with fasting plasma glucose in excess of 95 mg per dL on the OGTT should be referred to insulin therapy to minimize exposure of the fetus to a hyperglycemic environment during the diet trial. This, in conjunction with patient education on the importance of glycemic control, improves patient compliance, which in turn optimizes the management approach. 3 figures. 2 tables. 61 references. (AA-M). •

Reducing the Risks in Gestational Diabetes Source: Emergency Medicine. 22(3): 113-114, 116. February 15, 1990. Summary: This article stresses that the incidence of perinatal death or malformation at birth caused by the maternal hyperglycemic of gestational diabetes can be reduced by timely detection and careful control of the problem, both before and during labor. Topics covered include screening guidelines, risk factors for gestational diabetes, the use of the 100-gm, three-hour glucose tolerance test for diagnosis, the initial treatment regimen for gestational diabetes, the use of insulin in gestational diabetes, and considerations for delivery, including the risks of ketoacidosis. (AA-M).

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Gestational Diabetes: State of the Union Source: Diabetes Care. 15(5): 716-717. May 1992. Summary: This brief article presents a commentary on the Third International Workshop-Conference on Gestational Diabetes Mellitus, held in Chicago in November of 1990. The author summarizes the work of each of the four panels formed at the conference: diagnosis and prevalence, perinatal implications, long-range implications, and management strategies. Specific recommendations for universal screening procedures are noted. Other topics include the role of lipids and amino acids in fetal growth, the association of gestational diabetes with increased risk of later overt diabetes in the mother, the use of self-monitoring of blood glucose as standard treatment in women with gestational diabetes, nutritional therapy, and insulin therapy. 1 reference.

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Oral Hypoglycemic Drugs for Gestational Diabetes (editorial) Source: New England Journal of Medicine. 343(16): 1178-1179. October 19, 2000. Summary: This editorial comments on the use of oral hypoglycemic drugs for the treatment of gestational diabetes. Early use of first generation sulfonylurea drugs was not effective, as many women delivered infants with profound and prolonged hyperinsulinemic hypoglycemia. The observation that sulfonylurea drugs could cross the placenta and stimulate fetal insulin secretion was another cause for concern about their use in pregnancy. The risk of late fetal death for women with gestational diabetes is another concern that has been debated. Lastly, there has been concern about the possibility of congenital malformations in women taking sulfonylurea drugs during pregnancy. However, a recent randomized, controlled trial comparing the sulfonylurea drug glyburide with traditional insulin therapy found that only 4 percent of women in the glyburide group failed to achieve adequate blood glucose control. In addition, there was no evidence of any of complications resulting from fetal or neonatal hyperinsulinemia due to transplacental passage of the drug. The editorial considers the implications of these findings for clinical practice. 10 references.

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Gestational Diabetes: Strategies for Management Source: Diabetes Spectrum. 5(1): 17-53. January-February 1992. Summary: This From Research to Practice section of Diabetes Spectrum focuses on th e strategies for managing gestational diabetes mellitus (GDM). The first research article presents the summary and recommendations of the Third International WorkshopConference on Gestational Diabetes Mellitus and the second article discusses the criteria for the oral glucose tolerance test in pregnancy. The summary and commentary section discusses insulin sensitivity in pregnancy, metabolic alterations in adulthood in individuals who underwent intrauterine development in mothers with mild diabetes, the long-term prospective evaluation of the offspring of mothers with diabetes, obstetric complications of GDM, the energy requirements of pregnancy, the metabolic effects of hypocaloric diets in managing GDM, and exercise in gestational diabetes. Each article in the section includes references.

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Gestational Diabetes Mellitus: Practical Applications in Varied Practice Settings Source: On the Cutting Edge: Diabetes Care and Education. 13(6): 1-32. Fall-Winter 1992. Contact: Available from Anne M. Gallagher, RD. DCE Newsletter Editor, 1248 Elm Court, Glenview, IL 60025. Summary: This issue of On the Cutting Edge focuses on gestational diabetes mellitus (GDM). Written primarily for and by registered dietitians, the articles address such topics as weight gain in pregnancy; calorie requirements in GDM; carbohydrates and GDM; ketone management in GDM; insulin therapy in GDM; nutrition process and outcome review criteria; the meter loan program; nutrition reimbursement in GDM; one experience in GDM and malpractice; and GDM case studies. A final section lists and annotates eight resources on gestational diabetes. A post-test is included to receive continuing education credits.

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Gestational Diabetes: Detection, Management and Implications Source: Clinical Diabetes. 16(1): 4-11. January-February 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This review article addresses the detection, management, and implications of gestational diabetes. The authors note that gestational diabetes is the most common medical complication and metabolic disorder of pregnancy. It is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Topics include pathophysiology; maternal morbidity; perinatal morbidity and mortality; diagnosis; management; delivery timing; and postpartum follow up. Treatment for gestational diabetes includes diet therapy, glucose monitoring, and exercise. The article notes that oral hypoglycemic agents are not currently used in treating gestational diabetes. Because women with gestational diabetes have a significant risk for developing diabetes later in life, it is imperative that these women be identified. If diagnostic criteria and management based on maternal and fetal outcomes are to be established, continued research is necessary. 1 figure. 5 tables. 65 references. (AA-M).

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Gestational Diabetes Mellitus Diagnosed with a 2-h 75-g Oral Glucose Tolerance Test and Adverse Pregnancy Outcomes Source: Diabetes Care. 24(7): 1151-1155. July 2001.

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Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This review article describes a cohort study that evaluated American Diabetes Association (ADA) and World Health Organization (WHO) diagnostic criteria for gestational diabetes mellitus (GDM) against pregnancy outcomes. Although the ADA recommends a 3 hour 100 gram oral glucose tolerance test (OGTT) for the diagnosis of GDM, it has also recently included in its recommendations the use of a 2 hour 75 gram OGTT. GDM is defined by the new ADA test recommendations for the two hour 75 gram OGTT as at least two values greater than a fasting glucose of 5.3 mmol per liter, a 1 hour glucose of 10 mmol per liter, and a 2 hour glucose of 8.6 mmol per liter. WHO criteria require a fasting plasma glucose of equal to or greater than 7.0 mmol per liter or a 2 hour glucose of equal to or greater than 7.8 mmol per liter. The study population consisted of 4,977 Brazilian adult women attending general prenatal clinics who underwent a standardized 2 hour 75 gram OGTT between their estimated 24th to 28th gestational weeks. Among the women, 2.4 percent presented with GDM by ADA criteria and 7.2 percent by WHO criteria. After adjustment for the effects of age, obesity, and other risk factors, GDM by ADA criteria predicted an increased risk of macrosomia, preeclampsia, and perinatal death. Similarly, GDM by WHO criteria predicted increased risk for macrosomia, preeclampsia, and perinatal death. Of women positive by WHO criteria, 260 were negative by ADA criteria. Conversely, 22 women positive by ADA criteria were negative by WHO criteria. The article concludes that GDM based on a 2 hour 75 gram OGTT defined by either WHO or ADA criteria predicts adverse pregnancy outcomes. Thus, until consensual criteria are reached, these two criteria are valid options for the detection of a glucose tolerance state predictive of adverse pregnancy outcomes. 1 appendix. 1 figure. 2 tables. 18 references. (AA-M). •

Diagnosis and Management of Gestational Diabetes Source: Diabetes Reviews. 2(1): 43-52. Winter 1994. Summary: This review article discusses the diagnosis and management of gestational diabetes (GDM). The authors begin by briefly reviewing the controversies about the definition and diagnosis of GDM. They continue by describing a contemporary management protocol for GDM that emphasizes nutritional therapy and by discussing details associated with reductions in perinatal morbidity controlling for maternal obesity. The management scheme outlined here depends on a multidisciplinary approach in which dietitians, nurse educators, counselors, and physicians strive for integrated care. The authors stress that establishment and maintenance of euglycemia is the single most important objective to reduce perinatal morbidity and mortality. 2 figures. 7 tables. 87 references. (AA-M).

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Summary and Recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus Source: Diabetes Care. 21(Supplement 2): B161-B167. August 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This review article presents the summaries and conclusions resulting from the deliberations of four panels organized at the Fourth International WorkshopConference on Gestational Diabetes Mellitus (GDM). Panel one focused on the definition, diagnosis, and prevalence of GDM, which is defined as carbohydrate intolerance of varying degrees of severity with onset or first recognition during

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pregnancy. The panel presented a screening strategy for detecting GDM and described one-and two-step oral glucose tolerance tests. The panel also recommended that appropriately designed clinical trials be conducted to determine whether the results of the 75-g test can be applied in a manner similar to the 100-g test. The second panel addressed the perinatal implications of GDM, including its impact on fetal growth and the consequences of excessive fetal growth for both the infant and the mother. The panel recommended that various areas be investigated to further the understanding of fetal growth and neurological and psychological development. Panel three focused on therapeutic interventions during pregnancy and discussed metabolic management of GDM in terms of therapeutic goals, nutritional therapy, metabolic surveillance, intensified metabolic therapy, and labor and delivery. In addition, the panel examined obstetric management in terms of goals and fetal and maternal surveillance. The panel recommended that controlled trials be conducted to evaluate various management strategies. The final panel considered the long-range implications of GDM and management after pregnancy, focusing on clinical implications for both the mother and her child and recommending that more studies need to be conducted on various aspects of diabetes. 4 tables. 8 references. •

American Diabetes Association's Fourth International Workshop-Conference on Gestational Diabetes Mellitus: Summary and Discussion Source: Diabetes Care. 21(Supplement 2): B131-B137. August 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This review article summarizes the final session of the Fourth International Gestational Diabetes Workshop-Conference, which addressed the issue of therapeutic intervention strategies for gestational diabetes mellitus (GDM). The article focuses on the opinions of six presenters and their interpretations of a review of the literature in their specific areas, the synthesis of the 30 abstracts on therapeutic interventions presented at the symposium, and the author's interpretations of the literature on these interventions to date. The article outlines suggested intervention protocols on medical nutritional therapy, weight gain during pregnancies complicated by GDM, optimal glucose monitoring, target glucose levels, insulin therapy, and exercise programs for women with GDM. The goals of an intervention protocol for the pregnant woman who has GDM are to achieve and maintain normoglycemia and thus minimize the risk of maternal or fetal morbidity. The conclusion reached by workshop participants was that further studies of management protocols are needed. 3 tables. 66 references. (AA-M).

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Proceedings of the Third International Workshop-Conference On Gestational Diabetes Mellitus Source: Diabetes. 40(Supplement 2): 1-204. December 1991. Summary: This special issue of Diabetes presents the proceedings of the Third International Workshop-Conference on Gestational Diabetes Mellitus (GDM), sponsored by the American Diabetes Association and held in Chicago, Illinois, on November 8-10, 1990. Forty-three presentations are included, covering such topics as the role of epidemiology in GDM, including race factors, incidence, and severity; diagnosis; insulin secretion and insulin resistance; the placenta; fetal growth factors; impact of maternal fuels and nutritional state on fetal growth; neonatal hypoglycemia; obstetric complications with GDM; diabetic embryopathy; islet function in offspring; diabetes mellitus after GDM; preconception counseling and contraception after GDM; nutrition

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during pregnancy; exercise; insulin management in GDM; and management issues. Each paper includes extensive references. The issue concludes with author and subject indexes. •

Emotional Adjustment to Diagnosis and Intensified Treatment of Gestational Diabetes Source: Obstetrics and Gynecology. 84(3); 329-334. September 1994. Contact: Available from Elsevier Science, Inc. 655 Avenue of the Americas, New York, NY 10010. (212) 989-5800. Summary: This study determines the effect of intensified treatment on the emotional status of women with newly diagnosed gestational diabetes. The study also observes the relationship between metabolic control and emotional well-being. Women with newly diagnosed GDM (n=206) and nondiabetic controls (n=95) were compared for maternal characteristics and test results on the Profile of Mood States-Bipolar test. There was no significant difference between women with GDM in either the diet-or insulin-managed group and nondiabetic controls on each of the subscales of the test. Intensified therapy (SMBG and frequent insulin injections) for GDM does not negatively affect women's emotional status. Moreover, achievement of glycemic control contributes to patient reassurance. Psychological adjustment to the temporary disease state is then equal to that of a nondiabetic individual. 4 tables. 20 references. (AA-M).

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Caloric Restriction in Gestational Diabetes Mellitus: When and How Much? Source: Journal of the American College of Nutrition. 11(3): 259-262. June 1992. Summary: Variations in nutritional intake during pregnancy have measurable effects on the circulating levels of maternal nutrients, maternal weight gain, and birth weight of the offspring. This review article addresses caloric restriction in gestational diabetes mellitus (GDM). The authors conclude that adjusting caloric intake to meet new guidelines for weight gain during pregnancy may be advantageous in reducing maternal blood sugar and insulin levels, without producing abnormalities in other metabolic variables. Modest caloric reduction that limits excessive weight gain in the mother may also be associated with a small reduction of fetal weight. However, more stringent dietary manipulations in obese pregnant women should be discouraged as a routine measure until more knowledge is available. 24 references.

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Use of the Matchmaker Visual Reader for Women with Gestational Diabetes Source: Diabetes Educator. 16(4): 272-273. July-August 1990. Summary: Women who develop gestational diabetes are at greater risk for developing preeclampsia, undergoing operative delivery, and delivering high birth weight infants. Risks to the infants include birth injury, hypoglycemia, and hyperbilirubinemia. Research has shown that women with gestational diabetes who are diagnosed early and who maintain recommended blood glucose levels have the best maternal and infant outcomes. A case is presented in which a diabetes educator assisted a newly diagnosed woman with gestational diabetes in managing her blood glucose level using the Matchmaker Visual Reader. The Matchmaker is a relatively inexpensive visual reader designed to match Chemstrips bG with a color-chart wheel indicating blood glucose level. Directions in the use of this device are provided along with positive results from the case study described. 4 references.

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Federally Funded Research on Gestational Diabetes The U.S. Government supports a variety of research studies relating to gestational diabetes. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to gestational diabetes. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore gestational diabetes. The following is typical of the type of information found when searching the CRISP database for gestational diabetes: •

Project Title: ADAPTATION OF ISLETS OF LANGERHANS TO PREGNANCY Principal Investigator & Institution: Sorenson, Robert L.; Professor; Cell Biology and Neuroanatomy; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 01-DEC-1984; Project End 30-JUN-2007 Summary: (provided by applicant): Pregnancy is a unique condition in the life history of islet beta-cells. At this time there is an increased need for insulin secretion at normal glucose concentrations. This demand is met by major alterations in islet structure and function. The most important are: (a) an increase in glucose-stimulated insulin secretion (4-10 fold at normal blood glucose levels); (b) a lowering of the threshold for glucosestimulated insulin secretion:and (c) increased beta-cell proliferation. Using lactogenic hormones from the same species (i.e., placental lactogen or prolactin which share a common receptor), we have shown that these hormones induce all of the changes in islets that occur during pregnancy. The common theme in this project is the PRL signaling pathway and how it changes insulin secretion, islet cell division and how lipids interact with this process during pregnancy. Using islets from pregnancy and islets treated with lactogenic hormones in vitro we will determine: (1) Why prolactin (PRL) receptor activation is so effective in enhancing islet function? (2) How PRL receptor activation increases insulin secretion? (3) How PRL receptor activation increases islet cell growth? (4) How lipids interact with islets in the presence of lactogens? (5) How complete is our understanding of the PRL receptor/JAK/STAT pathway in accounting for the changes in islet function during pregnancy? The overall goal is to understand the cellular mechanisms responsible for increasing islet function during pregnancy. This information will provide insight into the long-term regulation of islet function and beta-cell mass in the maintenance of normal blood glucose. Failure of islets to adapt to the increased need for insulin during pregnancy leads to gestational diabetes, a condition that is detrimental to normal fetal development as well as the health of the mother. Understanding the regulation of beta-cell glucose sensitivity is

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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critical for understanding the progression of events that lead to gestational and type Il diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANTIOXIDANT TRANSGENE PROTECTS OFFPRING FROM MATERNAL DIABETES Principal Investigator & Institution: Liu, Ye Qi; University of Louisville University of Louisville Louisville, Ky 40292 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: Maternal diabetes is major cause of birth defects and a contributing factor to the development of diabetes in the offspring. A hyperglycemic environment during pregnancy significantly increases the rat of malformation and resorption in the fetus. In addition, children and adults from diabetic mothers have a markedly higher rate of Type 2 diabetes. The most widely proposed hypothesis for damage is free radical (oxidative) stress to the developing fetus. Based on this hypothesis, clinical trials of antioxidants are being proposed for antioxidant treatment of diabetic mothers. However, there are problems with the current evidence for this hypothesis, which we will address in our proposed studies. Most of the support for the antioxidant hypothesis derives from treatment of diabetic rats with antioxidant vitamins, E and C. Because these drugs are delivered systemically it is impossible to determine if the protective effect is exerted at the level of the fetus or the mother, since both are subject to hyperglycemia and subsequent oxidative stress. To overcome this limitation we will produce antioxidant transgenes that will be expressed exclusively in the developing embryo. An additional problem with prior studies is that they have been performed using streptozotocin induced diabetes. Streptozotocin is a powerful oxidant and its damaging effects are not confined to the pancreatic beta cell. To overcome this limitation we will use the OVE26 transgenic model of diabetes. In these mice diabetes is induced by a transgene that is absolutely confined to the pancreatic beta cell, eliminating any potential direct damaging effects on the fetus. The impact of maternal diabetes on the ultimate development of Type II diabetes in the offspring has recently been recognized. Until now most attention has been paid to the role of insulin resistance. However, impaired insulin secretion is at least as crucial to the development of Type II diabetes and diabetes will not develop unless secretion fails. The insulin secretin beta cell is one of the most sensitive cells in the body to free radical damage. We will apply our expertise in pancreatic islet function to determine if insulin secretion is impaired in the offspring of OVE26 diabetic mothers and to examine whether a fetal antioxidant transgene can protect from the development of Type II diabetes in the offspring. To test our hypothesis that fetal oxidative stress leads to congenital malformations and to long term damage to insulin secretion we will carry out the following Specific Aims: 1. Evaluate developmental aberrations in the offspring of diabetic OVE26 mice. 2. Characterize glucose homeostasis and pancreatic islet function in the offspring of diabetic OVE26 mice. 3. Produce transgenic mice that over-expressing antioxidants metallothionein (MT) and Mn superoxide dismutase (MnSOD) during embryonic and fetal development. 4. Determine if antioxidant transgenes can reduce maternal diabetes induced damage to fetal development and islet function. Completion of these Specific Aims will provide a definitive genetic test of the role of oxidative damage to the offspring. They will also provide a much-improved model of maternal diabetes, which is amenable to modern genetic manipulation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BARRIERS TO RECRUITING DIABETES IN DIABETES PREVENTION

WOMEN

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Principal Investigator & Institution: Marrero, David G.; Professor of Medicine; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2001 Summary: There is no text on file for this abstract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE--MODEL DEMONSTRATION UNIT Principal Investigator & Institution: Clark, Charles M.; Professor of Medicine; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2002 Summary: Description (taken from application): The guidelines for the Diabetes Research and Training Centers mandate a model demonstration unit (MDU) for the training of students and practitioners in diabetes care and for the support of diabetes research. The IU-DRTC has responded to this mandate by developing a multi-site MDU that addresses training and research in three diabetes patient populations: adults (with special emphasis on pregnant women with pre-existing and gestational diabetes), transitional age adolescents, and children. The primary goals of our multi-site MDU are to train health care professionals in state-of-the-art diabetes management and facilitate research that addresses barriers between what is thought to represent ideal diabetes care reflecting current scientific advances in the understanding of diabetes and what is routinely practiced. Even though there are distinct differences in patient populations served by the MDU, a unifying philosophy is involved in the demonstration of model diabetes care across all of these sites. Model care should: 1) be delivered by multidisciplinary teams with an emphasis on interactive decision making, 2) incorporate algorithmic protocols that are based on state-of-the-art care standards, 3) be supported by new technologies when possible, and 4) be rigorously evaluated and revised as necessary. During the past cycle we have significantly expanded diabetes treatment programs in the MDU. As a result, trainees have exposure to all aspects of model diabetes care including state-of-the-art measures to improve glycemic control, formal weight management programs, and cardiovascular risk reduction programs. The programs afford trainees exposure to patients of all age groups (i.e., pediatrics, adolescents, adults and the elderly) and of varied ethnic and socioeconomic status. Furthermore, through exposure to the proposed Women?s Health Initiative MDU program, gender-specific aspects of providing care to females with diabetes will be modeled. Finally, an important expansion of our MDU are programs designed to provide training and education in model diabetes care to medical students, trainees, and primary care physicians who practice at sites distant from these state-of-the-art model programs. 2.The specific objectives of the IU-DRTC MDU are: 1.To establish state-of-theart diabetes patient management programs for the demonstration of model care. 2.To train health professional students and practitioners in state-of-the-art management and education of persons with diabetes. 3.To serve as a resource to facilitate the conduct of biomedical, health care, educational, epidemiologic and psychosocial research in diabetes mellitus. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEFINING DIABETES IN YOUTH Principal Investigator & Institution: Hamman, Richard F.; Professor and Chairman; Preventive Med and Biometrics; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2005 Summary: (provided by applicant): There is very limited information about the epidemiology of Type 2 diabetes mellitus in youth, though it is believed that the prevalence is increasing rapidly. Risk factors similar to those in adults with Type 2 are thought to be important, (e.g., obesity, insulin resistance, diet, physical activity, positive family history), however, there are no reliable epidemiological studies of these risk factors in youth with type 2 diabetes using appropriate controls. In addition, risk factors such as low birth weight lack of breast-feeding, maternal diabetes during pregnancy and family dysfunction and depressive symptoms have received little epidemiological study in populations other than American Indians. This application addresses the lack of such studies. The Defining Diabetes in Youth (DDY) project will focus on type 2 diabetes in youth aged 10-19, drawing upon the CDC funded SEARCH diabetes registry project in Colorado and South Carolina. The SEARCH project will ascertain all cases of diabetes in youth, collect immunologic, clinical, and metabolic information, and classify cases as Type 1 or 2 diabetes. DDY will only have to recruit appropriate controls aged 10-19 from three ethnic backgrounds including African Americans (AA), Hispanics (H), and non-Hispanic whites (NHW) to test specific etiologic hypotheses in the cases classified by SEARCH as Type 2 diabetes. It will also explore cardiovascular risk factor differences in youth with Type 2 diabetes and controls, and will evaluate insulin resistance and secretion differences among controls by level of obesity and other factors. The primary design is a case-control study, through which risk factors for diabetes, selected complications and CVD risk factors will be evaluated. The current application is an approved SEARCH ancillary study. Collaborating investigators bring expertise in multiple areas relevant to diabetes in youth, and experience in large epidemiological studies of diabetes (both type 1 and 2) in minority populations. Given the low prevalence of Type 2 in Youth, DDY is an efficient design, since case ascertainment and typing will be conducted by SEARCH, and only control recruitment, addition of new measures, and analysis are requested. The biostatistical analysis, data management and central laboratory will be the same as used in SEARCH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DIABETES PREVENTION PROGRAM Principal Investigator & Institution: Ratner, Robert E.; Vice-President; Medstar Research Institute Hyattsville, Md 20783 Timing: Fiscal Year 2001; Project Start 20-AUG-1994; Project End 30-JUN-2003 Summary: (Directly incorporated from the application) The Washington Hospital Center/Medlantic Research Institute and the Howard University Medical School will collaborate in an effort to identify and enroll African Americans at risk for the development of IGT and NIDDM into a primary prevention trial. We will concentrate on recruitment of African Americans because of the disproportionate effect diabetes has on this community and the fact that Washington DC, with 70 percent African Americans, is estimated to have 52,000 citizens with diabetes, with half undiagnosed. The unique aspects of NIDDM in the African American population together with their disproportionate prevalence demand inclusion of African Americans as a major component of any primary prevention trial for NIDDM. Impaired glucose tolerance is

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the optimal time when interventions aimed at reversing the insulin resistance may prevent the progression of carbohydrate intolerance to NIDDM. We propose an efficient recruitment strategy based on the documented availability of groups enriched in the proportion of individuals with abnormal glucose tolerance. These include clinic patients seen at the Washington Hospital Center (WHC) and Howard University Hospital (HUH) who are obese and have relatives with NIDDM, patients with premature cardiovascular disease, and patients with a history of gestational diabetes. We propose a two by two factorial design to investigate aggressive lifestyle modification (diet and exercise), and pharmacologic intervention with metformin. Culturally appropriate interventions and follow-up techniques based on community support and input are presented designed to enhance retention and compliance. Primary endpoint determinations will be progression form IGT to NIDDM. Improvement of carbohydrate tolerance in newly diagnosed NIDDM will also be examined. Secondary end points include metabolic parameters related to insulin resistance, insulin secretion, lipoprotein changes and cardiovascular endpoints such as hypertension. Our center is experienced in the conduct of clinical trials and is committed to working with the Steering Committed in the design and conduct of the Trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIABETES PREVENTION PROGRAM Principal Investigator & Institution: Wing, Rena R.; Professor of Psychiatry; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 15-AUG-1994; Project End 30-JUN-2003 Summary: Diabetes mellitus is a major cause of morbidity and mortality in the United States, and individuals with impaired glucose tolerance (IGT) or a history of gestational diabetes (GDM) are at increased risk of developing this disease. Research to test whether it is possible to prevent the occurrence of NIDDM is a national priority. The University of Pittsburgh proposes a primary prevention trial that optimally tests the hypothesis that NIDDM is preventable through weight loss and physical activity and simultaneously addresses whether an intervention that is more easily adopted by the health care system is of benefit. Targeted advertisement and chart review will be used to identify 100 subjects with IGT (confirmed on repeat OGTT and with at least one 2-hour BS>170); 100 GDM subjects will be identified from a registry of over 1000 women with GDM; we aim for 40% of participants to be African American. These 200 high risk subjects will be randomized to a control group, a standard life-style intervention (SLI), or an enhanced life-style intervention (ELSI). The goals for the two intervention groups will be a 10% weight loss and 3 hours/week of physical activity. To achieve these goals, the SLI group will participate in a standard diet/exercise program that could be easily implemented by the health system; community-led exercise groups will also be available. The ELSI group will be given enhanced treatment to optimally test the prevention hypothesis; these subjects will be seen individually on a monthly basis; intervention will be prescribed as needed to achieve and maintain the weight and exercise goal. The primary outcome will be development of NIDDM (WHO criteria; confirmed by second test). Other endpoints will be changes in glucose, insulin resistance, insulin secretion, and the cardiovascular risk profile. During screening, some subjects will be identified as having non-fasting diabetes (NFD; FBS 200). These subjects will participate in a secondary prevention trial using a 2 x 2 factorial design with the two life-style conditions (SLI vs ESLI) crossed with 2 drug conditions (metformin vs placebo). The primary outcome measures for this secondary prevention study will be development of fasting hyperglycemia and incidence or progression of diabetic

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complications. The University of Pittsburgh is well qualified to participate in this trial as we have extensive experience in life-style interventions, exercise, clinical trials, diabetic complications, and in the medical management of diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIABETES PREVENTION PROGRAM (DDP-2) Principal Investigator & Institution: Kitabchi, Abbas E.; Professor; Medicine; University of Tennessee Health Sci Ctr Health Science Center Memphis, Tn 38163 Timing: Fiscal Year 2001; Project Start 20-AUG-1994; Project End 30-JUN-2003 Summary: Non-insulin dependent diabetes mellitus (NIDDM) has reached an epidemic proportion in the United States. Although NIDDM, cardiovascular diseases, and cancer account for two-thirds of all deaths in the United States, there is strong evidence to indicate that these diseases may be related to the lifestyle of the patients. There is no compelling evidence in the literature that the following are combined, or independent risk factors for development of NIDDM: (a) obesity, (b) family history of NIDDM, (c) upper body adiposity, (d) ethnicity, (e) hyperinsulinemia, (f) impaired glucose tolerance, (g) gestational diabetes, (h) sex hormone binding globulin (SHBG), (i) sedentary life. We hypothesize that in such individuals with high risk, alteration of lifestyle, such as dietary modification and physical exercise, will ameliorate or delay development of NIDDM. We, therefore, propose the following specific aims for this multicenter primary prevention trial: 1. To recruit a cohort of subjects at high risk for NIDDM consisting of 100 persons with previous history of gestational diabetes, most of whom will be African American, and 100 other persons who are hyperinsulinemic with upper body adiposity, insulin resistant, impaired glucose tolerant and strong family history of diabetes. Some of the patients will be undiagnosed NIDDM with fasting blood glucose of < 140 mg/dl. 2. To randomize these subjects into intensive therapy group versus usual care group (attention control). 3. The intensive therapy group will be designed to accomplish the following aims: (a) to modify the diets in these high risk subjects to reduce total fat to less than 30% of total calories and saturated fat to less than 10%, (b) to increase energy expenditure from physical activity to 2000 Kcal per week, (c) to combine dietary therapy with effective moderate exercise therapy to achieve a reduction of body weight of greater than 10% per individual which will be maintained over time, (d) to design these dietary and exercise interventions so they are flexible enough that they can be modified for the different target ethnic, gender, educational level, and other subgroups, and (e) to design a long term adherence program that will maximize adherence to prescribed therapies while minimizing drop outs and therapeutic cross overs. 4. To provide baseline and semi-annual evaluations of glycemic control and insulin resistance in all groups of patients, and repetition of all initial laboratory and physical examination data on an annual basis. We estimate 75% of our study population will be African American, and 25% will be Caucasian. Both male and female populations will be represented, with the majority being female, as 50% of our patients will consist of those persons with gestational diabetes. We understand the final protocol will be based on the decision arrived at by the Steering Committee, and may involve the use of insulin-resistancemodifying drugs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DIABETES PREVENTION PROGRAM (DPP) Principal Investigator & Institution: Shamoon, Harry; Professor and Dcrc Program Director; Medicine; Yeshiva University 500 W 185Th St New York, Ny 10033

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Timing: Fiscal Year 2001; Project Start 15-AUG-1994; Project End 30-JUN-2003 Summary: There is increasing evidence that the development of noninsulin dependent diabetes mellitus (NIDDM) is presaged many years earlier by the presence of biochemical and other phenotypic features in susceptible individuals. Earlier intervention in such individuals may prevent or slow the occurrence of overt hyperglycemia which, in turn, may limit the morbidity and mortality associated with diabetes. By selecting populations at higher than average risk for the ultimate development of NIDDM, we propose to be able to practically test the following hypothesis: The reduction in risk of developing NIDDM in persons at high risk for the development of diabetes will be dependent on treatment which affects insulin resistance, islet B-cell dysfunction, and/or hepatic glucose production. Interventions which include diet, exercise sulfonylurea drugs, and metformin in a factorial design can address this hypothesis. The Diabetes Center at the Albert Einstein College of Medicine is a multidisciplinary aggregation of scientists and clinicians actively involved in various aspects of diabetes. With the resources and expertise available among individuals in the Center, we will participate in a multicenter NIDDM Prevention Trial. The Albert Einstein Center would be able to contribute to the success of such a Trial for the following reasons: l) a Diabetes Research and Training Center underpinning and the Institutional commitment to addressing issues in underserved populations of New York City; 2) our participation in the Diabetes Control and Complications Trial as a clinical center; 3) the availability of a large, identified population of individuals from racial and ethnic minority groups in the Bronx and Westchester Counties who receive their medical care in Einstein-affiliated programs; 4) an identified and well characterized population of women who had gestational diabetes diagnosed between 1988 and the present, and an annual accrual of an additional cohort of women with gestational diabetes; 5) expertise in the design and implementation of clinical trials; 6) strong research foci of the principal and co-investigators in areas such as pathophysiology and diagnosis as well as nutritional and pharmacologic treatment of NIDDM; 7) members of the treatment team with specific competence in diabetes in Hispanic and in AfricanAmerican individuals; 8) a new outpatient facility in which to conduct a clinical trial; 9) expertise in related areas such as hypertension control, cardiovascular risk reduction, and behavioral techniques intended to achieve therapeutic goals; and lO) a track record of participating in constructive collaborative efforts to achieve the goals of NIH-initiated multicenter projects. We will participate in the Trial by providing personnel, resources, and study volunteers to achieve the aims of the planning, implementation, and data analysis phases of the proposed 7-year study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EARLY LIFE AND GENETIC EFFECTS ON OBESITY AND DIABETES Principal Investigator & Institution: Hunt, Kelly J.; Medicine; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-JUN-2007 Summary: (provided by applicant): Immediate career goals that the Division of Clinical Epidemiology at the University of Texas Health Science Center at San Antonio provides me the opportunity to pursue as a diabetes and cardiovascular epidemiologist, include training in statistical genetics and implementation of my own study. These skills are essential for my career development, my long-term career objective being to establish a solid independent research program as a genetic epidemiologist. The objective of the research project is to investigate and characterize intrauterine and early childhood exposures and their relationship to the development of obesity and type 2 diabetes in

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two ongoing studies, the San Antonio Family Diabetes Study (SAFDS) and the San Antonio Family Heart Study (SAFHS). The SAFDS and the SAFHS are studies of lowincome Mexican American families that combined include 2,361 adult participants from over 80 extended families. In each study, a standardized medical examination has been completed, including measurements of anthropometry and blood pressure, a fasting venipuncture and an oral glucose tolerance test. Moreover, in the coming months, a complete genomic scan of 400 highly polymorphic markers distributed throughout the genome at approximately 10 centimorgan intervals will be available on the vast majority of participants. Specific aims of the proposed project include collecting self-reported information on breast-feeding from over 1600 participants and mother, reported information on an array of early life exposures on 999 participants. Mother-reported exposures of interest include duration of breast-feeding, maternal smoking and alcohol consumption during pregnancy, gestational hypertension and/or diabetes during pregnancy, inter-pregnancy interval, and the time interval between pregnancy and future development of diabetes (among diabetic individuals). Research questions of interest include the association between early life exposures and adult obesity and diabetes, whether the heritability of diabetes and obesity is influenced by early life exposures that are themselves likely to be familial, and finally the identification of genes and gene by environment interactions related to obesity and diabetes. The proposed study, by combining previously collected information in two established studies with collection of information on early life exposures, bridges the gap between genetics and epidemiology, offering a unique training opportunity and an opportunity to further our understanding of obesity and diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPIDEMIOLOGY OF GALLBLADDER SLUDGE & STONES IN PREGNANCY Principal Investigator & Institution: Lee, Sum P.; Professor and Chief; Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2003; Project Start 01-APR-1996; Project End 28-FEB-2007 Summary: (provided by applicant): The female gender and multiparity are the two most important positive correlates of cholesterol gallstone disease. Pregnancy represents the period of time when the 'lithogenic' pressure on a woman is the highest. Biliary sludge is a precursor stage of gallstones. We studied the etiological factors associated with the development of sludge and stones during pregnancy, and our early results suggest that it is inversely related to physical activity. We also found that being overweight, a known risk factor for gallstone disease, is associated with high blood leptin levels. In addition, the risk associated with high leptin levels is partially mitigated by physical activity. In order to disentangle the effects of physical activity, leptin and gestational diabetes on gallbladder disease risk, and to understand the mechanisms behind the observed associations, we propose to conduct a randomized controlled trial. This interventional study is a logical extension of our previous observational investigation. Our Specific Aims are: 1. To evaluate whether an endurance exercise program is associated with lower risk of gallbladder disease in overweight pregnant women.2. To evaluate whether an endurance exercise intervention program changes leptin levels in pregnancy among overweight women.3. To examine the associations between gallbladder disease incidence and potential causal variables in this prospective trial. These variables include leptin levels, HDL, insulin levels, BMI (as it varies within women classified as overweight), as well as changes in these variables. Gallstone disease affects 15-20% of adult Americans. Cholecystectomy is one of the most commonly performed operations.

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The morbidity, and the burden of cost, incurred by gallstones are staggering. Yet there is a dearth of understanding in the epidemiology and the cause of this disease. The results of this investigation should generate new, important and useful insights into the pathogenesis, and provide a rational strategy for the prevention, of this common and costly disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FACTORS AFFECTING FETAL GROWTH Principal Investigator & Institution: Uvena, Jennifer; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001 Summary: The purpose of this study is to determine if there is a relationship between fetal growth factors (leptin, tumor necrosis factor alpha, insulin, and c-peptide) and neonatal weight and body composition, in babies of women with gestational diabetes mellitus and those with normal glucose tolerance. This study will also investigate whether or not the placenta is a possible source of these growth factors. Additionally, neonatal blood at 48 hours of life will be examined to see if the baby continues to make these growth factors after birth. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FAMILY STUDIES OF NIDDM--AFRICAN AMERICANS AND HISPANICS Principal Investigator & Institution: Guze, Carol D.; Professor; California State UnivDominguez Hills Carson, Ca 90747 Timing: Fiscal Year 2001; Project Start 30-SEP-1992; Project End 31-MAR-2005 Summary: The objective of this pilot study is to generate empiric counseling risks for use in counseling patients and families as well as to identify risk factors that contribute to the development and course of type 2 diabetes (DM-2) in African Americans and Hispanics in Central Los Angeles. Type 2 diabetes mellitus is a common disorder usually of middle-aged individuals and, if untreated, complications can arise. DM-2 is one of the top ten health problems in the United States and the prevalence in African Americans is estimated to be 10% and in Hispanics, 15%. These communities are also at greater risk for developing long-term complications of diabetes such as retinopathy (including blindness). An alarming new trend is an increase in DM-2 among young people especially Hispanics and African Americans. DM-2 has also been shown to have a disproportionate impact among ethnic seniors. We plan to use family studies gathered by personal interviews and questionnaires to obtain the necessary informati on from our DM-2 patients. 100 adult African American patients and 100 adult Hispanic patients in diabetes clinics at King Drew Medical Center and its outlying clinics will be interviewed. Interviews of non English speaking Hispanics will be conducted in Spanish. The specific aims of our project are 1. To develop empiric counseling risks using the information gathered from the family history studies and 2. to explore within our families those risk factors which in other studies have not been looked at in detail. These include the regions of origin in Mexican-Americans; acculturation factors; maternal pregnancy factors; birth weight; birth order; obesity in the family members. We anticipate that the information gathered from our pilot study will suggest testable hypothesis for future more focused studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FETAL METABOLIC CONSENQUENCES OF SPONTANEOUS GESTATIONAL DIABETES MELLITUS Principal Investigator & Institution: Friedman, Jacob E.; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001 Summary: The long-term goal of these studies is to understand how defects in maternal insulin transduction contribute to gestational diabetes mellitus (GDM) and the mechanisms leading to fetal macrosomia and obesity. Metabolic imprinting suggests the transmission of diabetic susceptibility genes from moth to offspring is less important than the maternal environment in producing second-generation insulin resistance, obesity, and diabetes. This proposal will use a series of established heterozygous transgenic mouse models will combined gene knockouts in the insulin receptor (IR/+), insulin receptor substrate-1 (IRS-1/+), and leptin receptor (db/+) genes to establish how genetic defects in insulin signaling and the hormones of pregnancy interact to provoke abnormalities in insulin signal transduction, beta-cell hypertrophy, and spontaneous hyperglycemia during pregnancy. Our studies will also determine how modifying maternal insulin resistance during pregnancy decreases hyperglycemia and the development of fetal macrosomia by studying db/+ mice that over-express the human GLUT4 gene. The association between maternal hyperglycemia and fetal genotype on fetal over/under growth and expression of insulin signaling proteins in liver and skeletal muscle will be determined during the perinatal period. The last goal will be to determine whether insulin resistance and obesity in early and later life is modified by inheritance of an abnormal genotype or the consequences of epigenetics (i.e. information that is heritable and alters the phenotype of offspring but is not encoded specifically in the genetic code of DNA. One of the immediate benefits of these models is that they provide information on the role of biochemical defects expressed against a constant genetic background, thus enabling us to observe epigenetic transmission of an altered metabolic phenotype originally induced by a genetic event (inheritance of the IR/IRS-1 or leptin receptor mutation). Because many metabolic disorders, such as diabetes, have both genetic and epigenetic components, this approach offers an opportunity to identify metabolic alterations that may be unique to genetic or epigenetic effects. The outcome of these studies will have important implications for the prevention and treatment of GDM. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FETOPLACENTAL GROWTH RETARDATION Principal Investigator & Institution: Clapp, James F.; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001 Summary: The three specific aims of this project continue to focus on the role of two maternal environmental factors (diet and physical activity) in prenatal growth regulation and their indirect effects, if any on postnatal growth and development. The project uses a prospective, randomized design to evaluate the effects of maternal diet and activity on maternal blood glucose levels, feto-placental growth, and post-natal growth and development. Parallel mechanistic studies will also be carried out using a prospective, randomized cross-over design. The basic hypothesis to be tested is that diet and activity during pregnancy modulate many aspects of the growth process through their effects on multiple maternal metabolic and cardiovascular parameters. The specific maternal parameters which will be evaluated include: glucose, insulin, glycolated

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hemoglobin, TNF-alpha, and leptin levels, metabolizable energy intake, weight gain and fat deposition, resting metabolic rate, glucose oxidative and non-oxidative disposal, and insulin sensitivity. Placental growth and functional capacity will also be evaluated as well as neonatal morphometrics and postnatal growth, metabolism and neurodevelopment. The techniques used include: tight control of the subject's diet and activity, diet and exercise tolerance tests, ultrasound, indirect calorimetry, stable isotope infusion, the hyperinsulinemic-euglycemic clamp, and standard gross and microscopic morphometry. The significance of the project is that it will define the effects of diet and physical activity during pregnancy on outcome and identify some of the underlying mechanisms responsible for these effects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENES & GESTATIONAL DM: CASE CONTROL ASSOCIATION STUDY Principal Investigator & Institution: King, Kathleen U.; None; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2003; Project Start 28-SEP-2003; Project End 27-SEP-2006 Summary: (provided by applicant): Gestational Diabetes (GDM) is diabetes that is first diagnosed during pregnancy; it occurs in 7% of all pregnancies. Many women with GDM are diagnosed with Type 2 Diabetes (T2DM) later in life. Certain genes are associated with T2DM but studies have not been done to determine whether these genes are associated with GDM. This case-control-association-study, matching women for age, ethnicity and body mass index will examine genes associated withT2DM in women with GDM as compared to those without. These genes include the PPAR gamma, B3-AR, GRL and CAPN10. From blood samples, DNA will be extracted. Polymerase Chain Reaction will be used to amplify the 4 genes and fragment size analysis will determine which of the gene variants are present in each sample. Chi square analysis will compare the frequency of the individual gene variants in women with GDM vs. those without. This study will contribute to an understanding of the genetics of GDM and T2DM. Identification of genes associated with diabetes may facilitate interventions to prevent the onset or ameliorate the complications associated with diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GESTATIONAL DIABETES IN WOMEN:TASTE & ENDOCRINE FACTORS Principal Investigator & Institution: Tepper, Beverly J.; Associate Professor; Food Science; Rutgers the St Univ of Nj New Brunswick Asb Iii New Brunswick, Nj 08901 Timing: Fiscal Year 2002; Project Start 08-APR-2002; Project End 31-MAR-2005 Summary: provided by applicant): Gestational Diabetes Mellitus (GDM) is a common complication of pregnancy with serious consequences for maternal and child health. Diet is an integral part of the management of GDM, but current diet strategies for pregnant women with 0DM are poorly defined and often fail. We have shown that GDM increases the preference for sweet taste and dietary intake of sweet foods, which could have important implications for the management of this disease. At the time of diagnosis (-30 30 wk gestational age) pregnant women with GDM showed a higher preference for sweetened dairy drinks compared to pregnant women without GDM. In addition, increased plasma glucose in women with GDM was related to higher preference for the sweet taste of glucose and higher dietary intake of simple sugars as fruit and fruit juices. Because these studies were limited to a single observation point

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Gestational Diabetes

during gestation and excluded women with severe diabetes or those treated with insulin, further studies are needed. The specific aims of this project are: 1) to determine the relationship between hyperglycemia and increased taste preference and dietary intake of sweet foods in GDM, 2) to compare the temporal pattern of taste and dietary changes in women with GDM to those of women without 0DM across pregnancy stages, and 3) to relate these taste changes to alterations in gestational hormone and metabolic profiles. A single prospective study will be conducted. We will measure sweet taste preferences, food cravings, dietary intake of sweet foods and plasma indices of selected hormones and metabolites (including insulin, cortisol and leptin) during early, middle and late gestation and at 6-wk and 26 wk post-delivery. Four groups of pregnant women will be studied; overweight women with GDM; normal weight women with GDM; overweight women without GDM and normal weight women without GDM. Non-pregnant controls will also be studied. The long-term goal of this project is to obtain a better understanding of taste changes in GDM to develop better preventative and therapeutic dietary intervention strategies for this disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GESTATIONAL DIABETES MELLITUS & HYPERTENSION Principal Investigator & Institution: Solomon, Caren; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2001 Summary: The purpose of this study is to assess whether there are differences in blood pressures, glucose tolerance, insulin resistance, and lipid levels in women who have had a pregnancy complicated by diabetes or hypertension, as compared with women who have had uncomplicated pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OUTCOMES

GESTATIONAL

DIABETES:

DIAGNOSTIC

CRITERIA

AND

Principal Investigator & Institution: Ferrara, Assiamira; Research Scientist Ii; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 94612 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-AUG-2004 Summary: (Adapted from Investigator's Abstract) Gestational diabetes mellitus (GDM) is associated with increased risk of several adverse infant and maternal outcomes and its clinical recognition can reduce these risks. There is concern that the current criteria for GDM may be to restrictive and that residual excess risk of perinatal complications exists below present cutoff values. The proposed study will evaluate whether among women without GDM (as defined by current criteria), increasing levels of maternal glycemia are associated with increased risk of selected perinatal complications: infant severe macrosomia, severe hyperbilirubinemia, hypoglycemia, respiratory distress syndrome, and maternal preeclampsia/eclampsia. To accomplish this, the investigators propose to conduct five nested case-control studies, one for each of the complications of interest, within a large multiethnic cohort of approximately 74,000 women who were screened at 24 to 28 weeks of gestation at Kaiser Permanente, Northern California between 1995 and 1998. In this setting nearly 94 percent of the pregnant women are screened for GDM by a 50 gm., 1 hr. oral glucose tolerance test (50 g, 1-h OGTT) and approximately 15 percent have are abnormal screening and go on to receive the diagnostic (100-g, 3-h OGTT) test. Potential cases of each type of complication will be identified by searching computerized hospitalization and laboratory databases. For each of the infant

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complications, 500 cases will be randomly selected without knowledge of the maternal glucose values. A single control group for the infant complication case groups will be 1,000 infants randomly selected from all births and frequency matched on gestational age to the distribution of the combined case group. Five hundred women with either preeclampsia or eclampsia and 500 age-matched controls will be randomly selected. The medical records of the 3,000 mother-infant pairs in the four case-control studies on infant complications, and 1,000 women for the case-control study of preeclampsia/eclampsia, will be abstracted to confirm eligibility, and, if so, to ascertain data on possible maternal and infant covariates. Logistic regression will be used to estimate the odds ratios associated with several levels of pregnancy glycemia and perinatal complications. The investigators state that the proposed study will provide important knowledge about the magnitude of the risk of severe perinatal complications associated with degrees of maternal hyperglycemia below the glucose cutpoints currently used to diagnose GDM. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GLUCOSE AND AMINO ACID METABOLISM IN PREGNANCY Principal Investigator & Institution: Kalhan, Satish C.; Professor; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001 Summary: The objectives of the proposed studies are to quantify longitudinally maternal metabolic responses to progressions of pregnancy and growth of the fetus. Specifically, the impact of pregnancy and alterations in fetal growth, e.g. in diabetes, upon whole body amino acid and glucose metabolism will be quantified using stable isotope tracer method. Data from our previous studies in human pregnancy have shown that while changes in energy delivering substrates, e.g. glucose and fatty acids, during pregnancy occur parallel with the energy requirements of the mother and growing conceptus, adaptive responses in protein/nitrogen metabolism appear in anticipation of the fetal needs. In addition, preliminary data suggest that (a) liver/splanchnic tissue may be an important organ system involved in the pregnancy related adaptation, and (b) amino acid transamination may be an important component of nitrogen conservation and accretion. The proposed studies are aimed at testing these two hypotheses. Multiple isotope tracers will be used simultaneously to quantify splanchnic extraction and metabolism of essential amino acids. Whole body kinetics of glutamine, a major nitrogen source for urea and for the fetus and its nitrogen source will be quantified. Since fetal macrosomia has continued to be a persistent problem in gestational diabetes despite rigorous intervention strategies, this clinical model of abnormal fetal growth will be evaluated for the changes in gluconeogenesis and amino acid metabolism. A recently developed novel method employing labeling of body water which has already been applied to normal pregnancy will be used to quantify gluconeogenesis in gestational diabetes. These studies will quantify kinetics of key nutrients and substrates in the whole body (mother and fetus) which can impact fetal growth. It is anticipated that these data will permit the development of intervention strategies for amelioration of aberrant fetal growth. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HAPO: DATA COORDINATING CENTER Principal Investigator & Institution: Dyer, Alan R.; Professor and Associate Chair; Preventive Medicine; Northwestern University Office of Sponsored Programs Chicago, Il 60611

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Timing: Fiscal Year 2001; Project Start 04-MAY-1999; Project End 31-MAR-2004 Summary: There is a consensus that overt diabetes mellitus (DM), whether or not accompanied by symptoms or signs of metabolic decompensation, is associated with a significant risk of adverse pregnancy outcome. On the other hand, the risk of adverse outcome associated with degrees of glucose intolerance less severe than overt DM is controversial. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study is a basic epidemiologic investigation aiming to clarify unanswered questions on the association of various levels of glucose intolerance during the third trimester of pregnancy and risk of adverse outcomes. Its General Aim -- by means of an international cooperative study involving 16 centers and approximately 25,000 pregnant women -- is to achieve a major advance in knowledge on levels of glucose during pregnancy that place the mother, fetus, and neonate at increased risk. The primary hypothesis is that hyperglycemia during pregnancy, less severe than overt DM, is associated with increased risk of adverse maternal, fetal, and neonatal outcome that is independently related to the degree of metabolic disturbance. Specific Aims of HAPO are: 1. to examine glucose tolerance in a large, heterogeneous, multinational, multicultural, ethnically diverse cohort of women in the third trimester of gestation with medical caregivers "blinded" to status of glucose tolerance (except in those instances where fasting and/or two hour OGTT plasma glucose concentration exceeds a predefined cutoff value); and 2. to derive internationally acceptable criteria for the diagnosis and classification of gestational diabetes mellitus (GDM) based on the specific relationships between maternal glycemia and the risk of specific adverse outcomes that are established through this study. The study is to be accomplished with high quality standardized data collection on the women during the third trimester of gestation (including the OGTT) and at time of delivery for assessment of adverse outcomes, including operative delivery (caesarean section), increased fetal size (macrosomia/obesity), neonatal morbidity (hypoglycemia), and fetal hyperinsulinism. HAPO is to include a Clinical Coordinating Center and Data Coordinating Center, both located at the Northwestern University Medical School in Chicago, as well as a Central Laboratory located in Belfast, United Kingdom. This application requests support for the Data Coordinating Center for HAPO. Cost effectiveness for HAPO is enhanced through cost sharing by colleagues in non-U.S. centers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HYPERGLYCEMIA AND ADVERSE PREGNANCY OUTCOMEN Principal Investigator & Institution: Metzger, Boyd Northwestern University 633 Clark St Evanston, Il 60208

E.;

Professor;

Medicine;

Timing: Fiscal Year 2001; Project Start 04-MAY-1999; Project End 31-MAR-2004 Summary: There is a consensus that overt diabetes mellitus (DM), whether or not accompanied by symptoms or signs of metabolic decompensation, is associated with a significant risk of adverse pregnancy outcome. On the other hand, the risk of adverse outcome associated with degrees of glucose intolerance less severe than overt DM is controversial. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study is a basic epidemiologic investigation aiming to clarify unanswered questions on the association of various levels of glucose intolerance during the third trimester of pregnancy and risk of adverse outcomes. Its General Aim, by means of an international cooperative study involving 16 field centers and approximately 25,000 pregnant women, is to achieve a major advance in knowledge on levels of glucose during pregnancy that place the mother, fetus, and neonate at increased risk. The primary hypothesis is that hyperglycemia, less severe than overt DM, is associated with increased risk of adverse

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maternal, fetal, and neonatal outcome that is independently related to the degree of metabolic disturbance. Specific Aims of HAPO are: 1. To examine glucose tolerance in a large, heterogeneous, multinational, multicultural, ethnically diverse cohort of women in the third trimester of gestation with medical caregivers "blinded" to status of glucose tolerance (except in those instances where fasting and/or two hour OGTT plasma glucose concentration exceeds a predefined cutoff value); and 2. To provide data that can be used to derive internationally acceptable criteria for the diagnosis and classification of gestational diabetes mellitus (GDM) based on the identification of pregnancies at risk for specific adverse outcomes. The study is to be accomplished with high quality standardized data collection on the women during the third trimester of gestation (including the OGTT) and at time of delivery for assessment of adverse outcomes, including fetal hyperinsulinism, fetal obesity (macrosomia), operative delivery (caesarian section), and neonatal morbidity (hypoglycemia). HAPO is to include field centers and regional centers where the participants will be studied, a Clinical Coordinating Center and Data Coordinating Center, both located at the Northwestern University Medical School in Chicago, as well as a Central Laboratory located in Belfast, Northern Ireland. This application requests support for the Clinical Coordinating Center, the field and regional centers and Central Laboratory. Cost effectiveness for the HAPO study is enhanced through cost sharing by colleagues in non-U.S. centers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IN UTERO METABOLIC PROGRAMMING OF THE OFFSPRING Principal Investigator & Institution: Devaskar, Sherin U.; Professor; Pediatrics; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2001; Project Start 05-AUG-2001; Project End 31-JUL-2006 Summary: Perinatal Origins of Adult Disease describes the association between the adult disease Syndrome X characterized by insulin resistance, obesity, dyslipidemia, hypertension and coronary artery disease, and intrauterine growth restriction (IUGR). To decipher the mechanism behind this association we examined the skeletal muscle insulin responsive glucose transporter (GLUT 4), that mediates the critical rate-limiting step in the insulin signaling cascade. We used two in-utero extremes of metabolic perturbations (nutrient excess versus restriction) associated with IUGR, along with postnatal nutrient modifications (ad lib restricted access to milk intake) and observed a decline in the adult skeletal muscle GLUT 4 function. This change was mediated by divergent mechanisms, e.g., by suppression of insulin-induced GLUT 4 translocation to the sarcolemma in the case of in-utero nutrient excess and a transcriptional decrease in GLUT 4 expression in the case of in-utero nutrient restriction. Based on the available information and our preliminary results, we hypothesize that aberrations in the in-utero metabolic environment of the IUGR progeny along with postnatal nutritional modifications (ad lib versus restricted access to milk intake) and observed a decline in the adult skeletal muscle GLUT 4 function. This change was mediated by divergent mechanisms, e.g., by suppression of insulin- induced GLUT translocation to the Sarcolemma in the case of in-utero nutrient excess and transcriptional decrease in GLUT 4 expression in the case of in-utero nutrient restriction. Based on the available information and our preliminary results, we hypothesize that aberrations in the in-utero metabolic environment of the IUGR progeny alone with postnatal nutritional modifications regulate mechanisms responsible for aberrant skeletal muscle GLUT4 expression, translocation, and function which cause a maladaptation in the adult that

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leads to insulin resistance. We will test this hypothesis by the following specific aims in rat models of streptozotocin-induced maternal diabetes with IUGR and prenatal starvation with IUGR. In both cases the offsprings will have ad lib or restricted access to milk intake 1] to determine the mechanisms regulating skeletal muscle GLUT 4 expression, availability, and function in the adult IUGR progeny exposed in-utero to nutrient excess and postnatal nutritional modifications, we will assess: a] total GLUT 4 mRNA and protein concentrations; b] the insulin-induced translocation of GLUT 4 from the intracellular, low-density microsomes to the sarcolemmal compartment; c] the alteration(s) in GLUT 4 DNA-bindability by certain nuclear trans-activating factors; and, d] the insulin translocation of GLUT 4 from LDM to PM, and the basal and insulininduced cytochalasin B inhibitable 14C- glucose transport at d2, d21, d60 and d180 developmental stages in the progeny of the prenatally starved or control mothers who are allowed either ad lib or restricted postnatal milk intake. The results of these investigations will test our hypothesis and characterize the divergent mechanisms involved that alter the adult IUGR skeletal muscle GLUT4 concentrations/availability and function due to an in-utero metabolic program modified by postnatal nutritional influences. Defining these aberrant mechanisms will provide insights into the etiology of NIDDM. These studies will ultimately server as an impetus for the future development of interventional strategies to implement in childhood to target and prevent adult disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INSULIN RESISTANCE AND GLUCOSE METABOLISM IN PREGNANCY Principal Investigator & Institution: Catalano, Patrick M.; Professor; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001; Project Start 01-DEC-2000; Project End 30-NOV-2001 Summary: The long term objectives are to understand the relationship of pregavid maternal lipid metabolism and maternal metabolic adaptations during pregnancy at the system and cellular level. The specific aims of this proposal are to : evaluate the longitudinal changes in maternal insulin sensitivity as it relates to maternal lipid metabolism and fat accretion in lean and obese women with normal glucose tolerance and gestational diabetes; evaluate the alterations in maternal lipid metabolism in late pregnancy in relationship to neonatal body composition; and, identify the cellular mechanisms underlying decreased insulin sensitivity in adipose tissue during late gestation in normal glucose tolerance and gestational diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INSULIN SENSITIVITY AND LIPID TURNOVER Principal Investigator & Institution: Reece, E A.; Temple University 406 Usb, 083-45 Philadelphia, Pa 19122 Timing: Fiscal Year 2001 Summary: The purpose of this project is to study fuel metabolism longitudinally during normal gestation and during pregnancies complicated by diabetes mellitus. The objectives are to examine insulin sensitivity and glucose turnover through normal pregnancy and the postpartal period and to characterize the normal and pathologic metabolic alterations that occur in a pregnancy complicated by both pre-gestational and gestational diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INSULIN SIGNALING IN GDM & PLACENTAL HORMONES Principal Investigator & Institution: Barbour, Linda A.; Medicine; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: As a candidate, I have a longstanding interdepartmental collaboration between the departments of Medicine and Obstetrics and Gynecology with a long-term goal to become an independent researcher in gestational diabetes (GDM) and placental hormone physiology. The K-23 Award would allow me to combined clinical research skills I have gained by attaining my MSPH degree and basic research skills I am obtaining through my endocrinology fellowship in order to become a productive clinical investigator. My proposed patient oriented research focuses on the mechanisms of abnormal insulin signaling in GDM and the role of placental hormones in causing the insulin resistance of pregnancy. This award would allow me to gain expertise in executing patient oriented research on the Adult GCRC. The goal of this proposed longitudinal research project is to define the underlying abnormalities in insulin signaling in women with gestational diabetes, determine whether these abnormalities persist in women with normalize their glucose tolerance postpartum versus those who do not, and determine the placental hormones responsible for causing the insulin resistance of pregnancy. Gestational diabetes (GDM) complicates 3-10% of all pregnancies and is increasing in incidence, yet little is known about the molecular mechanisms of the insulin resistance. It results in significant morbidity to both the mother and the fetus, including a 50% risk of developing Type 2 DM in the mother, and a high prevalence of childhood obesity and adult DM in the offspring. This research would examine mechanisms of insulin resistance in others with GDM compared to pregnant controls by studying abnormalities in insulin signaling in skeletal muscle in a longitudinal prospective manner. This would be achieved by obtaining muscle biopsies before and after an oral glucose load in these two groups of women at 24-32 weeks of pregnancy. In order to examine whether or not these abnormalities persist postpartum, repeat muscle biopsies will be taken at 8-12 weeks postpartum before and after the same glucose load. Women with history of GDM who normalize their glucose tolerance will be compared to those who continue to have impaired glucose tolerance postpartum. Lastly, the cause of the insulin resistance in pregnancy will be examined by exposing muscle fibers taken at elective abdominal surgeries in non- pregnant women to placental hormones, including human placental growth hormone and human placental lactogen. This will determine whether the in-vivo insulin signaling abnormalities can be recreated in vitro with placental hormones individuals or in combination. Identifying the abnormalities in insulin signaling in this high risk population as well as the role of placental hormones in mediating the insulin resistance of pregnancy is critical so that progress can ultimately be made towards the prevention of Type 2 diabetes in the mother as well obesity and glucose tolerance in her offspring. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ISLET FUNCTION IN TYPE 2 DIABETES Principal Investigator & Institution: Kahn, Steven E.; Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 01-AUG-1999; Project End 30-JUN-2004 Summary: The clinical studies in this application are focused on the pathophysiology of type 2 diabetes mellitus and specifically the alterations in islet B-cell function that characterize this disease process. Three specific objectives (with their experimental

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Gestational Diabetes

approaches) have been identified. 1. To determine whether subjects at high risk of developing type 2 diabetes (women with a history of gestational diabetes, individuals with a first degree relative with the disease and individuals with impaired glucose tolerance) have defects in B-cell function that can be exacerbated by increased secretory demand resulting in the development of hyperglycemia. Increased B-cell secretory demand will be produced by inducing experimental insulin resistance with nicotinic acid. 2. To determine whether the disproportionate pro-insulinemia observed in subjects with type 2 diabetes is due to a fundamental alteration in pro- insulin processing or whether it results from an increase in secretory demand with the premature release of Bcell secretory granules. Individuals with type 2 diabetes and healthy controls will be studied before and following 24 hours of islet B-cell result produced by an infusion of somatostatin. 3. To determine whether the disproportionate pro-insulinemia observed in subjects with type 2 diabetes is associated with disproportionate release of pro-islet amyloid polypeptide (proIAPP). An assay for proIAPP will be developed and measurements will be made in plasma from health subjects and subjects with type 2 diabetes to determine whether disproportionate release of proIAPP occurs in type 2 diabetes. The applicant has successfully trained a number of young investigators in the areas of patient-oriented and basic research and a plan to continue doing so is presented. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: KIDNEY PATHOLOGICAL STATES

DEVELOPMENT

DURING

NORMAL

AND

Principal Investigator & Institution: Robillard, Jean E.; Professor; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2002; Project Start 01-SEP-1997; Project End 31-AUG-2007 Summary: The processes that lead to the development and interaction of the specific absorptive and secretory functions of different nephron segments have not been evaluated in details. Recent studies have suggested that transition from metanephrogenic mesenchyme to functional epithelium is accompanied by reorganization and repatterning of plasma membrane ion channel expression and conductance. Studies by our group, as well as others have shown that Na+/K+-ATPase is localized to the apical membrane during early tubulogenesis and repolarized to the basolateral membrane later during development. Preliminary studies have demonstrated that alterations in the integrity of the fetal environment such as fetal hyperglycemia may have a profound effect on the normal development of Na+/K+ATPase polarization. The present proposal is designed to investigate in normal and pathological states (i.e., fetal hyperglycemia secondary to maternal diabetes) the mechanisms regulating the development of vectorial transport function in the kidney using Na+/K+-ATPase as a marker of tubular epithelial polarity. To achieve this aim we are proposing to test three specific hypotheses: (1) fetal hyperglycemia (as observed during maternal diabetes mellitus) leads to abnormalities of basolateral polarization of Na+/K+-ATPase and rearrangements of cytoskeleton proteins, namely ankyrin and spectrin; (2) phosphorylation of Na+/K+-ATPase and associated cytoskeleton proteins contributes to the development of Na+/K+-ATPase polarization and that fetal hyperglycemia alters these mechanisms; (3) abnormalities in epithelial Na+/K+-ATPase polarity originating during kidney embryogenesis become imprinted and lead to permanent alterations in tubular cellular organization postnatally. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MATERNAL DIABETES AND OOCYTE QUALITY Principal Investigator & Institution: Moley, Kelle H.; Associate Professor; Obstetrics and Gynecology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Despite a century of improvements in metabolic control, pregnancies in women with insulin-dependent diabetes are complicated by increased rates of spontaneous miscarriages and congenital malformations. In addition, animal models of diabetes show more serious in vivo effects on pregnancy outcome with diabetes starting prior to ovulation as compared to embryo culture in "diabetic" conditions. These observations suggest that the insult of maternal diabetes is occurring at the oocyte or early zygote stage and that this may represent irreversible maternal programming. In preliminary studies, we report that nuclear maturation is delayed in oocytes obtained from streptozotocin-induced diabetic mice and maturation is closely regulated by glucose metabolism. These mice also have a delay in the in vivo progression to a 2-cell zygote. We hypothesize that maternal hyperglycemia adversely affects the oocyte and/or early zygote at both a metabolic and morphologic level. We suggest this early programming may be responsible for subsequent problems in embryo development and for the adverse pregnancy outcomes in these patients. The following specific aims are designed to test these hypotheses: Specific Aim 1. Do denuded or intact murine oocytes exposed to hyperglycemia in vivo demonstrate any abnormalities compared to control oocytes with regard to in vivo maturation, glucose utilization and metabolism during maturation, or morphology and apoptotic signaling before and during maturation? Specific Aim 2. Are these abnormalities due to an irreversible preovulatory event or does ovarian transplantation into a nondiabetic mouse reverse these effects? Is embryo development improved with ovarian transplantation? Specific Aim 3. Are the delays at both the oocyte and early zygote stage responsible, in part, for the abnormalities in pre-implantation embryo development and poor pregnancy outcome? Is embryo development and pregnancy outcome improved with 1-cell transfer? If our hypothesis proves correct, abnormal carbohydrate metabolism, characteristic of not only insulin-dependent but also insulin-independent diabetics, as well as patients with Polycystic Ovary Syndrome, may be a risk factor for poor oocyte quality. These oocyte changes may explain the increased incidence of pregnancy failure in all three of these groups as well as obese, insulin resistant patients. Treatment that is more aggressive may be indicated for these patients throughout their reproductive years may be indicated. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MECHANISMS BY WHICH GDM LEADS TO DIABETES IN OFFSPRING Principal Investigator & Institution: Simmons, Rebecca A.; Associate Professor of Pediatrics; Pediatrics; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-JUL-2006 Summary: (provided by applicant) In the human, diabetic pregnancy induces marked abnormalities in glucose homeostasis and insulin secretion in the fetus that results in aberrant fetal growth. Studies have suggested that there are long-term consequences for the offspring of diabetic mothers. We have developed a model of gestational diabetes (GDM) in the rat to determine whether an altered metabolic intrauterine milieu is directly linked to the development of diabetes later in life. Uteroplacental insufficiency

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Gestational Diabetes

is induced in the pregnant rat on day 19 of gestation. Offspring are growth retarded at birth, however they catch-up by 5- 7 weeks of age. At 8 weeks of age they are bred to normal males. During pregnancy these animals develop hyperglycemia, hyperinsulinemia, and hyperlipidemia accompanied by impaired glucose tolerance and insulin resistance. Offspring, (F2's) are heavier at birth and remain heavy throughout life. F2's are insulin resistant very early in life and glucose homeostasis is progressively impaired. F2 rats go on to develop diabetes as adults. Although F2 animals display marked insulin resistance, the failure of the Beta-cell to compensate for defects in insulin action is the essential factor coincident with onset of diabetes. This failure of the Betacell to compensate may be due to a lack of compensatory increase in insulin secretion, an increased rate of cell death, a reduction in the rate of Beta-cell proliferation, or a combination of these events. The mechanism(s) underlying this lack of Beta-cell compensation and eventual decrease in Beta-cell mass in F2 animals are the focus of this proposal. We hypothesize that mitochondrial DNA damage from hyperglycemia via the production of reactive oxygen species (ROS) results in further escalation of genetic damage in the mitochondria, specifically in mutations. A self- reinforcing cycle of progressive deterioration in mitochondrial function leads to a corresponding decline in Beta-cell function. Finally, a threshold in mitochondrial dysfunction and ROS production is reached and Beta-cell death occurs. The onset of diabetes ensues when a critical level of abnormal Beta-cell insulin secretion combined with Beta-cell loss is reached. We will test the hypothesis that GDM does in fact cause mitochondrial dysfunction, oxidative stress, and deletions in mtDNA in the Beta-cell of the offspring, and whether these effects act synergistically to lead to the development of the Beta-cell failure and type II diabetes. To link the damage to the mitochondria caused by hyperglycemia to the Beta-cell phenotype observed in type II diabetes we will induce Beta-cell failure in vitro by transferring damaged mitochondria from F2 animals into Beta-cells from unaffected. non-F2 animals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: METABOLIC EFFECTS OF PREGNANCY IN CYSTIC FIBROSIS (SS) Principal Investigator & Institution: Hardin, Dana S.; Associate Professor; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2001; Project Start 01-DEC-2000; Project End 31-MAR-2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MOLECULAR BASIS OF ISL-1 INDUCED BIRTH DEFECTS Principal Investigator & Institution: Dinh, Hong-Khanh B.; Munroe-Meyer Institute; University of Nebraska Medical Center Omaha, Ne 681987835 Timing: Fiscal Year 2002; Project Start 01-AUG-2002 Summary: (provided by applicant): The purpose of this research is to investigate the molecular basis of birth defects, characteristic of diabetic embryopathy, resulting from maternal diabetes using an Islet-1 (Isl-1) transgenic mouse model. Expression of the transcription factor lsl-l is necessary for normal pancreatic development. We found that dysreguIation of Isl-1 causes sacral/caudal agenesis similar to human dIabetic embryopathy. These results suggest that embryonic lsl-1 expression may be dysregulated in diabetic pregnancies. The Isl-1 transgenic mouse model, therefore provides a suitable model for studying the genetic response and will be utilized to elucidate the molecular pathways and possible biological/transcriptional targets

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downstream of Is!-!. Using a binary transgenic mouse model to generate IsI- I transgenics. we have control over incremental differences in gene dosage, dependent on whether the embryo is hemizygous or homozygous for the transactivator or transresponder gene. This allows us to identify transcriptional targets of Isl-1 by focusing on two parameters, gene dosage and developmental tune point (E8.5-E 12.5). Three specific aims will be pursued: I) Evaluation of candidate lsl-1 targets using quantitative RT-PCR and in situ hybridizations. 2) Identification of new Isl-1 targets by gene expression profiling. The 15K mouse developmental gene cDNA collection and an interpretation framework specifically designed for this project will be used. in particular. microarray analysis of transgenics with high gene dosage. resulting in a more severe phenotype, will help identify compulsory target genes to the defect. 3) Gene expression studies on candidate and new Isl-l targets will be used to compare the developmental defects in lsl-1 transgenics to chemically (Alloxan) induced diabetic embrvopathies. Comparison of the genetic and the pharmacological mode! will determine whether developmental defects in diabetic embryopathv and in our Isl-1 transgenic model arise through common molecular perturbations. This study will elucidate the molecular pathways leading to sacral/caudal agenesis. The information may be further used to devise treatment strategies for diabetic mothers during pregnancy to offset the molecular changes that Lead to diabetic embrvopathies and to reduce newborn morbidity due to the developmental defect. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR GENETICS OF GESTATIONAL DIABETES MELLITUS-A GENETIC PREDISPOSITION Principal Investigator & Institution: Lowe, William; Northwestern University Office of Sponsored Programs Chicago, Il 60611 Timing: Fiscal Year 2001 Summary: Women who develop gestational diabetes mellitus (GDM) progress to diabetes outside of pregnancy at a rate >5%/yr and account, therefore, for a sizable proportion of people with non-insulin dependent diabetes mellitus (NIDDM) whose mean age at diagnosis is relatively young. Moreover, impaired b-cell function is an important early predictor of the risk of developing DM among women with GDM. For these reasons, we have hypothesized that women with gestational diabetes mellitus (GDM) share a unique set of genetic characteristics apart from other presentations of NIDDM. The proposed studies are designed to create a bank of genomic DNA from and phenotypic information on several groups of participants, including (i)women with NIDDM subsequent to a history of GDM, (ii)women with a history of GDM who have normal glucose tolerance, (iii)women who do not have a history of GDM, (iv)individuals with typical, late-onset NIDDM (defined as onset after age 50), and (v)a reference group of individuals with normal glucose tolerance but who are at risk factor for late-onset NIDDM based upon a family history of a first degree relative with NIDDM, age over 50, or ethnicity (African-American, Hispanic, or Native American). This DNA and phenotypic information will be used to address our hypothesis in the present and future studies by examining the frequency of polymorphisms/mutations in previously identified genes that predispose to the development of maturity onset diabetes of the young (MODY), NIDDM, and obesity (a risk factor for NIDDM) in the different groups of participants and the association of those polymorphisms/mutations with alterations in the different phenotypic characteristics. These studies will be conducted using the about 1000 people who are currently undergoing oral glucose tolerance tests to determine their eligibility for participation in the Diabetes Prevention

46

Gestational Diabetes

Program at Northwestern University Medical School and about 450 people who will be enrolled in another CRC-approved study ("Are Polymorphic Variants of the Leptin Receptor Gene Associated with Obesity and Gestational Diabetes Mellitus" - Protocol 597). The specific analysis that will be conducted in the proposed study will be to determine the prevalence rate of mutations in the transcription factor hepatocyte nuclear factor-1a in women with NIDDM subsequent to a history of GDM compared to the other four groups. Mutations in this gene result in maturity-onset diabetes of the young (MODY) and are, thus, associated with onset of diabetes at a young age. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MULTICENTER NETWORK OF MATERNAL-FETAL MEDICINE UNITS Principal Investigator & Institution: Conway, Deborah L.; Obstetrics and Gynecology; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2001; Project Start 01-MAY-1996; Project End 31-MAR-2003 Summary: We propose to participate as one of the academic centers in the Cooperative Multicenter Maternal-Fetal Medicine Units Network. The investigators are members of the Departments of Obstetrics, Internal Medicine, and Pediatrics (Neonatology) of the University of Texas Health Science Center at San Antonio. We have the capability of drawing from the large Mexican-American populations of Bexar County, Texas and surrounding counties in our region. We have extensive and recent experience in research design, recruitment of minority populations, and conduct of clinical and basic science studies. Our investigators are experienced in large clinical studies that have been multicentric, randomized, and observational studies. Prior investigations included two studies in which more than 5000 Mexican-American subjects were successfully enrolled. We also have extensive experience in the conduct of NIH-sponsored studies. Although our Department has multiple research interests in clinical obstetrics, it is in the areas of diabetes in pregnancy and prematurity that we have a special expertise. Diabetes is the most common medical complication in pregnancy and is especially common in Mexican-American women. A unique feature of our diabetic program is the conglomerate of experts available in San Antonio to study all aspects of the disease, i.e., epidemiological, clinical, and basic science components. Low birth weight and prematurity have been extensively studied in this Department where our added strength lies in the attention to psychosocial factors in the etiology of disease including design and evaluation of behavioral interventions, and experience with culturally appropriate questionnaires and protocols. With the largest Mexican-American pool of prospective subjects for study in Texas, our center may serve as a facilitator in a collaborative effort across centers that would allow comparison of several clinical conditions in different ethnic groups. At the UTHSCSA, the investigators are enthusiastic at the prospect of participating in the MFMU Network. They have a long record of successful collaboration and anticipate cooperative interaction with the NIH project officer, the Network, and Publication Committee in the implementation, conduct and publication of studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MULTICENTER NETWORK OF MATERNAL-FETAL MEDICINE UNITS Principal Investigator & Institution: Varner, Michael W.; Obstetrics-Gynecology; University of Utah 200 S University St Salt Lake City, Ut 84112

Studies

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Timing: Fiscal Year 2001; Project Start 01-MAY-1996; Project End 31-MAR-2001 Summary: The purpose of this proposal is to show that the Division of Maternal- Fetal Medicine (MFM) at the University of Utah Health Sciences Center is an excellent candidate to become a member of the Maternal-Fetal Medicine Units (MFMU) Network sponsored by the National Institute of Child Health and Human Development. The MFM Division has the past record of academic productivity, previous success in participating in multicenter trials, access to a suitable and cooperative patient population, and several unique strengths which allows the MFM Division to bring to the MFMU Network the ability to successfully perform clinical trials with a strong basic science background. The specific aims of this proposal are: (1) to describe the organizational structure of the division with regard to the MFMU network, the demographics of our patient population, and the strengths of individual division members; (2) to show our ability to design and propose a multicenter trial; and (3) to describe special strengths of the division which will be made available to the MFMU network. We have been successful in several multicenter trials over the past five years, and our participation in these studies will be detailed. We will describe the organization of our research efforts, the patient population available for study, research nurse staffing, the clinical strengths of our program, our computerized perinatal data base, and the neonatology services available for multicenter studies. Our proposed study, entitled "The safety and efficacy of single vs. weekly administration of corticosteroids for the acceleration of fetal lung maturity", will demonstrate our ability to use our current perinatal data base to design and execute a randomized clinical multicenter trial. The on-going research efforts in our Division have led to the development of renowned basic science programs in Perinatal Genetics (including molecular genetics) and Reproductive lmmunology and the services of these laboratories will be made available for participation in MFMU Network protocols. Most importantly, the MFM Division has access to a large number of high-risk and low-risk pregnancies because we provide clinical coverage for four affiliated hospitals with a combined delivery total of greater than 12,000 deliveries per year. Adequate patient numbers for MFMU Network protocols would be expected given the total number of patients which can be approached for enrollment and the cooperative nature of the population. These features, along with our unique geographic region, distinguish the MFM Division at the University of Utah as a productive and successful academic group which will enhance the MFMU Network. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MULTICENTER NETWORK OF MATERNAL-FETAL MEDICINE UNITS Principal Investigator & Institution: Egerman, Robert S.; Associate Professor; Obstetrics and Gynecology; University of Tennessee Health Sci Ctr Health Science Center Memphis, Tn 38163 Timing: Fiscal Year 2000; Project Start 05-MAY-1996; Project End 31-DEC-2003 Summary: The Department of Obstetrics and Gynecology at the University of Tennessee, Memphis has been part of the Maternal-Fetal Medicine Network since April 1986. With this application, we hope to participate in a large multicenter network designed to develop and conduct clinical trials in the field of Maternal-Fetal Medicine, which could not be undertaken in a single center. In comparison to our previous application, we have recently expanded our resources and facilities to include patients at all major hospitals in the city. The obstetric population will now total approximately 13,000 women of various ethnic and economic groups. We are particularly interested in

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Gestational Diabetes

pursuing trials which require large sample size in order to adequately address specific questions and those regarding rare events of obstetric interest. The Principal Investigator, Dr. Baha Sibai, and the Alternate Principal Investigator, Dr. Brian Mercer, as well as the faculty in the Division of Maternal-Fetal Medicine continue to be active in Network administrative activities, and the design and conduct of protocols. The Principal Investigator currently participates on the Concurrent Research Committee, the Ad Hoc Committee on Preterm Studies, and the "High-Risk" Aspirin Protocol, the Interim Progesterone, and the Preliminary Terbutaline subcommittees. The Alternate Principal Investigator chairs the "Premature Rupture of Membranes" protocol and the Chart Review Subcommittee. He serves on the Capitation Subcommittee, Preterm PROM Pathology Subcommittee, Preterm Prediction Protocol Subcommittee, Obstetrical Determinants of Neonatal Survival Protocol Subcommittee, Neural Tube Defect Protocol Subcommittee and the Preliminary MgSO4 Subcommittee. He has recently submitted for consideration a clinical trial regarding tocolytic, corticosteroid and antimicrobial therapy after PROM. We are applying to continue as a clinical research center within the Network and agree to join protocols in existence and participate in the design of protocols in cooperation with other centers selected by the NICHD. The University of Tennessee, Memphis, and the Department of Obstetrics and Gynecology are committed to collaborative Maternal-Fetal research as documented by listed publications and the enclosed letters of commitment. The Division of Maternal-Fetal Medicine agrees to cooperate with the policy of capitation of research costs for each individual protocol, in addition to a base budget. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MULTICENTER NETWORK OF MATERNAL-FETAL MEDICINE UNITS Principal Investigator & Institution: Leveno, Kenneth J.; Professor; Obstetrics and Gynecology; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2001; Project Start 05-MAY-1996; Project End 31-MAR-2001 Summary: This proposal describes the qualifications and experience of the MaternalFetal Medicine faculty and research team at the University of Texas Southwestern Medical Center and Parkland Hospital and the facilities and patient population available to them for carrying out clinical protocols to be designed by the NICHD Maternal-Fetal Medicine Units Network. UT Southwestern's Division of Maternal-Fetal Medicine include 11 physicians, 9 of whom are board-certified in Maternal-Fetal Medicine. A total of 6 research nurses experienced in perinatal research lead by a research nurse coordinator with 12 years experience in protocol development and implementation are available for participation in MFM Units Network protocols. A computerized perinatal database that has been operational since late 1982 is a centerpiece in perinatal research team efforts at UT Southwestern Medical Center Parkland Hospital. The perinatal research team has successfully completed several randomized trials and submitted with this application is an example of such effort in 2,138 women with pregnancy-induced hypertension who were randomized to receive magnesium sulfate or phenytoin for eclampsia prophylaxis during labor. In 1994 there were 13,935 deliveries at Parkland Hospital and approximately 55% were high-risk. Pregnancy complications of particular interest to the MFM Units Network, e.g. preterm birth and gestational diabetes are well represented in the obstetric population at Parkland Hospital. Importantly the maternal-fetal medicine physicians at Parkland Hospital are philosophically committed to rigorous controlled trials intended to objectively evaluate principals of obstetrical care before adoption of these interventions

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into clinical practice. Other resources brought to the MFM Units Network include support of UT Southwestern's NIH General Clinical Research Center, the Cecil H. and Ida Green Center for Reproductive Biology Sciences and collaboration with the NICHD Neonatal Unit Network through support of the local neonatal network principle investigator. The perinatal research team now described is committed to collaborative participation consistent with the goals of the MFM Units Network. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MULTICENTER NETWORK OF NEONATAL INTENSIVE CARE UNITS Principal Investigator & Institution: Korones, Sheldon B.; Pediatrics; University of Tennessee Health Sci Ctr Health Science Center Memphis, Tn 38163 Timing: Fiscal Year 2001; Project Start 01-APR-1991; Project End 31-MAR-2003 Summary: We present qualifications in this application to justify continued participation in the Neonatal Network. They are as follow: Size: Few, if any single, nurseries can contribute a larger patient population for study. Expertise: We have an uncommonly rich and protracted experience in multicenter trials. Our scientific research and its publications are substantial; the diversity and depth of expert support personnel is noteworthy. Training program: As a division of the Department of pediatrics, Newborn Medicine is taught in accordance with residency requirements. We are approved for fellowship training in Neonatal- perinatal Medicine. Administrative control: This large unit has been favored with considerable intramural control and institutional priority by virtue of its role in community health and its research activities. Facilities: Copious space, ample equipment and intramural control of a clinical laboratory with broad functions provide the wherewithal for effective clinical investigation. Perinatal data system: We have compiled data manually since 1972, by computer since 1979. We have extensive data stored for the past 15 years, describing demographics, diagnoses, outcomes, procedures and therapies. Inborn admissions: Approximately 95% of admissions are inborn and the number of back-transferred outborn infants is negligible, thereby increasing the number of babies available for study. Obstetrical coordination: The Neonatal Division is an official component of the Department of Obstetrics and Gynecology. Historically, our relationship with the obstetricians has been exemplary and productive. Fiscal efficiency: We are adept at budget management; in previous multicenter studies our costs have been lower than most other participants. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROPHYSIOLOGIC ASSESSMENT OF AT RISK NEWBORNS Principal Investigator & Institution: Nelson, Charles A.; Distinguished Mcknight University Profes; Institute of Child Development; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2001; Project Start 01-JAN-1995; Project End 30-APR-2003 Summary: (adapted from applicant's abstract) In this competing continuation grant we propose to continue testing samples of infants born to diabetic mothers (IDM) and health control infants. The hypothesis under investigations is that iron deficiency with or without fetal hypoxia can selectively damage the structures in the medial temporal lobe that are involved in explicit memory; thus, we predict that IDM infants may be at risk for developing impairments in memory. In our current grant we have focused on evaluating auditory and visual recognition memory in newborn through 12 month old infants. In this competing continuation grant, we intend to a) enroll subjects for one

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Gestational Diabetes

additional year, and b) test these subjects, as well as our existing cohort of subjects, through the age of 4 years. In the first year of life we will use electrophysiological (event-related potentials, or ERPs) and behavioral (e.g., looking time) tools to evaluate infants recognition memory of social) e.g., mother's voice, face) stimuli, as well as evaluate simple auditory discrimination abilities (speech vs. non-speech). At 12 months of age the Bayley exam will be performed, as well as the first of three tests involving deferred imitation abilities (a task presumed to be mediated by the hippocampus). Deferred imitation will also be performed at 18 and 24 months of age. At 36 and 48 months we will evaluate hippocampal and amygdala functioning by studying children's performance in (respectively) a Delayed Non-Matching to Sample paradigm, and in a task of visual recognition of emotion. At all ages beyond 1 year testing will involve the recording of high-density (128 channels) ERPs. Finally, at 48 months of age the WPPSI IQ test will be administered. We are hypothesizing that our IDM infants will show selective deficits in our temporal lobe (memory) tasks, and will perform in the normal range on our IQ outcome measures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NIDDM PRIMARY PREVENTION TRIAL (DPT 2) Principal Investigator & Institution: Pi-Sunyer, F. Xavier.; Director; St. Luke's-Roosevelt Inst for Hlth Scis Health Sciences New York, Ny 10019 Timing: Fiscal Year 2001; Project Start 15-AUG-1994; Project End 30-JUN-2003 Summary: The specific aims of this proposal are two-fold: the first aim is to conduct a multi-center, randomized clinical trial to evaluate the efficacy of intervening to delay or prevent the onset of non-insulin dependent diabetes mellitus (NIDDM) in individuals at increased risk of NIDDM. These individuals will consist of persons with impaired glucose tolerance (IGT) and persons with a previous diagnosis of gestational diabetes mellitus (GDM) who now have IGT. The second aim is to conduct a multi-center, randomized clinical trial to evaluate the efficacy of intervening to prevent the deterioration of previously undiagnosed NIDDM (early, asymptomatic NIDDM found during screening). All subjects will be identified by screening. At least 50% of the sample will be minority. The individuals in the first group will be those with IGT. Individuals in the second group will be those with newly diagnosed NIDDM. Criteria will be set to take only mild NIDDM for the trial, the more severely compromised patients will be referred for treatment. Individuals in both groups will be randomized into an Experimental and a Control Group. Intervention for the Experimental Group will consist of two Levels. Level I will be initiated first and will be a diet, exercise, and behavior modification program. Level II, pharmacological intervention with metformin, will be added in Level I is unsuccessful. Intervention in the Control Group will only be contact every 6 months for glucose testing. Subjects will be followed for 5 yrs with periodic testing for glucose intolerance. The major end point will be the 2 hr post glucose venous plasma. value. Twenty sites will serve as Centers and each site will enroll 98 patients. Each site will emphasize one or two racial/ethnic groups. Our Center will plan to study Caucasian and Black volunteers, although we could also study Hispanics if the protocol writers wished us to do so. There will be an initial planning phase of 1 yr, a clinical trial phase of 5 yrs, and a close-out phase of 1 yr. There will be a Data Coordinating Center that will collect all data and will be in charge of the central clinical laboratory. Our Center has the appropriate population base for both the IGT and the GMD parts of this clinical trial and well-trained, experienced personnel for carrying out the protocol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NIDDM PRIMARY PREVENTION TRIAL (DPT 2) Principal Investigator & Institution: Goldstein, Barry J.; Director; Medicine; Thomas Jefferson University Office of Research Administration Philadelphia, Pa 191075587 Timing: Fiscal Year 2001; Project Start 15-AUG-1994; Project End 30-JUN-2003 Summary: The objective of this multicenter clinical trial is to develop interventions to prevent the development of NIDDM in people with a history of gestational diabetes (GDM) and impaired glucose tolerance (IGT) (Cohort I primary prevention) and the worsening of glucose tolerance in people with newly diagnosed NIDDM with an FPG less than 140 mg/dl (Cohort II, secondary prevention). The central hypothesis of this application is that improvement of insulin resistance will delay the onset of NIDDM in individuals at risk. Therefore, we propose a five year randomized non-pharmacological and pharmacological factorial treatment design aimed to improve insulin resistance: Stratification will assure an overall trial representation of Black (0.4), Hispanic (0.2), Native American (0.2), GDM (0.2) and other races including Caucasian (1.0) Power calculations indicate that 20 centers contributing with 200 patients each will be necessary to fulfill the goal of the study. We will recruit the study subjects from among the Thomas Jefferson University employees. From a preliminary survey of the 7,294 fulltime employees with a response rate of 58% revealed that 52% of the employees are at risk for NIDDM and that 76% have indicated interest in a NIDDM prevention trial, if available. It is hoped that the screening treatment follow-up and outcome measures methods will be translated to the society at large. To this end, it is important that both community and work-site models be developed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NIDDM PRIMARY PREVENTION TRIAL (DPT 2) Principal Investigator & Institution: Bray, George A.; Director; None; Lsu Pennington Biomedical Research Ctr 6400 Perkins Rd Baton Rouge, La 70808 Timing: Fiscal Year 2001; Project Start 15-AUG-1994; Project End 30-JUN-2003 Summary: Non-insulin Dependent Diabetes Mellitus develops in individuals who have peripheral tissue resistance to the action of insulin. These individuals often make normal or increased amounts of insulin but are unable to maintain physiologic blood glucose concentrations because of this defect. Women who develop gestational diabetes mellitus manifest this peripheral insulin resistance and 30% go on to develop noninsulin dependent diabetes within five years of the diagnosis of gestational diabetes mellitus. Women with increased risk for developing NIDDM will be identified as high risk at the Genesis Obstetrical Center in Tampa. These women will be evaluated after pregnancy and divided into two categories based upon fasting plasma glucose values. The first will be those women with fasting plasma glucose values less than 110 mg/ dl. The second will be women with fasting plasma glucose equal to or greater than 110 mg/ dl but less than 140 mg/dl. These individuals will have serum islet cell antibodies, insulin autoantibodies, tested to determine that they do not have autoimmune diabetes mellitus. They will then have an oral glucose tolerance test to determine whether they have normal or impaired glucose tolerance or diabetes mellitus as defined by the National Diabetes Data Group. These individuals will then be randomized into four intervention groups. Each individual will have - peripheral insulin sensitivity determined with a glucose clamp experiment. The first group will be placed on a calorically restricted diet (1600-1800 Kcal/day) and started on an aerobic exercise program designed to reduce body mass index. The next group will receive one of a number of oral agents (sulfonylureas, thiozolidinolione, or magnesium chloride) with

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Gestational Diabetes

potential for reducing peripheral insulin resistance will be evaluated. The third group will have intensified insulin therapy provided 5 days annually since this has been shown in insulin dependent diabetes to reduce peripheral insulin resistance. The fourth group will receive an oral placebo and serve as controls. Each of these individuals will be seen on a quarterly basis to measure their height, weight, blood pressure, fasting plasma glucose levels, glycosylated hemoglobin, sex hormone binding protein, serum insulin and urinary C-peptide levels. Each of these individuals will have a glucose clamp experiment performed to determine the degree of insulin resistance and oral glucose tolerance test as an indicator of glucose homeostasis on an annual basis. This protocol will require two years to enroll the study subjects and 5-6 years of follow-up to determine the role of peripheral insulin resistance and the above interventions for the delay or prevention of NIDDM. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NIDDM PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: Goldberg, Ronald B.; Chief, Division of Diabetes and Metaboli; Medicine; University of Miami-Medical Box 248293 Coral Gables, Fl 33124 Timing: Fiscal Year 2001; Project Start 20-AUG-1994; Project End 30-JUN-2003 Summary: The objectives of this research proposal is to participate as a clinical center in a multicenter trial to determine whether the development of non- insulin dependent diabetes (NIDDM) can be prevented. We propose to identify 200 subjects at high risk for developing NIDDM over a 12-month period. Group I subjects with impaired glucose tolerance (IGT) will be identified from the African-American minority group by oral glucose tolerance testing (OGTT) and Group Il subjects with IGT will be identified from a large data base of women who have had post-gestational diabetes. In the course of screening these populations, it is anticipated that a proportion of subjects with undiagnosed diabetes will be identified by OGTT. Those without fasting hyperglycemia (<140 mg/dl) represent a very high risk group for progression to fasting hyperglycemia and will be included in the trial (Group III). Recruited subjects will be randomized either into a usual referred care (RC) group and a special intervention (SI) group aimed at achieving dietary modification (4% weight loss) and increased physical activity (600 Kcal/week) for a 4-5 year period. Half of the SI group will in addition receive the antihyperglycemic drug, Metformin (850 mg b.i.d.), and the other half placebo. Performance of yearly OGTT's will be used to compare rates of deterioration to fasting hyperglycemia in each of the three treatment groups, in addition to changes in insulin and cardiovascular risk factors. Subjects with IGT will be analyzed separately from those originally found to have diabetes, since the natural history and response to treatment may differ between the two. It is anticipated that intervention in patients at high risk for diabetes, with diet, physical activity or pharmacologic agents may slow or prevent their deterioration to NIDDM and offer a new approach to the treatment of this disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NIDDM PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: Saudek, Christopher D.; Professor of Medicine; Endocrinology and Metabolism; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-SEP-1994; Project End 30-JUN-2003

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Summary: The application proposes to be a collaborating clinical center in the Noninsulin-dependent diabetes (NIDDM) Primary Trial. Working on a Steering Committee, we will help design the trial and Operations Manual in Year 01, implement it in Years 02-06, and close it in Year 07. The enormity of the NIDDM problem, rationale for primary prevention, and specific background are reviewed. Eligibility will be determined by the presence of impaired glucose tolerance, a history of gestational diabetes mellitus, or previously undiagnosed mild (FPG less than 140 mg/dl) NIDDM. Recruitment of more than 200 subjects randomized will be accomplished by proven methods of community screening and mailings, in large employment and population centers, targeting more than 50% African-American subjects. The trial will be implemented in an existing facility (Hopkins ProHealth) designed and staffed specifically for the implementation of large, multicenter, NIH-supported clinical trials. A faculty with wide diversity of expertise in clinical diabetes, epidemiology, behavioral change, exercise, diet and community intervention strategies and assessment will take part in study development and implementation; an expert staff is already in place at ProHealth, including a Study Coordinator, Recruiters, Interventionists and Data Collectors, will implement the study on a daily basis. Based on preliminary biostatistical considerations, a 3-arm trial is proposed, comparing intensive life style changes (diet and increased activity) with a pharmacologic arm (sulfinylureas) and a placebo are. The proposed primary outcome measure is incidence of NIDDM with FPG greater than 140 mg/dl; secondary outcome measures include a stepped deterioration of glucose tolerance, cardiovascular risk factors associated with NIDDM, quality of life measures, cost, and morbidity/mortality. Intervention strategies and visit schedules are outlined. Assuming a placebo-group event rate of 5% to 10% per year, two intervention groups will detect a 22% to 30% effect of interventions. In sum, this is a strong faculty and staff with extensive experience, an up-and-running clinical trials facility ready to take part in the collaborative effort of designing and implementing this primary prevention trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NIDDM PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: White, Neil; Pediatrics; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2001; Project Start 20-AUG-1994; Project End 30-JUN-2003 Summary: The applicants propose that the overall goal of the proposed NIDDM Primary Prevention Trial should be to prevent the development or progression of early NIDDM in high risk volunteers with IGT or a prior history of gestational diabetes mellitus (GDM) by correcting behaviors thought responsible for the increase in NIDDM. The proposed intervention is centered on an intensive, multi-disciplinary, program to promote long-term weight loss and increased physical activity among 200 volunteers who work in or live near the Washington University Medical Center in St. Louis. The proposed intervention is designed to minimize physical discomfort and life style disruption, to emphasize gradual, moderate changes in the foods usually eaten, to maximize continued adherence over five years and to be acceptable to both white and African American volunteers. In order to sustain this weight loss long term, it is proposed to have the intensively managed patients seen regularly by trained members of a multidisciplinary team that will consist of an exercise technician, a nutritionist, a nurse, and a social worker trained in behavioral medicine. Volunteers randomized to the control group will be seen quarterly and provided with state of the art educational and motivational materials that will include recommendations for weight loss, increased physical activity aid a prudent diet low in saturated fats and cholesterol. Three first

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stage studies are proposed for high risk white and African American volunteers. The NIDDM Primary Prevention Study, will compare rates of conversion from persistent IGT to persistent, mild NIDDM (defined operationally as patients with fasting plasma glucoses less than 140 mg/dl and both one and two hour values above 200 mg/dl) and improvement to normal glucose tolerance. The NIDDM Early Intervention Study, will examine the effects of the intensive intervention on patients found during screening to have mild NIDDM. The third, GDM Primary Prevention Study, will compare rates of progression from normal glucose tolerance to IGT or NIDDM in women with previous GDM. A single, second stage, intervention is proposed for volunteers who proceed to develop sustained fasting glucoses> 140 mg/dl. These patients will remain in their original treatment assignment (i.e. intensive or conventional treatment) for the duration of the Trial but will be randomly assigned to one of two drug treatment protocols to be chosen by early 1995 during the design of the trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NIDDM PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: Horton, Edward S.; Director, Endocrinology & Metabolism; Joslin Diabetes Center Boston, Ma 02215 Timing: Fiscal Year 2001; Project Start 20-AUG-1994; Project End 30-JUN-2003 Summary: Several factors are known to increase the risk of developing NIDDM, including a family history of diabetes, previous history of gestational diabetes (GDM), obesity, decreased physical activity, presence of impaired glucose tolerance (IGT) or insulin resistance. Moreover, the incidence of NIDDM is higher in several racial and ethnic minority groups in the US including African Americans, Hispanics, Native Americans, Native Alaskans, and Asian Americans. A five year multicenter trial is proposed to evaluate intervention strategies to prevent or delay the progression of IGT to NIDDM, or the progression of previously undiagnosed NIDDM with normal fasting glucose to fasting hyperglycemia. Within the context of the overall study design, the Joslin Diabetes Center, (JDC) South Cove Community Health Center (SCCHC) and Brigham and Women's Hospital (BWH) will collaborate to form a participating clinical center and will identify a cohort of 200 high risk patients (equal to approximately 100 patients with IGT or previously undiagnosed NIDDM and 100 obese women with a previous history of GDM) to be prospectively and randomly assigned to one of four intervention groups, comprising a 2 x 2 factorial design. Half of the patients will receive standard diet and exercise recommendations (standard group), while half will receive an intensive lifestyle modification program, including individualized dietary and exercise programs, instruction in behavioral change, stress reduction, smoking cessation and close follow up (intensive group). Within each group, half will be randomized to treatment with low dose sulfonylurea, and half will receive placebo. Volunteers will be screened and recruited from specifically identified high risk populations. These include first degree relatives of patients with NIDDM at the JDC, first degree relatives of patients with NIDDM at the SCCHC, first degree relatives of patients with NIDDM in the Harvard Community Health Plan and patients with a past history of obesity and GDM at BWH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OBESITY, GLUCOSE METABOLISM AND DIET IN OLDER WOMEN Principal Investigator & Institution: Ryan, Alice S.; Associate Professor; Medicine; University of Maryland Balt Prof School Baltimore, Md 21201

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Timing: Fiscal Year 2001; Project Start 01-SEP-1997; Project End 31-AUG-2003 Summary: The candidate is an Exercise Physiologist whose initial research and funded pilot projects focused on the effects of diet and exercise on obesity and glucose metabolism in sedentary normals and patients with diabetes. The proposed MRSDA will allow her to gain training in the areas of muscle and fat metabolism while investigating the interactions of aging and glucose metabolism in women with a high risk of developing diabetes. Research: Gestational diabetes mellitus (GDM) affects 90,000 women per yr in the U.S. Within 10-20 y of pregnancy, 40-65% of these women develop non-insulin dependent diabetes mellitus (NIDDM); a disease linked to obesity, physical inactivity and characterized by abnormalities in glucose and fatty acid metabolism. We hypothesize that women with a history of GDM who present with impaired glucose tolerance (IGT) or NIDDM after the menopause will be sedentary, have visceral obesity and abnormalities in their glucose, fat and muscle metabolism. A structured weight loss and aerobic exercise program (WL+AEX) will be more effective than weight loss (WL) alone in reducing visceral obesity and increasing aerobic capacity to 1) decrease free fatty acid (FFA) levels and increase fat oxidation; 2) increase muscle GLUT-4 protein and glycogen storage; and 3) enhance insulin sensitivity thereby improving glucose tolerance. This study will investigate glucose homeostasis in IGT or NIDDM (N=80) postmenopausal women (50-60 y) with a history of GDM. Measurements will be performed at baseline and after 6 months of WL or WL+AEX. Follow-up of patients will occur 1 yr after the intervention(s) to evaluate the patient's glucose tolerance, body composition and VO2max. Total and regional percent body fat, fat mass, lean tissue mass and hone mineral content will be determined by dual-energy x-ray absorptiometry. Computed tomography will quantify' intraabdominal and subcutaneous adipose tissue areas and mid-thigh muscle and adipose tissue area. VO2 max will be measured during a progressive treadmill test. Hyperinsulinemiceuglycemic clamps with tritiated glucose will assess glucose utilization, insulin sensitivity, and quantitate the role of the liver with respect to glucose production. During the clamp, plasma FFA levels and fat oxidation will be determined. Muscle biopsies of the vastus lateralis will be obtained for measurement of fiber characteristics, GLUT-4 transporters, and oxidative enzyme levels. The effects of WL or WL+AEX program on glucose homeostasis in IGT or NlDDM postmenopausal women with prior GDM are unknown. The projected study will contribute valuable information to help develop guidelines for the management of the metabolic control in the obese glucose intolerant and diabetic patient. Environment: Receipt of this MSRDA with the guidance of Drs. Goldberg and Nagey will allow the candidate to launch a career in gerontology studying disorders of glucose homeostasis in women at a high risk for NIDDM, and investigate the mechanisms by which WL or WL+AEX improve carbohydrate metabolism. The interdisciplinary environment in the School of Medicine provides excellent training and resources for advanced learning in gerontology and metabolism. The proposed work will provide the candidate with the requisite skills and training to embark on an independent research career. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ORAL GLUCOSE TOLERANCE TEST & PREPARATORY DIET Principal Investigator & Institution: Mastrobattista, Joan M.; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PERINATAL IMPRINTING OF ENERGY METABOLISM IN THE FETUS Principal Investigator & Institution: Bernstein, Ira M.; Associate Professor; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PERIODONTAL DISEASE IN DIABETIC WOMEN WITH PRETERM BIRTH Principal Investigator & Institution: Offenbacher, Steven; Professor of Periodontology; Periodontology; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): This pilot proposal is in response to an RFA to Prevent or Reduce Oral Health Disparities and seeks to establish a collaborative study partnering the periodontal and molecular epidemiology expertise at the University of North Carolina School of Dentistry with the Obstetrics/Gynecology expertise at the University of Hawaii School of Medicine to examine the role of periodontal disease in pre-term deliveries among pregnant diabetic Asian & Pacific Islander (API) women. This is an understudied minority population with a high prevalence of both diabetes and pre-term delivery. Periodontal disease is an oral infection that is more severe among diabetics and also increases insulin resistance among diabetics. Periodontitis also is associated with increased risk for pre-term delivery, pre-term premature rupture of membranes and growth restriction. Diabetes among pregnant women is a risk factor for both pre-term delivery and macrosomia. Thus, we seek to examine whether periodontal infection among diabetic women may provide some contribution to the observed high rate of pre-term delivery among API diabetics. Specifically, this proposal seeks to conduct a pilot case-control study to determine the extent of periodontal disease in API diabetic (Type 1, Type 2 or gestational) and non-diabetic women who have term and pre-term deliveries (<37 weeks gestational age). Approximately 92 diabetic and 92 nondiabetic pre-term delivery API mothers and 184 diabetic and 184 non-diabetic term delivery API mothers will be studied (frequency matched on race 1 case: 2 controls). Full-mouth periodontal examinations will be performed using standardized methods and calibrated examiners. Preliminary data will be generated by analyzing fetal cord blood for markers of fetal exposure to oral pathogens of maternal origin, as indexed by bacterial-specific fetal IgM levels and fetal stress as reflected by slCAM and CRP levels. In addition a subset of fetal membranes will be analyzed for protein expression of IL-lb, TNFa and IL-6 by ELISAs and MMP-8 mRNA by Northerns. Pilot data will be generated to support an R01 application that will originate from the U of H (a minority institution) with Dr. Millar as PI, to test the hypothesis that periodontitis is more extensive among API diabetic women and associated with higher rate of fetal exposure to oral pathogens than among non-diabetics and that the prevalence of periodontal disease and frequency of fetal exposure is higher among pre-term deliveries for both diabetics and nondiabetics, as compared to term deliveries. In this collaboration UNC will also provide the U of H study personnel the periodontal and molecular epidemiology research training and experience needed in multi-disciplinary studies of periodontal disease and obstetrics to conduct the planned R01 application. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PILOT--ETHNIC GROUPS AT RISK FOR ADVERSE PREGNANCY OUTCOMEN Principal Investigator & Institution: Silva, Jana; University of Hawaii at Manoa Honolulu, Hi 96822 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2007 Summary: SUBPROJECT ABSTRACT NOT PROVIDED Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PLACENTAL GLUCOSE TRANSPORT IN DIABETIC PREGNANCIES Principal Investigator & Institution: Illsley, Nicholas P.; Associate Professor; Ob/Gyn & Women's Health; Univ of Med/Dent Nj Newark Newark, Nj 07103 Timing: Fiscal Year 2001; Project Start 01-AUG-1999; Project End 31-JUL-2003 Summary: Diabetes in pregnancy is associated with a number of perinatal problems such as macrosomia and neonatal hypoglycemia. There is also evidence suggesting that diabetes or even impaired glucose tolerance during pregnancy may be risk factors for the development of diabetes in the offspring. It is clear that the perinatal consequences of gestational diabetes are not simply a function of maternal hyperglycemia, since macrosomic infants are frequently born to mothers whose diabetes is well controlled. Preliminary research suggests that there are increases in the expression and activity of GLUT1 glucose transporters in the syncytial basal membrane of placental tissue from women whose diabetes is adequately controlled. Thus there appear to be continuing perturbations in a system intimately involved in fetal growth and development. It is hypothesized that elevated fetal glucose, resulting from maternal fetal hyperglycemia, causes, through stimulation of fetal growth factors, increased fetoplacental growth including increased expression of the basal membrane GLUT1 glucose transporter, the rate-limiting barrier to placental glucose transport. The resultant increase in transplacental glucose flux prolongs fetal hyperglycemia and leads to continued derangement of the fetal growth axis, despite normalization of maternal plasma glucose. This project is designed to explore this hypothesis by investigating the expression and activity of the human placental GLUT1 glucose transporter in diabetic pregnancies. Aim number 1 : To characterize the changes in placental glucose transporter expression and activity in diabetic pregnancy and to correlate these parameters with measures of maternal glycemic status and fetal growth factors. Aim number 2 : To assess the functional consequences of changes in glucose transporter expression and activity for the placental transfer of glucose. Aim number 3 : To establish the mechanisms responsible for the changes in glucose transporter expression and activity through transcriptional and posttranscriptional modulation and through short term regulatory events. Aim number 4 : To examine the mechanisms governing the (re)distribution of transporters between microvillous and basal membranes. The information obtained from these experimental approaches will significantly advance our understanding of the fetal response to maternal diabetes and the factors generating adverse perinatal consequences. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PRECOSE IN GLUCOSE AND HORMONES OF GESTATIONAL DIABETES Principal Investigator & Institution: Matsumoto, Larry; University of California San Diego 9500 Gilman Dr, Dept. 0934 La Jolla, Ca 92093

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Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT

PREGNANT

BLACK

DIABETIC

WOMEN--ADHERENCE

TO

Principal Investigator & Institution: Brooks, Latina M.; None; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001; Project Start 15-NOV-2000 Summary: Diabetes during pregnancy is a major health problem. Pregnant women with diabetes are at risk for acute and chronic complications while their infants are at high risk for morbidity and mortality. African American childbearing women have higher rates of diabetes, higher maternal complication rates and higher rates of low birthweight infants. These combined factors make study of pregnant African American women with diabetes a very timely and important group to study. The purpose of the proposed research is to examine barriers to treatment adherence in African American women whose pregnancies have been complicated by gestational diabetes. Using focus groups, modification of the Barriers to Self-Care Scale, and the Diabetes Compliance Questionnaire, the proposed study will examine: 1) what aspects of the diabetes treatment regimen are most difficult to adhere to; 2) environmental and social factors that act as barriers to adherence; 3) whether barriers and measures of adherence vary according to age, parity, or level of education; and 4) environmental and social factors that may be related to adherence among African American women with gestational diabetes. This information is basic to developing acceptable and effective plans of care for this group. The major long-term goal of this program of research is to develop acceptable, and effective treatment plans that improve pregnancy outcomes for African American women whose pregnancies are complicated by diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRIMARY PREVENTION PROGRAM -DATA COORDINATING CENTER Principal Investigator & Institution: Fowler, Sarah E.; Professor and Director; Statistics; George Washington University 2121 I St Nw Washington, Dc 20052 Timing: Fiscal Year 2001; Project Start 20-AUG-1994; Project End 30-JUN-2003 Summary: (Directly incorporated from the application) The Biostatistics Center of The George Washington University proposes to work in cooperative agreement with the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) to serve as the Data Coordinating Center (DCC) for a proposed multi-center clinical trial of the primary prevention of non-insulin dependent diabetes mellitus (NIDDM). Adiposity and inactivity have been established as critical factors in the etiology of glucose intolerance and are strongly associated with increased risk of glucose intolerance. We propose to determine the safety and efficacy of an intensive lifestyle intervention or prophylactic use of an oral hypoglycemic agent on the incidence of NIDDM among high risk patients (obese, minority, family history of NIDDM, history of gestational diabetes mellitus) in a state of impaired glucose tolerance (IGT). The objective of the one year planning phase is to develop a protocol, operations manual and data collection forms to be implemented in a five year full-scale clinical trial. The trial will require large-scale screening and randomization of 4,000 high risk patients with a diagnosis of IGT over a one year period in 20 clinical centers. Eligible patients will be randomized to

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"conventional" dietary counseling or one of the comparison groups (intensive lifestyle intervention or an oral hypoglycemic agent). Randomized patients will be followed for a minimum of four years with quarterly follow-up visits. Conversion from a state of IGT to overt NIDDM will be determined by semi-annual 2-hour oral glucose tolerance tests (OGTTs) following a 75 g glucose load confirmed by a central laboratory. Covariates and secondary outcomes include carotid ultrasound imaging, electrocardiograms, serum lipids, albumin excretion rate, adiposity, insulin sensitivity, hemoglobin A1c, and fundus photographs. The specific aims of the DCC are to provide centralized support and biostatistical consultation in the development of the patient management protocols, operations manual, data collection forms and randomization procedures; implementation of a data processing system including data quality assessment; interim analysis of protocol performance, patient safety and treatment efficacy; and final analysis for publication of the results in collaboration with the clinical investigators. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: Olefsky, Jerrold M.; Professor; Medicine; University of California San Diego 9500 Gilman Dr, Dept. 0934 La Jolla, Ca 92093 Timing: Fiscal Year 2001; Project Start 10-SEP-1994; Project End 30-JUN-2003 Summary: Non-insulin dependent diabetes mellitus (NIDDM) is a common, chronic disease with increasing incidence in the United States, responsible for an enormous burden of morbidity and mortality. Most of the morbidity, mortality, and financial burden of NIDDM is related to the development of complications. Consequently, prevention of NIDDM, or even a substantial delay in disease onset, will have a major financial and health impact in this country. Compelling evidence exists to indicate that insulin resistance is an early defect present in the pre-diabetic state. Consequently, it is logical to direct primary prevention interventions at improving this metabolic defect. It is well established that physical exercise is a lifestyle intervention which can ameliorate insulin resistance, and therefore, might prevent NIDDM. Troglitazone is a newly available oral hypoglycemic agent, from the Thiozoladinedione class of drugs. This agent exerts its effects primarily by improving insulin resistance, and this has been demonstrated in NIDDM and IGT populations. Consequently, we propose a 2 X 2 factorial design in which patients will be randomly assigned in a double blind fashion to either Troglitazone, placebo, exercise, or Troglitazone plus exercise groups. The study will be performed in patients with IGT, as well as in those with NIDDM who do not have fasting hyperglycemia. Power calculations indicate that a total of 4,000 patients in this multi-center cooperative trial will be sufficient to detect positive outcomes, and this will incorporate approximately 200 patients/Clinical Center. This study cohort will consist of patients with IGT, former gestational diabetes mellitus, NIDDM without fasting hyperglycemia, and approximately 50% of all subjects should be from minority populations. This study will be conducted over 7 years, including a planning phase, recruitment phase, 4-5 year treatment phase, and close out phase. This study should provide a rigorous test of the hypothesis that the proposed interventions will prevent NIDDM. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: Schade, David S.; Professor; Medicine; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131

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Timing: Fiscal Year 2001; Project Start 20-AUG-1994; Project End 30-JUN-2003 Summary: During the last 30 years, the combined mortality of the Native American and Hispanic populations living in New Mexico has almost doubled. This dramatic rise can be partially attributed to the increased incidence of type II diabetes. We will assess the outcome of interVention strategies to prevent the onset of type Il diabetes in high risk groups (impaired glucose tolerance and/or a history of gestational diabetes). The two principal minority groups in the state of New Mexico will be studied: the urban Native American population and the urban Hispanic (Mexican-American) population. Recruitment techniques will include direct interrogation of three large health care databases and participation of many community support organizations involved with Native Americans and Hispanics. Two hundred individuals (100 Native Americans, 100 Hispanics) will be randomized into one of four treatment groups. The first treatment group will receive standard therapy (diet plus exercise counseling every six months). The second treatment group will also receive standard therapy plus glyburide 5 mg once per day. The third treatment group will receive' intensified dietary instruction plus scheduled exercise with the goal of achieving ideal body weight and a healthy lifestyle. These individuals will exercise three times per week and meet monthly for dietary counseling and body weight measurements. The fourth treatment group will receive the same therapy as the third group (a combination of the intensified dietary instruction and scheduled exercise) plus glyburide 5 mg once per day. In order to increase adherence, volunteers and their families will interact with nurse/educators sensitive to the cultural needs of the study population. Positive reinforcement techniques will be used. Primary study endpoints include 75 gm oral glucose tolerance testing every six months plus measurement of integrated C-peptide and insulin. Secondary endpoints include hemoglobin AlC, body composition measurements, body weight, dietary alterations, and changes in health status. Administratively, a Central Coordinating Unit, composed of individuals experienced in the various treatments, will oversee the trial. Guidance to the Central Coordinating Unit will be provided by an Advisory Committee comprised of prominent members of both the Native American and Hispanic communities. A nurse/educator will be provided for each of the three satellite clinics caring for the volunteers. Comparing standard treatment against other treatment(s), the protocol design provides 90% power to detect a 33% minimum improvement in the conversion rate from impaired glucose tolerance to diabetes, p<0.Ol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: Molitch, Mark E.; Professor; Northwestern University Office of Sponsored Programs Chicago, Il 60611

Medicine;

Timing: Fiscal Year 2002; Project Start 20-AUG-1994; Project End 30-APR-2003 Summary: This proposal is submitted in response to the RFA: DK-93-07, "NIDDM primary Prevention Trial" NIDDM is a major public health problem in the United States and its prevalence is disproportionately high among a number of minority groups including Native American, Hispanics and African-Americans, Members of these minority groups, obese subjects, persons with a family history of NIDDM among first degree relatives and women with prior gestational diabetes mellitus (GDM) of all racial and ethic groups are at high risk for the development of NIDDM. We have developed a protocol for a multicenter study to test the hypothesis that the appearance of NIDDM can be delayed or prevented by life style or pharmacological intervention in women with prior GDM or in subjects at high risk for NIDDM who presently have impaired glucose tolerance (IGT). We propose to compare the rate of progression of IGT to

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NIDDM and mild NIDDM to NIDDM with fasting hyperglycemia in groups receiving intensive life-style intervention with diet, (low fat moderated fiber reduced calorie) and exercise (supervise instruction and maintenance of physical fitness) or drug treatment (sulfonylurea oral hypoglycemic agent or an anorectic agent) with conventional advice regarding diet and exercise. We propose that subjects with prior GDM represent half of the women recruited for the study and that the total population enrolled include 20 percent Hispanics, 20 percent African-American, 10 percent native Americans and 50 percent Caucasians and members of other minorities. We have identified a large population of women with previous GDM that includes approximately equal numbers of Black, hispanic and White women and are prepared to serve as a center for a concentrated subgroup enrollment of such subjects. We are also prepared to recruit Hispanic, African- American and White subjects from the general population who are at high risk for IGT. Our study investigators have extensive experience in the care of patients with diabetes mellitus, have broad and in depth experience in collaborative diabetes related and cardiovascular disease related clinical and epidemiological studies. These projects have provided extensive experience in recruitment and retention of minority subjects including women with prior GDM. The project investigators are prepared to collaborate and cooperate in the final design of the study protocol by the steering committee as well as implement it with enthusiasm and to the best of our collective abilities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROMOTING HEALTHY LIFESTYLES AMONG WOMEN Principal Investigator & Institution: Kieffer, Edith C.; Health Behavior and Hlth Educ; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): The prevalence of type 2 diabetes is rising among African American and Latino women of childbearing age, with severe consequences for individuals, families and communities. Diet and exercise behaviors, excessive pregnancy weight gain and postpartum weight retention may lead to the development of longerterm obesity that contributes to this trend. The prenatal-postpartum period offers a unique opportunity for interventions that may reduce these risks. The overall aim of this community-based randomized controlled clinical trial is to demonstrate the effectiveness of a healthy lifestyle intervention tailored to the needs of pregnant and postpartum African American and Latino women in Detroit, Michigan and designed to reduce behavioral and clinical risk factors for type 2 diabetes. Two hypotheses (specific aims 1 and 2) will be tested: Compared to the control intervention, healthy lifestyle intervention participants will have 1) improved levels of protective behaviors (increased daily level of physical activity and improved daily dietary composition) that reduce the risk of type 2 diabetes; and 2) improved their status on clinical measures of risk for type 2 diabetes (anthropometric and metabolic status). Specific aim 3 addresses whether theory-based variables, including changes in attitudes, behavioral and control beliefs, perceived social support and behavioral intention change from baseline, and whether these changes influence behavioral outcomes. Specific aim 4 will identify aspects of project planning and implementation that contribute. to achievement of behavioral and clinical outcomes. The study will be conducted by an existing partnership between university and community organizations that has a successful record of communitybased participatory epidemiological and intervention research. The healthy lifestyle intervention draws from the theories of planned behavior and social support and takes

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into account specific social, cultural, economic and physical environmental challenges faced by low-income women in Detroit. It addresses the rapidly changing context of pregnancy and the postpartum period, which bring additional challenges but also opportunities for adoption and maintenance of healthy behaviors. The target population will be 400 Latino and African American women who will be recruited in prenatal care settings during their first trimester of pregnancy. After a qualifying period designed to reduce later attrition, 320 will be randomized into either a healthy lifestyle intervention or a control intervention group. The healthy lifestyle intervention will include a 17session curriculum that integrates pregnancy, childbirth and postpartum preparation, social support from a Women's Health Advocate (WHA) and group social support activities. The control intervention group will receive a 4-session curriculum that integrates pregnancy, childbirth and postpartum preparation. Measures will be collected at 10-14 weeks, -26 weeks and -36 weeks of gestation and -6 weeks postpartum. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PSYCHIATRIC DISORDERS IN ADULTS WITH DIABETES MELLITUS Principal Investigator & Institution: Lustman, Patrick J.; Professor of Psychiatry; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2001; Project Start 01-JUL-1985; Project End 31-MAR-2004 Summary: Diabetes increases the risks of maternal, fetal, and neonatal complications from pregnancy. Tight glycemic control during pregnancy reduces these risks but is difficult to achieve. Major depression is present in approximately 25 percent of diabetic women and is associated with significant deterioration in glycemic control. There has been no study in diabetic or nondiabetic subjects of depression treatment during pregnancy, and the effects of depression treatment on obstetric outcomes remain unknown. Recently, we showed that cognitive behavior therapy (CBT) was an effective nonpharmacologic treatment for depression in diabetes that produced durable improvements in glycemic control. In this study we plan to treat major depression in pregnant diabetic women with CBT and determine its effects on depression, glycemic control, and maternal and neonatal outcomes. We also plan to assess the relationship of diabetes during pregnancy and postpartum depression to neuropsychological development of the infants. 150 pregnant diabetic women will be recruited for study: 100 with and 50 without major depression. The nondepressed subjects function only as a comparison group in some of the statistical analyses. All subjects will be assessed serially during the 2nd and 3rd trimesters and the 1 year postpartum period while receiving the usual degree of intensive medical care for the diabetic pregnancy. Depressed patients will be assigned randomly to treatment with individual CBT (n =50) or supportive counseling (n =50). The pregnancy care team is informed of the depression status of all subjects and advised to give usual care for depression. The design blinds the pregnancy care team to treatment assignment, controls for nonspecific effects of attention and the influence of enhanced diabetes control on mood, provides a comparison group likely to remain depression free during gestation and the postpartum period, and is sensitive to human subject issues. We hypothesize that CBT will be superior to supportive counseling in terms of improving depression and glycemic control, and that the treatment-related improvements in glycemic control will reduce the adverse effects of diabetes in pregnancy, including c-section, macrosomia, neonatal hypoglycemia, and fetal hyperinsulinemia. We also expect that by improving glycemic control during pregnancy and reducing the risk of postpartum depression CBT will improve neuropsychological development in the offspring. The findings should

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demonstrate the relevance of depression treatment to maternal and neonatal outcomes of diabetic pregnancies and translate directly to the management of patients living with diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RACE AND LONG-TERM DIABETES SELF-MANAGEMENT IN AN HMO Principal Investigator & Institution: Ross-Degnan, Dennis; Harvard Pilgrim Health Care, Inc. 93 Worcester St Wellesley, Ma 02481 Timing: Fiscal Year 2002; Project Start 15-JAN-2002; Project End 31-DEC-2004 Summary: (provided by applicant): This project will examine the complex relationships between race, diabetes self-management (including self-monitoring of blood glucose and diabetes drug therapy), glycemic control, and diabetes complications in a managed care setting over a nine-year period. African Americans with diabetes are less likely to be in glycemic control, a major risk factor for development of complications, including nephropathy, retinopathy, and peripheral vascular disease. Randomized controlled trials suggest that diabetes self-management including patient education, drug therapy, changes in diet, and regular exercise can improve glycemic control in the African American population. However, there is little epidemiological evidence regarding the role of race/ethnicity as a determinant of adherence to recommended diabetes selfmanagement practices, or regarding the relationship between self-management, glycemic control, and subsequent clinical outcomes. Further, previous studies of race and diabetes self-management have been limited by short study periods, inadequate sample size, and reliance on self-reported measures of self-monitoring of blood glucose. The clinical setting for this study is Harvard Vanguard Medical Associates (HVMA), a large multi-site, multi-specialty group affiliated with Harvard Pilgrim Health Care. HVMA consists of 14 health centers serving over 300,000 people in the Boston area. We will use an open cohort design to enroll all adult (l8 years) patients between 1991 and 1999 who have 24 months or more of uninterrupted enrollment in HVMA following ascertainment of non-gestational diabetes, defined by (1) hospital discharge diagnosis of diabetes mellitus, (2) outpatient diagnoses of diabetes mellitus, HbAlc lab test result 8.0, or use of a diabetes drug (insulin, sulfonylurea, or metformin). We estimate that the cohort will include approximately 1,800 adults identified as African American and 5,000 identified as Caucasian. Access to HVMA computerized medical records, hospital emergency room and inpatient claims, lab, and pharmacy data will allow us to create reliable, objective measures of self-monitoring (home glucose monitor test strip use), drug therapy. glycemic control (HbAlc lab results), and diabetes complications (as measured in outpatient visits, emergency room visits, and hospitalizations). Stratifying by type of drug therapy (insulin/combined therapy vs. oral therapy), we will use descriptive analyses, generalized linear mixed models, and proportional hazards models to (1) identify racial differences in self-management practices and diabetes-related health outcomes over time; (2) assess whether African American race is an independent predictor of self-monitoring practice or adherence to drug regimen; and (3) whether there are racial/ethnic differences in the association between self-management and specific clinical endpoints, including glycemic control (HbAlc<8.0) and the incidence of diabetes-related complications over the nine-year study period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RISK OF TYPE 1 AND TYPE 2 DIABETES AMONG YOUNG FINNS Principal Investigator & Institution: Tuomilehto, Jaakko O.; National Public Health Institute Mannerheimintie 166, Sf-00280 Helsinki, Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2006 Summary: (provided by applicant): The incidence of type 1 diabetes (DM1) in children (14 years or under) is the highest in the world in Finland. DM1 can, however, develop at any age. Clinical, biological and epidemiological data obtained from children may not be fully applicable to adults with DM1. It will be very important to know about the factors that postpone the disease onset to occur later in life. Such information might be crucial for the development of preventive measures against DM1. Type 2 diabetes (DM2) is increasing rapidly worldwide and its age-of-diagnosis is becoming younger. There are hardly any population-based epidemiological data on DM2 in youth or young adults. This research aims at assessing the incidence of DM1 and DM2 in young adults and we have a unique possibility to compare findings with data from Finnish DM1 children. We will determine the incidence of DM1 and DM2 in young adults (15-39 years) in Finland during 1992 to 2001. This will also permit us to calculate the 10-year trend in incidence, and the cumulative incidence of DM1 in the Finnish population by the age of 40 years. We will assess the familial aggregation and sibling risk of DM1 in young adults and compare it with that in childhood-onset DM1. In addition, we have a possibility to ascertain diabetes in the offspring of these patients with DM1 and DM2 whose age-at-onset of diabetes is in preadolescence or in adulthood. The reasons for the apparent gender differences in the risk of DM1 and the familial aggregation of DM1 will be studied in detail. The effect of intra-uterine growth retardation, fetal programming, and growth and weight development during childhood on the risk of DM1 and DM2 in young adults will be assessed. Cases originally classified as DM2 or gestational diabetes will be followed up five to nine years, and thereby population-based estimates for slowonset DM1 will be obtained. The detailed epidemiological data obtained in this study will also lay a foundation for further research of etiological factors, genetic and environmental, predisposing to DMI and DM2 in this age group. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SEARCH FOR THE MOLECULAR CAUSES OF DIABETIC EMBRYOPATHY Principal Investigator & Institution: Loeken, Mary R.; Assistant Professor; Joslin Diabetes Center Boston, Ma 02215 Timing: Fiscal Year 2001; Project Start 01-AUG-1998; Project End 31-JUL-2003 Summary: Diabetic embryopathy is a well recognized, but poorly understood, complication of diabetes in which the early embryo of a diabetic method develops congenital malformations. The objective of the work proposed here is to study the regulation by diabetes of a critical development control gene, Pax-3, during the development of one of the most common diabetes- associated malformations, neural tube defects (NTD). Using a new mouse model that was developed in my laboratory, we have observed that the rate of NTD is about three-fold higher in the embryos of diabetic mice than in the embryos of non-diabetic mice. The high rate of NTD is correlated with reduced expression of Pax-3, an embryonic gene which encodes a DNA-binding transcription factor that is required for formation of the brain and spinal chord. Subsequent to the reduction in expression of Pax-3, and apparently as a consequence, cells forming the neural tube are seen to undergo unscheduled apoptosis. There are three specific aims of this proposal. In the first aim, we will test the hypothesis that

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glucose toxicity associated with maternal diabetes is responsible for abnormalities in embryonic gene expression, apoptosis, and NTD. This will be accomplished by (1) attempting to prevent glucose toxicity by lowering glucose levels in pregnant diabetic mice with insulin or phlorizin administration, (2) attempting to induce glucose toxicity in pregnant non-diabetic mice by a hyperglycemic glucose clamp procedure, (3) attempting to induce glucose toxicity during culture of post-implementation mouse embryos in media containing elevated levels of glucose, and (4) testing whether expression of the high Km GLUT-2 glucose transporter renders the early embryos sensitive to glucose toxicity during diabetic pregnancy. In the second aim, we will determine whether the reduction in Pax-3 mRNA observed in embryos of diabetic and non-diabetic mice is due to transcriptional or post-transcriptional control, and identify the Pax-3 control elements involved in inhibition by diabetes. In the third aim, we will test the hypothesis that mouse strains which fail to develop NTD during diabetic pregnancy are resistant to the inhibition of Pax-3 expression that occurs in strains which are susceptible to NTD. These experiments will reveal, in a way that has not been done in the past, the molecular mechanisms by which embryonic development is during diabetic pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SENSITIZATION OF INSULIN STIMULATED PHOSPHORYLATION BY EXERCISE Principal Investigator & Institution: Mandarino, Lawrence; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2001 Summary: This study is part of a program project the overall goal of which is to determine how insulin resistance alters insulin-stimulated phosphorylation events in vivo in humans and to determine how exercise interacts with insulin to influence these early phosphorylation events. This study will determine if a prior bout of exercise enhances subsequent insulin stimulation of protein phosphorylation by comparing and contrasting five groups: nondiabetic subjects, patients with impaired glucose tolerance, normal glucose tolerant subjects who have a parent with NIDDM, subjects with a history of gestational DM, and subjects with NIDDM. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TROGLITAZONE IN WOMEN WITH PRIOR GESTATIONAL DIABETES MELLITUS Principal Investigator & Institution: Buchanan, Thomas S.; Professor and Director; University of Southern California 2250 Alcazar Street, Csc-219 Los Angeles, Ca 90033 Timing: Fiscal Year 2001; Project Start 01-DEC-2000; Project End 30-NOV-2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TROPHOBLAST REGULATION /ANGIOGENESIS /DIABETIC PLACENTA Principal Investigator & Institution: Golos, Thaddeus G.; Associate Professor; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2006

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Summary: The placenta and uterus conduct an essential dialogue at the maternal- fetal interface for the initiation, maintenance and completion of pregnancy via the coordinated functions of trophoblasts in contact with maternal blood, and the fetal vasculature within the chorionic in the placental vascular system in diabetic pregnancies is incompletely understood. Our overall hypothesis is that the dysregulation of glucose disposition in Type I diabetic pregnancy precipitates changes in angiogenesis impacting the placental villous vasculature, responsible for the pathophysiology of fetal growth and maternal well-being associated with the Type I diabetic pregnancy. We further hypothesize that glucose and oxygen-mediated pathways influence placental (trophoblast) regulation of angiogenesis. In order to test these hypotheses, we have set the following Specific Aims. Specific Aim 1, To define the changes in expression of mRNAs and proteins important for angiogenic and vasodilatory adaptation in normal and Type I diabetic placentas. Expt.1A/B. Angiogenic factors, eNOS, oxidative stress marker expression in viii and placental vessels Expt. 1C Morphometric analysis of placental villous proliferation, structure and vascular density. Expt. 1D Molecular phenotyping of the diabetic placenta Specific Aim 2. Define in vitro the mechanisms by which glucose, NO and hypoxia alter placental angiogenesis. Expt 2B. Effects of diabetes on trophoblast function and glucose-oxygen responsiveness Expt. 2D Evaluate the role of eNOS/NO in mediating glucose effects on trophoblast function Expt. 2D Evaluate the role of oxidative stress in glucose effects on trophoblast function. Reductions in placental vascularity due to the disruption of angiogenesis in Type 1 diabetic pregnancy can lead to decreased placental blood flow and reduction in fetal weight, survivability and health of the neonate. The mother is also at increased risk for development of ketoacidosis, pyelonephritis and preeclampsia. Type I Diabetes during pregnancy may have additional significance in the offspring for the long-term health and risk for adult disease. A better understanding of the intrauterine environment and its regulation will benefit not only maternal and fetal health, but also further the understanding of disease processes in all individuals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “gestational diabetes” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for gestational diabetes in the PubMed Central database: •

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Birth characteristics of women who develop gestational diabetes: population based study. by Egeland GM, Skjaerven R, Irgens LM.; 2000 Sep 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27469 Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Does screening for gestational diabetes mellitus make a difference? by Sermer M.; 2003 Feb 18; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=143548

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Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation. by Gray-Donald K, Robinson E, Collier A, David K, Renaud L, Rodrigues S.; 2000 Nov 14; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80308

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Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study. by Perucchini D, Fischer U, Spinas GA, Huch R, Huch A, Lehmann R.; 1999 Sep 25; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28232

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with gestational diabetes, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “gestational diabetes” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for gestational diabetes (hyperlinks lead to article summaries): •

A comparison of costs associated with screening for gestational diabetes with twotiered and one-tiered testing protocols. Author(s): Lavin JP Jr, Lavin B, O'Donnell N. Source: American Journal of Obstetrics and Gynecology. 2001 February; 184(3): 363-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11228488&dopt=Abstract

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A comparison of glyburide and insulin in women with gestational diabetes mellitus. Author(s): Dornhorst A. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2001 May; Suppl 3: 12-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11534307&dopt=Abstract

6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A planned randomized clinical trial of treatment for mild gestational diabetes mellitus. Author(s): Landon MB, Thom E, Spong CY, Gabbe SG, Leindecker S, Johnson F, Lain K, Miodovnik M, Carpenter M. Source: J Matern Fetal Neonatal Med. 2002 April;11(4):226-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12375675&dopt=Abstract

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A population-based study of maternal and perinatal outcome in patients with gestational diabetes. Author(s): Jacobson JD, Cousins L. Source: American Journal of Obstetrics and Gynecology. 1989 October; 161(4): 981-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2801849&dopt=Abstract

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A postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo a postnatal oral glucose tolerance test. Author(s): Holt RI, Goddard JR, Clarke P, Coleman MA. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2003 July; 20(7): 594-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12823243&dopt=Abstract

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A prospective controlled study of neonatal morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-class Al). Author(s): Sarkar S, Watman J, Seigel WM, Schaeffer HA. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 2003 April-May; 23(3): 223-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732860&dopt=Abstract

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A random plasma glucose method for screening for gestational diabetes. Author(s): Maheshwari JR, Mataliya MV. Source: Journal of Postgraduate Medicine. 1989 January; 35(1): 36-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2585336&dopt=Abstract

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A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Author(s): Garcia-Patterson A, Corcoy R, Balsells M, Altirriba O, Adelantado JM, Cabero L, de Leiva A. Source: Diabetes Care. 2002 July; 25(7): 1261; Author Reply 1261-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12087047&dopt=Abstract

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A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Author(s): Kjos SL, Schaefer-Graf U, Sardesi S, Peters RK, Buley A, Xiang AH, Bryne JD, Sutherland C, Montoro MN, Buchanan TA. Source: Diabetes Care. 2001 November; 24(11): 1904-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11679455&dopt=Abstract

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A simple index for detection of gestational diabetes mellitus. Author(s): Perea-Carrasco R, Perez-Coronel R, Albusac-Aguilar R, Lombardo-Grifol M, Bassas-Baena de Leon E, Romero-Diaz C. Source: Journal of the Royal Society of Medicine. 2002 September; 95(9): 435-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12205206&dopt=Abstract

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Accuracy of glucose meter use in gestational diabetes. Author(s): Ryan EA, Nguyen G. Source: Diabetes Technology & Therapeutics. 2001 Spring; 3(1): 91-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11469713&dopt=Abstract

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ACOG Practice Bulletin. Clinical management guidelines for obstetriciangynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational diabetes. Author(s): American College of Obstetricians and Gynecologists Committee on Practice Bulletins--Obstetrics. Source: Obstetrics and Gynecology. 2001 September; 98(3): 525-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11547793&dopt=Abstract

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Acute effect of exercise on blood glucose and insulin levels in women with gestational diabetes. Author(s): Avery MD, Walker AJ. Source: The Journal of Maternal-Fetal Medicine. 2001 February; 10(1): 52-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11332421&dopt=Abstract

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alpha-Thalassaemia trait and gestational diabetes mellitus in Hong Kong. Author(s): Lao TT, Ho LF. Source: Diabetologia. 2001 August; 44(8): 966-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11484072&dopt=Abstract

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An unusual case of gestational diabetes mellitus. Author(s): Shankar P, Sundarka MK, Sundarka A. Source: Postgraduate Medical Journal. 2002 September; 78(923): 562-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12357021&dopt=Abstract

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Antenatal fetal testing in pregnancies complicated by gestational diabetes mellitus. Author(s): Rosenn BM. Source: Semin Perinatol. 2002 June; 26(3): 210-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12099311&dopt=Abstract

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Association between maternal and child leptin levels 9 years after pregnancy complicated by gestational diabetes. Author(s): Malee MP, Verma A, Messerlian G, Tucker R, Vohr BR. Source: Hormone and Metabolic Research. Hormon- Und Stoffwechselforschung. Hormones Et Metabolisme. 2002 April; 34(4): 212-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11987032&dopt=Abstract

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Association between maternal pre-existing or gestational diabetes and health problems in children. Author(s): Aberg A, Westbom L. Source: Acta Paediatrica (Oslo, Norway : 1992). 2001 July; 90(7): 746-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11519976&dopt=Abstract

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Association of a woman's own birth weight with subsequent risk for gestational diabetes. Author(s): Innes KE, Byers TE, Marshall JA, Baron A, Orleans M, Hamman RF. Source: Jama : the Journal of the American Medical Association. 2002 May 15; 287(19): 2534-41. Erratum In: Jama 2002 June 26; 287(24): 3212. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12020334&dopt=Abstract

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Autoimmunity in “type 2” and gestational diabetes mellitus. Author(s): Fitz-Patrick D. Source: Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2001 September-October; 7(5): 407-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11585380&dopt=Abstract

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Beta-cell function and visceral fat in lactating women with a history of gestational diabetes. Author(s): McManus RM, Cunningham I, Watson A, Harker L, Finegood DT. Source: Metabolism: Clinical and Experimental. 2001 June; 50(6): 715-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11398150&dopt=Abstract

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Birth characteristics of women who develop gestational diabetes: population based study. Author(s): Egeland GM, Skjaerven R, Irgens LM. Source: Bmj (Clinical Research Ed.). 2000 September 2; 321(7260): 546-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10968815&dopt=Abstract

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Birth weight influence on the subsequent development of gestational diabetes mellitus. Author(s): Savona-Ventura C, Chircop M. Source: Acta Diabetologica. 2003 June; 40(2): 101-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861409&dopt=Abstract

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Birth weight of women with gestational diabetes. Author(s): Moses RG, Moses J, Knights S. Source: Diabetes Care. 1999 July; 22(7): 1059-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10388967&dopt=Abstract

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Birthweight in women with potential gestational diabetes mellitus--an effect of obesity rather than glucose intolerance? Author(s): Lauszus FF, Paludan J, Klebe JG. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1999 July; 78(6): 520-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10376862&dopt=Abstract

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Blood glucose monitoring in gestational diabetes mellitus. Author(s): Buchanan TA, Kjos SL, Montoro MN. Source: The New England Journal of Medicine. 1996 February 29; 334(9): 598-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8569836&dopt=Abstract

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Blood glucose monitoring in gestational diabetes mellitus. Author(s): Miles JM, Coppack SW. Source: The New England Journal of Medicine. 1996 February 29; 334(9): 598; Author Reply 599. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8569835&dopt=Abstract

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Blood glucose monitoring in gestational diabetes mellitus. Author(s): Bansal RK, Ecker JL, Laros RK Jr. Source: The New England Journal of Medicine. 1996 February 29; 334(9): 598; Author Reply 599. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8569834&dopt=Abstract

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Blood glucose monitoring in gestational diabetes mellitus: 1- versus 2-h blood glucose determinations. Author(s): Leguizamon G, Krupitzki H, Glujovsky D, Olivera Ravasi M, Reece EA. Source: J Matern Fetal Neonatal Med. 2002 December;12(6):384-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12683648&dopt=Abstract

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Blood glucose rise following prenatal vitamins in gestational diabetes. Author(s): Sparks SP, Jovanovic-Peterson L, Peterson CM. Source: Journal of the American College of Nutrition. 1993 October; 12(5): 543-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8263271&dopt=Abstract

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Blood glucose targets for gestational diabetes. Author(s): Cheung NW, Byth K, Simmons D. Source: The Medical Journal of Australia. 2000 November 6; 173(9): 502-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11149311&dopt=Abstract

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Blood pressure predicts insulin requirement and exogenous insulin is associated with increased blood pressure in women with gestational diabetes mellitus. Author(s): Bevier WC, Jovanovic-Peterson L, Burns A, Peterson CM. Source: American Journal of Perinatology. 1994 September; 11(5): 369-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7993522&dopt=Abstract

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Blood viscosity and erythrocyte deformability in gestational diabetes. Author(s): Kaibara M, Marumoto Y, Kobayashi T. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1984 June; 22(3): 221-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6148281&dopt=Abstract

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Body fat distribution before pregnancy and gestational diabetes: findings from coronary artery risk development in young adults (CARDIA) study. Author(s): Zhang S, Folsom AR, Flack JM, Liu K. Source: Bmj (Clinical Research Ed.). 1995 October 28; 311(7013): 1139-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7580711&dopt=Abstract

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Chromosomal anomalies among the offspring of women with gestational diabetes. Author(s): Moore LL, Bradlee ML, Singer MR, Rothman KJ, Milunsky A. Source: American Journal of Epidemiology. 2002 April 15; 155(8): 719-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11943689&dopt=Abstract

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Circulating concentrations of asymmetrical dimethyl-L-arginine are increased in women with previous gestational diabetes. Author(s): Mittermayer F, Mayer BX, Meyer A, Winzer C, Pacini G, Wagner OF, Wolzt M, Kautzky-Willer A. Source: Diabetologia. 2002 October; 45(10): 1372-8. Epub 2002 August 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12378377&dopt=Abstract

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Clinical impact of mild carbohydrate intolerance in pregnancy: a study of 2904 nondiabetic Danish women with risk factors for gestational diabetes mellitus. Author(s): Jensen DM, Damm P, Sorensen B, Molsted-Pedersen L, Westergaard JG, Klebe J, Beck-Nielsen H. Source: American Journal of Obstetrics and Gynecology. 2001 August; 185(2): 413-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11518901&dopt=Abstract

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Clinical outcomes related to either the 1- or 2-hour postprandial glucose level in women with gestational diabetes. Author(s): Moses RG, Lucas EM. Source: American Journal of Obstetrics and Gynecology. 2002 September; 187(3): 817-8; Author Reply 818. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12237669&dopt=Abstract

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Clinical predictors for a high risk for the development of diabetes mellitus in the early puerperium in women with recent gestational diabetes mellitus. Author(s): Schaefer-Graf UM, Buchanan TA, Xiang AH, Peters RK, Kjos SL. Source: American Journal of Obstetrics and Gynecology. 2002 April; 186(4): 751-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11967502&dopt=Abstract

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Clinically useful estimates of insulin sensitivity during pregnancy: validation studies in women with normal glucose tolerance and gestational diabetes mellitus. Author(s): Kirwan JP, Huston-Presley L, Kalhan SC, Catalano PM. Source: Diabetes Care. 2001 September; 24(9): 1602-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11522706&dopt=Abstract

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Comparison of alterations in insulin signalling pathway in adipocytes from Type II diabetic pregnant women and women with gestational diabetes mellitus. Author(s): Tomazic M, Janez A, Sketelj A, Kocijancic A, Eckel J, Sharma PM. Source: Diabetologia. 2002 April; 45(4): 502-8. Epub 2002 March 26. Retraction In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12032625&dopt=Abstract

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Comparison of an insulin analog, insulin aspart, and regular human insulin with no insulin in gestational diabetes mellitus. Author(s): Pettitt DJ, Ospina P, Kolaczynski JW, Jovanovic L. Source: Diabetes Care. 2003 January; 26(1): 183-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12502678&dopt=Abstract

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Comparison of two diagnostic tests for gestational diabetes in predicting macrosomia. Author(s): Chastang N, Hartemann-Heurtier A, Sachon C, Vauthier D, Darbois Y, Bissery A, Golmard JL, Grimaldi A. Source: Diabetes & Metabolism. 2003 April; 29(2 Pt 1): 139-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12746634&dopt=Abstract

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Congenital anomalies in the offspring of women with type 1, type 2 and gestational diabetes. Author(s): Farrell T, Neale L, Cundy T. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2002 April; 19(4): 322-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11943005&dopt=Abstract

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Continuous glucose monitoring during pregnancy complicated by gestational diabetes mellitus. Author(s): Jovanovic L. Source: Curr Diab Rep. 2001 August; 1(1): 82-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12762962&dopt=Abstract

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Contraindications to use of metformin. Metformin may be useful in gestational diabetes. Author(s): Hague WM, Davoren PM, Oliver J, Rowan J. Source: Bmj (Clinical Research Ed.). 2003 April 5; 326(7392): 762; Author Reply 762. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12680386&dopt=Abstract

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Correlation of maternal serum fetuin/alpha2-HS-glycoprotein concentration with maternal insulin resistance and anthropometric parameters of neonates in normal pregnancy and gestational diabetes. Author(s): Kalabay L, Cseh K, Pajor A, Baranyi E, Csakany GM, Melczer Z, Speer G, Kovacs M, Siller G, Karadi I, Winkler G. Source: European Journal of Endocrinology / European Federation of Endocrine Societies. 2002 August; 147(2): 243-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12153747&dopt=Abstract

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Cost-effectiveness analysis of gestational diabetes mellitus screening in France. Author(s): Poncet B, Touzet S, Rocher L, Berland M, Orgiazzi J, Colin C. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002 July 10; 103(2): 122-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12069733&dopt=Abstract

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Could fasting plasma glucose be used for screening high-risk outpatients for gestational diabetes mellitus? Author(s): de Aguiar LG, de Matos HJ, de Brito Gomes M. Source: Diabetes Care. 2001 May; 24(5): 954-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11347763&dopt=Abstract

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Counterpoint: glucose monitoring in gestational diabetes: lots of heat, not much light. Author(s): Buchanan TA, Kjos SL. Source: Diabetes Care. 2003 March; 26(3): 948-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12610065&dopt=Abstract

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C-reactive protein and gestational diabetes: the central role of maternal obesity. Author(s): Retnakaran R, Hanley AJ, Raif N, Connelly PW, Sermer M, Zinman B. Source: The Journal of Clinical Endocrinology and Metabolism. 2003 August; 88(8): 3507-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12915627&dopt=Abstract

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Critical appraisal of published research evidence: treatment of gestational diabetes. Author(s): Dornan T, Hollis S. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2001 May; Suppl 3: 1-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11534305&dopt=Abstract

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Current controversies in the mechanisms and treatment of gestational diabetes. Author(s): Tamas G, Kerenyi Z. Source: Curr Diab Rep. 2002 August; 2(4): 337-46. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12643194&dopt=Abstract

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Cutoff value of 1 h, 50 g glucose challenge test for screening of gestational diabetes mellitus in a Japanese population. Author(s): Miyakoshi K, Tanaka M, Ueno K, Uehara K, Ishimoto H, Yoshimura Y. Source: Diabetes Research and Clinical Practice. 2003 April; 60(1): 63-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12639767&dopt=Abstract

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Decompensation of leucine nitrogen kinetics in gestational diabetes mellitus. Author(s): Kalhan S, Rossi K, Gruca L. Source: Diabetes Care. 2000 July; 23(7): 1033-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10895870&dopt=Abstract

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Decrease in incidence of gestational diabetes mellitus in far north Queensland between 1992 and 1996. Author(s): Humphrey M. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2000 August; 40(3): 362. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11065055&dopt=Abstract

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Decreased insulin binding in Asian Indian women with gestational diabetes mellitus. Author(s): Ramachandran A, Susheela L, Mohan V, Kuzhali DA, Viswanathan M. Source: Acta Diabetol Lat. 1989 April-June; 26(2): 123-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2675519&dopt=Abstract

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Decreased insulin receptor tyrosine kinase activity and plasma cell membrane glycoprotein-1 overexpression in skeletal muscle from obese women with gestational diabetes mellitus (GDM): evidence for increased serine/threonine phosphorylation in pregnancy and GDM. Author(s): Shao J, Catalano PM, Yamashita H, Ruyter I, Smith S, Youngren J, Friedman JE. Source: Diabetes. 2000 April; 49(4): 603-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10871198&dopt=Abstract

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Delayed metabolic and thermogenic response to a mixed meal in normoglycemic European women with previous gestational diabetes. Author(s): Kousta E, Parker KH, Lawrence NJ, Penny A, Millauer BA, Anyaoku V, Mulnier H, Forster DC, MacDonald IA, Robinson S, McCarthy MI, Johnston DG. Source: The Journal of Clinical Endocrinology and Metabolism. 2002 July; 87(7): 3407-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12107258&dopt=Abstract

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Detecting glucose intolerance after gestational diabetes: inadequacy of fasting glucose alone and risk associated with gestational diabetes and second trimester waist-hip ratio. Author(s): Jacob Reichelt AA, Ferraz TM, Rocha Oppermann ML, Costa e Forti A, Duncan BB, Fleck Pessoa E, Schmidt MI. Source: Diabetologia. 2002 March; 45(3): 455-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11914756&dopt=Abstract

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Determinants of fetal growth at different periods of pregnancies complicated by gestational diabetes mellitus or impaired glucose tolerance. Author(s): Schaefer-Graf UM, Kjos SL, Kilavuz O, Plagemann A, Brauer M, Dudenhausen JW, Vetter K. Source: Diabetes Care. 2003 January; 26(1): 193-8. Erratum In: Diabetes Care. 2003 April; 26(4): 1329. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12502680&dopt=Abstract

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Determinants of mild gestational hyperglycemia and gestational diabetes mellitus in a large dutch multiethnic cohort. Author(s): Weijers RN, Bekedam DJ, Smulders YM. Source: Diabetes Care. 2002 January; 25(1): 72-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11772904&dopt=Abstract

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Determination of cytokine mRNA-expression in term human placenta of patients with gestational hypertension, intrauterine growth retardation and gestational diabetes mellitus using polymerase chain reaction. Author(s): Heinig J, Wilhelm S, Muller H, Briese V, Bittorf T, Brock J. Source: Zentralblatt Fur Gynakologie. 2000; 122(8): 413-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11005132&dopt=Abstract

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Diabetes and abnormal glucose tolerance in women with previous gestational diabetes. Author(s): Albareda M, Caballero A, Badell G, Piquer S, Ortiz A, de Leiva A, Corcoy R. Source: Diabetes Care. 2003 April; 26(4): 1199-205. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12663597&dopt=Abstract

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Diabetes Prevention in high-risk women with gestational diabetes. Author(s): Banerji MA. Source: Curr Diab Rep. 2003 June; 3(3): 185-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12762964&dopt=Abstract

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Diabetic family history is an isolated risk factor for gestational diabetes after 30 years of age. Author(s): Chan LY, Wong SF, Ho LC. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 February; 81(2): 115-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11942900&dopt=Abstract

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Diagnosing gestational diabetes mellitus. Is the gold standard valid? Author(s): Naylor CD. Source: Diabetes Care. 1989 September; 12(8): 565-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2673696&dopt=Abstract

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Diagnosis of gestational diabetes by use of a glucose polymer. Author(s): Reece EA, Gabrielli S, Abdalla M, O'Connor T, Bargar M, Hobbins JC. Source: American Journal of Obstetrics and Gynecology. 1989 February; 160(2): 383-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2916622&dopt=Abstract

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Did publication of a clinical practice guideline recommendation to screen for type 2 diabetes in women with gestational diabetes change practice? Author(s): Clark HD, van Walraven C, Code C, Karovitch A, Keely E. Source: Diabetes Care. 2003 February; 26(2): 265-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12547846&dopt=Abstract

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Dietary regulation for 'gestational diabetes'. Author(s): Walkinshaw SA. Source: Cochrane Database Syst Rev. 2000; (2): Cd000070. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796112&dopt=Abstract

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Dietary therapy for gestational diabetes: how long is long enough? Author(s): McFarland MB, Langer O, Conway DL, Berkus MD. Source: Obstetrics and Gynecology. 1999 June; 93(6): 978-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10362166&dopt=Abstract

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Does insulin secretion in patients with one abnormal glucose tolerance test value mimic gestational diabetes mellitus? Author(s): Ergin T, Lembet A, Duran H, Kuscu E, Bagis T, Saygili E, Batioglu S. Source: American Journal of Obstetrics and Gynecology. 2002 February; 186(2): 204-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11854636&dopt=Abstract

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Does screening for gestational diabetes mellitus make a difference? Author(s): Sermer M. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2003 February 18; 168(4): 429-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12591783&dopt=Abstract

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Downregulated IRS-1 and PPARgamma in obese women with gestational diabetes: relationship to FFA during pregnancy. Author(s): Catalano PM, Nizielski SE, Shao J, Preston L, Qiao L, Friedman JE. Source: American Journal of Physiology. Endocrinology and Metabolism. 2002 March; 282(3): E522-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11832353&dopt=Abstract

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Early diagnosis of gestational diabetes mellitus and prevention of diabetes-related complications. Author(s): Bartha JL, Martinez-Del-Fresno P, Comino-Delgado R. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2003 July 1; 109(1): 41-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818441&dopt=Abstract

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Early glycemic control reduces large-for-gestational-age infants in 250 Japanese gestational diabetes pregnancies. Author(s): Sameshima H, Kamitomo M, Kajiya S, Kai M, Furukawa S, Ikenoue S. Source: American Journal of Perinatology. 2000; 17(7): 371-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12141524&dopt=Abstract

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Early postpartum metabolic assessment in women with prior gestational diabetes. Author(s): Pallardo F, Herranz L, Garcia-Ingelmo T, Grande C, Martin-Vaquero P, Janez M, Gonzalez A. Source: Diabetes Care. 1999 July; 22(7): 1053-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10388966&dopt=Abstract

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Early-pregnancy glucose screening for gestational diabetes mellitus. Author(s): Nahum GG, Wilson SB, Stanislaw H. Source: J Reprod Med. 2002 August; 47(8): 656-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12216433&dopt=Abstract

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Effect of a high monounsaturated fatty acid diet on blood pressure and glucose metabolism in women with gestational diabetes mellitus. Author(s): Lauszus FF, Rasmussen OW, Henriksen JE, Klebe JG, Jensen L, Lauszus KS, Hermansen K. Source: European Journal of Clinical Nutrition. 2001 June; 55(6): 436-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11423920&dopt=Abstract

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Effect of fetal hyperinsulinism on oral glucose tolerance test results in patients with gestational diabetes mellitus. Author(s): Weiss PA, Scholz HS, Haas J, Tamussino KF. Source: American Journal of Obstetrics and Gynecology. 2001 February; 184(3): 470-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11228505&dopt=Abstract

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Effect of modem transmission of blood glucose data on telephone consultation time, clinic work flow, and patient satisfaction for patients with gestational diabetes mellitus. Author(s): Kruger DF, White K, Galpern A, Mann K, Massirio A, McLellan M, Stevenson J. Source: Journal of the American Academy of Nurse Practitioners. 2003 August; 15(8): 371-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14509102&dopt=Abstract

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Effect of selective screening for gestational diabetes. Author(s): Williams CB, Iqbal S, Zawacki CM, Yu D, Brown MB, Herman WH. Source: Diabetes Care. 1999 March; 22(3): 418-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10097921&dopt=Abstract

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Effects of gestational diabetes on human placental glucose uptake, transfer, and utilisation. Author(s): Osmond DT, Nolan CJ, King RG, Brennecke SP, Gude NM. Source: Diabetologia. 2000 May; 43(5): 576-82. Erratum In: Diabetologia 2000 November; 43(11): 1451. Diabetologia 2001 July; 44(7): 927. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10855532&dopt=Abstract

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Effects of gestational diabetes on junctional adhesion molecules in human term placental vasculature. Author(s): Babawale MO, Lovat S, Mayhew TM, Lammiman MJ, James DK, Leach L. Source: Diabetologia. 2000 September; 43(9): 1185-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11043866&dopt=Abstract

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Effects of maternal gestational diabetes on offspring adiposity at 4-7 years of age. Author(s): Vohr BR, McGarvey ST, Tucker R. Source: Diabetes Care. 1999 August; 22(8): 1284-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10480772&dopt=Abstract

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Effects of new criteria for type 2 diabetes on the rate of postpartum glucose intolerance in women with gestational diabetes. Author(s): Conway DL, Langer O. Source: American Journal of Obstetrics and Gynecology. 1999 September; 181(3): 610-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10486471&dopt=Abstract

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Elevation of soluble E-selectin levels following gestational diabetes is restricted to women with persistent abnormalities of glucose regulation. Author(s): Lawrence NJ, Kousta E, Penny A, Millauer B, Robinson S, Johnston DG, McCarthy MI. Source: Clinical Endocrinology. 2002 March; 56(3): 335-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11940045&dopt=Abstract

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Enhanced fetoplacental angiogenesis in pre-gestational diabetes mellitus: the extra growth is exclusively longitudinal and not accompanied by microvascular remodelling. Author(s): Mayhew TM. Source: Diabetologia. 2002 October; 45(10): 1434-9. Epub 2002 September 05. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12378385&dopt=Abstract

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Etiology and pathogenesis of gestational diabetes. Author(s): Kuhl C. Source: Diabetes Care. 1998 August; 21 Suppl 2: B19-26. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9704223&dopt=Abstract

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Evaluation of DIABNET, a decision support system for therapy planning in gestational diabetes. Author(s): Hernando ME, Gomez EJ, Corcoy R, del Pozo F. Source: Computer Methods and Programs in Biomedicine. 2000 July; 62(3): 235-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10837909&dopt=Abstract

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Evaluation of light exercise in the treatment of gestational diabetes. Author(s): Garcia-Patterson A, Martin E, Ubeda J, Maria MA, de Leiva A, Corcoy R. Source: Diabetes Care. 2001 November; 24(11): 2006-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11679479&dopt=Abstract

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Evaluation of T-cell receptor CD3+ gamma delta in gestational diabetes mellitus. Author(s): Lapolla A, Sanzari M, Betterle C, Dalfra MG, Masin M, Zanchetta R, Zancanaro F, Capovilla F, Toniato R, Plebani M, Fedele D. Source: Acta Diabetologica. 2000; 37(4): 207-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11450505&dopt=Abstract

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Evidence-based screening for gestational diabetes? Author(s): Hadden D. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2000 May; 17(5): 402-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10872544&dopt=Abstract

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Exercise: the alternative therapeutic intervention for gestational diabetes. Author(s): Artal R. Source: Clinical Obstetrics and Gynecology. 2003 June; 46(2): 479-87. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12808397&dopt=Abstract

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Factors predictive of recurrent gestational diabetes diagnosed before 24 weeks' gestation. Author(s): Wein P, Dong ZG, Beischer NA, Sheedy MT. Source: American Journal of Perinatology. 1995 September; 12(5): 352-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8540942&dopt=Abstract

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Factors predisposing to and outcome of gestational diabetes. Author(s): Maresh M, Beard RW, Bray CS, Elkeles RS, Wadsworth J. Source: Obstetrics and Gynecology. 1989 September; 74(3 Pt 1): 342-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2761910&dopt=Abstract

82

Gestational Diabetes

•

Failure to obtain follow-up testing for gestational diabetes in a rural population. Author(s): Jonas GQ. Source: Obstetrics and Gynecology. 1999 September; 94(3): 481. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10472884&dopt=Abstract

•

Fasting plasma glucose as a screening test for gestational diabetes in a multi-ethnic, high-risk population. Author(s): Agarwal MM, Hughes PF, Punnose J, Ezimokhai M. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2000 October; 17(10): 720-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11110505&dopt=Abstract

•

Fasting plasma glucose is a useful test for the detection of gestational diabetes. Brazilian Study of Gestational Diabetes (EBDG) Working Group. Author(s): Reichelt AJ, Spichler ER, Branchtein L, Nucci LB, Franco LJ, Schmidt MI. Source: Diabetes Care. 1998 August; 21(8): 1246-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9702428&dopt=Abstract

•

Fasting plasma glucose test at the first prenatal visit as a screen for gestational diabetes. Author(s): Sacks DA, Chen W, Wolde-Tsadik G, Buchanan TA. Source: Obstetrics and Gynecology. 2003 June; 101(6): 1197-203. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798525&dopt=Abstract

•

Fetal erythrocyte phospholipid polyunsaturated fatty acids are altered in pregnancy complicated with gestational diabetes mellitus. Author(s): Wijendran V, Bendel RB, Couch SC, Philipson EH, Cheruku S, Lammi-Keefe CJ. Source: Lipids. 2000 August; 35(8): 927-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10984116&dopt=Abstract

•

Fetal hyperinsulinism at 14-20 weeks and subsequent gestational diabetes. Author(s): Carpenter MW, Canick JA, Star J, Carr SR, Burke ME, Shahinian K. Source: Obstetrics and Gynecology. 1996 January; 87(1): 89-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8532274&dopt=Abstract

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Fetal lung maturity in pregnancies complicated by insulin-dependent and gestational diabetes: a matched cohort study. Author(s): Piazze JJ, Anceschi MM, Maranghi L, Brancato V, Marchiani E, Cosmi EV. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1999 April; 83(2): 145-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10391524&dopt=Abstract

Studies

83

•

Fetal outcome in gestational diabetes with elevated amniotic fluid insulin levels. Dietary versus insulin treatment. Author(s): Weiss PA, Hofmann HM, Kainer F, Haas JG. Source: Diabetes Research and Clinical Practice. 1988 May 19; 5(1): 1-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3042342&dopt=Abstract

•

Fetal overnutrition in polynesian pregnancies and in gestational diabetes may lead to dysregulation of the adipoinsular axis in offspring. Author(s): Simmons D, Breier BH. Source: Diabetes Care. 2002 September; 25(9): 1539-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12196424&dopt=Abstract

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First-trimester blood pressure and gestational diabetes in high-risk Chinese women. Author(s): Lao TT, Ho LF. Source: Journal of the Society for Gynecologic Investigation. 2003 February; 10(2): 94-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12593998&dopt=Abstract

•

First-trimester C-reactive protein and subsequent gestational diabetes. Author(s): Wolf M, Sandler L, Hsu K, Vossen-Smirnakis K, Ecker JL, Thadhani R. Source: Diabetes Care. 2003 March; 26(3): 819-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12610043&dopt=Abstract

•

First-trimester sex hormone binding globulin and subsequent gestational diabetes mellitus. Author(s): Thadhani R, Wolf M, Hsu-Blatman K, Sandler L, Nathan D, Ecker JL. Source: American Journal of Obstetrics and Gynecology. 2003 July; 189(1): 171-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861158&dopt=Abstract

•

Foetal outcome in gestational diabetes in south Indians. Author(s): Ramachandran A, Snehalatha C, Clementina M, Sasikala R, Vijay V. Source: Diabetes Research and Clinical Practice. 1998 September; 41(3): 185-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9829347&dopt=Abstract

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Fourth International Workshop-Conference on Gestational Diabetes Mellitus. Overview and commentary on first session. Author(s): Oats JJ. Source: Diabetes Care. 1998 August; 21 Suppl 2: B58-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9704228&dopt=Abstract

84

Gestational Diabetes

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Free fatty acids and gestational diabetes mellitus. Author(s): Meyer B, Calvert D, Moses R. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1996 August; 36(3): 255-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8883745&dopt=Abstract

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Frequency of islet autoantibodies in relatives of patients with Type II diabetes or gestational diabetes. Author(s): Naserke HE, Schenker M, Ziegler AG. Source: Diabetologia. 1999 November; 42(11): 1377. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10550425&dopt=Abstract

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Fructosamine in the management of gestational diabetes. Author(s): Roberts AB, Baker JR, James AG, Henley P. Source: American Journal of Obstetrics and Gynecology. 1988 July; 159(1): 66-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3394755&dopt=Abstract

•

Fuel metabolism in pregnancy and in gestational diabetes mellitus. Author(s): Boden G. Source: Obstetrics and Gynecology Clinics of North America. 1996 March; 23(1): 1-10. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8684772&dopt=Abstract

•

Gestational diabetes and its impact on the neonate. Author(s): Jones CW. Source: Neonatal Netw. 2001 September; 20(6): 17-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12144115&dopt=Abstract

•

Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Author(s): Kim C, Newton KM, Knopp RH. Source: Diabetes Care. 2002 October; 25(10): 1862-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12351492&dopt=Abstract

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Gestational diabetes complicated by hydramnios was not associated with increased risk of perinatal morbidity and mortality. Author(s): Shoham I, Wiznitzer A, Silberstein T, Fraser D, Holcberg G, Katz M, Mazor M. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2001 December 10; 100(1): 46-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11728656&dopt=Abstract

Studies

85

•

Gestational diabetes in Victoria in 1996: incidence, risk factors and outcomes. Author(s): Stone CA, McLachlan KA, Halliday JL, Wein P, Tippett C. Source: The Medical Journal of Australia. 2002 November 4; 177(9): 486-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12405890&dopt=Abstract

•

Gestational diabetes in Victoria in 1996: incidence, risk factors and outcomes. Author(s): Davey RX. Source: The Medical Journal of Australia. 2003 July 21; 179(2): 118; Author Reply 118-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12864728&dopt=Abstract

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Gestational diabetes mellitus and glucose tolerance test: value of the values. Author(s): Rohilla M. Source: American Journal of Obstetrics and Gynecology. 2002 November; 187(5): 1424; Author Reply 1424-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439542&dopt=Abstract

•

Gestational diabetes mellitus and lesser degrees of pregnancy hyperglycemia: association with increased risk of spontaneous preterm birth. Author(s): Hedderson MM, Ferrara A, Sacks DA. Source: Obstetrics and Gynecology. 2003 October; 102(4): 850-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14551018&dopt=Abstract

•

Gestational diabetes mellitus and neonatal hyperthyrotropinemia. Author(s): Lao TT, Lee CP. Source: Gynecologic and Obstetric Investigation. 2002; 53(3): 135-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12053096&dopt=Abstract

•

Gestational diabetes mellitus in women of single gravidity in Tianjin City, China. Author(s): Yang X, Hsu-Hage B, Zhang H, Yu L, Dong L, Li J, Shao P, Zhang C. Source: Diabetes Care. 2002 May; 25(5): 847-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11978679&dopt=Abstract

•

Gestational diabetes mellitus. Author(s): American Diabetes Association. Source: Diabetes Care. 2003 January; 26 Suppl 1: S103-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12502631&dopt=Abstract

•

Gestational diabetes mellitus: a kitchen table approach. Author(s): Vogel E, Anderson K, Raine K, Clandinin T. Source: Can J Diet Pract Res. 2001 Winter; 62(4): 169-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11742557&dopt=Abstract

86

Gestational Diabetes

•

Gestational diabetes mellitus: a call for systematic tracing. Author(s): Tan HH, Tan HK, Lim HS, Tan AS, Lim SC. Source: Ann Acad Med Singapore. 2002 May; 31(3): 281-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12061286&dopt=Abstract

•

Gestational diabetes mellitus: accuracy of Midwives Data Collection. Author(s): Moses RG, Webb AJ, Comber CD. Source: The Medical Journal of Australia. 2003 August 18; 179(4): 218-9; Discussion 219. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914515&dopt=Abstract

•

Gestational diabetes mellitus: diagnosis, treatment, and beyond. Author(s): Borsello AA, Shickmanter B. Source: Diabetes Educ. 2001 May-June; 27(3): 419. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11912803&dopt=Abstract

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Gestational diabetes mellitus: diagnosis, treatment, and beyond. Author(s): Simon ER. Source: Diabetes Educ. 2001 January-February; 27(1): 69-74. No Abstract Available. Erratum In: Diabetes Educ 2001 May-June; 27(3): 419. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11912617&dopt=Abstract

•

Gestational diabetes mellitus: is a diagnosis associated with an increase in maternal anxiety and stress in the short and intermediate term? Author(s): Daniells S, Grenyer BF, Davis WS, Coleman KJ, Burgess JA, Moses RG. Source: Diabetes Care. 2003 February; 26(2): 385-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12547867&dopt=Abstract

•

Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. Author(s): Xiong X, Saunders LD, Wang FL, Demianczuk NN. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 December; 75(3): 221-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11728481&dopt=Abstract

•

Gestational diabetes versus obesity as risk factors for pregnancy-induced hypertensive disorders and fetal macrosomia. Author(s): van Hoorn J, Dekker G, Jeffries B. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 February; 42(1): 29-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926638&dopt=Abstract

Studies

87

•

Gestational diabetes: implications of variation in diagnostic criteria. Author(s): Agarwal MM, Punnose J. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 July; 78(1): 45-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12113970&dopt=Abstract

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Glyburide compared to insulin for the treatment of gestational diabetes mellitus: a cost analysis. Author(s): Goetzl L, Wilkins I. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 2002 July-August; 22(5): 403-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12082477&dopt=Abstract

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Hair chromium content of women with gestational diabetes compared with nondiabetic pregnant women. Author(s): Aharoni A, Tesler B, Paltieli Y, Tal J, Dori Z, Sharf M. Source: The American Journal of Clinical Nutrition. 1992 January; 55(1): 104-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1728809&dopt=Abstract

•

Heavy-for-date infants: their backgrounds and relationship with gestational diabetes. Author(s): Hiramatsu Y, Masuyama H, Mizutani Y, Kudo T, Oguni N, Oguni Y. Source: The Journal of Obstetrics and Gynaecology Research. 2000 June; 26(3): 193-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10932981&dopt=Abstract

•

Height and gestational diabetes mellitus. Author(s): Tabak AG, Kerenyi Z, Nagy E, Bosnyak Z, Madarasz E, Tamas G. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2002 April; 19(4): 344-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11943010&dopt=Abstract

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High frequency of antithyroid autoantibodies in pregnant women at increased risk of gestational diabetes mellitus. Author(s): Olivieri A, Valensise H, Magnani F, Medda E, De Angelis S, D'Archivio M, Sorcini M, Carta S, Baccarini S, Romanini C. Source: European Journal of Endocrinology / European Federation of Endocrine Societies. 2000 December; 143(6): 741-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11124856&dopt=Abstract

88

Gestational Diabetes

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High prevalence of gestational diabetes in women from ethnic minority groups. Author(s): Dornhorst A, Paterson CM, Nicholls JS, Wadsworth J, Chiu DC, Elkeles RS, Johnston DG, Beard RW. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1992 November; 9(9): 820-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1473322&dopt=Abstract

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High prevalence of polycystic ovaries and associated clinical, endocrine, and metabolic features in women with previous gestational diabetes mellitus. Author(s): Holte J, Gennarelli G, Wide L, Lithell H, Berne C. Source: The Journal of Clinical Endocrinology and Metabolism. 1998 April; 83(4): 114350. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9543131&dopt=Abstract

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Higher carbohydrate intake is associated with decreased incidence of newborn macrosomia in women with gestational diabetes. Author(s): Romon M, Nuttens MC, Vambergue A, Verier-Mine O, Biausque S, Lemaire C, Fontaine P, Salomez JL, Beuscart R. Source: Journal of the American Dietetic Association. 2001 August; 101(8): 897-902. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11501863&dopt=Abstract

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History of gestational diabetes leads to distinct metabolic alterations in nondiabetic African-American women with a parental history of type 2 diabetes. Author(s): Osei K, Gaillard TR, Schuster DP. Source: Diabetes Care. 1998 August; 21(8): 1250-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9702429&dopt=Abstract

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History of gestational diabetes, insulin resistance and coronary risk. Author(s): Davis CL, Gutt M, Llabre MM, Marks JB, O'Sullivan MJ, Potter JE, Landel JL, Kumar M, Schneiderman N, Gellman M, Skyler JS. Source: Journal of Diabetes and Its Complications. 1999 July-August; 13(4): 216-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10616862&dopt=Abstract

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HLA antigens and islet cell antibodies in gestational diabetes. Author(s): Rubinstein P, Walker M, Krassner J, Carrier C, Carpenter C, Dobersen MJ, Notkins AL, Mark EM, Nechemias C, Hausknecht RU, Ginsberg-Fellner F. Source: Human Immunology. 1981 November; 3(3): 271-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7031028&dopt=Abstract

Studies

89

•

HLA antigens in asymptomatic diabetes. A 10-year follow-up study of potential diabetes in pregnancy and gestational diabetes. Author(s): Mawhinney H, Hadden DR, Middleton D, Harley JM, Montgomery DA. Source: Ulster Med J. 1979; 48(2): 166-72. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=505670&dopt=Abstract

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Hormonal choices after gestational diabetes. Subsequent pregnancy, contraception, and hormone replacement. Author(s): Kjos SL, Peters RK, Xiang A, Schaefer U, Buchanan TA. Source: Diabetes Care. 1998 August; 21 Suppl 2: B50-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9704227&dopt=Abstract

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Hormonal parameters in gestational diabetes mellitus during the third trimester: high glucagon levels. Author(s): Grigorakis SI, Alevizaki M, Beis C, Anastasiou E, Alevizaki CC, Souvatzoglou A. Source: Gynecologic and Obstetric Investigation. 2000; 49(2): 106-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10671817&dopt=Abstract

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Hypertension in women with gestational diabetes. Author(s): Roberts R. Source: Diabetes Care. 1998 August; 21 Suppl 2: B27-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9704224&dopt=Abstract

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Hypertensive disorders of pregnancy and gestational diabetes mellitus in mature gravidae. Author(s): Chin RK. Source: Br J Clin Pract. 1990 December; 44(12): 560-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2102143&dopt=Abstract

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Impact of different levels of carbohydrate intolerance on neonatal outcomes classically associated with gestational diabetes mellitus. Author(s): Jimenez-Moleon JJ, Bueno-Cavanillas A, Luna-del-Castillo Jde D, GarciaMartin M, Lardelli-Claret P, Galvez-Vargas R. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002 April 10; 102(1): 36-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12039087&dopt=Abstract

90

Gestational Diabetes

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Impact of prenatal glucose screening on the diagnosis of gestational diabetes and on pregnancy outcomes. Author(s): Wen SW, Liu S, Kramer MS, Joseph KS, Levitt C, Marcoux S, Liston RM. Source: American Journal of Epidemiology. 2000 December 1; 152(11): 1009-14; Discussion 1015-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11117609&dopt=Abstract

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Impaired fasting glucose and impaired glucose tolerance in women with prior gestational diabetes are associated with a different cardiovascular profile. Author(s): Pallardo LF, Herranz L, Martin-Vaquero P, Garcia-Ingelmo T, Grande C, Janez M. Source: Diabetes Care. 2003 August; 26(8): 2318-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12882855&dopt=Abstract

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Incidence and risk factors for neonatal hypoglycaemia among women with gestational diabetes mellitus in South Auckland. Author(s): Simmons D, Thompson CF, Conroy C. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2000 December; 17(12): 830-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11168324&dopt=Abstract

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Incidence and severity of gestational diabetes in Bahrain and Australia. Author(s): el-Shafei AM, Bashmi YA, Beischer NA, Henry OA, Walstab JE. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1989 August; 29(3 Pt 1): 204-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2604648&dopt=Abstract

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Incidence of gestational hypertension in gestational diabetes mellitus. Author(s): Kvetny J, Poulsen HF. Source: Archives of Gynecology and Obstetrics. 2003 January; 267(3): 153-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12552326&dopt=Abstract

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Increased intramyocellular lipid concentration identifies impaired glucose metabolism in women with previous gestational diabetes. Author(s): Kautzky-Willer A, Krssak M, Winzer C, Pacini G, Tura A, Farhan S, Wagner O, Brabant G, Horn R, Stingl H, Schneider B, Waldhausl W, Roden M. Source: Diabetes. 2003 February; 52(2): 244-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12540593&dopt=Abstract

Studies

91

•

Increased plasma leptin in gestational diabetes. Author(s): Kautzky-Willer A, Pacini G, Tura A, Bieglmayer C, Schneider B, Ludvik B, Prager R, Waldhausl W. Source: Diabetologia. 2001 February; 44(2): 164-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11270672&dopt=Abstract

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Increased retinal vascular tortuosity in gestational diabetes mellitus. Author(s): Boone MI, Farber ME, Jovanovic-Peterson L, Peterson CM. Source: Ophthalmology. 1989 February; 96(2): 251-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2704545&dopt=Abstract

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Increased risk for gestational diabetes mellitus associated with insulin receptor and insulin-like growth factor II restriction fragment length polymorphisms. Author(s): Ober C, Xiang KS, Thisted RA, Indovina KA, Wason CJ, Dooley S. Source: Genetic Epidemiology. 1989; 6(5): 559-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2574127&dopt=Abstract

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Influence of maternal and fetal glucokinase mutations in gestational diabetes. Author(s): Spyer G, Hattersley AT, Sykes JE, Sturley RH, MacLeod KM. Source: American Journal of Obstetrics and Gynecology. 2001 July; 185(1): 240-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11483936&dopt=Abstract

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Insulin resistance and beta-cell dysfunction in normoglycaemic European women with a history of gestational diabetes. Author(s): Kousta E, Lawrence NJ, Godsland IF, Penny A, Anyaoku V, Millauer BA, Cela E, Johnston DG, Robinson S, McCarthy MI. Source: Clinical Endocrinology. 2003 September; 59(3): 289-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12919151&dopt=Abstract

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Insulin resistance syndrome in women with prior history of gestational diabetes mellitus. Author(s): Verma A, Boney CM, Tucker R, Vohr BR. Source: The Journal of Clinical Endocrinology and Metabolism. 2002 July; 87(7): 3227-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12107230&dopt=Abstract

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Insulin response patterns contribute to different perinatal risks in gestational diabetes. Author(s): Yamada H, Hirayama Kato E, Tsuruga R, Ebina Y, Kobashi G, Sagawa T, Makita Z, Koike T, Fujimoto S. Source: Gynecologic and Obstetric Investigation. 2001; 51(2): 103-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11223703&dopt=Abstract

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Insulin secretion during and after pregnancy in patients with gestational diabetes mellitus. Author(s): Homko C, Sivan E, Chen X, Reece EA, Boden G. Source: The Journal of Clinical Endocrinology and Metabolism. 2001 February; 86(2): 568-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11158010&dopt=Abstract

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Insulin-meal interval and short-term glucose fluctuation in tightly controlled gestational diabetes mellitus. Author(s): Sameshima H, Kamitomo M, Kajiya S, Kai M, Ikenoue T. Source: The Journal of Maternal-Fetal Medicine. 2001 August; 10(4): 241-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11531149&dopt=Abstract

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Insulin-sensitivity index and carbohydrate and lipid metabolism in gestational diabetes. Author(s): Bartha JL, Comino-Delgado R, Martinez-Del-Fresno P, Fernandez-Barrios M, Bethencourt I, Moreno-Corral L. Source: J Reprod Med. 2000 March; 45(3): 185-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10756494&dopt=Abstract

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Intravenous glucose tolerance test in gestational diabetes and pregnancy: 'manual' versus computerized assessment. Author(s): Kanter Y, Kol S, Wiener F. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1988 April; 27(4): 307-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3289981&dopt=Abstract

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Irregular menses: an independent risk factor for gestational diabetes mellitus. Author(s): Haver MC, Locksmith GJ, Emmet E. Source: American Journal of Obstetrics and Gynecology. 2003 May; 188(5): 1189-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748474&dopt=Abstract

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Is a multiple birth pregnancy a risk factor for gestational diabetes? Author(s): Egeland GM, Irgens LM. Source: American Journal of Obstetrics and Gynecology. 2001 November; 185(5): 1275-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11717676&dopt=Abstract

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Jelly beans as an alternative to a fifty-gram glucose beverage for gestational diabetes screening. Author(s): Lamar ME, Kuehl TJ, Cooney AT, Gayle LJ, Holleman S, Allen SR. Source: American Journal of Obstetrics and Gynecology. 1999 November; 181(5 Pt 1): 1154-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10561636&dopt=Abstract

Studies

93

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John B. O'Sullivan: a pioneer in the study of gestational diabetes. Author(s): Knopp RH. Source: Diabetes Care. 2002 May; 25(5): 943-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11978704&dopt=Abstract

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Kallmann's syndrome: pregnancy through intracytoplasmic sperm injection and complicated by gestational diabetes. Author(s): Szilagyi A, Manfai Z, Kiesel L, Szabo I. Source: Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology. 2001 October; 15(5): 325-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11727353&dopt=Abstract

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Ketoacidosis during gestational diabetes. Case report. Author(s): Pitteloud N, Binz K, Caulfield A, Philippe J. Source: Diabetes Care. 1998 June; 21(6): 1031-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9614632&dopt=Abstract

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Laboratory monitoring of gestational diabetes. Author(s): Narayanan S. Source: Ann Clin Lab Sci. 1991 November-December; 21(6): 392-401. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1781664&dopt=Abstract

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Late complications of gestational diabetes--maternal effects. Author(s): Nagy G. Source: Zentralblatt Fur Gynakologie. 1993; 115(10): 450-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8273435&dopt=Abstract

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Leptin administration prevents spontaneous gestational diabetes in heterozygous Lepr(db/+) mice: effects on placental leptin and fetal growth. Author(s): Yamashita H, Shao J, Ishizuka T, Klepcyk PJ, Muhlenkamp P, Qiao L, Hoggard N, Friedman JE. Source: Endocrinology. 2001 July; 142(7): 2888-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11416008&dopt=Abstract

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Levels of advanced glycosylation end-products (AGE) in sera of pregnant diabetic women: comparison between type 1, type 2 and gestational diabetes mellitus. Author(s): Buongiorno AM, Morelli S, Sagratella E, Castaldo P, Di Virgilio A, Maroccia E, Ricciardi G, Sciullo E, Cardellini G, Fallucca F, Sensi M. Source: Ann Ist Super Sanita. 1997; 33(3): 375-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9542265&dopt=Abstract

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Lipid metabolism alterations in patients with gestational diabetes mellitus associated fetal macrosomia. Author(s): Ersanli ZO, Damci T, Sen C, Hacibekiroglu M, Gorpe U, Ozyazar M, Ilkova H, Bagriacik N. Source: Ann Ist Super Sanita. 1997; 33(3): 411-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9542273&dopt=Abstract

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Liver-fat accumulation and insulin resistance in obese women with previous gestational diabetes. Author(s): Tiikkainen M, Tamminen M, Hakkinen AM, Bergholm R, Vehkavaara S, Halavaara J, Teramo K, Rissanen A, Yki-Jarvinen H. Source: Obesity Research. 2002 September; 10(9): 859-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12226133&dopt=Abstract

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Long term follow up of women who have had gestational diabetes. Author(s): Holt TA. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 1992 September; 42(362): 354-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1457167&dopt=Abstract

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Longitudinal assessment of glycosylated blood protein concentrations in normal pregnancy and gestational diabetes. Author(s): Morris MA, Grandis AS, Litton JC. Source: Diabetes Care. 1986 March-April; 9(2): 107-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3698777&dopt=Abstract

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Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. Author(s): Catalano PM, Huston L, Amini SB, Kalhan SC. Source: American Journal of Obstetrics and Gynecology. 1999 April; 180(4): 903-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10203659&dopt=Abstract

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Long-term diabetogenic effect of single pregnancy in women with previous gestational diabetes mellitus. Author(s): Peters RK, Kjos SL, Xiang A, Buchanan TA. Source: Lancet. 1996 January 27; 347(8996): 227-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8551882&dopt=Abstract

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Long-term high fibre, low fat diet in gestational diabetes. Author(s): Paisey RB, Savage P, Marsland I, Cooke P. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1985 July; 2(4): 286-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3030616&dopt=Abstract

Studies

95

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Long-term implications of gestational diabetes for the mother. Author(s): Henry OA, Beischer NA. Source: Baillieres Clin Obstet Gynaecol. 1991 June; 5(2): 461-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1954723&dopt=Abstract

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Low energy diets in the treatment of gestational diabetes. Author(s): Gillmer MD, Maresh M, Beard RW, Elkeles RS, Alderson C, Bloxham B. Source: Acta Endocrinol Suppl (Copenh). 1986; 277: 44-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3532669&dopt=Abstract

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Low frequency of autoantibodies to islet cell, glutamic acid decarboxylase, and second-islet antigen in patients with gestational diabetes mellitus: a follow-up study. Author(s): Lapolla A, Fedele D, Pedini B, Dal Fra MG, Sanzari M, Masin M, Zanchetta R, Betterle C. Source: Annals of the New York Academy of Sciences. 2002 April; 958: 263-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12021120&dopt=Abstract

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Low levels of Sex-Hormone-Binding Globulin predict insulin requirement in patients with gestational diabetes mellitus. Author(s): Kopp HP, Festa A, Krugluger W, Schernthaner G. Source: Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association. 2001; 109(7): 365-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11573147&dopt=Abstract

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Low mitochondrial glycerophosphate dehydrogenase activity in lymphocytes of women with gestational diabetes. Author(s): Vidal J, Corominola H, Cardona F, Levy I, Cararach V, Gomis R, Malaisse WJ. Source: Hormone and Metabolic Research. Hormon- Und Stoffwechselforschung. Hormones Et Metabolisme. 1997 February; 29(2): 60-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9105900&dopt=Abstract

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Low prevalence of islet autoantibodies in patients with gestational diabetes mellitus. Author(s): Dozio N, Beretta A, Belloni C, Castiglioni M, Rosa S, Bosi E, Bonifacio E. Source: Diabetes Care. 1997 January; 20(1): 81-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9028700&dopt=Abstract

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Low sensitivity of serum fructosamine as a screening parameter for gestational diabetes mellitus. Author(s): Huter O, Drexel H, Brezinka C, Soelder E, Koelle D, Patsch JR. Source: Gynecologic and Obstetric Investigation. 1992; 34(1): 20-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1526526&dopt=Abstract

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Low socioeconomic status as a risk factor for gestational diabetes. Author(s): Bo S, Menato G, Bardelli C, Lezo A, Signorile A, Repetti E, Massobrio M, Pagano G. Source: Diabetes & Metabolism. 2002 April; 28(2): 139-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11976566&dopt=Abstract

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Lowering the threshold for the diagnosis of gestational diabetes. Author(s): Rust OA, Bofill JA, Andrew ME, Kincaid TA, Stubbs TM, Miller EH, Morrison JC. Source: American Journal of Obstetrics and Gynecology. 1996 October; 175(4 Pt 1): 961-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8885755&dopt=Abstract

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Making the diagnosis of gestational diabetes mellitus. Author(s): Coustan DR. Source: Clinical Obstetrics and Gynecology. 2000 March; 43(1): 99-105. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10694992&dopt=Abstract

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Management of gestational diabetes with a conservative insulin protocol. Author(s): Simpson RW, Kast SJ. Source: The Medical Journal of Australia. 2000 June 5; 172(11): 537-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10920751&dopt=Abstract

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Management of gestational diabetes. Author(s): Langer O. Source: Clinical Obstetrics and Gynecology. 2000 March; 43(1): 106-15. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10694993&dopt=Abstract

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Maternal age and screening for gestational diabetes: a population-based study. Author(s): Barss V, Greene MF, Frigoletto FD. Source: Obstetrics and Gynecology. 1989 August; 74(2): 286-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2748070&dopt=Abstract

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Maternal age and screening for gestational diabetes: a population-based study. Author(s): Coustan DR, Nelson C, Carpenter MW, Carr SR, Rotondo L, Widness JA. Source: Obstetrics and Gynecology. 1989 April; 73(4): 557-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2494619&dopt=Abstract

Studies

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Maternal and neonatal outcomes in pregestational and gestational diabetes mellitus, and the influence of maternal obesity and weight gain: the DEPOSIT study. Diabetes Endocrine Pregnancy Outcome Study in Toronto. Author(s): Ray JG, Vermeulen MJ, Shapiro JL, Kenshole AB. Source: Qjm : Monthly Journal of the Association of Physicians. 2001 July; 94(7): 347-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11435630&dopt=Abstract

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Maternal and paternal family history of diabetes in women with gestational diabetes or insulin-dependent diabetes mellitus type I. Author(s): Harder T, Franke K, Kohlhoff R, Plagemann A. Source: Gynecologic and Obstetric Investigation. 2001; 51(3): 160-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11306901&dopt=Abstract

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Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with a similar risk profile. Author(s): Jensen DM, Sorensen B, Feilberg-Jorgensen N, Westergaard JG, Beck-Nielsen H. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2000 April; 17(4): 281-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10821294&dopt=Abstract

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Maternal gestational diabetes, birth weight, and adolescent obesity. Author(s): Gillman MW, Rifas-Shiman S, Berkey CS, Field AE, Colditz GA. Source: Pediatrics. 2003 March; 111(3): E221-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612275&dopt=Abstract

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Maternal hemoglobin and risk of gestational diabetes mellitus in Chinese women. Author(s): Lao TT, Chan LY, Tam KF, Ho LF. Source: Obstetrics and Gynecology. 2002 May; 99(5 Pt 1): 807-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11978291&dopt=Abstract

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Maternal homocysteine levels and plasma lipids in gestational diabetes: is there any relationship? Author(s): Vitoratos N, Kassanos D, Salamalekis E, Sirisratidis Ch, Baimacou E, Creatsas G. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 July; 22(4): 366-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521455&dopt=Abstract

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Maternal obesity not maternal glucose values correlates best with high rates of fetal macrosomia in pregnancies complicated by gestational diabetes. Author(s): Schaefer-Graf UM, Heuer R, Kilavuz O, Pandura A, Henrich W, Vetter K. Source: Journal of Perinatal Medicine. 2002; 30(4): 313-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12235720&dopt=Abstract

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Maternal plasma phospholipid polyunsaturated fatty acids in pregnancy with and without gestational diabetes mellitus: relations with maternal factors. Author(s): Wijendran V, Bendel RB, Couch SC, Philipson EH, Thomsen K, Zhang X, Lammi-Keefe CJ. Source: The American Journal of Clinical Nutrition. 1999 July; 70(1): 53-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10393139&dopt=Abstract

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Membrane-type matrix metalloproteinase-9 activity in placental tissue from patients with pre-existing and gestational diabetes mellitus. Author(s): Pustovrh C, Jawerbaum A, Sinner D, Pesaresi M, Baier M, Micone P, Gimeno M, Gonzalez ET. Source: Reproduction, Fertility, and Development. 2000; 12(5-6): 269-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11451017&dopt=Abstract

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Metabolic and immunologic effects of insulin lispro in gestational diabetes. Author(s): Jovanovic L, Ilic S, Pettitt DJ, Hugo K, Gutierrez M, Bowsher RR, Bastyr EJ 3rd. Source: Diabetes Care. 1999 September; 22(9): 1422-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10480503&dopt=Abstract

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Metabolic and steroidogenic alterations related to increased frequency of polycystic ovaries in women with a history of gestational diabetes. Author(s): Koivunen RM, Juutinen J, Vauhkonen I, Morin-Papunen LC, Ruokonen A, Tapanainen JS. Source: The Journal of Clinical Endocrinology and Metabolism. 2001 June; 86(6): 2591-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11397859&dopt=Abstract

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Metformin and gestational diabetes. Author(s): Glueck CJ, Goldenberg N, Streicher P, Wang P. Source: Curr Diab Rep. 2003 August; 3(4): 303-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866993&dopt=Abstract

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Mitochondrial gene mutations in gestational diabetes mellitus. Author(s): Chen Y, Liao WX, Roy AC, Loganath A, Ng SC. Source: Diabetes Research and Clinical Practice. 2000 April; 48(1): 29-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10704697&dopt=Abstract

Studies

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Mitochondrial gene transfer ribonucleic acid (tRNA)Leu(UUR) 3243 is not a common cause of gestational diabetes mellitus in Spanish women. Author(s): Albareda M, Gallart L, Mato ME, Ortiz A, Puig-Domingo M, de Leiva A, Corcoy R. Source: Endocrine Journal. 2000 December; 47(6): 805-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11228058&dopt=Abstract

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Natural course of gestational diabetes mellitus: long term follow up of women in the SPAWN study. Author(s): Linne Y, Barkeling B, Rossner S. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 November; 109(11): 1227-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452459&dopt=Abstract

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Neonatal morbidities in gestational diabetes mellitus. Author(s): Persson B, Hanson U. Source: Diabetes Care. 1998 August; 21 Suppl 2: B79-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9704232&dopt=Abstract

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Neonatal outcome and obstetric complications in women with gestational diabetes: effects of maternal body mass index. Author(s): Di Cianni G, Benzi L, Bottone P, Volpe L, Orsini P, Murru S, Casadidio I, Clemente F, Navalesi R. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 1996 May; 20(5): 445-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8696423&dopt=Abstract

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Neurodevelopmental outcome at early school age of children born to mothers with gestational diabetes. Author(s): Ornoy A, Wolf A, Ratzon N, Greenbaum C, Dulitzky M. Source: Archives of Disease in Childhood. Fetal and Neonatal Edition. 1999 July; 81(1): F10-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10375355&dopt=Abstract

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Nitric oxide, cGMP and cAMP modulate nitrobenzylthioinosine-sensitive adenosine transport in human umbilical artery smooth muscle cells from subjects with gestational diabetes. Author(s): Aguayo C, Sobrevia L. Source: Experimental Physiology. 2000 July; 85(4): 399-409. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10918079&dopt=Abstract

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No deterioration in insulin sensitivity, but impairment of both pancreatic beta-cell function and glucose sensitivity, in Japanese women with former gestational diabetes mellitus. Author(s): Sakamaki H, Yamasaki H, Matsumoto K, Izumino K, Kondo H, Sera Y, Ozaki M, Abe T, Kawasaki E, Takino H, Yamaguchi Y, Eguchi K. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1998 December; 15(12): 1039-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9868979&dopt=Abstract

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Norethisterone and gestational diabetes. Author(s): Beischer NA, Cookson T, Sheedy M, Wein P. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1992 August; 32(3): 233-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1445134&dopt=Abstract

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Nucleated red blood cells in healthy infants of women with gestational diabetes. Author(s): Yeruchimovich M, Mimouni FB, Green DW, Dollberg S. Source: Obstetrics and Gynecology. 2000 January; 95(1): 84-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10636508&dopt=Abstract

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Nurse-based management in patients with gestational diabetes. Author(s): Garcia-Patterson A, Martin E, Ubeda J, Maria MA, Adelantado JM, Ginovart G, de Leiva A, Corcoy R. Source: Diabetes Care. 2003 April; 26(4): 998-1001. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12663563&dopt=Abstract

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Nutrition management in women with gestational diabetes mellitus: a review by ADA's Diabetes Care and Education Dietetic Practice Group. Author(s): Fagen C, King JD, Erick M. Source: Journal of the American Dietetic Association. 1995 April; 95(4): 460-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7699189&dopt=Abstract

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Obesity and gestational diabetes among African-American women and Latinas in Detroit: implications for disparities in women's health. Author(s): Kieffer EC, Carman WJ, Gillespie BW, Nolan GH, Worley SE, Guzman JR. Source: J Am Med Womens Assoc. 2001 Fall; 56(4): 181-7, 196. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11759788&dopt=Abstract

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Observed increase in prevalence of gestational diabetes is real. Author(s): Wein P, Beischer NA. Source: American Journal of Obstetrics and Gynecology. 2000 April; 182(4): 992-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10764494&dopt=Abstract

Studies

101

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Occurrence of gestational diabetes mellitus and the value of different screening indicators for the oral glucose tolerance test. Author(s): Ostlund I, Hanson U. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 February; 82(2): 103-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12648169&dopt=Abstract

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Of gestational diabetes, finesse, and an antipodean snark. Author(s): Davey R. Source: Diabetes Care. 1999 May; 22(5): 873-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10332712&dopt=Abstract

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Optimization of insulin therapy in patients with gestational diabetes. Author(s): Jovanovic L. Source: Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2000 January-February; 6(1): 98-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11419929&dopt=Abstract

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Oral hypoglycemic drugs for gestational diabetes. Author(s): Greene MF. Source: The New England Journal of Medicine. 2000 October 19; 343(16): 1178-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11036125&dopt=Abstract

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Outcome of pregnancies complicated by pre-gestational diabetes mellitus. Author(s): Gunton JE, McElduff A, Sulway M, Stiel J, Kelso I, Boyce S, Fulcher G, Robinson B, Clifton-Bligh P, Wilmshurst E. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2000 February; 40(1): 38-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10870777&dopt=Abstract

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Outcome of pregnancy complicated by pre-gestational diabetes--improvement in outcomes. Author(s): Gunton JE, Morris J, Boyce S, Kelso I, McElduff A. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 November; 42(5): 478-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12495089&dopt=Abstract

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Overweight and obesity in infants of mothers with long-term insulin-dependent diabetes or gestational diabetes. Author(s): Plagemann A, Harder T, Kohlhoff R, Rohde W, Dorner G. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 1997 June; 21(6): 451-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9192228&dopt=Abstract

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Oxidative metabolism in insulin-treated gestational diabetes mellitus. Author(s): Hsu HW, Butte NF, Wong WW, Moon JK, Ellis KJ, Klein PD, Moise KJ. Source: The American Journal of Physiology. 1997 June; 272(6 Pt 1): E1099-107. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9227457&dopt=Abstract

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Perinatal complications in women with gestational diabetes mellitus. Author(s): Svare JA, Hansen BB, Molsted-Pedersen L. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2001 October; 80(10): 899-904. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11580734&dopt=Abstract

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Postpartum glucose intolerance in Chinese women with gestational diabetes. Author(s): Yang X, Hsu-Hage BH, Dong L, Zhang H, Zhang C, Zhang Y. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2003 August; 20(8): 687-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873301&dopt=Abstract

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Predictive factors of developing diabetes mellitus in women with gestational diabetes. Author(s): Aberg AE, Jonsson EK, Eskilsson I, Landin-Olsson M, Frid AH. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 January; 81(1): 11-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11942881&dopt=Abstract

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Prevalence and features of pancreatic islet cell autoimmunity in women with gestational diabetes from different ethnic groups. Author(s): Kousta E, Lawrence NJ, Anyaoku V, Johnston DG, McCarthy MI. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 July; 108(7): 716-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11467697&dopt=Abstract

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Prevalence and risk factors of microalbuminuria in a cohort of African-American women with gestational diabetes. Author(s): Go RC, Desmond R, Roseman JM, Bell DS, Vanichanan C, Acton RT. Source: Diabetes Care. 2001 October; 24(10): 1764-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11574439&dopt=Abstract

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Prevalence of gestational diabetes mellitus detected by the national diabetes data group or the carpenter and coustan plasma glucose thresholds. Author(s): Ferrara A, Hedderson MM, Quesenberry CP, Selby JV. Source: Diabetes Care. 2002 September; 25(9): 1625-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12196438&dopt=Abstract

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Progesterone in gestational diabetes mellitus: guilty or not guilty? Author(s): Branisteanu DD, Mathieu C. Source: Trends in Endocrinology and Metabolism: Tem. 2003 March; 14(2): 54-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12591170&dopt=Abstract

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Prognosis of patients with positive screening but negative diagnostic test for gestational diabetes. Author(s): Gezer A, Esen F, Mutlu H, Ozturk E, Ocak V. Source: Archives of Gynecology and Obstetrics. 2002 August; 266(4): 201-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12192479&dopt=Abstract

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Proposed diagnostic thresholds for gestational diabetes mellitus according to a 75-g oral glucose tolerance test. Maternal and perinatal outcomes in 3260 Danish women. Author(s): Jensen DM, Damm P, Sorensen B, Molsted-Pedersen L, Westergaard JG, Korsholm L, Ovesen P, Beck-Nielsen H. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2003 January; 20(1): 51-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12519320&dopt=Abstract

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Psychomotor development in the children of mothers with type 1 diabetes mellitus or gestational diabetes mellitus. Author(s): Kowalczyk M, Ircha G, Zawodniak-Szalapska M, Cypryk K, Wilczynski J. Source: J Pediatr Endocrinol Metab. 2002 March; 15(3): 277-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11924929&dopt=Abstract

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Race, parity, and gestational diabetes as risk factors for type 2 diabetes mellitus. Author(s): Kahn HS, Williamson DF. Source: Jama : the Journal of the American Medical Association. 2000 November 8; 284(18): 2318-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11066172&dopt=Abstract

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Randomized trial of diet versus diet plus cardiovascular conditioning on glucose levels in gestational diabetes. Author(s): Jovanovic-Peterson L, Durak EP, Peterson CM. Source: American Journal of Obstetrics and Gynecology. 1989 August; 161(2): 415-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2764059&dopt=Abstract

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Rates and risk factors for recurrence of gestational diabetes. Author(s): MacNeill S, Dodds L, Hamilton DC, Armson BA, VandenHof M. Source: Diabetes Care. 2001 April; 24(4): 659-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11315827&dopt=Abstract

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Recurrence of gestational diabetes. Author(s): Foster-Powell KA, Cheung NW. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1998 November; 38(4): 384-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9890214&dopt=Abstract

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Relationship between gestational diabetes mellitus and low maternal birth weight. Author(s): Seghieri G, Anichini R, De Bellis A, Alviggi L, Franconi F, Breschi MC. Source: Diabetes Care. 2002 October; 25(10): 1761-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12351474&dopt=Abstract

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Relationship of neonatal body composition to maternal glucose control in women with gestational diabetes mellitus. Author(s): Uvena-Celebrezze J, Fung C, Thomas AJ, Hoty A, Huston-Presley L, Amini SB, Catalano PM. Source: J Matern Fetal Neonatal Med. 2002 December;12(6):396-401. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12683650&dopt=Abstract

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Relative hypoleptinaemia in women with mild gestational diabetes mellitus. Author(s): Festa A, Shnawa N, Krugluger W, Hopmeier P, Schernthaner G, Haffner SM. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1999 August; 16(8): 656-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10477210&dopt=Abstract

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Results from screening for gestational diabetes mellitus in a Danish county. Author(s): Kvetny J, Poulsen HF, Damgaard DW. Source: Dan Med Bull. 1999 February; 46(1): 57-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10081653&dopt=Abstract

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Risk factors for development of diabetes mellitus in women with a history of gestational diabetes mellitus. Author(s): Bian X, Gao P, Xiong X, Xu H, Qian M, Liu S. Source: Chinese Medical Journal. 2000 August; 113(8): 759-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11776065&dopt=Abstract

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Risk factors for gestational diabetes among Asian women. Author(s): Cheung NW, Wasmer G, Al-Ali J. Source: Diabetes Care. 2001 May; 24(5): 955-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11347764&dopt=Abstract

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Screening for gestational diabetes mellitus in the subsequent pregnancy: is it worthwhile? Author(s): Lu GC, Luchesse A, Chapman V, Cliver S, Rouse DJ. Source: American Journal of Obstetrics and Gynecology. 2002 October; 187(4): 918-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12388977&dopt=Abstract

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Screening for gestational diabetes mellitus. Author(s): Berger H, Crane J, Farine D. Source: J Obstet Gynaecol Can. 2003 February; 25(2): 96-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12577126&dopt=Abstract

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Screening for gestational diabetes mellitus. Author(s): Berger H, Crane J, Farine D, Armson A, De La Ronde S, Keenan-Lindsay L, Leduc L, Reid G, Van Aerde J; Maternal-Fetal Medicine Committee; Executive and Coundil fo the Society of Obstetricians and Gynaecologists of Canada. Source: J Obstet Gynaecol Can. 2002 November; 24(11): 894-912. English, French. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12417905&dopt=Abstract

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Screening for gestational diabetes mellitus: recommendation and rationale. Author(s): U.S. Preventive Services Task Force (USPSTF). Source: American Family Physician. 2003 July 15; 68(2): 331-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892353&dopt=Abstract

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Screening for gestational diabetes mellitus: recommendations and rationale. Author(s): U.S. Preventive Services Task Force. Source: Obstetrics and Gynecology. 2003 February; 101(2): 393-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12576265&dopt=Abstract

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Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force. Author(s): Brody SC, Harris R, Lohr K. Source: Obstetrics and Gynecology. 2003 February; 101(2): 380-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12576264&dopt=Abstract

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Screening for gestational diabetes: a systematic review and economic evaluation. Author(s): Scott DA, Loveman E, McIntyre L, Waugh N. Source: Health Technology Assessment (Winchester, England). 2002; 6(11): 1-161. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12433317&dopt=Abstract

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Screening for gestational diabetes: the time of day is important. Author(s): McElduff A, Hitchman R. Source: The Medical Journal of Australia. 2002 February 4; 176(3): 136. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11936316&dopt=Abstract

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Selective or universal diagnostic testing for gestational diabetes mellitus. Author(s): Baliutaviciene D, Petrenko V, Zalinkevicius R. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 September; 78(3): 207-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12384265&dopt=Abstract

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Self-monitored blood glucose in pregnant women without gestational diabetes mellitus. Author(s): Montaner P, Dominguez R, Corcoy R. Source: Diabetes Care. 2002 November; 25(11): 2104-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401765&dopt=Abstract

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The contentious nature of gestational diabetes: diet, insulin, glyburide and metformin. Author(s): Glueck CJ, Goldenberg N, Streicher P, Wang P. Source: Expert Opinion on Pharmacotherapy. 2002 November; 3(11): 1557-68. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12437490&dopt=Abstract

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The effect of gender and gestational diabetes mellitus on cord leptin concentration. Author(s): Okereke NC, Uvena-Celebrezze J, Hutson-Presley L, Amini SB, Catalano PM. Source: American Journal of Obstetrics and Gynecology. 2002 September; 187(3): 798803. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12237665&dopt=Abstract

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The impact of self-monitoring of blood glucose on self-efficacy and pregnancy outcomes in women with diet-controlled gestational diabetes. Author(s): Homko CJ, Sivan E, Reece EA. Source: Diabetes Educ. 2002 May-June; 28(3): 435-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12073958&dopt=Abstract

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The prevalence of urinary tract infections in patients with gestational diabetes mellitus. Author(s): Rizk DE, Mustafa N, Thomas L. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(5): 317-21; Discussion 321-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11715998&dopt=Abstract

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The principles of dietary management of gestational diabetes: reflection on current evidence. Author(s): Dornhorst A, Frost G. Source: Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association. 2002 April; 15(2): 145-56; Quiz 157-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11972744&dopt=Abstract

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Total sialic acid and associated elements of the metabolic syndrome in women with and without previous gestational diabetes. Author(s): Sriharan M, Reichelt AJ, Opperman ML, Duncan BB, Mengue SS, Crook MA, Schmidt MI. Source: Diabetes Care. 2002 August; 25(8): 1331-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12145230&dopt=Abstract

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Treatment of gestational diabetes with short- or long-acting insulin and neonatal outcome: a pilot study. Author(s): Poyhonen-Alho M, Teramo K, Kaaja R. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 March; 81(3): 258-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11966484&dopt=Abstract

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Treatments for gestational diabetes and impaired glucose tolerance in pregnancy. Author(s): Tuffnell DJ, West J, Walkinshaw SA. Source: Cochrane Database Syst Rev. 2003; (3): Cd003395. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12917965&dopt=Abstract

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Tumor necrosis factor system in insulin resistance in gestational diabetes. Author(s): Winkler G, Cseh K, Baranyi E, Melczer Z, Speer G, Hajos P, Salamon F, Turi Z, Kovacs M, Vargha P, Karadi I. Source: Diabetes Research and Clinical Practice. 2002 May; 56(2): 93-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11891016&dopt=Abstract

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Two-hour 75-g oral glucose tolerance test early in pregnancy detects most cases of gestational diabetes. Author(s): Dashora U, Dashora V, Kennedy L. Source: Diabetes Care. 2002 April; 25(4): 803; Author Reply 804. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11919147&dopt=Abstract

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Unilateral bowing of long bones and multiple congenital anomalies in a child born to a mother with gestational diabetes. Author(s): Courtens W, De laet C, Ziereisen F, Vamos E, Mortier G. Source: Annales De Genetique. 2000 April-June; 43(2): 81-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10998449&dopt=Abstract

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Universal screening and intensive metabolic management of gestational diabetes: cost-effectiveness in Italy. Author(s): Di Cianni G, Volpe L, Casadidio I, Bottone P, Marselli L, Lencioni C, Boldrini A, Teti G, Del Prato S, Benzi L. Source: Acta Diabetologica. 2002 June; 39(2): 69-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12120916&dopt=Abstract

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Universal versus selective gestational diabetes screening: application of 1997 American Diabetes Association recommendations. Author(s): Danilenko-Dixon DR, Van Winter JT, Nelson RL, Ogburn PL Jr. Source: American Journal of Obstetrics and Gynecology. 1999 October; 181(4): 798-802. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10521732&dopt=Abstract

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Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome. Author(s): Griffin ME, Coffey M, Johnson H, Scanlon P, Foley M, Stronge J, O'Meara NM, Firth RG. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2000 January; 17(1): 26-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10691156&dopt=Abstract

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Updated guidelines outline options for gestational diabetes mellitus. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2001 October 18; 12(20): 8-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12378760&dopt=Abstract

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Use of insulin pumps in pregnancies complicated by type 2 diabetes and gestational diabetes in a multiethnic community. Author(s): Simmons D, Thompson CF, Conroy C, Scott DJ. Source: Diabetes Care. 2001 December; 24(12): 2078-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11723086&dopt=Abstract

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Usefulness of a breakfast test in the management of women with gestational diabetes. Author(s): Rey E. Source: Obstetrics and Gynecology. 1997 June; 89(6): 981-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9170478&dopt=Abstract

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Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study. Author(s): Perucchini D, Fischer U, Spinas GA, Huch R, Huch A, Lehmann R. Source: Bmj (Clinical Research Ed.). 1999 September 25; 319(7213): 812-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10496823&dopt=Abstract

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Usual delay in sample processing can modify gestational diabetes screening. Author(s): Corcoy R, Gascon N, de Leiva A, Ordonez-Llanos J. Source: Diabetes Care. 2000 March; 23(3): 429. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10868886&dopt=Abstract

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Utility of fetal measurements in the management of gestational diabetes mellitus. Author(s): Buchanan TA, Kjos SL, Schafer U, Peters RK, Xiang A, Byrne J, Berkowitz K, Montoro M. Source: Diabetes Care. 1998 August; 21 Suppl 2: B99-106. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9704235&dopt=Abstract

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Vaginal birth after cesarean among women with gestational diabetes. Author(s): Coleman TL, Randall H, Graves W, Lindsay M. Source: American Journal of Obstetrics and Gynecology. 2001 May; 184(6): 1104-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11349170&dopt=Abstract

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Validating change in risk criteria for a birth center: gestational diabetes. Author(s): Scupholme A, Kamons AS. Source: Journal of Nurse-Midwifery. 1988 May-June; 33(3): 129-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3404275&dopt=Abstract

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Value of early glucose tolerance testing in women who had gestational diabetes in their previous pregnancy. Author(s): Dong ZG, Beischer NA, Wein P, Sheedy MT. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1993 November; 33(4): 350-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8179539&dopt=Abstract

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Vanadate enhances but does not normalize glucose transport and insulin receptor phosphorylation in skeletal muscle from obese women with gestational diabetes mellitus. Author(s): Shao J, Catalano PM, Yamashita H, Ishizuka T, Friedman JE. Source: American Journal of Obstetrics and Gynecology. 2000 November; 183(5): 126370. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11084576&dopt=Abstract

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Variability in diagnostic evaluation and criteria for gestational diabetes. Author(s): Solomon CG, Willett WC, Rich-Edwards J, Hunter DJ, Stampfer MJ, Colditz GA, Manson JE. Source: Diabetes Care. 1996 January; 19(1): 12-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8720526&dopt=Abstract

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Vascular function in women with previous gestational diabetes mellitus. Author(s): Hannemann MM, Liddell WG, Shore AC, Clark PM, Tooke JE. Source: Journal of Vascular Research. 2002 July-August; 39(4): 311-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12187121&dopt=Abstract

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Verified self-monitored blood glucose data versus glycosylated hemoglobin and glycosylated serum protein as a means of predicting short- and long-term metabolic control in gestational diabetes. Author(s): Brustman L, Langer O, Engel S, Anyaegbunam A, Mazze R. Source: American Journal of Obstetrics and Gynecology. 1987 September; 157(3): 699703. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3631170&dopt=Abstract

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Very high prevalence of gestational diabetes in Vietnamese and Cambodian women. Author(s): Doery JC, Edis K, Healy D, Bishop S, Tippett C. Source: The Medical Journal of Australia. 1989 July 17; 151(2): 111. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2739599&dopt=Abstract

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Vitamin B6 treatment of gestational diabetes mellitus: studies of blood glucose and plasma insulin. Author(s): Spellacy WN, Buhi WC, Birk SA. Source: American Journal of Obstetrics and Gynecology. 1977 March 15; 127(6): 599-602. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=842585&dopt=Abstract

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When and how to start insulin treatment in gestational diabetes: a UK perspective. Author(s): Hadden DR. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2001 December; 18(12): 960-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11903394&dopt=Abstract

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When diet fails: insulin and oral hypoglycemic agents as alternatives for the management of gestational diabetes mellitus. Author(s): Langer O. Source: J Matern Fetal Neonatal Med. 2002 April;11(4):218-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12375674&dopt=Abstract

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When is fasting really fasting? The influence of time of day, interval after a meal, and maternal body mass on maternal glycemia in gestational diabetes. Author(s): Sacks DA, Chen W, Wolde-Tsadik G, Buchanan TA. Source: American Journal of Obstetrics and Gynecology. 1999 October; 181(4): 904-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10521751&dopt=Abstract

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Which cutoff level should be used in screening for glucose intolerance in pregnancy? Definition of Screening Methods for Gestational Diabetes Study Group of the Lombardy Section of the Italian Society of Diabetology. Author(s): Bonomo M, Gandini ML, Mastropasqua A, Begher C, Valentini U, Faden D, Morabito A. Source: American Journal of Obstetrics and Gynecology. 1998 July; 179(1): 179-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9704785&dopt=Abstract

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Which screening test is the best for gestational impaired glucose tolerance and gestational diabetes mellitus? Author(s): Tam WH, Rogers MS, Yip SK, Lau TK, Leung TY. Source: Diabetes Care. 2000 September; 23(9): 1432. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10977047&dopt=Abstract

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Why does ethnicity affect prevalence of gestational diabetes? The underwater volcano theory. Author(s): Yue DK, Molyneaux LM, Ross GP, Constantino MI, Child AG, Turtle JR. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1996 August; 13(8): 748-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8862951&dopt=Abstract

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Women diagnosed with gestational diabetes mellitus do not carry antibodies against minor islet cell antigens. Author(s): Balaji M, Shtauvere-Brameus A, Balaji V, Seshiah V, Sanjeevi CB. Source: Annals of the New York Academy of Sciences. 2002 April; 958: 281-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12021124&dopt=Abstract

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Women with a history of gestational diabetes of European and South Asian origin are shorter than women with normal glucose tolerance in pregnancy. Author(s): Kousta E, Lawrence NJ, Penny A, Millauer BA, Robinson S, Johnston DG, McCarthy MI. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2000 November; 17(11): 792-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11131104&dopt=Abstract

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Women with gestational diabetes should be targeted to reduce cardiovascular risk. Author(s): Toescu V, Nuttall SL, Kendall MJ, Martin U, Dunne F. Source: Bmj (Clinical Research Ed.). 2002 October 26; 325(7370): 966. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12399355&dopt=Abstract

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CHAPTER 2. NUTRITION AND GESTATIONAL DIABETES Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and gestational diabetes.

Finding Nutrition Studies on Gestational Diabetes The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “gestational diabetes” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “gestational diabetes” (or a synonym): •

A planned randomized clinical trial of treatment for mild gestational diabetes mellitus. Author(s): The Maternal Fetal Medicine Units Network, The National Institute of Child Health and Human Development, Bethesda, Maryland, USA. Source: Landon, M B Thom, E Spong, C Y Gabbe, S G Leindecker, S Johnson, F Lain, K Miodovnik, M Carpenter, M J-Matern-Fetal-Neonatal-Med. 2002 April; 11(4): 226-31 1476-7058

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A simplified model for management of women with gestational diabetes at the primary care level. Author(s): Department of Obstetrics and Gynecology, Karolinska Hospital, Stockholm, Sweden. Source: Nord, E Hanson, U Persson, B Diabetes-Res. 1991 August; 17(4): 175-9 0265-5985

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Alternative therapies for the management of gestational diabetes. Author(s): Santa Barbara Cottage Hospital, California. Source: Mulford, M I Jovanovic Peterson, L Peterson, C M Clin-Perinatol. 1993 September; 20(3): 619-34 0095-5108

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Amylophagia presenting as gestational diabetes. Author(s): Department of Family Medicine, University of Tennessee, Memphis, USA. Source: Jackson, W C Martin, J P Arch-Fam-Med. 2000 July; 9(7): 649-52 1063-3987

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An unusual case of gestational diabetes mellitus. Author(s): Department of Medicine, Manipal College of Medical Sciences-Teaching Hospital, Pokhara, Nepal. [email protected] Source: Shankar, P Sundarka, M K Sundarka, A Postgrad-Med-J. 2002 September; 78(923): 562-3 0032-5473

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Antepartum and early postpartum predictors of type 2 diabetes development in women with gestational diabetes mellitus. Author(s): Department of Medical and Surgical Sciences, Padova University, Via E. Vendramini 7, 35137 Padua, Italy. Source: Dalfra, M G Lapolla, A Masin, M Giglia, G Dalla Barba, B Toniato, R Fedele, D Diabetes-Metab. 2001 December; 27(6): 675-80 1262-3636

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Can a diagnosis of gestational diabetes be an advantage to the outcome of pregnancy? Author(s): Diabetes Education Centre, Wollongong, Australia. Source: Moses, R G Griffiths, R D J-Soc-Gynecol-Investig. 1995 May-June; 2(3): 523-5 1071-5576

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Counseling programs and the outcome of gestational diabetes in Austrian and Mediterranean Turkish women. Author(s): Department of Internal Medicine, Hospital Barmherzige Bruder Salzburg, Kajetanerplatz 1, Austria. Source: Hoppichler, F Lechleitner, M Patient-Educ-Couns. 2001 December 15; 45(4): 2714 0738-3991

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Diabetes during pregnancy--United States, 1993-1995. Source: Anonymous MMWR-Morb-Mortal-Wkly-Repage 1998 May 29; 47(20): 408-14 0149-2195

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DIABNET: a qualitative model-based advisory system for therapy planning in gestational diabetes. Author(s): Grupo de Bioingenieria y Telemedicina, ETSI de Telecommunication, Unversidad Politecnica de Madrid, Spain. Source: Hernando, M E Gomez, E J del Pozo, F Corcoy, R Med-Inform-(Lond). 1996 OctDecember; 21(4): 359-74 0307-7640

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Dietary regulation for 'gestational diabetes'. Author(s): Fetal Centre, Liverpool Women's Hospital NHS Trust, Crown Street, Liverpool, UK, L8 7SS. [email protected] Source: Walkinshaw, S A Cochrane-Database-Syst-Revolume 2000; (2): CD000070 1469493X

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Downregulated IRS-1 and PPARgamma in obese women with gestational diabetes: relationship to FFA during pregnancy. Source: Catalano, P.M. Nizielski, S.E. Shao, J. Preston, L. Qiao, L. Friedman, J.E. Am-jphysiol. Bethesda, Md. : American Physiological Society, 1898-. March 2002. volume 282 (3,pt.1) page E522-E533. 0002-9513

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Effect of 1,25-dihydroxycholecalciferol on glucose metabolism in gestational diabetes mellitus. Author(s): Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Denmark. Source: Rudnicki, P M Molsted Pedersen, L Diabetologia. 1997 January; 40(1): 40-4 0012186X

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Effects of gestational diabetes on human placental glucose uptake, transfer, and utilisation. Author(s): Department of Perinatal Medicine, Royal Women's Hospital, Carlton Victoria, Australia. Source: Osmond, D T Nolan, C J King, R G Brennecke, S P Gude, N M Diabetologia. 2000 May; 43(5): 576-82 0012-186X

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Euglycemic control of gestational diabetes mellitus by specific dietary manipulation: a case study presentation. Source: Mahaffey, P J Podell, S K Diabetes-Educ. 1991 Nov-December; 17(6): 460-5 01457217

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Evaluation of DIABNET, a decision support system for therapy planning in gestational diabetes. Author(s): ETSI Telecomunicacion, Grupo de Bioingenieria y Telemedicina, Universidad Politecnica de Madrid, 28040, Madrid, Spain. [email protected] Source: Hernando, M E Gomez, E J Corcoy, R del Pozo, F Comput-Methods-ProgramsBiomed. 2000 July; 62(3): 235-48 0169-2607

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Exercise as a treatment modality to maintain normoglycemia in gestational diabetes. Source: Rosas, T Constantino, N J-Perinat-Neonatal-Nurs. 1992 June; 6(1): 14-24 08932190

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From diagnosis to home management: nutritional considerations for women with gestational diabetes. Source: Armstrong, C L Brown, L P York, R Robbins, D Swank, A Diabetes-Educ. 1991 Nov-December; 17(6): 455-9 0145-7217

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Gestational diabetes mellitus and neonatal hyperthyrotropinemia. Author(s): Department of Obstetrics and Gynaecology, The University of Hong Kong, Tsan Yuk Hospital, Hong Kong SAR, China. [email protected]

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Source: Lao, Terence T Lee, Chin Peng Gynecol-Obstet-Invest. 2002; 53(3): 135-9 03787346 •

Glucose monitoring in women with insulin-requiring gestational diabetes mellitus. Author(s): Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507, USA. Source: de Veciana, M Diabetes-Metab-Revolume 1998 September; 14 Suppl 1S25-30 0742-4221

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Glyburide compared to insulin for the treatment of gestational diabetes mellitus: a cost analysis. Author(s): Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA. Source: Goetzl, Laura Wilkins, Isabelle J-Perinatol. 2002 Jul-August; 22(5): 403-6 07438346

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Insulin receptor binding to monocytes and erythrocytes in gestational diabetes. Author(s): Department of Obstetrics and Gynaecology Y, Rigshospitalet, Copenhagen, Denmark. Source: Andersen, O Kuhl, C Diabete-Metab. 1987 Nov-December; 13(6): 607-12 03381684

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Insulin secretion to glucose infusion in gestational diabetes subjects with differing DNA polymorphisms flanking the insulin gene. Source: Samanta, A Burden, A C Jowett, N I Galton, D J Hosker, J P Turner, R C Diabetes-Res. 1987 March; 4(3): 109-12 0265-5985

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Insulin sensitivity and insulin response in women with gestational diabetes mellitus. Author(s): Department of Pediatrics, St. Goran's Children's Hospital, Stockholm, Sweden. Source: Persson, B Edwall, L Hanson, U Nord, E Westgren, M Horm-Metab-Res. 1997 August; 29(8): 393-7 0018-5043

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Late complications of gestational diabetes--maternal effects. Author(s): Department of Obstetrics and Gynecology, University Medical School of Debrecen. Source: Nagy, G Zentralbl-Gynakol. 1993; 115(10): 450-3 0044-4197

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Management of the woman with gestational diabetes mellitus. Author(s): Patient Care Services, University of California, Davis Medical Center, USA. Source: Jones, M W Stone, L C J-Perinat-Neonatal-Nurs. 1998 March; 11(4): 13-24 08932190

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Maternal implications of gestational diabetes. Author(s): Department of Obstetrics and Gynecology, Women and Children's Hospital, University of Southern California, Los Angeles 90033. Source: Kjos, S L Semin-Perinatol. 1994 October; 18(5): 470-4 0146-0005

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Membrane-type matrix metalloproteinase-9 activity in placental tissue from patients with pre-existing and gestational diabetes mellitus. Author(s): Centro de Estudios Farmacologicos y Botanicos, Consejo Nacional de Investigaciones Cientificas y Tecnicas, Buenos Aires, Argentina. Source: Pustovrh, C Jawerbaum, A Sinner, D Pesaresi, M Baier, M Micone, P Gimeno, M Gonzalez, E T Reprod-Fertil-Devolume 2000; 12(5-6): 269-75 1031-3613

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Optimization of insulin therapy in patients with gestational diabetes. Author(s): Sansum Medical Research Foundation, Santa Barbara, California 93105-3210, USA. Source: Jovanovic, L Endocr-Pract. 2000 Jan-February; 6(1): 98-100 1530-891X

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Oral contraceptives: effects on glucose and lipid metabolism in insulin-dependent diabetic women and women with previous gestational diabetes. A clinical and biochemical assessment. Author(s): Department of Obstetrics and Gynaecology, University of Copenhagen, Denmark. Source: Skouby, S O Dan-Med-Bull. 1988 April; 35(2): 157-67 0907-8916

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Physical and glycemic responses of women with gestational diabetes to a moderately intense exercise program. Source: Durak, E P Jovanovic Peterson, L Peterson, C M Diabetes-Educ. 1990 Jul-August; 16(4): 309-12 0145-7217

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Predictive factors for insulin treatment in women with diagnosis of gestational diabetes. Author(s): Cattedra di Endocrinologia e Malattie del Metabolismo, Universita degli Studi, Palermo, Italy. Source: Botta, R M Di Giovanni, B M Cammilleri, F Taravella, V Ann-Ist-Super-Sanita. 1997; 33(3): 403-6 0021-2571

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Preventing NIDDM among aboriginal people: is exercise the answer? Description of a pilot project using exercise to prevent gestational diabetes. Author(s): University of Saskatchewan, Saskatoon, Canada. Source: Dyck, R F Sheppard, M S Cassidy, H Chad, K Tan, L Van Vliet, S H Int-JCircumpolar-Health. 1998; 57 Suppl 1375-8 1239-9736

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Relationships between the perceived impact of gestational diabetes mellitus and treatment adherence. Author(s): West Virginia University School of Nursing, Charleston 25304, USA. Source: Persily, C A J-Obstet-Gynecol-Neonatal-Nurs. 1996 September; 25(7): 601-7 08842175

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Review of gestational diabetes mellitus and low-calorie diet and physical exercise as therapy. Author(s): Sansum Medical Research Foundation, Santa Barbara, CA 93105, USA. Source: Jovanovic Peterson, L Peterson, C M Diabetes-Metab-Revolume 1996 December; 12(4): 287-308 0742-4221

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Screening and management for gestational diabetes. Source: Bunkers Lawson, T Davidson, J Hollander, P Reader, D Strock, E Diabetes-Educ. 1988 Sep-October; 14(5): 440-2 0145-7217

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Sonographic measurements of subcutaneous fetal fat in pregnancies complicated by gestational diabetes and in normal pregnancies. Author(s): Department of Obstetrics and Gynecology, ISBM L. Sacco, Via G. B. Grassi, 74, 20157 Milan, Italy. [email protected] Source: Rigano, S Ferrazzi, E Radaelli, T Cetin, E T Pardi, G Croat-Med-J. 2000 September; 41(3): 240-4 0353-9504

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Studies of gestational diabetes using the pig as a model. Source: Hausman, D.B. Kasser, T.R. Seerley, R.W. Martin, R.J. Swine in biomedical research / edited by M.E. Tumbleson. New York : Plenum Press, c1986. page 561-572. ISBN: 0306424142

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The glucose challenge test: a screening test for gestational diabetes mellitus. Author(s): Department of Obstetrics and Gynaecology, National University Hospital, Singapore. Source: Chua, S Thai, A C Kek, L P Yeoh, S C Ratnam, S S Singapore-Med-J. 1993 August; 34(4): 303-5 0037-5675

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The impact of self-monitoring of blood glucose on self-efficacy and pregnancy outcomes in women with diet-controlled gestational diabetes. Author(s): General Clinical Research Center, Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple University Hospital, 4 West, 3401 North Broad Street, Philadelphia, PA 19140, USA. [email protected] Source: Homko, Carol J Sivan, Eyal Reece, E Albert Diabetes-Educ. 2002 May-June; 28(3): 435-43 0145-7217

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The principles of dietary management of gestational diabetes: reflection on current evidence. Author(s): Nutrition & Dietetic Research Group, Department of Metabolic Medicine and Nutrition & Dietetics, Division of Investigative Science, Hammersmith Hospital Campus, Faculty of Medicine, Imperial School of Medicine, London, UK. Source: Dornhorst, A Frost, G J-Hum-Nutr-Diet. 2002 April; 15(2): 145-56; quiz 157-9 0952-3871

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Thiamine supplementation to prevent induction of low birth weight by conventional therapy for gestational diabetes mellitus. Author(s): Department of Internal Medicine, University Hospital Groningen, The Netherlands. [email protected] Source: Bakker, S J ter Maaten, J C Gans, R O Med-Hypotheses. 2000 July; 55(1): 88-90 0306-9877

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When diet fails: insulin and oral hypoglycemic agents as alternatives for the management of gestational diabetes mellitus. Author(s): Department of Obstetrics and Gynecology, St Luke's-Roosevelt Hospital Center, New York, New York 10019, USA. Source: Langer, O J-Matern-Fetal-Neonatal-Med. 2002 April; 11(4): 218-25 1476-7058

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMD®Health: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to gestational diabetes; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Vitamin B6 Source: Healthnotes, Inc.; www.healthnotes.com Vitamin B6 Source: Prima Communications, Inc.www.personalhealthzone.com

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Minerals Chromium Source: Prima Communications, Inc.www.personalhealthzone.com

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•

Food and Diet Diabetes Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND GESTATIONAL DIABETES Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to gestational diabetes. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to gestational diabetes and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “gestational diabetes” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to gestational diabetes: •

A girl with a perineal phallic mass. Author(s): Han H, Saing H, Choi AC, Nicholls JM. Source: British Journal of Urology. 1997 December; 80(6): 962-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9439424&dopt=Abstract

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A high-fibre diet in gestational diabetes--wheat fibre, leguminous fibre or both? Author(s): Paisey RB, Hartog M, Savage P. Source: Hum Nutr Appl Nutr. 1987 April; 41(2): 146-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3032872&dopt=Abstract

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Alternative therapies for the management of gestational diabetes. Author(s): Mulford MI, Jovanovic-Peterson L, Peterson CM.

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Source: Clin Perinatol. 1993 September; 20(3): 619-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8222473&dopt=Abstract •

Amylophagia presenting as gestational diabetes. Author(s): Jackson WC, Martin JP. Source: Archives of Family Medicine. 2000 July; 9(7): 649-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10910314&dopt=Abstract

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Chromium, glucose intolerance and diabetes. Author(s): Anderson RA. Source: Journal of the American College of Nutrition. 1998 December; 17(6): 548-55. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9853533&dopt=Abstract

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Complementary therapy for severe Rh-alloimmunization. Author(s): Noia G, De Santis M, Romano D, Cavaliere AF, Ligato MS, Petrone A, Fortunato G, Filippetti F, Caruso A, Mancuso S. Source: Clin Exp Obstet Gynecol. 2002; 29(4): 297-301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635750&dopt=Abstract

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Counseling programs and the outcome of gestational diabetes in Austrian and Mediterranean Turkish women. Author(s): Hoppichler F, Lechleitner M. Source: Patient Education and Counseling. 2001 December 15; 45(4): 271-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11755772&dopt=Abstract

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Diabetes. Author(s): Oats JN. Source: Baillieres Clin Obstet Gynaecol. 1995 September; 9(3): 481-95. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8846551&dopt=Abstract

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Do fiber-enriched diabetic diets have glucose-lowering effects in pregnancy? Author(s): Reece EA, Hagay Z, Caseria D, Gay LJ, DeGennaro N. Source: American Journal of Perinatology. 1993 July; 10(4): 272-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8397560&dopt=Abstract

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Effects of acute maternal hyperglycaemia and hyperosmolality on maternofetal transfer of calcium and magnesium across the in situ perfused rat placenta. Author(s): Husain SM, Mughal MZ, Sibley CP. Source: Magnes Res. 2000 December; 13(4): 239-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11153894&dopt=Abstract

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Fasting plasma glucose as a screening test for gestational diabetes in a multi-ethnic, high-risk population. Author(s): Agarwal MM, Hughes PF, Punnose J, Ezimokhai M. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2000 October; 17(10): 720-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11110505&dopt=Abstract

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Fetal erythrocyte phospholipid polyunsaturated fatty acids are altered in pregnancy complicated with gestational diabetes mellitus. Author(s): Wijendran V, Bendel RB, Couch SC, Philipson EH, Cheruku S, Lammi-Keefe CJ. Source: Lipids. 2000 August; 35(8): 927-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10984116&dopt=Abstract

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Gestational diabetes mellitus in the last trimester - a feature of maternal iron excess? Author(s): Lao TT, Chan PL, Tam KF. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2001 March; 18(3): 218-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11318843&dopt=Abstract

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High intake of energy, sucrose, and polyunsaturated fatty acids is associated with increased risk of preeclampsia. Author(s): Clausen T, Slott M, Solvoll K, Drevon CA, Vollset SE, Henriksen T. Source: American Journal of Obstetrics and Gynecology. 2001 August; 185(2): 451-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11518908&dopt=Abstract

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High-dose biotin, an inducer of glucokinase expression, may synergize with chromium picolinate to enable a definitive nutritional therapy for type II diabetes. Author(s): McCarty MF. Source: Medical Hypotheses. 1999 May; 52(5): 401-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10416947&dopt=Abstract

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Inherited diseases in North American Mennonites: focus on Old Colony (Chortitza) Mennonites. Author(s): Jaworski MA, Severini A, Mansour G, Hennig K, Slater JD, Jeske R, Schlaut J, Yoon JW, Maclaren NK, Nepom GT. Source: American Journal of Medical Genetics. 1989 February; 32(2): 158-68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2784628&dopt=Abstract

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Introducing herbal medicine into conventional health care settings. Author(s): Lee L.

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Source: Journal of Nurse-Midwifery. 1999 May-June; 44(3): 253-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10380444&dopt=Abstract •

Long-term high fibre, low fat diet in gestational diabetes. Author(s): Paisey RB, Savage P, Marsland I, Cooke P. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1985 July; 2(4): 286-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3030616&dopt=Abstract

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Management of the woman with gestational diabetes mellitus. Author(s): Jones MW, Stone LC. Source: The Journal of Perinatal & Neonatal Nursing. 1998 March; 11(4): 13-24. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9592458&dopt=Abstract

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Maternal and infant complications in high and normal weight infants by method of delivery. Author(s): Gregory KD, Henry OA, Ramicone E, Chan LS, Platt LD. Source: Obstetrics and Gynecology. 1998 October; 92(4 Pt 1): 507-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9764620&dopt=Abstract

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Maternal plasma phospholipid polyunsaturated fatty acids in pregnancy with and without gestational diabetes mellitus: relations with maternal factors. Author(s): Wijendran V, Bendel RB, Couch SC, Philipson EH, Thomsen K, Zhang X, Lammi-Keefe CJ. Source: The American Journal of Clinical Nutrition. 1999 July; 70(1): 53-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10393139&dopt=Abstract

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Pregnancy following gastric bypass for morbid obesity. Author(s): Wittgrove AC, Jester L, Wittgrove P, Clark GW. Source: Obesity Surgery : the Official Journal of the American Society for Bariatric Surgery and of the Obesity Surgery Society of Australia and New Zealand. 1998 August; 8(4): 461-4; Discussion 465-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9731683&dopt=Abstract

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Prevalence and clinical significance of postpartum endometritis and wound infection. Author(s): Chaim W, Bashiri A, Bar-David J, Shoham-Vardi I, Mazor M. Source: Infectious Diseases in Obstetrics and Gynecology. 2000; 8(2): 77-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10805361&dopt=Abstract

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Thiamin status of gravidas treated for gestational diabetes mellitus compared to their neonates at parturition. Author(s): Baker H, Hockstein S, DeAngelis B, Holland BK.

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Source: Int J Vitam Nutr Res. 2000 December; 70(6): 317-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11214358&dopt=Abstract •

Thiamine supplementation to prevent induction of low birth weight by conventional therapy for gestational diabetes mellitus. Author(s): Bakker SJ, ter Maaten JC, Gans RO. Source: Medical Hypotheses. 2000 July; 55(1): 88-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11021334&dopt=Abstract

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Unusual clustering of diseases in a Canadian Old Colony (Chortitza) Mennonite kindred and community. Author(s): Jaworski MA, Slater JD, Severini A, Hennig KR, Mansour G, Mehta JG, Jeske R, Schlaut J, Pak CY, Yoon JW. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1988 June 1; 138(11): 1017-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3370569&dopt=Abstract

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Will feeding mothers prevent the Asian metabolic syndrome epidemic? Author(s): James WP. Source: Asia Pacific Journal of Clinical Nutrition. 2002; 11 Suppl 3: S516-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12492642&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

Chinese Medicine: http://www.newcenturynutrition.com/

•

drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html

•

Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

•

Google: http://directory.google.com/Top/Health/Alternative/

•

Healthnotes: http://www.healthnotes.com/

•

MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

•

Open Directory Project: http://dmoz.org/Health/Alternative/

•

HealthGate: http://www.tnp.com/

•

WebMD®Health: http://my.webmd.com/drugs_and_herbs

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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•

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to gestational diabetes; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Diabetes Source: Prima Communications, Inc.www.personalhealthzone.com Diabetes Mellitus Source: Integrative Medicine Communications; www.drkoop.com Obesity Source: Integrative Medicine Communications; www.drkoop.com Preeclampsia Source: Healthnotes, Inc.; www.healthnotes.com Pregnancy and Postpartum Support Source: Healthnotes, Inc.; www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON GESTATIONAL DIABETES Overview In this chapter, we will give you a bibliography on recent dissertations relating to gestational diabetes. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “gestational diabetes” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on gestational diabetes, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Gestational Diabetes ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to gestational diabetes. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Aspects of Gestational Diabetes. Screening System, Maternal and Fetal Complications by Ostlund, Ingrid; PhD from Uppsala Universitet (Sweden), 2003, 38 pages http://wwwlib.umi.com/dissertations/fullcit/f153537

•

Maternal Weight Relationships and Infant Outcomes in Women with Gestational Diabetes Mellitus As Compared to the Weight Gain Recommendations for Pregnancy of the Institutes of Medicine by Jonaitis, Mary Ann; EDD from Columbia University Teachers College, 2002, 136 pages http://wwwlib.umi.com/dissertations/fullcit/3052886

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Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. DIABETES

CLINICAL TRIALS AND GESTATIONAL

Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning gestational diabetes.

Recent Trials on Gestational Diabetes The following is a list of recent trials dedicated to gestational diabetes.8 Further information on a trial is available at the Web site indicated. •

Gestational Diabetes Mellitus Trial Condition(s): Diabetes, Gestational Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Child Health and Human Development (NICHD) Purpose - Excerpt: Gestational diabetes mellitus (GDM) is a type of diabetes (high blood sugar) that occurs in pregnant women. This study will determine whether treating pregnant women with mild GDM improves the health of their babies. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00069576

•

Safety & Efficacy of Insulin Aspart vs. Regular Human Insulin in Gestational Diabetes Condition(s): Gestational Diabetes Study Status: This study is currently recruiting patients. Sponsor(s): Novo Nordisk Pharmaceuticals

8

These are listed at www.ClinicalTrials.gov.

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Purpose - Excerpt: The purpose of this study is to test whether NovoLog (insulin aspart) is a safe and at least as effective alternative to regular human insulin for the control of blood glucose after meals in women who develop diabetes during pregnancy. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00065130

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “gestational diabetes” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

•

For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

•

For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

•

For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

•

For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

•

For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

•

For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

•

For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

•

For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

•

For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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•

For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

•

For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

•

For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

•

For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON GESTATIONAL DIABETES Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “gestational diabetes” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on gestational diabetes, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Gestational Diabetes By performing a patent search focusing on gestational diabetes, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 9Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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The following is an example of the type of information that you can expect to obtain from a patent search on gestational diabetes: •

Method of diagnosing gestational diabetes Inventor(s): Peterson; Charles M. (Santa Barbara, CA), Peterson; Lois G. (Santa Barbara, CA) Assignee(s): Sansum Medical Research Foundation (Santa Barbara, CA) Patent Number: 5,670,377 Date filed: March 14, 1996 Abstract: Methods of diagnosis of gestational diabetes mellitus are disclosed. In preferred embodiments, a blood sample is obtained from a pregnant female in the 24th to 28th week of pregnancy after an overnight fast, after a 1-hour 50-gram glucose challenge test, or at the 1-hour time point during a 3-hour 100-gram oral glucose tolerance test. The concentrations of fasting plasma glucose and glycosylated plasma proteins in this blood sample are then determined. A fasting plasma glucose concentration equal to or exceeding 90 mg/dL is 100% sensitive and 64% specific in predicting glucose-related macrosomia (i.e., birth weight above 4000 grams). A glycosylated plasma protein concentration equal to or exceeding 23% is 100% sensitive and 52% specific in predicting glucose-related macrosomia. A fasting plasma protein value equal to or exceeding 90 mg/dL and a glycosylated plasma protein value equal to or exceeding 23% is 100% sensitive and 93% specific in predicting glucose-related macrosomia. Excerpt(s): The present invention is broadly concerned with methods of diagnosing gestational diabetes mellitus (GDM). More particularly, in these methods, the concentrations of fasting plasma glucose (FPG) and glycosylated plasma protein (GPP) in the blood of a female in the 24th to 28th week of pregnancy are determined; concentrations of FPG and GPP equal to or exceeding 90 mg/dL and 23%, respectively, indicate that the pregnant female may be suffering from GDM and is therefore at risk of giving birth to a macrosomic infant. Measurement of glycosylated hemoglobin (GHb) levels, a single test and an indicator of long-term glucose control, lacks the sensitivity needed to screen for GDM, let alone milder elevations of glucose levels (7, 12). Therefore, it is unlikely that GHb is useful in screening for macrosomia. The studies on the use of GHb to predict macrosomia have been controversial and generally are retrospective, with measurement of GHb levels performed at delivery (24, 25). Studies on the use of glycosylated albumin, glycosylated serum protein (GSP), and fructosamine (8-14) have shown that these glycosylated proteins are not useful indicators of GDM. Some researchers have examined glucose concentrations determined on the glucose challenge test (GCT) and the oral glucose tolerance test (OGTT) to predict macrosomia (6, 15, 26-29). Sacks et al. (15) reported that the fasting blood glucose concentration on the OGTT performed in those women with a positive GCT correlated with macrosomia. Magee et al. (27) found that the frequency of macrosomia was 27% in women who screened negative on the GCT, 19% in women who screened positive on the GCT and negative on the OGTT, and 27% in women who screened positive on the GCT and on the OGTT. Little and coworkers (28) found that FPG concentrations and 2-hour plasma glucose concentrations on the OGTT were higher in those mothers who delivered an infant large for gestational age. Jovanovic and Peterson (6) showed that an elevated 1hour plasma glucose concentration on the GCT correlated with an increased risk of

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macrosomia despite normal results on the OGTT. Skyler and coworkers (29) showed that a FPG concentration above 90 mg/dL increased the risk for macrosomia. Web site: http://www.delphion.com/details?pn=US05670377__ •

Use of exendins and agonists thereof for the treatment of gestational diabetes mellitus Inventor(s): Hiles; Richard A. (San Diego, CA), Prickett; Kathryn S. (San Diego, CA) Assignee(s): Amylin Pharmaceuticals, Inc. (San Diego, CA) Patent Number: 6,506,724 Date filed: June 1, 1999 Abstract: Methods for treating gestational diabetes which comprise administration of an effective amount of an exendin or an exendin agonist, alone or in conjunction with other compounds or compositions that lower blood glucose levels. Excerpt(s): The present invention relates to methods for treating gestational diabetes mellitus comprising administration of an effective amount of an exendin or an exendin agonist alone or in conjunction with other compounds or compositions that affect blood glucose control, such as an insulin or an amylin agonist. Pharmaceutical compositions for use in the methods of the invention are also disclosed. The following description summarizes information relevant to the present invention. It is not an admission that any of the information provided herein is prior art to the presently claimed invention, nor that any of the publications specifically or implicitly referenced are prior art to that invention. Gestational diabetes mellitus ("GDM") is a disorder associated with elevated circulating plasma glucose. Although the diagnostic criteria for GDM have been the subject of controversy for decades, it was defined by the Third Workshop Conference on Gestational Diabetes Mellitus as carbohydrate intolerance of varying severity with onset or first recognition during pregnancy, irrespective of the glycemic status after delivery. Metzger (ed.) Proceedings of the Third International Workshop Conference on Gestational Diabetes Mellitus, Diabetes 40(Suppl. 2), 1991. Despite advances in clinical management of GDM, there are problems associated with GDM which persist, including elevated rate of perinatal morbidity and elevated rate of malformations in newborns. Persson et al., Diabetes and Pregnancy, In International Textbook of Diabetes Mellitus, Second Edition, John Wiley & Sons 1997 (Alberti et al. Eds.). For example, it has been reported that, when the mean blood glucose level is greater than 105 mg/dl, there is a greater risk for the development of large-for-gestational age ("LGA") infants when compared with a control population. Id. Additional reported consequences of untreated GDM include an increased incidence of macrosomia, respiratory distress syndrome, and other abnormalities of fetal metabolism. Langer, Am. J. Obstet Gynecol. 176:S186, 1997; American Diabetes Association: Self-Monitoring of Blood Glucose Consensus Statement, Diabetes Care 17:81-82, 1994("ABA Consensus Statement"); Coetzee & Jackson, S. Afr. Med. J. 56:467-475, 1979. It has been clearly established by those in the field that tight glycemic control can serve as the primary prevention of fetal disease relating to GDM. Drexel et al., Diabetes Care 11:761-768, 1988; Roversi et al., Diabetes Care 3:489-494, 1980; Langer & Mazze, Am. J. Obstet Gynecol. 159:1478-1483, 1988; Langer et al., Am. J. Obstet Gynecol. 161:646-653, 1989). GDM results in a greater incidence of intrauterine death or neonatal mortality. Position Statement American Diabetes Association: Gestational Diabetes Mellitus, Diabetes Care 21 (Suppl. 1):S60-61, 1998. GDM pregnancies are at an increased risk for fetal macrosomia and neonatal morbidities including neural tube defects, hypoglycemia, hypocalcemiea, hypomagnsemia,

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polycythemia and hyperbilirubinemia and subsequent childhood and adolescent obesity. Siccardi, Gestational Diabetes. Other complications to the woman include increased rates of cesarean delivery, hypertensive disorders including preeclamsia and urinary tract infections. Web site: http://www.delphion.com/details?pn=US06506724__ •

Use of thiazolidinedione derivatives in the treatment of polycystic ovary syndrome, gestational diabetes and disease states at risk for progressing to noninsulindependent diabetes mellitus Inventor(s): Antonucci; Tammy (Thousand Oaks, CA), Lockwood; Dean (Ann Arbor, MI), Norris; Rebecca (Kewadin, MI) Assignee(s): Warner-Lambert Company (Morris Plains, NJ) Patent Number: 5,874,454 Date filed: May 15, 1997 Abstract: Novel methods of using thiazolidinone derivatives and related antihyperglycemic agents to treat populations at risk for developing noninsulindependent diabetes mellitus (NIDDM) and complications arising therefrom are disclosed In one embodiment, the compounds of the invention are used to treat polycystic ovary syndrome in order to prevent or delay the onset of noninsulindependent diabetes mellitus. In another embodiment, the compounds of the invention are used to treat gestational diabetes in order to prevent or delay the onset of noninsulin-dependent diabetes mellitus. Excerpt(s): The present invention pertains to a number of compounds which can be used to treat certain disease states in order to prevent or delay the onset of noninsulindependent diabetes mellitus (NIDDM). More specifically, the present invention involves in one embodiment administering to a patient certain known thiazolidinedione derivatives and related antihyperglycemic agents which treat disease states such as polycystic ovary and gestational diabetes syndrome which are at increased risk in the development of NIDDM, thus preventing or delaying the onset of NIDDM or complications resulting therefrom. Diabetes is one of the most prevalent chronic disorders worldwide with significant personal and financial costs for patients and their families, as well as for society. Different types of diabetes exist with distinct etiologies and pathogeneses. For example, diabetes mellitus is a disorder of carbohydrate metabolism, characterized by hyperglycemia and glycosuria and resulting from inadequate production or utilization of insulin. Reports indicate that insulin secretion is often enhanced early-on, presumably as compensation for the insulin resistance. People who actually develop NIDDM appear to do so because their B-cells eventually fail to maintain sufficient insulin secretion to compensate for the insulin resistance. Mechanisms responsible for the B-cell failure have not been identified, but may be related to the chronic demands placed on the B-cells by peripheral insulin resistance and/or to the effects of hyperglycemia to impair B-cell function. The B-cell failure could also occur as an independent, inherent defect in "pre-diabetic" individuals. Web site: http://www.delphion.com/details?pn=US05874454__

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Patent Applications on Gestational Diabetes As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to gestational diabetes: •

Alpha-substituted carboxylic acid derivatives Inventor(s): Fujita, Takashi; (Kashiwa-shi, JP), Fujiwara, Toshihiko; (Ebina-shi, JP), Honma, Hidehito; (Shinagawa-ku, JP), Iwabuchi, Haruo; (Urawa-shi, JP), Oguchi, Minoru; (Katsushika-ku, JP), Wada, Kunio; (Asaka-shi, JP) Correspondence: Frishauf, Holtz, Goodman & Chick, PC; 767 Third Avenue; 25th Floor; New York; NY; 10017-2023; US Patent Application Number: 20030069294 Date filed: October 5, 2001 Abstract: The.alpha.-substituted carboxylic acid derivatives having the formula (I): 1wherein R.sub.1 is an alkyl group, etc., R.sub.2 is a hydrogen atom, etc., R.sub.3 is a hydrogen atom, etc., A is.dbd.CH-group, etc., B is an oxygen atom, etc., W.sub.1 is a C.sub.1-C.sub.8 alkylene group, W.sub.2 is a single bond or a C.sub.1-C.sub.8 alkylene group, X is a hydrogen atom, etc., Y is an oxygen atom, etc., and Z.sub.1 is an alkoxy group, etc., and pharmacologically acceptable salts, esters and amides thereof are useful for treatment and/or prevention of diabetes mellitus, impaired glucose tolerance, gestational diabetes mellitus, or the like. Some of the derivatives of the formula (I) are novel compounds. Excerpt(s): This application is a continuation-in-part application of International Application PCT/JP00/02215 filed Apr. 6, 2000 (not published in English) which is incorporated herein by this reference. The present invention relates to.alpha.-substituted carboxylic acid derivatives having excellent insulin resistance improving activity, hypoglycemic activity, anti-inflammatory activity, immunoregulatory activity, aldose reductase inhibiting activity, 5-lipoxygenase inhibiting activity, peroxidized lipid production suppressing activity, PPAR activating activity, anti-osteoporosis activity, leukotrienes antagonistic activity, adipose cell formation promoting activity, cancer cell proliferation suppressing activity or calcium antagonistic activity, to their pharmacologically acceptable esters, to their pharmacologically acceptable amides and to their pharmacologically acceptable salts. Further, the present invention is directed to preventives and/or therapeutic agents for diseases such as diabetes mellitus, hyperlipemia, obesity, glucose tolerance insufficiency, hypertension, fatty liver, diabetic complications (e.g. retinopathy, nephropathy, neurosis, cataract, coronary artery diseases, etc.), arteriosclerosis, gestational diabetes mellitus, polycystic ovary syndrome, cardiovascular diseases (e.g. ischemic heart disease, etc.), cell injury lesion (e.g. cerebral injury induced by stroke, etc.) caused by atherosclerosis or ischemic heart disease, gout, inflammatory diseases (e.g. arthrosteitis, pain, fervescence, rheumatic arthritis, inflammatory enteritis, acne, sunburn, psoriasis, eczema, allergic diseases, asthma, GI ulcer, cachexia, autoimmune disease, pancreatitis, etc.), cancer, osteoporosis, cataract, and so on containing said.alpha.-substituted carboxylic acid derivatives, their pharmacologically acceptable esters, their pharmacologically acceptable amides or their pharmacologically acceptable salts as an active ingredient.

10

This has been a common practice outside the United States prior to December 2000.

138 Gestational Diabetes

Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Compositions and methods for inhibiting islet dysfunction and autoimmune disorders Inventor(s): Hill, David J.; (London, CA), Remacle, Claude; (Louvain-la-Neuve, BE), Reusens, Brigitte; (Braine-I'Alleud, BE) Correspondence: Kenneth I. Kohn; Kohn & Associates, Pllc; Suite 410; 30500 Northwestern Highway; Farmington Hills; MI; 48334; US Patent Application Number: 20030180345 Date filed: February 10, 2003 Abstract: The invention relates to a composition comprising an amino acid like structure carrying a sulfur moiety and a biologically acceptable carrier for inhibiting islet dysfunction and/or autoimmune disorders. The structure may be taurine, L-cysteine, Lmethionine, or a combination of these. Conditions of islet dysfunction include insulitis, Type 1 diabetes (IDDM), Type 2 diabetes (NIDDM), mature onset diabetes of the young (MODY), and gestational diabetes. Autoimmune disorders include insulitis, Type 1 diabetes, rheumatoid arthritis, thyroiditis and pancreatitis. The composition can act to inhibit islet dysfunction through exerting anti-apoptotic or immunomodulatory activity. Methods are provided for inhibiting islet dysfunction and/or autoimmune disorders by administering an amino acid like structure carrying a sulfur moiety to an individual. Excerpt(s): This application is a continuation-in-part of International Patent Application PCT/CA01/01137, which was filed Aug. 9, 2001, and published Feb. 21, 2002, and claims the benefit of priority from International Patent Application PCT/CA00/00925, filed on Aug. 11, 2000, which was published Feb. 21, 2002, the entirety of which is herein incorporated by reference. The present invention relates to a compositions and methods for inhibiting pancreatic islet dysfunction and for inhibiting autoimmune disorders. The compositions and methods are prophylactic and therapeutically effective against such conditions as insulitis, Type 1 diabetes, and Type 2 diabetes. Diabetes involves dysfunction of the pancreatic islet cells. In the case of Type 1 diabetes, also referred to as insulin dependent diabetes mellitus (IDDM), dysfunction is initiated in the event of an immunological challenge. In the case of Type 2 diabetes, also referred to as non-insulin dependent diabetes mellitus (NIDDM), islet dysfunction occurs in upon exposure to a homeostatic challenge. Diabetes can alter total.beta. cell mass, as well as the properties of individual.beta. cells. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Use of potassium channel openers for the treatment of insulitis Inventor(s): Bjork, Elisabeth; (Taby, SE), Hansen, John Bondo; (Jyderup, DK), Karlsson, Anders; (Uppsala, SE), Kullin, Mikael; (Uppsala, SE), Li, Zhanchun; (Uppsala, SE), Lund, Jesper Svendstorp; (Copenhagen O, DK), Michelsen, Birgitte; (Lyngby, DK), Sandler, Stellan; (Uppsala, SE) Correspondence: Reza Green, ESQ.; Novo Nordisk OF North America, INC.; Suite 6400; 405 Lexington Avenue; New York; NY; 10174-6401; US Patent Application Number: 20020032193 Date filed: June 26, 2001

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Abstract: The present invention relates to the use of potassium channel agonists for the treatment of insulitis associated with various forms of diabetes such as IDDM, NIDDM, SPIDDM (LADA) and gestational diabetes. Excerpt(s): This application claims priority under 35 U.S.C. 119 of Danish application no. PA 2000 00988 filed on Jun. 26, 2000, and U.S. provisional application No. 60/217,902 filed on Jul. 13, 2000, the contents of which are fully incorporated herein by reference. The present invention relates to the use of potassium channel openers, which are able to protect the beta cells against toxic damage, for treating or preventing diseases related to autoimmune destruction of human beta cells, such as different types of diabetes, and methods of using these compounds. Streptozotocin and alloxan are beta cell toxins. The toxic effect of these compounds on rat pancreatic islets in vitro and in vivo mimics the beta-cell death associated with Type 1 and late state Type 2 diabetes. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Use of selective potassium channel openers Inventor(s): Sturis, Jeppe; (Vaerlose, DK) Correspondence: Reza Green, ESQ.; Novo Nordisk Pharmaceuticals, INC.; 100 College Road West; Princeton; NJ; 08540; US Patent Application Number: 20030109519 Date filed: November 25, 2002 Abstract: The present invention relates to a use of SUR1/Kir6.2 selective potassium channel openers for the preparation of a pharmaceutical composition for the prevention or the treatment of diabetes in women with prior Gestational Diabetes Mellitus (GDM) as well as a pharmaceutical composition for use in the treatment of diabetes in women with prior GDM. Excerpt(s): The present invention relates to a use of SUR1/Kir6.2 selective potassium channel openers for the preparation of a medicament for the prevention or the treatment of diabetes in women with prior Gestational Diabetes Mellitus (GDM) as well as a pharmaceutical composition for use in the treatment of diabetes in women with prior GDM. Potassium channels play an important role in the physiological and pharmacological control of cellular membrane potential. Amongst the different types of potassium channels are the ATP-sensitive (K.sub.ATP-) channels, which are regulated by changes in the intracellular concentration of adenosine triphosphate. The K.sub.ATPchannels have been found in cells from various tissues such as cardiac cells, pancreatic cells, skeletal muscles, smooth muscles, central neurons and adenohypophysis cells. The channels have been associated with diverse cellular functions for example hormone secretion (insulin from pancreatic beta cells, growth hormone and prolactin from adenohypophysis cells), vasodilation (in smooth muscle cells), cardiac action potential duration, neurotransmitter release in the central nervous system. Modulators of the K.sub.ATP-channels have been found to be of importance for the treatment of various diseases. Certain sulphonylureas, which have been used for the treatment of noninsulin-dependent diabetes mellitus, act by stimulating insulin release through an inhibition of the K.sub.ATP-channels on pancreatic beta-cells. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with gestational diabetes, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “gestational diabetes” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on gestational diabetes. You can also use this procedure to view pending patent applications concerning gestational diabetes. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON GESTATIONAL DIABETES Overview This chapter provides bibliographic book references relating to gestational diabetes. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on gestational diabetes include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “gestational diabetes” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on gestational diabetes: •

Managing Your Gestational Diabetes: A Guide for You and Your Baby's Good Health Source: Minneapolis, MN: Chronimed Publishing. 1994. 132 p. Contact: Available from Chronimed Publishing. P.O. Box 59032, Minnetonka, MN 55459-0032. (800) 848-2793. PRICE: $9.95. ISBN: 1565610520. Summary: This book provides pregnant women with information about gestational diabetes. Women diagnosed with gestational diabetes should follow a special meal plan and self-monitor blood glucose. They also may need to follow a regular exercise program and inject insulin each day. Fourteen chapters address an introduction to diabetes, emotions, gestational diabetes treatment, meal planning, exercise, insulin and insulin reactions, self monitoring of blood glucose and urine ketone testing, stress management, delivery, breastfeeding, and planning for the future. The author notes that meal planning is central to controlling gestational diabetes and ensuring delivery of a

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healthy baby. All other parts of the treatment program hinge on successfully following an appropriate meal plan. A list of meal planning publications, a glossary, biographical information, sample record pages, a comparison of American and Canadian food group exchanges, and a subject index conclude the book. (AA-M). •

Gestational Diabetes: What to Expect Source: Alexandria, VA: American Diabetes Association. 1992. 76 p. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-6733. PRICE: $7.95 for ADA members; $9.95 for nonmembers (as of 1995). ISBN: 0945448104. Order Number CPREGD. Summary: This book, from the American Diabetes Association, provides a comprehensive guide for the pregnant woman who has gestational diabetes. The authors explain proper care during pregnancy, including nutrition, exercise, insulin therapy, and blood glucose monitoring. Other subjects related to pregnancy are discussed, including stages of a fetus' development, tests to expect during pregnancy, labor and delivery, and birth control. An extensive glossary of terms is included, and a subject index concludes the book.

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Understanding Gestational Diabetes: A Practical Guide to a Healthy Pregnancy. Revised ed Source: Bethesda, MD: National Institute of Child Health and Human Development. 1993. 46 p. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. E-mail: [email protected]. PRICE: Single copy free. Bulk copies available from National Institute of Child Health and Human Development. 31 Center Drive, MSC 2425, Building 31, Room 2A32, Bethesda, MD 20892. (301) 496-5133. Summary: This booklet for pregnant women and their families explains gestational diabetes and its impact on the health of mother and baby. It addresses many questions about diet, exercise, measurement of blood glucose levels, and general medical and obstetric care of women with gestational diabetes. Screening methods for gestational diabetes are discussed. The primary focus of this health guide is on diet and weight gain. Several tables are included to assist the pregnant woman in following a nutritionally sound diet that fosters an appropriate weight gain and that keeps blood glucose levels as normal as possible. Footnotes cite 4 bibliographic citations and a brief glossary is included. Blank Self Blood Glucose Monitoring Diary and Food and Exercise Record Sheet charts are appended.

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Best for You and Your Baby: Answers About Gestational Diabetes Source: Indianapolis, IN: Boehringer Mannheim Corporation. 1993. 40 p. Contact: Available from Boehringer Mannheim Corporation. Medical Services Department. 9115 Hague Road, Indianapolis, IN 46250. (800) 428-5076. PRICE: Single copy free. Summary: This easy-to-read patient education booklet offers general information about gestational diabetes. Topics include the patient care team and the patient's role in it; a definition of gestational diabetes; the causes of high blood glucose levels; complications to the fetus and the mother caused by hyperglycemia; monitoring fetal health; self-

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monitoring of blood glucose (SMBG); meal planning; the use of insulin; the role of exercise; emotional support; labor and delivery; postpartum problems with diabetes; and breastfeeding. Written in clear, basic language, the booklet features charcoal drawing illustrations and sidebars that highlight the important points on each page. The booklet concludes with a glossary of relevant terms. It is also available in Spanish (Lo Mejor para Usted y su Bebe: Respuestas Sobre la Diabetes del Embarazo).

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “gestational diabetes” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “gestational diabetes” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “gestational diabetes” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

ADA Mnt Evidence-Based Guides for Practice: Nutrition Practice Guidelines for Gestational Diabetes Mellitus (CD-ROM) by American Dietetic Association (2001); ISBN: 0880913010; http://www.amazon.com/exec/obidos/ASIN/0880913010/icongroupinterna

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Are you at risk for gestational diabetes? (SuDoc HE 20.3352:G 33) by U.S. Dept of Health and Human Services; ISBN: B0001148YC; http://www.amazon.com/exec/obidos/ASIN/B0001148YC/icongroupinterna

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Clinician's Manual on Type 2 Diabetes & Gestational Diabetes by Zimmet, et al; ISBN: 1858730406; http://www.amazon.com/exec/obidos/ASIN/1858730406/icongroupinterna

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Diabetes Sourcebook: Basic Information About Insulin-Dependent and NoninsulinDependent Diabetes Mellitus, Gestational Diabetes, and Diabetic Complications Symptoms (Health Reference, Vol 3) by Karen Bellenir (Editor), Peter D. Dresser (Editor) (1995); ISBN: 1558887512; http://www.amazon.com/exec/obidos/ASIN/1558887512/icongroupinterna

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Gestational Diabetes by Donald R. Coustan (Editor), Peter A. M. Weiss; ISBN: 0387820078; http://www.amazon.com/exec/obidos/ASIN/0387820078/icongroupinterna

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Gestational Diabetes; ISBN: 3211820078; http://www.amazon.com/exec/obidos/ASIN/3211820078/icongroupinterna

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Gestational diabetes : how to have a healthy baby (SuDoc HE 20.9408:G 33) by U.S. Dept of Health and Human Services; ISBN: B000102412; http://www.amazon.com/exec/obidos/ASIN/B000102412/icongroupinterna

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Gestational diabetes; guidelines for a safe pregnancy and a healthy baby by Marion J. Franz; ISBN: 093772114X; http://www.amazon.com/exec/obidos/ASIN/093772114X/icongroupinterna

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Gestational Diabetes: What to Expect by American Diabetes Association; ISBN: 1580400728; http://www.amazon.com/exec/obidos/ASIN/1580400728/icongroupinterna

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How to have a healthy baby : gestational diabetes (SuDoc HE 20.9408:G 33/990) by U.S. Dept of Health and Human Services; ISBN: B000106VWU; http://www.amazon.com/exec/obidos/ASIN/B000106VWU/icongroupinterna

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Managing Your Gestational Diabetes : A Guide for You and Your Baby's Good Health by Lois Jovanovic-Peterson (Author); ISBN: 0471346845; http://www.amazon.com/exec/obidos/ASIN/0471346845/icongroupinterna

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The Official Patient's Sourcebook on Gestational Diabetes by James N., Md. Parker (Editor), Philip M., Ph.D. Parker (Editor) (2002); ISBN: 0597831416; http://www.amazon.com/exec/obidos/ASIN/0597831416/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “gestational diabetes” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 •

Diabetes sourcebook: basic consumer health information about Type 1 diabetes (insulin-dependent or juvenile-onset diabetes), Type 2 diabetes (noninsulindependent or adult-onset diabetes, gestational diabetes, impaired glucose tolerance (IGT), and related complications, such as amputation, eye disease, gum disease, nerve damage, and end-stage renal disease: including facts about insulin, oral diabetes medications, blood sugar testing, and the role of exercise and nutrition in the control of diabetes: along with a glossary and resources for further help and informations Author: Matthews, Dawn D.; Year: 1994; Detroit, MI: Omnigraphics, c2003; ISBN: 0780806298 http://www.amazon.com/exec/obidos/ASIN/0780806298/icongroupinterna

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Proceedings of the Second International Workshop-Conference on Gestational Diabetes Mellitus: October 25-27, 1984, Chicago, Illinois Author: Freinkel, Norbert,; Year: 2003; New York, N.Y.: The Association, 1985

Chapters on Gestational Diabetes In order to find chapters that specifically relate to gestational diabetes, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search 11

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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to book chapters and gestational diabetes using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “gestational diabetes” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on gestational diabetes: •

Exercise and Gestational Diabetes Source: in Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p.533-545. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $69.95 plus shipping and handling. ISBN: 1580400191. Summary: Exercise can play an important role in attaining and maintaining target levels of glycemia during pregnancy in women with gestational diabetes mellitus (GDM). This chapter on exercise and gestational diabetes is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. Regular, light exercise (e.g., walking for 20 to 30 minutes daily) is a rational component of the initial management regimen regardless of maternal regimen regardless of maternal glycemia. Intensification of the exercise prescription (e.g., to 25 to 40 minutes of exercise of 50 percent of calculated maximal aerobic capacity three times per week) can help to achieve safe levels of glycemia when diet and light exercise fail to do so. Pregnancy-induced hypertension (high blood pressure), preterm rupture of membranes, preterm labor in current or past pregnancies, incompetent cervix, persistent vaginal bleeding, or evidence for intrauterine growth retardation are contraindications to exercise during pregnancy. Women with a history of GDM are at high risk of developing diabetes, especially type 2 diabetes, after pregnancy. Insulin resistance appears to be an important component of and risk factor for progression to type 2 diabetes. Recommendations for behaviors, such as regular exercise, that reduce insulin resistance and help in attaining ideal body weight are an important part of postpartum management in women with GDM. 35 references.

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Testing for Gestational Diabetes Source: in Reece, E.A. and Coustan, D.R., eds. Diabetes Mellitus in Pregnancy. 2nd ed. New York, NY: Churchill Livingstone. 1995. p. 261-275. Contact: Available from Churchill Livingstone. 300 Lighting Way, Secaucus, NJ 07094. (800) 553-5426. PRICE: $92.00. ISBN: 0443089795. Summary: This chapter covers diagnostic criteria for the oral glucose tolerance test and for the intravenous glucose tolerance test (IVGTT) in testing for gestational diabetes. In addition, the author examines proposed screening tests, including historical factors, glycosylated hemoglobin and other blood protein levels, and other oral challenge tests. The diagnostic use of amniotic fluid glucose, insulin, and C-peptide, as well as postpartum evaluation of women with suspected diabetic fetopathy, are also discussed. 6 tables. 90 references. (AA-M).

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Management of Gestational Diabetes Source: in Reece, E.A.; Coustan, D.R., eds. Diabetes Mellitus in Pregnancy. 2nd ed. New York, NY: Churchill Livingstone. 1995. p. 277-286. Contact: Available from Churchill Livingstone. 300 Lighting Way, Secaucus, NJ 07094. (800) 553-5426. PRICE: $92.00. ISBN: 0443089795. Summary: This chapter, from a medical textbook on diabetes mellitus in pregnancy, discusses the management of gestational diabetes (GDM). The author stresses that the most important step in the management of GDM is its diagnosis. Once this has been achieved, almost every type of management protocol has been associated with a reduction in the perinatal mortality rate. The author briefly discusses the goals of management, then outlines a plan for achieving these goals. Steps in the plan include dietary therapy, glucose monitoring, oral hypoglycemic agents, insulin therapy, and the use of insulin to prevent morbidity (prophylactic insulin). The author concludes the chapter with a discussion of recommended fetal evaluation tests, and delivery considerations. The author stresses that all women diagnosed with GDM should be given dietary counseling and should be monitored at least weekly for fasting and postprandial hyperglycemia. Should hyperglycemia occur, insulin should be administered to restore glucose homeostasis and reduce perinatal mortality risks. Intervention to reduce perinatal morbidity is less clear. 1 figure. 2 tables. 53 references.

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Gestational Diabetes: Where Do We Look for It and How Do We Find It? Source: in Hall, J.E.; Nieman, L.K., eds. Handbook of Diagnostic Endocrinology. Totowa, NJ: The Humana Press, Inc. 2003. p. 179-191. Contact: Humana Press, Inc. 999 Riverview Dr., Suite 208 Totowa, NJ 07512. (973) 2561699. Fax (973) 256-8341. E-mail: [email protected] PRICE: $99.50 plus shipping and handling. ISBN: 0896037576. Summary: With the rapid development of new and more reliable diagnostic tests, and aided by the molecular and genetic approaches that continue to deepen the understanding of these diseases, the ability to diagnose patients with endocrine disease has dramatically increased. This chapter on gestational diabetes is from a book that explains the pathophysiology and clinical manifestations of endocrine disorders and surveys all the latest laboratory tests used in their diagnosis. In this chapter, the author discusses the definition of gestational diabetes (GDM), clinical features of the disease, diagnostic strategies and the controversies around diagnosis, threshold glucose levels for perinatal morbidity (complications during the prenatal and postnatal period), and appropriate screening tests for GDM. The author concludes that selective screening is advocated with no screening necessary only in those women meeting all of the low risk characteristics. High risk women require glucose screening at the first clinical contact following diagnosis of pregnancy, with women of average risk being screened at 24 to 28 weeks gestation. 1 figure. 4 tables. 42 references.

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CHAPTER 8. MULTIMEDIA ON GESTATIONAL DIABETES Overview In this chapter, we show you how to keep current on multimedia sources of information on gestational diabetes. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on gestational diabetes is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “gestational diabetes” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “gestational diabetes” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on gestational diabetes: •

University of Minnesota case studies: Iron deficiency anemia, gestational diabetes Source: Minneapolis, MN: Division of Epidemiology, Public Health Nutrition, University of Minnesota. 1995. 2 videotapes (37:38 minutes). Contact: Available from Margie Konopliv, University of Minnesota, Division of Epidemiology, Public Health Nutrition, 1300 South Second Street, Suite 300, Minneapolis, MN 55454-1015. Telephone: (612) 626-7933 / fax: (612) 624-0315 / e-mail: [email protected]. $25 each videotape. Summary: This set of two videotapes explores two complications of pregnancy. Both videotapes are accompanied by a teaching guide. Gestational diabetes covers definition, prevalence, significance, screening, diagnosis, nutritional management, dietary strategies, monitoring and postpartum follow-up. Iron deficiency covers definition, prevalence, prevention, and treatment. Both of the guides contain references. [Funded by the Maternal and Child Health Bureau].

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Diabetes: Gestational Diabetes Source: Chicago, IL: American Association of Diabetes Educators. 2002. (videocassette). Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, Suite 400, Chicago, IL 60603. (312) 424-2426. Fax (312) 424-2427. E-mail: [email protected]. Website: www.aadenet.org. PRICE: $65.00 for nonmembers; $50.00 for members. Summary: This video helps patients with gestational diabetes understand how they can get their blood glucose in a safe and healthy range for the remainder of their pregnancy. The video defines gestational diabetes, then discusses the risk factors, and the treatment plan, including home blood glucose and ketone monitoring, making healthy food choices, and increasing physical activity. Basic information about labor and delivery are included. Insulin injection is addressed in a separate section at the end of the video.

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Gestational Diabetes: Your Questions Answered Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1996. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. PRICE: $19.95 plus shipping and handling; bulk copies available. Order number 093096B. Summary: This videotape answers frequently asked questions about gestational diabetes. A moderator asks an obstetrician-gynecologist and a dietitian about various aspects of gestational diabetes. Topics include what gestational diabetes is and what causes it, how it differs from other kinds of diabetes, and how it will affect a baby. Gestational diabetes, which usually develops between 24 to 26 weeks of gestation, is caused when the placenta produces chemicals that interfere with insulin and the mother's body cannot compensate for this change. Risk factors for gestational diabetes include being over 30 years old and overweight, having a family history of diabetes, and having had a baby over 9.5 pounds or a stillborn infant. Most women have no symptoms so blood tests are usually performed between 24 and 28 weeks of gestation. Many women who have gestational diabetes can manage the disease with diet and exercise. However, some women may need insulin to manage their diabetes. If a woman needs insulin, she needs to self monitor her blood glucose levels, give herself insulin injections, have her pregnancy monitored more closely, do urine tests to monitor ketones, and have tests to make sure the baby is developing properly. Participants also answer questions about the effect of gestational diabetes on the baby, the impact of gestational diabetes on delivery, and other pregnancy complications. The videotape concludes by identifying sources of additional information.

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Nutrition Plan for Gestational Diabetes Source: Dallas, TX: St. Paul Medical Center, Diabetes Management Institute. 1993. Contact: Available from St. Paul Medical Center, Diabetes Management Institute, 2010 Record Crossing, Dallas, TX 75235. (214) 879-3285. PRICE: $39.95 plus $3.50 shipping and handling (as of 1995). Summary: This videotape program is designed to help viewers newly diagnosed with gestational diabetes (GDM) learn about nutrition. Topics covered include a brief discussion of the emotional aspects of GDM; how the disease occurs; the control of GDM

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with diet therapy, notably selecting the right foods at the right time in the right amounts; monitoring one's blood glucose levels; the basics of the GDM diet; working with dietitians; and the use of artificial sweeteners. Also included is a detailed, step-bystep guide to avoiding table sugar, incorporating three meals and three snacks per day, food selection, and the exchange list system of food groups for diabetes. •

Gestational Diabetes: Common Sense Guide for Expectant Moms Source: Evanston, IL: Altschul Group Corporation. 1994. Contact: Available from Altschul Group Corporation. 1560 Sherman Avenue, Suite 100, Evanston, IL 60201. (800) 421-2363 or (708) 328-6700. Fax (708) 328-6706. PRICE: $295 (as of 1995). Order no. 7843. Summary: This videotape program is one of a series of six videotapes that present a common sense approach for living with and controlling diabetes mellitus. This program is for pregnant women who have been diagnosed with gestational diabetes. The program emphasizes a team approach to control diabetes through blood glucose monitoring, meal planning, exercising, and insulin injections. The program reiterates that knowing what to expect and how to care for oneself can lessen the fears of women who have gestational diabetes. (AA-M).

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “gestational diabetes” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on gestational diabetes: •

Happy, Healthy Babies: Gestational Source: Van Nuys, CA: Prana Publications. 1995. (audiocassette). Contact: Available from Prana Publications. 5623 Matilija Avenue, Van Nuys, CA 91401. (800) 735-7726 or (818) 780-1308. Fax (818) 786-7359. E-Mail [email protected]. PRICE: $11.95 plus $3.25 shipping and handling (as of 1995). Order Number A11. Summary: This audiocassette program features Dr. Lois Jovanovic-Peterson discussing gestational diabetes mellitus (GDM). Topics include testing blood glucose, diet, taking insulin if necessary, exercising safely, labor and delivery, and breast feeding. Dr. Jovanovic-Peterson also has diabetes. (AA-M).

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CHAPTER 9. PERIODICALS AND NEWS ON GESTATIONAL DIABETES Overview In this chapter, we suggest a number of news sources and present various periodicals that cover gestational diabetes.

News Services and Press Releases One of the simplest ways of tracking press releases on gestational diabetes is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “gestational diabetes” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to gestational diabetes. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “gestational diabetes” (or synonyms). The following was recently listed in this archive for gestational diabetes: •

Subtle defects in glucose metabolism persist years after gestational diabetes Source: Reuters Medical News Date: September 15, 2003

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Serum test may allow early intervention for gestational diabetes Source: Reuters Medical News Date: August 01, 2003

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Blood test can predict diabetes during pregnancy Source: Reuters Health eLine Date: August 01, 2003

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Elevated first-trimester C-reactive protein may predict gestational diabetes Source: Reuters Medical News Date: March 28, 2003

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Women with gestational diabetes often uninformed about future risk Source: Reuters Medical News Date: December 09, 2002

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Fasting hyperglycemia in gestational diabetes raises risk of infant malformation Source: Reuters Medical News Date: November 04, 2002

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Early screening for gestational diabetes recommended Source: Reuters Medical News Date: August 26, 2002

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Mother's birthweight linked to gestational diabetes mellitus risk Source: Reuters Medical News Date: May 15, 2002

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Chromosomal anomalies seen in offspring of women with gestational diabetes Source: Reuters Medical News Date: May 01, 2002

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Glycemic parameters during gestational diabetes predict postpartum diabetes Source: Reuters Medical News Date: April 29, 2002

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Gestational diabetes tied to chromosome defects Source: Reuters Health eLine Date: April 19, 2002

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Gestational diabetes can be safely managed using insulin pumps Source: Reuters Industry Breifing Date: December 25, 2001

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Ultrasound helps assess fetal macrosomia risk in patients with gestational diabetes Source: Reuters Medical News Date: December 04, 2001

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Postprandial glucose discrepancies noted in women with gestational diabetes Source: Reuters Medical News Date: October 11, 2001

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ACOG issues new guidelines for management of gestational diabetes Source: Reuters Medical News Date: September 07, 2001

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Vaginal birth after cesarean unlikely in setting of gestational diabetes Source: Reuters Medical News Date: June 07, 2001

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Maternal weight before pregnancy is predictive of recurrent gestational diabetes Source: Reuters Medical News Date: March 26, 2001

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Universal screening for gestational diabetes of "limited benefit" Source: Reuters Medical News Date: November 22, 2000

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Pill as safe as insulin for gestational diabetes Source: Reuters Health eLine Date: October 18, 2000

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Glyburide effective treatment for gestational diabetes Source: Reuters Industry Breifing Date: October 18, 2000

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Gestational diabetes not associated with increased cesarean section rate Source: Reuters Medical News Date: January 14, 2000

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Patients prefer jelly beans to glucose beverage for gestational diabetes testing Source: Reuters Medical News Date: December 31, 1999

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Gestational diabetes related to minor neurological deficits in offspring Source: Reuters Medical News Date: July 20, 1999

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Risk of diabetes high but follow-up compliance poor for women with history of gestational diabetes Source: Reuters Medical News Date: May 10, 1999

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Gestational diabetes may account for common "idiopathic" birth defects Source: Reuters Medical News Date: April 23, 1999

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Vascular changes persist in healthy women 2 to 4 years after resolution of gestational diabetes Source: Reuters Medical News Date: January 12, 1999

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Low-dose combination OCs safe after gestational diabetes Source: Reuters Medical News Date: August 12, 1998

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Women with polycystic ovaries at high risk for gestational diabetes Source: Reuters Medical News Date: July 28, 1998

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Exercise Reduces Gestational Diabetes Risk In Morbidly Obese Wome Source: Reuters Medical News Date: January 02, 1998

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Gestational Diabetes Increases Risk Of Difficult Labor And Delivery Source: Reuters Medical News Date: December 29, 1997

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Steroids Plus Beta-Adrenergics Increase Risk Of Gestational Diabetes Source: Reuters Medical News Date: December 26, 1997

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New Strategy May Reduce Need For Gestational Diabetes Screening Source: Reuters Medical News Date: November 27, 1997

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Risk Factors For Gestational Diabetes Same As For NIDDM Source: Reuters Medical News Date: October 01, 1997

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Screening All Pregnant Women For Gestational Diabetes Called Into Question Source: Reuters Medical News Date: June 24, 1997

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Breakfast Test Identifies Low-Risk Gestational Diabetes Source: Reuters Medical News Date: June 05, 1997

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Glucose Levels Predict Fetal Abnormality Risk In Gestational Diabetes Source: Reuters Medical News Date: December 27, 1996

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Weight Gain Increases Likelihood Of Gestational Diabetes Recurrence Source: Reuters Medical News Date: December 12, 1996

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After Gestational Diabetes, NIDDM Risk Rises With Hormonal Contraception Source: Reuters Medical News Date: August 12, 1996

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C-Section Delivery For Gestational Diabetes: More Habit Than Necessity Source: Reuters Medical News Date: April 17, 1996

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Diagnosing Gestational Diabetes Without The GTT Source: Reuters Medical News Date: March 18, 1996

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Subsequent Pregnancy Increases NIDDM Risk In Women With History Of Gestational Diabetes Source: Reuters Medical News Date: January 26, 1996

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Jelly Beans An Alternative To Cola For Diagnosis Of Gestational Diabetes Source: Reuters Medical News Date: January 04, 1996

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New Recommendations For Glucose Monitoring Of Women With Gestational Diabetes Published Source: Reuters Medical News Date: November 09, 1995

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Gestational Diabetes Increases Offspring's Risk Of Hypertension, Obesity and Glucose Intolerance Source: Reuters Medical News Date: August 08, 1995

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Treatment For Gestational Diabetes In Women With Borderline Values Improves Fetal Outcome Source: Reuters Medical News Date: May 09, 1995 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “gestational diabetes” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “gestational diabetes” (or synonyms). If you know the name of a company that is relevant to gestational diabetes, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “gestational diabetes” (or synonyms).

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Academic Periodicals covering Gestational Diabetes Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to gestational diabetes. In addition to these sources, you can search for articles covering gestational diabetes that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for gestational diabetes. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI® Advice for the Patient® can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with gestational diabetes. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).

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The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to gestational diabetes: Insulin •

Systemic - U.S. Brands: Humulin 50/50; Humulin 70/30; Humulin 70/30 Pen; Humulin L; Humulin N; Humulin N Pen; Humulin R; Humulin R, Regular U500 (Concentrated); Humulin U; Lente; Lente Iletin II; Novolin 70/30; Novolin 70/30 PenFill; Novolin 70/30 Prefilled; Novolin L; Novoli http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203298.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult™ Mosby’s Drug Consult™ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

12

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

13

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “gestational diabetes” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “gestational diabetes” (or synonyms) into the “For these words:” box. The following is a sample result: •

Self-Monitoring of Blood Glucose Source: Diabetes Care. 17(1): 81-86. January 1994. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article discusses the consensus statement arising from a Consensus Development Conference on Self-Monitoring of Blood Glucose (SMBG), held in September 1993. The conference consisted of 24 invited presentations and contributions from a large audience of health care professionals and representatives from industry. The consensus panel reached a consensus on the answers to five questions: What is the epidemiology of SMBG?; Who should self-monitor?; What is the current technology?; How should the data obtained from self-monitoring be used?; and What is the future of self-monitoring? This article briefly reports on each of these five areas. Specific topics include the achievement and maintenance of a specific level of glycemic control; the prevention and detection of hypoglycemia; the avoidance of severe hyperglycemia; adjusting care in response to changes in life-style; determining the need for initiating insulin therapy in gestational diabetes mellitus (GDM); measurement principles and limitations of SMBG systems; performance of SMBG systems; the assessment of clinically significant error; and quality assurance. 10 references.

•

Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus Source: Diabetes Care. 23(Supplement 1): S4-S19. January 2000. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus aims to define and describe diabetes as it is currently understood, present a classification scheme that reflects the etiology or pathogenesis of the disease, provide diagnostic criteria for diabetes mellitus, and develop recommendations for testing that can help reduce the morbidity and mortality associated with diabetes.

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Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia that results from defects in insulin secretion, insulin action, or both. The pathogenic processes involved in the development of diabetes range from autoimmune destruction of the beta cells of the pancreas to abnormalities that result in resistance to insulin action. The classification of diabetes published in 1979 divided diabetes into insulin dependent diabetes mellitus (IDDM), noninsulin dependent diabetes mellitus (NIDDM), gestational diabetes mellitus, malnutrition-related diabetes, and other types. The Expert Committee is proposing changes to this classification scheme. One of the major changes is the elimination of the terms IDDM and NIDDM and the retention of the terms type 1 diabetes and type 2 diabetes. The report presents the features of immune mediated and idiopathic type 1 diabetes; type 2 diabetes; gestational diabetes; and other specific types of diabetes caused by genetic defects of the beta cell, genetic defects in insulin action, endocrinopathies, drugs, infections, and other genetic syndromes. The report also presents the rationale for revising the diagnostic criteria for diabetes and discusses the new criteria for diagnosing diabetes. The report concludes with criteria for testing for diabetes in asymptomatic, undiagnosed people. 2 figures. 6 tables. 143 references.

The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “gestational diabetes” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 3549 45 931 7 1 4533

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as 15

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

16

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18

The HSTAT URL is http://hstat.nlm.nih.gov/.

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AHRQ’s Put Prevention Into Practice.19 Simply search by “gestational diabetes” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

19 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 20 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 21

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on gestational diabetes can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internetbased services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to gestational diabetes. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to gestational diabetes. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “gestational diabetes”:

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•

Guides on gestational diabetes Diabetes http://www.nlm.nih.gov/medlineplus/diabetes.html

•

Other guides Birth Defects http://www.nlm.nih.gov/medlineplus/birthdefects.html Diabetes and Pregnancy http://www.nlm.nih.gov/medlineplus/diabetesandpregnancy.html High Risk Pregnancy http://www.nlm.nih.gov/medlineplus/highriskpregnancy.html Juvenile Diabetes http://www.nlm.nih.gov/medlineplus/juvenilediabetes.html Prenatal Care http://www.nlm.nih.gov/medlineplus/prenatalcare.html

Within the health topic page dedicated to gestational diabetes, the following was listed: •

General/Overviews Diabetes and Pregnancy Source: American Diabetes Association http://www.diabetes.org/type1/living/sex_pregnancy/diab_pregnancy.jsp Gestational Diabetes Source: March of Dimes Birth Defects Foundation http://www.modimes.org/pnhec/188_1025.asp Gestational Diabetes: What It Means for Me and My Baby Source: American Academy of Family Physicians http://familydoctor.org/handouts/075.html

•

Diagnosis/Symptoms Diagnosis of Diabetes Source: National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/index.htm Glucose Tests Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/glucose/test.html

•

Nutrition Nutrition Basics for Women with Gestational Diabetes Source: Cleveland Clinic Foundation http://www.clevelandclinic.org/health/healthinfo/docs/2300/2306.asp?index=9372

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Specific Conditions/Aspects Are You at Risk for Gestational Diabetes? Source: National Institute of Child Health and Human Development http://www.nichd.nih.gov/publications/pubs/gest_diabetes.htm Financial Help for Diabetes Care Source: National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov/dm/pubs/financialhelp/index.htm Infant of Diabetic Mother Source: University of Wisconsin http://www.pediatrics.wisc.edu/childrenshosp/parents_of_preemies/IDM.html Take Charge of Your Diabetes: Pregnancy, Diabetes, and Women's Health Source: National Center for Chronic Disease Prevention and Health Promotion http://www.cdc.gov/diabetes/pubs/tcyd/pregnant.htm

•

From the National Institutes of Health Disorders of Pregnancy: Gestational Diabetes Mellitus (GDM) & Preeclampsia and Eclampsia Source: National Institute of Child Health and Human Development http://www.nichd.nih.gov/about/womenhealth/disorders_of_pregnancy.cfm

•

Organizations American Diabetes Association http://www.diabetes.org/ National Diabetes Information Clearinghouse Source: National Institute of Diabetes and Digestive and Kidney Diseases http://diabetes.niddk.nih.gov/ National Institute of Child Health and Human Development http://www.nichd.nih.gov/ National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/

•

Prevention/Screening Pregnant Women Should be Screened for Gestational Diabetes; Though No One Test is Ideal Source: American College of Obstetricians and Gynecologists http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ6XLY41RC& sub_cat=266 Task Force Issues Two Recommendations on Screening for Diabetes in Adults and Pregnant Women Source: Agency for Healthcare Research and Quality http://www.ahrq.gov/news/press/pr2003/diabscpr.htm

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•

Research Do Multivitamin Supplements Reduce the Risk for Diabetes-Associated Birth Defects? http://www.cdc.gov/ncbddd/factsheets/pediatrics/Pediatrics_Diabetesvitamin.p df

•

Statistics Diabetes Facts: Women and Diabetes Source: Food and Drug Administration http://www.fda.gov/womens/taketimetocare/diabetes/fswomen.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on gestational diabetes. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Gestational Diabetes Mellitus Source: Dallas, TX: Methodist Medical Center. 1991. 22 p. Contact: Available from Methodist Medical Center. Women's Center, 301 West Colorado, Dallas, TX 75208. (214) 944-7160. PRICE: $2 for 1-120, $1.75 for 11-49, $1.50 for 50 or more. Summary: A booklet for pregnant women provides information on the characteristics, potential causes, diagnosis, treatment, and potential consequences of gestational diabetes. Answers are given to a variety of typical questions covering pregnancy, delivery, and after birth. Dietary information, diet tips, and a sample menu are included for managing gestational diabetes.

•

Nutritional Guidelines for Women with Gestational Diabetes Source: Clinical Diabetes. 17(4): 177. 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article provides nutritional guidelines for women who have gestational diabetes. Guidelines include eating three meals and three snacks per day, omitting foods high in sugar and concentrated sweets, eating whole pieces of fruit instead of drinking

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fruit juices, spreading carbohydrates out throughout the day, eating foods high in fiber and low in fat, limiting foods from fast food restaurants, and gaining at least 1/2 pound per week. •

Gestational Diabetes: What It Means for You and Your Baby Source: American Family Physician. 60(3): 1009-1010. September 1, 1999. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This article uses a question and answer format to provide women with information on gestational diabetes. This type of diabetes occurs during pregnancy, and affects about 3 percent of all pregnant women. Gestational diabetes can cause a baby to grow somewhat larger than a normal baby and can cause hypoglycemia or jaundice in the baby at birth. Between the 24th and 28th week of pregnancy, women may undergo blood glucose testing to monitor blood glucose levels. Women diagnosed with gestational diabetes need to eat well-balanced meals with plenty of fruits, vegetables, and grains, and participate in a safe form of moderate exercise. Gestational diabetes usually goes away following the baby's birth; however, it may return during a subsequent pregnancy. Most babies born to mothers with gestational diabetes do not have diabetes after birth, but they may be at higher risk of getting type 2 diabetes as adults.

•

About Gestational Diabetes Source: South Deerfield, MA: Channing L. Bete Company, Inc. 1997. 15 p. Contact: Available from Channing L. Bete Company, Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. PRICE: $0.89 each for 1-99 copies; discounts available for larger orders. Item number: 39495A396. Summary: This booklet provides basic information about gestational diabetes. Written in non-technical language, the booklet defines and describes gestational diabetes. Topics include risk factors for developing gestational diabetes; problems that gestational diabetes can cause in a fetus; and screening tests. The booklet also discusses the role of good nutrition as the basis of gestational diabetes management; recommendations for exercise; self-monitoring; insulin therapy; coping with the psychological stresses associated with gestational diabetes; tests used to monitor the fetus' health before delivery; and post-natal health care and the risk of the mother later developing type 2 diabetes. The booklet concludes with a brief summary and section of questions and answers. The booklet is illustrated with cartoon drawings of patients and health care providers from a variety of ethnic groups.

•

How to Manage Gestational Diabetes Source: Indianapolis, IN: Eli Lilly and Company. 1994. 11 p. Contact: Available from Eli Lilly and Company. Lilly Corporate Center, Indianapolis, IN 46285. (800) 545-5979 or (317) 276-2000. PRICE: Single copy free. Summary: This brochure describes gestational diabetes mellitus (GDM) and its effect on pregnant women and fetuses. Because GDM usually has no symptoms, all pregnant women should have their blood tested between the 24th and 28th weeks of pregnancy, or earlier if they had GDM in an previous pregnancy. The brochure advises that women who develop gestational diabetes work with a health care team follow special meal

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plans devised by a registered dietitian, test their blood sugar and urine ketones, keep accurate records, maintain a healthy weight, and exercise in accordance with their doctor's advice. The brochure also describes the use of insulin in GDM, tests doctors may perform to measure the growth of the fetus, and the post-partum effects of GDM. •

Gestational Diabetes: When You and Your Baby Need Special Care Source: San Bruno, CA: Krames Health and Safety Education. 2002. 16 p. Contact: Available from Krames Health and Safety Education. Order Department, 1100 Grundy Lane, San Bruno, CA 94066. (800) 333-3032. Fax (650) 244-4512. Website: www.krames.org. PRICE: $1.59; discounts available for larger quantities. Order number: 1784 (English) or 1792 (Spanish). Summary: This brochure familiarizes readers with gestational diabetes, a type of diabetes that happens only during pregnancy. Topics include understanding how the body uses energy, and problems resulting from high blood glucose levels; nutrition and diet therapy; the role of exercise; testing one's blood glucose levels; insulin therapy; monitoring the baby; labor and delivery considerations; and postnatal care for the mother, particularly that designed to reduce the risk of subsequent diabetes. The brochure is written in nontechnical language and features full-color line drawings, charts and graphs illustrating the concepts presented. The brochure depicts men and women of different ethnicities, and is available in English or Spanish. 3 references.

•

Gestational Diabetes: Diabetes When You're Pregnant Source: Santa Cruz, CA: ETR Associates. 2000. 6 p. Contact: Available from ETR Associates. 4 Carbonero Way, Scotts Valley, CA 950664200. (800) 321-4407. Fax (800) 435-8433. Website: www.etr.org. PRICE: Single copy free; $16.00 for 50 copies, discounts for larger orders. Summary: This brochure focuses on gestational diabetes. This form of diabetes occurs during pregnancy if a woman has too much sugar in her blood. A one hour glucose test and a glucose tolerance test are used to diagnose gestational diabetes. The brochure provides a checklist of health risks for gestational diabetes and suggests ways women can manage gestational diabetes. Tips include eating healthy foods every day, eating small meals and snacks, drinking eight glasses of water per day, drinking caffeine free drinks, taking vitamin supplements, avoiding foods that increase blood sugar, avoiding alcoholic beverages, checking blood sugar levels, quitting smoking, being physically active, and keeping track of weight gain. Other topics include labor, delivery, and follow up.

•

Are you at risk for gestational diabetes? Source: Bethesda, MD: National Institute of Child Health and Human Development. 2000. 6 pp. Contact: Available from National Institute of Child Health and Human Development Clearinghouse, P.O. Box 3006, Rockville, MD 20847. Telephone: (800) 370-2943 TTY: (888) 320-6942 / fax: (301) 984-1473 / e-mail: [email protected] / Web site: http://www.nichd.nih.gov/publications/info.htm. Available at no charge. Summary: This brochure for pregnant women describes gestational diabetes, lists the risk factors, provides information the importance of screening, testing methods, causes of the condition, and treatment options and an resource.

Patient Resources

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Gestational Diabetes: Caring for Yourself and Your Baby Source: Minneapolis, MN: International Diabetes Center, Park Nicollet Medical Foundation. 1995. 29 p. Contact: Available from HealthSource. 3800 Park Nicollet Boulevard, Minneapolis, MN 55416-9963. (800) 372-7776. PRICE: $2.95. ISBN: 1885115210. Summary: This brochure provides basic information about gestational diabetes. It covers caring for mother and baby with blood glucose control and monitoring; emotional balance; nutrition needs during pregnancy, including carbohydrate, protein, fat, making food choices, caloric intake, and weight gain; food and blood glucose control; physical activity and blood glucose control; taking insulin; testing guidelines and goals, including those for blood glucose and ketones; record-keeping; and postpregnancy considerations. The booklet features lists of practical suggestions for implementing each recommendation. The booklet also includes blank forms for readers to use for keeping blood glucose records. Simple charts and line drawings illustrate the booklet.

•

Diabetes Health Care Facts: Gestational Diabetes Source: Tarrytown, NY: Bayer Corporation. 2000. 4 p. Contact: Available from Bayer Corporation. Diagnostics Division, 511 Benedict Avenue, Tarrytown, NY 10591-5097. (800) 445-5901. E-mail: www.pharm.bayer.com. PRICE: Single copy free. Summary: This brochure, which is presented in question and answer format, provides information about gestational diabetes. According to the brochure, a family history of diabetes, obesity, a previous pregnancy with delivery of a large baby (10 pounds or more), and previous miscarriages or stillbirths tend to increase the risk of developing gestational diabetes. Topics include the causes of gestational diabetes, common problems of gestational diabetes, treatment, and insulin. The authors point out that a pregnant woman with diabetes can increase her chances of having a healthy pregnancy and baby by testing her blood glucose and urine ketones daily and following her meal plan closely. A list of products concludes the brochure. (AA-M).

•

How to Have a Healthy Baby: Gestational Diabetes Source: Albuquerque, NM: Indian Health Service. 1991. 24 p. Contact: Available from IHS HQW Diabetes Program. 5300 Homestead Road, NE, Albuquerque, NM 78110. (505) 837-4182. Fax (505) 837-4188. PRICE: Materials are available only to health care professionals serving American Indian populations; contact the IHS Diabetes Program for list of currently available materials. Summary: This brochure, written for Native American women with gestational diabetes, explains steps to take to increase the chances of a healthy pregnancy and a healthy baby. Topics include pregnancy and high blood glucose, problems that high blood glucose can cause during pregnancy, healthy food choices, exercise during pregnancy, selfmonitoring of blood glucose (SMBG), and special diagnostic tests that may be used. This brochure is written in clear, easy-to-understand language, with culturally relevant line drawings illustrating the concepts presented. Space is included for specific clinic information and phone numbers and for patient notes.

•

Why Worry About Gestational Diabetes? Source: Alexandria, VA: American Diabetes Association. 199x. 3 p.

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Contact: Available from American Diabetes Association, Inc. Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. PRICE: $9.95 (members), $11.95 (nonmembers) for 50 copies; single copy free. Order number CDBD23. Summary: This fact sheet, one in a series of 42 fact sheets about daily living and coping with diabetes, provides information about gestational diabetes, which affects about 3 percent of all pregnant women in the United States. Pregnant women who have never had diabetes before but who have high blood glucose levels during pregnancy are said to have gestational diabetes. Topics include the effect of gestational diabetes on the fetus, gestational diabetes treatment, precautions for the future, and keeping worry in perspective. Because untreated or poorly controlled gestational diabetes can harm both the pregnant woman and the fetus, it is important to start treatment immediately after diagnosis. Treatment includes special meal plans and scheduled physical activity and may include daily blood glucose testing and insulin injections. (AA-M). •

Gestational Diabetes: How You Can Deal With It Source: Lexington, KY: Lexington-Fayette County Health Department. 199x. 9 p. Contact: Available from Lexington-Fayette County Health Department. Division of Nutrition and Health Education, 650 Newtown Pike, Lexington, KY 40508. (606) 2882333. Fax (606) 288-2359. PRICE: $38.00 per 25 copies plus shipping. Summary: This guide to gestational diabetes is one in a series of 22 diabetes education materials that combine practical tips and humorous drawings with current diabetes information. The series is written at a sixth grade reading level and is designed to teach and motivate patients to take good care of themselves. The booklet provides specific suggestions for readers to implement in their everyday diabetes management. Gestational diabetes is defined as high blood glucose levels during pregnancy. The booklet provides information about the causes of gestational diabetes, how gestational diabetes can affect the fetus and baby, how to keep blood glucose levels normal, what to eat, snack ideas, sweets and desserts, and what happens after the baby is born. The booklet also provides a sample 1-day, 2,000-calorie menu designed for a person with gestational diabetes. Readers are cautioned against smoking and alcohol use.

•

Gestational Diabetes: Dealing with Diabetes During Pregnancy Source: San Diego, CA: Sweet Success: California Diabetes and Pregnancy Program. 1997. [2 p.]. Contact: Available from Sweet Success: California Diabetes and Pregnancy Program. Resource Center, 4543 Ruffner Street, Suite 130, San Diego, CA 92111. (619) 467-4990. Fax (619) 467-4993. Website: www.llu.edu/llumc/sweetsuccess. PRICE: $0.50. Order number: SS2400. Summary: This pamphlet offers advice on coping with gestational diabetes. The pamphlet identifies the members of a health care team for women with gestational diabetes, highlights feelings and body changes that women may experience during pregnancy, notes the effects of these changes, and outlines steps that women diagnosed with gestational diabetes need to take to have a healthy pregnancy.

•

Gestational Diabetes and You Source: Olathe, KS: Nutrition Counseling/Education Services (NCES). 1995. 28 p.

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Contact: Available from Nutrition Counseling/Education Services (NCES). 1904 East 123rd Street, Olathe, KS 66061. (800) 445-5653 for orders, or (913) 782-4385. Fax (913) 7828230. PRICE: $2.95 each; $16.95 for 10 copies (as of 1995). Summary: This patient education booklet on gestational diabetes (GDM) provides detailed information in an easy-to-read, accessible format. Topics include a definition of GDM; the causes of GDM; how GDM affects the fetus; normal blood glucose levels; recording blood glucose levels, insulin, and exercise; the use of a food diary; meal planning; the use of exchange lists; weight loss; meal planning considerations for patients using insulin; emotional adjustment; breastfeeding; and optimizing choices for a healthy baby. The booklet is illustrated with line drawings depicting both Caucasian and African-American pregnant women. The booklet is available in English or Spanish. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “gestational diabetes” (or synonyms). The following was recently posted: •

Gestational diabetes mellitus Source: American Diabetes Association - Professional Association; 1986 (revised 2000; republished 2003 Jan); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3580&nbr=2806&a mp;string=diabetes+AND+during+AND+pregnancy

•

Gestational diabetes practice guidelines Source: International Diabetes Center - Private Nonprofit Organization; 2000; 33 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2563&nbr=1789&a mp;string=diabetes+AND+during+AND+pregnancy

•

Nutrition practice guidelines for gestational diabetes mellitus Source: American Dietetic Association - Professional Association; 2001 September; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3294&nbr=2520&a mp;string=gestational+AND+diabetes

•

Screening for gestational diabetes mellitus: recommendations and rationale Source: United States Preventive Services Task Force - Independent Expert Panel; 1996 (revised 2003 Feb); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3493&nbr=2719&a mp;string=gestational+AND+diabetes

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Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Diabetes in Pregnancy - Gestational Diabetes Source: New South Wales Multicultural Health Communication Service http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7476 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to gestational diabetes. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMD®Health: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to gestational diabetes. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with gestational diabetes.

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The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about gestational diabetes. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “gestational diabetes” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “gestational diabetes”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “gestational diabetes” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “gestational diabetes” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.23

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

23

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)24: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

24

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

187

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on gestational diabetes: •

Basic Guidelines for Gestational Diabetes Gestational diabetes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000896.htm

•

Signs & Symptoms for Gestational Diabetes Blurred vision Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003029.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Increased appetite Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003134.htm Increased thirst Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003085.htm

188 Gestational Diabetes

Increased urination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003146.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Obesity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003101.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm •

Diagnostics and Tests for Gestational Diabetes Blood glucose level Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm Blood glucose levels Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm Glucose tolerance test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003466.htm Oral glucose tolerance test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003466.htm Ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm

•

Nutrition for Gestational Diabetes Carbohydrate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002469.htm Diet for diabetics Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002440.htm

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Background Topics for Gestational Diabetes Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm

Online Glossaries 189

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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GESTATIONAL DIABETES DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal fat: Fat (adipose tissue) that is centrally distributed between the thorax and pelvis and that induces greater health risk. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acculturation: Process of cultural change in which one group or members of a group assimilates various cultural patterns from another. [NIH] ACE: Angiotensin-coverting enzyme. A drug used to decrease pressure inside blood vessels. [NIH]

Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenosine Triphosphate: Adenosine 5'-(tetrahydrogen triphosphate). An adenine nucleotide containing three phosphate groups esterified to the sugar moiety. In addition to its crucial roles in metabolism adenosine triphosphate is a neurotransmitter. [NIH] Adipocytes: Fat-storing cells found mostly in the abdominal cavity and subcutaneous tissue. Fat is usually stored in the form of tryglycerides. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]

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Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adult-Onset Diabetes: Former term for noninsulin-dependent or type II diabetes. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Age-Adjusted: Summary measures of rates of morbidity or mortality in a population using statistical procedures to remove the effect of age differences in populations that are being compared. Age is probably the most important and the most common variable in determining the risk of morbidity and mortality. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agenesis: Lack of complete or normal development; congenital absence of an organ or part. [NIH]

Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps

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to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Allantois: An embryonic diverticulum of the hindgut of reptiles, birds, and mammals; in man its blood vessels give rise to those of the umbilical cord. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveolar Process: The thickest and spongiest part of the maxilla and mandible hollowed out into deep cavities for the teeth. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amnion: The extraembryonic membrane which contains the embryo and amniotic fluid. [NIH]

Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]

Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of

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the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Anomalies: Birth defects; abnormalities. [NIH] Anovulation: Suspension or cessation of ovulation in animals and humans. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Anthropometry: The technique that deals with the measurement of the size, weight, and proportions of the human or other primate body. [NIH] Antiallergic: Counteracting allergy or allergic conditions. [EU] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidiabetic: An agent that prevents or alleviates diabetes. [EU] Antidiabetic Agent: A substance that helps a person with diabetes control the level of glucose (sugar) in the blood so that the body works as it should. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH]

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Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Aqueous: Having to do with water. [NIH] Arachidonate 12-Lipoxygenase: An enzyme that catalyzes the oxidation of arachidonic acid to yield 12-hydroperoxyarachidonate (12-HPETE) which is itself rapidly converted by a peroxidase to 12-hydroxy-5,8,10,14-eicosatetraenoate (12-HETE). The 12-hydroperoxides are preferentially formed in platelets. EC 1.13.11.31. [NIH] Arachidonate 15-Lipoxygenase: An enzyme that catalyzes the oxidation of arachidonic acid to yield 15-hydroperoxyarachidonate (15-HPETE) which is rapidly converted to 15-hydroxy5,8,11,13-eicosatetraenoate (15-HETE). The 15-hydroperoxides are preferentially formed in neutrophils and lymphocytes. EC 1.13.11.33. [NIH] Arachidonate Lipoxygenases: Enzymes catalyzing the oxidation of arachidonic acid to hydroperoxyarachidonates (HPETES). These products are then rapidly converted by a peroxidase to hydroxyeicosatetraenoic acids (HETES). The positional specificity of the enzyme reaction varies from tissue to tissue. The final lipoxygenase pathway leads to the leukotrienes. EC 1.13.11.- . [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriolosclerosis: Sclerosis and thickening of the walls of the smaller arteries (arterioles). Hyaline arteriolosclerosis, in which there is homogeneous pink hyaline thickening of the arteriolar walls, is associated with benign nephrosclerosis. Hyperplastic arteriolosclerosis, in

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which there is a concentric thickening with progressive narrowing of the lumina may be associated with malignant hypertension, nephrosclerosis, and scleroderma. [EU] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autoantibodies: Antibodies that react with self-antigens (autoantigens) of the organism that produced them. [NIH] Autoantigens: Endogenous tissue constituents that have the ability to interact with autoantibodies and cause an immune response. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Base Sequence: The sequence of purines and pyrimidines in nucleic acids and polynucleotides. It is also called nucleotide or nucleoside sequence. [NIH] Behavior Therapy: The application of modern theories of learning and conditioning in the treatment of behavior disorders. [NIH] Behavioral Medicine: The interdisciplinary field concerned with the development and integration of behavioral and biomedical science, knowledge, and techniques relevant to health and illness and the application of this knowledge and these techniques to prevention, diagnosis, treatment, and rehabilitation. [NIH] Beta-pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Bilateral: Affecting both the right and left side of body. [NIH]

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Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotin: Hexahydro-2-oxo-1H-thieno(3,4-d)imidazole-4-pentanoic acid. Growth factor present in minute amounts in every living cell. It occurs mainly bound to proteins or polypeptides and is abundant in liver, kidney, pancreas, yeast, and milk.The biotin content of cancerous tissue is higher than that of normal tissue. [NIH] Birth Order: The sequence in which children are born into the family. [NIH] Bivalent: Pertaining to a group of 2 homologous or partly homologous chromosomes during the zygotene stage of prophase to the first metaphase in meiosis. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH]

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Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breast Feeding: The nursing of an infant at the mother's breast. [NIH] Buffers: A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a pH buffer. [NIH]

Cachexia: General ill health, malnutrition, and weight loss, usually associated with chronic disease. [NIH] Caesarean section: A surgical incision through the abdominal and uterine walls in order to deliver a baby. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH]

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Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Caloric intake: Refers to the number of calories (energy content) consumed. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case-Control Studies: Studies which start with the identification of persons with a disease of interest and a control (comparison, referent) group without the disease. The relationship of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group. [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH]

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Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Check-up: A general physical examination. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Chorion: The outermost extraembryonic membrane. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromium: A trace element that plays a role in glucose metabolism. It has the atomic symbol Cr, atomic number 24, and atomic weight 52. According to the Fourth Annual Report on Carcinogens (NTP85-002,1985), chromium and some of its compounds have been listed as known carcinogens. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH]

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Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical Protocols: Precise and detailed plans for the study of a medical or biomedical problem and/or plans for a regimen of therapy. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Codon: A set of three nucleotides in a protein coding sequence that specifies individual amino acids or a termination signal (codon, terminator). Most codons are universal, but some organisms do not produce the transfer RNAs (RNA, transfer) complementary to all codons. These codons are referred to as unassigned codons (codons, nonsense). [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognitive behavior therapy: A system of psychotherapy based on the premise that distorted or dysfunctional thinking, which influences a person's mood or behavior, is common to all psychosocial problems. The focus of therapy is to identify the distorted thinking and to replace it with more rational, adaptive thoughts and beliefs. [NIH] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline,

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hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH]

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Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished. [NIH]

Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune

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response. Called also adrenocortical hormone and corticoid. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] C-Peptide: A 31-amino acid peptide which connects the A and B chains of proinsulin. The exact composition of the peptide is species dependent. In beta cells proinsulin is enzymatically converted to insulin with the liberation of the C-peptide. An immunoassay has been developed for assessing pancreatic beta cell secretory function in diabetic patients in whom circulating insulin antibodies and exogenous insulin interfere with insulin immunoassay. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cystine: A covalently linked dimeric nonessential amino acid formed by the oxidation of cysteine. Two molecules of cysteine are joined together by a disulfide bridge to form cystine. [NIH]

Cytogenetics: A branch of genetics which deals with the cytological and molecular behavior of genes and chromosomes during cell division. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Cytotoxic: Cell-killing. [NIH] Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water buffalo. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU]

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Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dentate Gyrus: Gray matter situated above the gyrus hippocampi. It is composed of three layers. The molecular layer is continuous with the hippocampus in the hippocampal fissure. The granular layer consists of closely arranged spherical or oval neurons, called granule cells, whose axons pass through the polymorphic layer ending on the dendrites of pyramidal cells in the hippocampus. [NIH] Deoxyribonucleic: A polymer of subunits called deoxyribonucleotides which is the primary genetic material of a cell, the material equivalent to genetic information. [NIH] Deoxyribonucleic acid: A polymer of subunits called deoxyribonucleotides which is the primary genetic material of a cell, the material equivalent to genetic information. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Dermatitis: Any inflammation of the skin. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH]

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Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disposition: A tendency either physical or mental toward certain diseases. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU] Diuresis: Increased excretion of urine. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Eclampsia: Onset of convulsions or coma in a previously diagnosed pre-eclamptic patient. [NIH]

Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents (Dorland, 27th ed). [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is

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concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Embryogenesis: The process of embryo or embryoid formation, whether by sexual (zygotic) or asexual means. In asexual embryogenesis embryoids arise directly from the explant or on intermediary callus tissue. In some cases they arise from individual cells (somatic cell embryoge). [NIH] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Encephalocele: Cerebral tissue herniation through a congenital or acquired defect in the skull. The majority of congenital encephaloceles occur in the occipital or frontal regions. Clinical features include a protuberant mass that may be pulsatile. The quantity and location of protruding neural tissue determines the type and degree of neurologic deficit. Visual defects, psychomotor developmental delay, and persistent motor deficits frequently occur. [NIH]

Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] Endpoint Determination: Establishment of the level of a quantifiable effect indicative of a biologic process. The evaluation is frequently to detect the degree of toxic or therapeutic effect. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Energy balance: Energy is the capacity of a body or a physical system for doing work. Energy balance is the state in which the total energy intake equals total energy needs. [NIH] Energy Intake: Total number of calories taken in daily whether ingested or by parenteral routes. [NIH] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enterocolitis: Inflammation of the intestinal mucosa of the small and large bowel. [NIH] Entorhinal Cortex: Cortex where the signals are combined with those from other sensory systems. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

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Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Ergometer: An instrument for measuring the force of muscular contraction. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythrocyte Deformability: Ability of erythrocytes to change shape as they pass through narrow spaces, such as the microvasculature. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Escalation: Progressive use of more harmful drugs. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by

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determining a person's exercise capacity. [NIH] Exercise Therapy: Motion of the body or its parts to relieve symptoms or to improve function, leading to physical fitness, but not physical education and training. [NIH] Exercise Tolerance: The exercise capacity of an individual as measured by endurance (maximal exercise duration and/or maximal attained work load) during an exercise test. [NIH]

Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]

Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extraction: The process or act of pulling or drawing out. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fatty Liver: The buildup of fat in liver cells. The most common cause is alcoholism. Other causes include obesity, diabetes, and pregnancy. Also called steatosis. [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fetal Blood: Blood of the fetus. Exchange of nutrients and waste between the fetal and maternal blood occurs via the placenta. The cord blood is blood contained in the umbilical vessels at the time of delivery. [NIH] Fetal Death: Death of the young developing in utero. [NIH] Fetal Development: Morphologic and physiologic growth and development of the mammalian embryo or fetus. [NIH] Fetal Distress: Adverse or threatening condition of the fetus identified by fetal bradycardia or tachycardia and passage of meconium in vertex presentation. [NIH] Fetal Macrosomia: A complication of several conditions including diabetes mellitus and prolonged pregnancy. A macrosomic fetus is defined as weighing more than 4000 grams. [NIH]

Fetal Membranes: Thin layers of tissue which surround the embryo or fetus and provide for its nutrition, respiration, excretion and protection; they are the yolk sac, allantois, amnion,

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and chorion. [NIH] Fetal Weight: The weight of the fetus in utero, which is usually estimated by various formulas based on measurements made during prenatal ultrasonography. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Food Preferences: The selection of one food over another. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fructosamine: An amino sugar formed when glucose non-enzymatically reacts with the Nterminal amino group of proteins. The fructose moiety is dervied from glucose by the "classical" Amadori rearrangement. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Bypass: Surgical procedure in which the stomach is transected high on the body. The resulting proximal remnant is joined to a loop of the jejunum in an end-to-side anastomosis. This procedure is used frequently in the treatment of morbid obesity. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Dosage: The number of copies of a given gene present in a cell or nucleus. An increase

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in gene dosage can result in the formation of higher levels of gene product, provided that the gene is not subject to autogenous regulation. [NIH] Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomeruli: Plural of glomerulus. [NIH] Glucocorticoids: A group of corticosteroids that affect carbohydrate metabolism (gluconeogenesis, liver glycogen deposition, elevation of blood sugar), inhibit corticotropin secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. [NIH] Glucokinase: A group of enzymes that catalyzes the conversion of ATP and D-glucose to ADP and D-glucose 6-phosphate. They are found in invertebrates and microorganisms and are highly specific for glucose. (Enzyme Nomenclature, 1992) EC 2.7.1.2. [NIH] Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [NIH]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Clamp Technique: Maintenance of a constant blood glucose level by perfusion or infusion with glucose or insulin. It is used for the study of metabolic rates (e.g., in glucose, lipid, amino acid metabolism) at constant glucose concentration. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of

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glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] Glyburide: An antidiabetic sulfonylurea derivative with actions similar to those of chlorpropamide. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosuria: The presence of glucose in the urine; especially the excretion of an abnormally large amount of sugar (glucose) in the urine, i.e., more than 1 gm. in 24 hours. [EU] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or

Dictionary 213

as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Resources: Available manpower, facilities, revenue, equipment, and supplies to produce requisite health care and services. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Refers to the liver. [NIH] Hepatocyte: A liver cell. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heritability: The proportion of observed variation in a particular trait that can be attributed to inherited genetic factors in contrast to environmental ones. [NIH] Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Host: Any animal that receives a transplanted graft. [NIH]

214 Gestational Diabetes

Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperglycaemia: Abnormally increased content of sugar in the blood. [EU] Hyperglycemia: Abnormally high blood sugar. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]

Hypoglycemic Agents: Agents which lower the blood glucose level. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hysterotomy: An incision in the uterus, performed through either the abdomen or the

Dictionary 215

vagina. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Imaging procedures: Methods of producing pictures of areas inside the body. [NIH] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunoglobulins: Glycoproteins present in the blood (antibodies) and in other tissue. They are classified by structure and activity into five classes (IgA, IgD, IgE, IgG, IgM). [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be

216 Gestational Diabetes

clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intravenous: IV. Into a vein. [NIH] Invertebrates: Animals that have no spinal column. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH]

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Islet: Cell producing insulin in pancreas. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Cortex: The outer zone of the kidney, beneath the capsule, consisting of kidney glomerulus; kidney tubules, distal; and kidney tubules, proximal. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Labor Complications: Medical problems associated with labor including cephalopelvic disproportion, hemorrhage, fetal distress, or other disorders. [NIH] Lacerations: Torn, ragged, mangled wounds. [NIH] Lactation: The period of the secretion of milk. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Leptin: A 16-kD peptide hormone secreted from white adipocytes and implicated in the regulation of food intake and energy balance. Leptin provides the key afferent signal from fat cells in the feedback system that controls body fat stores. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU]

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Limbic System: A set of forebrain structures common to all mammals that is defined functionally and anatomically. It is implicated in the higher integration of visceral, olfactory, and somatic information as well as homeostatic responses including fundamental survival behaviors (feeding, mating, emotion). For most authors, it includes the amygdala, epithalamus, gyrus cinguli, hippocampal formation (see hippocampus), hypothalamus, parahippocampal gyrus, septal nuclei, anterior nuclear group of thalamus, and portions of the basal ganglia. (Parent, Carpenter's Human Neuroanatomy, 9th ed, p744; NeuroNames, http://rprcsgi.rprc.washington.edu/neuronames/index.html (September 2, 1998)). [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5lipoxygenase, arachidonate 12-lipoxygenase, and arachidonate 15-lipoxygenase. EC 1.13.11.12. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Low-calorie diet: Caloric restriction of about 800 to 1,500 calories (approximately 12 to 15 kcal/kg of body weight) per day. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lutein Cells: The cells of the corpus luteum which are derived from the granulosa cells and the theca cells of the Graafian follicle. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH]

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Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Magnesium Chloride: Magnesium chloride. An inorganic compound consisting of one magnesium and two chloride ions. The compound is used in medicine as a source of magnesium ions, which are essential for many cellular activities. It has also been used as a cathartic and in alloys. [NIH] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Glycoproteins: Glycoproteins found on the membrane or surface of cells. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH]

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Mental Health: The state wherein the person is well adjusted. [NIH] Mesoderm: The middle germ layer of the embryo. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolic therapy: Treatment to correct changes in metabolism that can be caused by disease. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metallothionein: A low-molecular-weight (approx. 10 kD) protein occurring in the cytoplasm of kidney cortex and liver. It is rich in cysteinyl residues and contains no aromatic amino acids. Metallothionein shows high affinity for bivalent heavy metals. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Minority Groups: A subgroup having special characteristics within a larger group, often bound together by special ties which distinguish it from the larger group. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH]

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Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monounsaturated fat: An unsaturated fat that is found primarily in plant foods, including olive and canola oils. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multicenter Studies: Controlled studies which are planned and carried out by several cooperating institutions to assess certain variables and outcomes in specific patient populations, for example, a multicenter study of congenital anomalies in children. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatology: A subspecialty of pediatrics concerned with the newborn infant. [NIH] Nephron: A tiny part of the kidneys. Each kidney is made up of about 1 million nephrons, which are the working units of the kidneys, removing wastes and extra fluids from the blood. [NIH] Nephropathy: Disease of the kidneys. [EU] Nephrotic: Pertaining to, resembling, or caused by nephrosis. [EU] Nephrotic Syndrome: Clinical association of heavy proteinuria, hypoalbuminemia, and generalized edema. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH]

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Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural tube defects: These defects include problems stemming from fetal development of the spinal cord, spine, brain, and skull, and include birth defects such as spina bifida, anencephaly, and encephalocele. Neural tube defects occur early in pregnancy at about 4 to 6 weeks, usually before a woman knows she is pregnant. Many babies with neural tube defects have difficulty walking and with bladder and bowel control. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nurseries: Facilities which provide care for infants. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Oligomenorrhea: Abnormally infrequent menstruation. [NIH] Oocytes: Female germ cells in stages between the prophase of the first maturation division and the completion of the second maturation division. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated

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by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Ovum Implantation: Endometrial implantation of the blastocyst. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, cell respiration, or aerobic metabolism. [NIH] Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Particle: A tiny mass of material. [EU]

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Parturition: The act or process of given birth to a child. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Care Team: Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex.

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[NIH]

Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Piloerection: Involuntary erection or bristling of hairs. [NIH] Pilot Projects: Small-scale tests of methods and procedures to be used on a larger scale if the pilot study demonstrates that these methods and procedures can work. [NIH]

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Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Placental tissue: The tissue intervening between fetal blood and maternal blood in the placenta; it acts as a selective membrane regulating the passage of substances from the maternal to the fetal blood. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polycystic Ovary Syndrome: Clinical symptom complex characterized by oligomenorrhea or amenorrhea, anovulation, and regularly associated with bilateral polycystic ovaries. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together

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chemically. [NIH] Polyunsaturated fat: An unsaturated fat found in greatest amounts in foods derived from plants, including safflower, sunflower, corn, and soybean oils. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postnatal Care: The care provided a woman following the birth of a child. [NIH] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Postprandial Blood Glucose: Blood taken 1-2 hours after eating to see the amount of glucose (sugar) in the blood. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potassium Channels: Cell membrane glycoproteins selective for potassium ions. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Pre-eclamptic: A syndrome characterized by hypertension, albuminuria, and generalized oedema, occurring only in pregnancy. [NIH] Pregnancy Complications: The co-occurrence of pregnancy and a disease. The disease may precede or follow conception and it may or may not have a deleterious effect on the pregnant woman or fetus. [NIH] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Care: Care provided the pregnant woman in order to prevent complications, and

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decrease the incidence of maternal and prenatal mortality. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Progeny: The offspring produced in any generation. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proinsulin: The substance made first in the pancreas that is then made into insulin. When insulin is purified from the pancreas of pork or beef, all the proinsulin is not fully removed. When some people use these insulins, the proinsulin can cause the body to react with a rash, to resist the insulin, or even to make dents or lumps in the skin at the place where the insulin is injected. The purified insulins have less proinsulin and other impurities than the other types of insulins. [NIH] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH]

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Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purified Insulins: Insulins with much less of the impure proinsulin. It is thought that the use of purified insulins may help avoid or reduce some of the problems of people with diabetes such as allergic reactions. [NIH] Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and

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rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [NIH] Reassurance: A procedure in psychotherapy that seeks to give the client confidence in a favorable outcome. It makes use of suggestion, of the prestige of the therapist. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH]

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Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal vein thrombosis: Blood clots in the vessel that carries blood away from the kidney. This can occur in people with the nephrotic syndrome. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory distress syndrome: A lung disease that occurs primarily in premature infants; the newborn must struggle for each breath and blueing of its skin reflects the baby's inability to get enough oxygen. [NIH] Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [NIH] Resting metabolic rate: RMR accounts for 65 to 75 percent of daily energy expenditure and represents the minimum energy needed to maintain all physiological cell functions in the resting state. The principal determinant of RMR is lean body mass (LBM). Obese subjects have a higher RMR in absolute terms than lean individuals, an equivalent RMR when corrected for LBM and per unit surface area, and a lower RMR when expressed per kilogram of body weight. Obese persons require more energy for any given activity because of a larger mass, but they tend to be more sedentary than lean subjects. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative,

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noninflammatory condition of the retina). [EU] Retrospective: Looking back at events that have already taken place. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Ribonucleic acid: RNA. One of the two nucleic acids found in all cells. The other is deoxyribonucleic acid (DNA). Ribonucleic acid transfers genetic information from DNA to proteins produced by the cell. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Rod: A reception for vision, located in the retina. [NIH] Rural Population: The inhabitants of rural areas or of small towns classified as rural. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Sarcolemma: The plasma membrane of a smooth, striated, or cardiac muscle fiber. [NIH] Satellite: Applied to a vein which closely accompanies an artery for some distance; in cytogenetics, a chromosomal agent separated by a secondary constriction from the main body of the chromosome. [NIH] Saturated fat: A type of fat found in greatest amounts in foods from animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products, lard, and in some vegetable oils, including coconut, palm kernel, and palm oils. Saturated fat raises blood cholesterol more than anything else eaten. On a Step I Diet, no more than 8 to 10 percent of total calories should come from saturated fat, and in the Step II Diet, less than 7 percent of the day's total calories should come from saturated fat. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretin: A hormone made in the duodenum. Causes the stomach to make pepsin, the liver to make bile, and the pancreas to make a digestive juice. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is

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synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sludge: A clump of agglutinated red blood cells. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic

234 Gestational Diabetes

system. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somatostatin: A polypeptide hormone produced in the hypothalamus, and other tissues and organs. It inhibits the release of human growth hormone, and also modulates important physiological functions of the kidney, pancreas, and gastrointestinal tract. Somatostatin receptors are widely expressed throughout the body. Somatostatin also acts as a neurotransmitter in the central and peripheral nervous systems. [NIH] Soybean Oil: Oil from soybean or soybean plant. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrin: A high molecular weight (220-250 kDa) water-soluble protein which can be extracted from erythrocyte ghosts in low ionic strength buffers. The protein contains no lipids or carbohydrates, is the predominant species of peripheral erythrocyte membrane proteins, and exists as a fibrous coating on the inner, cytoplasmic surface of the membrane. [NIH]

Sperm: The fecundating fluid of the male. [NIH] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Standard therapy: A currently accepted and widely used treatment for a certain type of cancer, based on the results of past research. [NIH] Steatosis: Fatty degeneration. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation.

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[EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subiculum: A region of the hippocampus that projects to other areas of the brain. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Sunburn: An injury to the skin causing erythema, tenderness, and sometimes blistering and resulting from excessive exposure to the sun. The reaction is produced by the ultraviolet radiation in sunlight. [NIH] Superoxide: Derivative of molecular oxygen that can damage cells. [NIH] Superoxide Dismutase: An oxidoreductase that catalyzes the reaction between superoxide anions and hydrogen to yield molecular oxygen and hydrogen peroxide. The enzyme protects the cell against dangerous levels of superoxide. EC 1.15.1.1. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH]

236 Gestational Diabetes

Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroiditis: Inflammation of the thyroid gland. [NIH]

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Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Time Management: Planning and control of time to improve efficiency and effectiveness. [NIH]

Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Toxaemia: 1. The condition resulting from the spread of bacterial products (toxins) by the bloodstream. 2. A condition resulting from metabolic disturbances, e.g. toxaemia of pregnancy. [EU] Toxemia: A generalized intoxication produced by toxins and other substances elaborated by an infectious agent. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Tracer: A substance (such as a radioisotope) used in imaging procedures. [NIH] Traction: The act of pulling. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transferases: Transferases are enzymes transferring a group, for example, the methyl group or a glycosyl group, from one compound (generally regarded as donor) to another compound (generally regarded as acceptor). The classification is based on the scheme "donor:acceptor group transferase". (Enzyme Nomenclature, 1992) EC 2. [NIH] Transgenes: Genes that are introduced into an organism using gene transfer techniques. [NIH]

Translocation: The movement of material in solution inside the body of the plant. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH]

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Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trophoblast: The outer layer of cells of the blastocyst which works its way into the endometrium during ovum implantation and grows rapidly, later combining with mesoderm. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH]

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Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Villous: Of a surface, covered with villi. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral fat: One of the three compartments of abdominal fat. Retroperitoneal and subcutaneous are the other two compartments. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH]

240 Gestational Diabetes

Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Wound Infection: Invasion of the site of trauma by pathogenic microorganisms. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Yolk Sac: An embryonic membrane formed from endoderm and mesoderm. In reptiles and birds it incorporates the yolk into the digestive tract for nourishing the embryo. In placental mammals its nutritional function is vestigial; however, it is the source of most of the intestinal mucosa and the site of formation of the germ cells. It is sometimes called the vitelline sac, which should not be confused with the vitelline membrane of the egg. [NIH] Zygote: The fertilized ovum. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

241

INDEX A Abdominal, 16, 41, 191, 198, 200, 223, 239 Abdominal fat, 191, 239 Aberrant, 37, 39, 43, 191 Acceptor, 191, 218, 223, 237 Acculturation, 33, 191 ACE, 191 Acne, 137, 191 Adaptability, 191, 200 Adaptation, 37, 66, 191 Adenine, 191, 229 Adenosine, 99, 139, 191, 198, 225 Adenosine Triphosphate, 139, 191, 225 Adipocytes, 6, 73, 191, 217 Adipose Tissue, 40, 55, 191 Adjustment, 8, 13, 18, 20, 22, 24, 177, 191 Adolescence, 191, 224 Adrenal Cortex, 192, 203, 204, 228 Adult-Onset Diabetes, 144, 192 Adverse Effect, 62, 192, 233 Aerobic, 4, 17, 51, 55, 145, 192, 208, 220, 223 Aerobic Exercise, 17, 51, 55, 192 Afferent, 192, 217 Affinity, 192, 220, 233 Age Groups, 27, 192 Age of Onset, 192, 238 Age-Adjusted, 6, 192 Aged, 80 and Over, 192 Agenesis, 44, 192 Agonist, 135, 192 Albumin, 59, 134, 192, 226 Alertness, 192, 198 Algorithms, 192, 197 Alkaline, 193, 198 Allantois, 193, 209 Alternative medicine, 155, 193 Alveolar Process, 193, 231 Amenorrhea, 193, 226 Amino Acid Sequence, 193, 194, 211 Amino Acids, 20, 37, 193, 201, 211, 220, 224, 226, 229, 233, 235, 238 Ammonia, 193, 212, 235, 238 Amnion, 193, 209 Amniotic Fluid, 83, 145, 193, 211 Amputation, 144, 193 Amygdala, 50, 193, 218 Amyloid, 42, 193

Anaesthesia, 193, 215 Analog, 16, 73, 193 Analytes, 170, 193 Anastomosis, 193, 210 Anatomical, 193, 205, 215, 232 Androgens, 192, 193, 203 Anemia, 147, 194 Aneurysm, 194, 239 Angiogenesis, 66, 80, 194, 219 Animal model, 43, 194 Anions, 192, 194, 216, 235 Annealing, 194, 226 Anomalies, 11, 72, 74, 107, 152, 194, 221 Anovulation, 194, 226 Antagonism, 194, 198 Anthropometry, 8, 32, 194 Antiallergic, 194, 203 Antibodies, 51, 88, 111, 194, 196, 204, 215, 218, 226 Antibody, 192, 194, 202, 215, 216 Anticoagulant, 194, 228 Antidiabetic, 5, 194, 212 Antidiabetic Agent, 5, 194 Antigen, 95, 192, 194, 202, 214, 215, 216 Anti-inflammatory, 137, 194, 203, 211 Anti-Inflammatory Agents, 195, 203 Antimicrobial, 48, 195 Antineoplastic, 195, 203 Antioxidant, 26, 195, 223 Anxiety, 13, 86, 195 Apolipoproteins, 195, 218 Apoptosis, 64, 195 Aqueous, 195, 196, 204, 214, 217 Arachidonate 12-Lipoxygenase, 195, 218 Arachidonate 15-Lipoxygenase, 195, 218 Arachidonate Lipoxygenases, 195, 218 Arachidonic Acid, 9, 195, 217, 228 Arginine, 72, 195 Aromatic, 195, 220, 225 Arterial, 6, 195, 196, 200, 211, 214, 228, 236 Arteries, 195, 196, 197, 203, 218, 220, 236 Arterioles, 195, 196, 197, 199 Arteriolosclerosis, 195, 196 Arteriosclerosis, 137, 196, 214 Assay, 17, 42, 196, 215 Asymptomatic, 50, 89, 165, 196, 223 Auditory, 49, 196 Autoantibodies, 51, 84, 87, 95, 196

242 Gestational Diabetes

Autoantigens, 196 Autodigestion, 196, 223 Autoimmune disease, 137, 196 Autoimmunity, 70, 102, 196 B Back Pain, 16, 196 Bacteria, 194, 196, 207, 220, 230, 237, 238, 239 Bacterial Physiology, 191, 196 Bacteriophage, 196, 237 Base, 47, 48, 50, 52, 191, 196, 205, 211, 217, 236, 238 Base Sequence, 196, 211 Behavior Therapy, 196 Behavioral Medicine, 53, 196 Beta-pleated, 193, 196 Bilateral, 196, 226 Bile, 197, 210, 217, 218, 232, 234, 236 Bile Acids, 197, 234, 236 Bile Ducts, 197, 210 Bile Pigments, 197, 217 Biliary, 32, 197, 199, 223 Biliary Tract, 197, 199, 223 Bilirubin, 192, 197, 210, 214 Biochemical, 31, 34, 117, 197, 212 Biological therapy, 197, 212 Biosynthesis, 195, 197, 233 Biotechnology, 66, 67, 144, 155, 163, 197 Biotin, 123, 197 Birth Order, 33, 197 Bivalent, 197, 220 Bladder, 197, 210, 222, 238 Blastocyst, 197, 202, 207, 223, 226, 238 Blood Coagulation, 197, 198, 236 Blood pressure, 32, 36, 52, 72, 79, 83, 145, 197, 199, 211, 214, 220, 225, 233 Blood vessel, 191, 193, 194, 197, 199, 200, 224, 225, 230, 233, 235, 236, 239 Body Composition, 33, 40, 55, 60, 104, 198 Body Mass Index, 9, 35, 51, 99, 198, 223 Bone Marrow, 198, 208, 215, 218, 221, 233 Bowel, 198, 205, 207, 216, 222 Bowel Movement, 198, 205 Bradykinin, 198, 226 Branch, 185, 198, 204, 206, 224, 229, 234, 236 Breast Feeding, 149, 198 Buffers, 198, 234 C Cachexia, 137, 198 Caesarean section, 38, 198 Caffeine, 174, 198, 229

Calcification, 196, 198 Calcium, 122, 137, 198, 202, 219, 233 Calculi, 199, 212 Callus, 199, 207 Caloric intake, 15, 24, 175, 199 Capillary, 5, 10, 198, 199, 239 Carbon Dioxide, 199, 226, 231 Carcinogenic, 199, 216, 234 Carcinogens, 199, 200 Cardiac, 139, 198, 199, 204, 208, 221, 232, 234 Cardiorespiratory, 17, 192, 199 Cardiovascular, 11, 27, 28, 29, 30, 31, 34, 52, 53, 61, 90, 103, 111, 137, 199, 208, 217 Cardiovascular disease, 29, 30, 61, 137, 199 Carotene, 199, 231 Carrier Proteins, 199, 226 Case-Control Studies, 36, 199 Cataract, 137, 199 Caudal, 44, 199, 214, 227 Causal, 32, 199 Cell Death, 44, 139, 195, 200, 221 Cell Differentiation, 200, 233 Cell Division, 25, 196, 200, 204, 212, 220, 226, 228 Cell membrane, 76, 199, 200, 205, 225, 227 Cell proliferation, 25, 44, 137, 196, 200, 233 Cell Respiration, 200, 220, 223, 231 Cell Survival, 200, 212 Central Nervous System, 139, 198, 200, 211, 212, 213, 217 Cerebral, 137, 200, 203, 207, 208, 236 Cerebrovascular, 199, 200 Cerebrum, 200 Cervix, 145, 200 Cesarean Section, 6, 14, 153, 200 Check-up, 16, 200 Cholesterol, 32, 53, 197, 200, 201, 203, 206, 210, 214, 218, 232, 234 Cholesterol Esters, 200, 218 Chorion, 200, 210 Chromatin, 195, 200 Chromium, 87, 119, 122, 123, 200 Chromosomal, 72, 152, 200, 232 Chromosome, 152, 200, 218, 232 Chronic, 6, 8, 58, 59, 136, 171, 196, 198, 200, 201, 207, 216, 217, 218, 223, 226, 229, 235, 238 Chronic Disease, 59, 171, 198, 200 Chronic renal, 201, 226, 238 Chylomicrons, 201, 218

Index 243

CIS, 201, 231 Clamp, 35, 51, 55, 65, 201 Clinical Medicine, 201, 227 Clinical Protocols, 48, 201 Clinical study, 201, 203 Clinical trial, 23, 25, 26, 29, 30, 31, 47, 50, 51, 53, 58, 129, 130, 163, 201, 203, 221, 224, 229, 230 Cloning, 197, 201 Coagulation, 197, 201, 226 Codon, 201, 211 Cofactor, 201, 228, 236 Cognitive behavior therapy, 62, 201 Cognitive restructuring, 201, 235 Collagen, 201, 209, 210, 219 Colloidal, 192, 202 Complement, 202, 226 Complementary and alternative medicine, 121, 126, 202 Complementary medicine, 121, 202 Computational Biology, 163, 202 Conception, 202, 203, 210, 227, 234 Cones, 202, 231 Confounding, 8, 202 Confusion, 202, 214, 238 Constriction, 203, 232 Consultation, 59, 79, 203 Consumption, 5, 32, 203, 205, 208, 231 Continuum, 8, 203 Contraception, 10, 23, 89, 154, 203 Contraindications, ii, 74, 145, 203 Control group, 9, 14, 15, 17, 29, 37, 53, 203, 230 Controlled clinical trial, 61, 203 Controlled study, 68, 203 Conventional therapy, 118, 125, 203 Conventional treatment, 54, 203 Convulsions, 203, 206, 214, 227 Coordination, 49, 203 Coronary, 11, 39, 72, 88, 137, 199, 203, 220 Coronary heart disease, 199, 203 Coronary Thrombosis, 203, 220 Corticosteroid, 48, 203 Cortisol, 36, 192, 204 C-Peptide, 33, 204 Curative, 204, 236 Cyclic, 198, 204 Cysteine, 138, 204, 235 Cystine, 204 Cytogenetics, 204, 232 Cytokine, 77, 204 Cytoplasm, 195, 200, 204, 212, 220, 221

Cytoskeleton, 42, 204 Cytotoxic, 204, 233 D Dairy Products, 204, 232 Data Collection, 38, 39, 58, 86, 204, 210 Databases, Bibliographic, 163, 204 Deamination, 204, 238 Decidua, 204, 226 Decision Making, 27, 204 Decompensation, 38, 75, 204 Degenerative, 205, 231 Deletion, 195, 205 Denaturation, 205, 226 Dendrites, 205, 222 Density, 40, 50, 66, 198, 205, 206, 218, 222 Dentate Gyrus, 205, 213 Deoxyribonucleic, 205, 232 Deoxyribonucleic acid, 205, 232 Depolarization, 205, 233 Dermatitis, 205, 206 Deuterium, 205, 214 Developing Countries, 13, 205 Diagnostic procedure, 133, 155, 205 Diastolic, 205, 214 Dietitian, 12, 15, 148, 174, 205 Digestion, 197, 198, 205, 216, 218, 235 Digestive system, 131, 205 Dihydrotestosterone, 205, 230 Dilatation, 194, 205, 239 Dilatation, Pathologic, 205, 239 Dilation, 198, 205, 239 Dimethyl, 72, 206 Direct, iii, 26, 59, 60, 157, 201, 206, 231 Discrimination, 50, 206 Disposition, 66, 206 Distention, 16, 206 Diuresis, 198, 206 Drug Interactions, 158, 206 Drug Tolerance, 206, 237 Duodenum, 197, 206, 217, 232, 235 Dyes, 193, 206 Dyslipidemia, 39, 206 Dyspnea, 204, 206 E Eclampsia, 36, 48, 171, 206, 227 Eczema, 137, 206 Edema, 204, 206, 217, 221, 227, 238 Efficacy, 16, 47, 50, 58, 106, 118, 129, 206 Elasticity, 196, 206 Elective, 41, 106, 206 Electrolyte, 203, 206, 220, 227, 233, 238 Electrons, 195, 196, 206, 216, 223, 230

244 Gestational Diabetes

Electrophysiological, 50, 206 Embryo, 26, 43, 45, 64, 193, 197, 200, 207, 209, 215, 220, 227, 234, 240 Embryo Transfer, 207, 227 Embryogenesis, 42, 207 Empiric, 33, 207 Encephalocele, 207, 222 Endocrine System, 207 Endocrinology, 41, 52, 54, 70, 74, 75, 76, 78, 80, 87, 88, 91, 92, 93, 95, 98, 101, 103, 146, 207 Endometrium, 204, 207, 238 Endotoxin, 207, 238 Endpoint Determination, 29, 207 End-stage renal, 144, 201, 207, 226 Energy balance, 207, 217 Energy Intake, 35, 207 Enteritis, 137, 207 Enterocolitis, 207 Entorhinal Cortex, 207, 213 Environmental Health, 162, 164, 207 Enzymatic, 198, 199, 202, 208, 226, 231 Enzyme, 55, 191, 195, 208, 211, 218, 220, 224, 226, 230, 233, 235, 236, 237, 239, 240 Enzyme Inhibitors, 208, 226 Epidemic, 13, 30, 125, 208 Epidemiological, 13, 28, 46, 61, 63, 64, 208 Epigastric, 208, 223 Epinephrine, 208, 238 Epithelial, 42, 204, 208 Epithelial Cells, 208 Epithelium, 42, 208 Ergometer, 17, 208 Erythema, 208, 235 Erythrocyte Deformability, 72, 208 Erythrocytes, 116, 194, 198, 208, 230 Erythropoietin, 6, 208 Escalation, 44, 208 Esophagus, 205, 208, 235 Estrogen, 11, 208, 228 Ethnic Groups, 13, 18, 46, 50, 102, 173, 208 Eukaryotic Cells, 208, 215, 222 Excitatory, 208, 212 Exercise Test, 208, 209 Exercise Therapy, 30, 209 Exercise Tolerance, 35, 209 Exocrine, 209, 223 Exogenous, 17, 72, 204, 206, 209, 238 Extensor, 209, 229 Extracellular, 193, 209, 219, 233 Extracellular Matrix, 209, 219 Extracellular Matrix Proteins, 209, 219

Extraction, 37, 200, 209 F Family Planning, 163, 209 Fatty acids, 9, 37, 84, 192, 209, 218, 228 Fatty Liver, 137, 209 Fertilization in Vitro, 209, 227 Fetal Blood, 209, 226 Fetal Death, 6, 20, 209 Fetal Development, 25, 26, 209, 222 Fetal Distress, 209, 217 Fetal Macrosomia, 16, 34, 37, 86, 94, 98, 135, 152, 209 Fetal Membranes, 56, 209 Fetal Weight, 24, 66, 210 Fibrinogen, 210, 226, 236 Focus Groups, 58, 210 Fold, 25, 50, 64, 210 Food Preferences, 4, 210 Forearm, 197, 210 Fructosamine, 84, 95, 134, 210 Fructose, 210 Fundus, 59, 210 G Gallbladder, 32, 191, 197, 205, 210 Gallstones, 32, 210 Gas, 193, 199, 210, 214, 222 Gastric, 124, 196, 210 Gastric Bypass, 124, 210 Gastrin, 210, 213 Gastrointestinal, 198, 208, 210, 217, 234, 235 Gastrointestinal tract, 210, 217, 234 Gelatin, 210, 212, 236 Gene, 32, 34, 35, 45, 46, 64, 98, 99, 116, 144, 197, 210, 211, 237 Gene Dosage, 45, 210 Gene Expression, 45, 65, 211 Genetic Code, 34, 211, 222 Genetic testing, 211, 226 Genetics, 31, 35, 47, 123, 204, 211 Genotype, 34, 211, 225 Germ Cells, 211, 222, 223, 240 Gestation, 5, 8, 11, 36, 38, 39, 40, 44, 62, 68, 81, 108, 146, 148, 211, 224, 226, 234 Gestational Age, 5, 11, 35, 37, 56, 134, 135, 211 Gland, 192, 211, 223, 226, 232, 235, 236 Glomeruli, 211, 230 Glucocorticoids, 192, 203, 211 Glucokinase, 91, 123, 211 Gluconeogenesis, 37, 211 Glucose Clamp Technique, 18, 211

Index 245

Glucose Intolerance, 4, 12, 13, 15, 18, 21, 38, 50, 58, 71, 76, 80, 102, 111, 122, 154, 205, 211 Glutamate, 212 Glutamic Acid, 95, 212 Glutamine, 37, 212 Glyburide, 11, 20, 60, 67, 87, 106, 116, 153, 212 Glycine, 212, 233 Glycogen, 55, 211, 212 Glycoprotein, 74, 76, 208, 210, 212, 236, 238 Glycosuria, 19, 136, 212 Glycosylation, 93, 212 Gout, 137, 212 Governing Board, 212, 227 Grade, 176, 212 Grafting, 212, 215 Granulocytes, 212, 233 Gravidity, 85, 212, 223 Growth factors, 23, 33, 57, 212 H Headache, 198, 212, 214 Health Resources, iv, 16, 25, 213 Health Services, 13, 213 Health Status, 11, 60, 213 Heart attack, 199, 213 Hemoglobin, 9, 17, 19, 35, 52, 59, 60, 97, 110, 134, 145, 194, 208, 213, 217 Hemoglobin A, 97, 110, 145, 213 Hemorrhage, 213, 217, 235 Hepatic, 31, 192, 212, 213 Hepatocyte, 46, 213 Heredity, 210, 211, 213 Heritability, 32, 213 Hippocampus, 50, 205, 213, 218, 235 Homeostasis, 26, 43, 52, 55, 146, 213 Homogeneous, 195, 203, 213 Hormonal, 10, 89, 154, 203, 213 Hormonal therapy, 11, 213 Hormone therapy, 213 Host, 196, 213, 215, 217, 239 Hydrogen, 137, 191, 196, 198, 199, 205, 209, 214, 218, 220, 223, 229, 235 Hydrogen Peroxide, 214, 218, 235 Hydrolysis, 214, 225, 226 Hydrophobic, 214, 218 Hyperbilirubinemia, 6, 24, 36, 136, 214, 217 Hypercholesterolemia, 206, 214 Hyperglycaemia, 122, 214 Hyperlipidemia, 44, 206, 214

Hypersensitivity, 214, 217, 232 Hypertension, 29, 31, 32, 36, 39, 48, 77, 89, 90, 137, 145, 154, 196, 199, 213, 214, 227, 238 Hypertriglyceridemia, 206, 214 Hypertrophy, 34, 214 Hyperuricemia, 212, 214 Hypoglycaemia, 90, 214 Hypoglycemia, 5, 6, 11, 17, 20, 23, 24, 36, 38, 39, 57, 62, 135, 164, 173, 214 Hypoglycemic, 14, 20, 21, 58, 59, 61, 101, 110, 118, 137, 146, 214 Hypoglycemic Agents, 21, 110, 118, 146, 214 Hypothalamus, 214, 218, 226, 234 Hypothermia, 214 Hypoxia, 49, 66, 214 Hysterotomy, 200, 214 I Id, 77, 119, 125, 135, 177, 178, 184, 186, 215 Idiopathic, 153, 165, 215 Imaging procedures, 215, 237 Imidazole, 197, 215 Immune response, 194, 196, 204, 215, 235, 239 Immune system, 196, 197, 215, 217, 218, 239 Immunization, 215, 228 Immunoassay, 204, 215 Immunoglobulins, 215, 226 Immunologic, 28, 98, 211, 215 Impairment, 100, 215, 219 Implantation, 43, 202, 215, 223 In situ, 45, 122, 215 In Situ Hybridization, 45, 215 In vitro, 25, 41, 44, 66, 139, 207, 215, 226 In vivo, 43, 65, 139, 215, 236 Incision, 198, 214, 215 Indicative, 143, 207, 215, 224, 239 Induction, 118, 125, 194, 215, 228 Infant, Newborn, 192, 215 Infarction, 203, 215, 220 Infection, 56, 197, 215, 218, 230, 232, 235 Infertility, 4, 216 Inflammation, 191, 192, 194, 195, 205, 207, 216, 217, 223, 224, 229, 231, 232, 236, 239 Infusion, 35, 42, 116, 211, 216 Ingestion, 212, 216 Initiation, 19, 66, 216 Inorganic, 216, 219 Insight, 25, 216

246 Gestational Diabetes

Insulin-dependent diabetes mellitus, 97, 139, 216 Insulin-like, 91, 216 Intensive Care, 11, 216 Intermittent, 216, 218 Internal Medicine, 46, 114, 118, 207, 216 Intestinal, 199, 207, 212, 216, 240 Intestine, 198, 207, 216, 217 Intoxication, 216, 237 Intracellular, 40, 139, 198, 216, 219, 227, 233 Intravenous, 14, 18, 92, 145, 216, 223 Invertebrates, 211, 216 Ions, 196, 198, 206, 214, 216, 219, 227 Islet, 23, 25, 26, 31, 41, 44, 51, 84, 88, 95, 102, 111, 138, 217 J Jaundice, 173, 214, 217 Jejunum, 210, 217 K Kb, 162, 217 Kidney Cortex, 217, 220 Kidney Failure, 207, 217 Kinetics, 37, 75, 217 L Labor Complications, 6, 217 Lacerations, 14, 217 Lactation, 217, 228 Large Intestine, 205, 216, 217, 230, 233 Latent, 217, 227 Lens, 199, 217 Leptin, 32, 33, 34, 35, 36, 46, 70, 91, 93, 106, 217 Lesion, 137, 217, 238 Leucine, 75, 217 Leukocytes, 198, 212, 217, 221, 238 Leukotrienes, 137, 195, 217 Library Services, 184, 217 Ligaments, 203, 217 Limbic, 193, 217, 218 Limbic System, 193, 218 Linkages, 213, 218 Lipid, 18, 36, 40, 90, 92, 94, 117, 137, 195, 196, 211, 216, 218, 223 Lipid Peroxidation, 218, 223 Lipoprotein, 29, 206, 218 Lipoxygenase, 137, 195, 217, 218 Liver, 34, 37, 55, 94, 191, 192, 195, 197, 205, 208, 209, 210, 211, 212, 213, 218, 220, 232, 238 Lobe, 50, 218 Localized, 42, 216, 218, 226, 238

Long-Term Care, 31, 218 Loop, 210, 218 Low-calorie diet, 117, 218 Low-density lipoprotein, 206, 218 Lumbar, 196, 218 Lutein Cells, 218, 228 Lymphatic, 216, 218, 233 Lymphocyte, 194, 218 Lymphoid, 194, 219 M Magnesium Chloride, 51, 219 Malformation, 20, 26, 152, 219 Malnutrition, 165, 192, 198, 219 Mandible, 193, 219, 231 Manifest, 8, 51, 219 Matrix metalloproteinase, 98, 116, 219 Meat, 219, 232 Medial, 49, 196, 219 Medical Records, 37, 63, 219 Medicament, 139, 219 MEDLINE, 163, 219 Melanin, 219, 225, 238 Membrane Glycoproteins, 219 Membrane Proteins, 219, 234 Memory, 49, 219 Meninges, 200, 219 Menopause, 55, 219, 227 Menstruation, 193, 204, 219, 222 Mental Disorders, 131, 219, 228 Mental Health, iv, 25, 131, 162, 166, 220, 228, 229 Mesoderm, 220, 238, 240 Metabolic disorder, 21, 34, 165, 212, 220 Metabolic therapy, 23, 220 Metabolite, 206, 220 Metallothionein, 26, 220 Metastasis, 219, 220 Methionine, 138, 206, 220, 235 MI, 43, 76, 80, 82, 91, 102, 107, 111, 121, 136, 144, 175, 189, 220 Microbe, 220, 237 Microbiology, 191, 220 Mineralocorticoids, 192, 203, 220 Minority Groups, 31, 54, 60, 88, 220 Mitochondria, 44, 220, 222 Mitochondrial Swelling, 220, 221 Mitosis, 195, 220 Modification, 10, 29, 30, 50, 52, 54, 58, 220, 230 Molecule, 194, 196, 202, 214, 220, 223, 230, 233, 239 Monitor, 4, 63, 141, 148, 164, 173, 220, 222

Index 247

Monocytes, 116, 217, 221 Mononuclear, 221, 238 Monounsaturated fat, 79, 221 Morphological, 207, 221 Morphology, 43, 199, 221 Mucosa, 207, 221, 228, 240 Multicenter Studies, 47, 49, 221 Multicenter study, 60, 221 Muscle Fibers, 41, 221 Myocardium, 220, 221 N NCI, 1, 130, 161, 201, 221 Necrosis, 107, 195, 215, 220, 221 Need, 3, 10, 13, 15, 23, 25, 141, 144, 147, 148, 154, 164, 173, 174, 176, 179, 192, 201, 212, 219, 221, 237 Neonatology, 46, 47, 221 Nephron, 42, 221 Nephropathy, 63, 137, 221 Nephrotic, 221, 231 Nephrotic Syndrome, 221, 231 Nerve, 144, 205, 221, 222, 227, 231, 232, 235 Nervous System, 192, 200, 221, 222, 225 Networks, 19, 221 Neural, 6, 48, 64, 135, 192, 193, 207, 222 Neural tube defects, 64, 135, 222 Neurons, 139, 205, 208, 222, 236 Neurosis, 137, 222 Nitrogen, 37, 75, 194, 209, 212, 222 Nuclear, 40, 43, 46, 206, 208, 218, 221, 222 Nuclei, 193, 206, 218, 220, 222, 229 Nucleic acid, 196, 211, 215, 222, 229, 232 Nucleus, 195, 200, 204, 205, 208, 210, 221, 222, 228, 229, 235 Nurseries, 49, 222 O Odds Ratio, 8, 37, 222 Oligomenorrhea, 222, 226 Oocytes, 43, 222 Opacity, 199, 205, 222 Opsin, 222, 231 Organelles, 204, 221, 222 Osmotic, 192, 220, 222 Osteoporosis, 137, 223 Outpatient, 14, 31, 63, 223 Ovaries, 88, 98, 153, 223, 226 Ovary, 136, 223 Overweight, 13, 32, 36, 101, 118, 148, 223 Ovulation, 43, 194, 223 Ovum, 204, 211, 223, 228, 238, 240 Ovum Implantation, 223, 238

Oxidation, 55, 191, 195, 204, 218, 223 Oxidative metabolism, 102, 217, 223 Oxidative Stress, 26, 44, 66, 223 P Palliative, 223, 236 Pancreas, 165, 191, 197, 205, 216, 217, 223, 228, 232, 234 Pancreatic, 6, 26, 44, 100, 102, 138, 139, 204, 223 Pancreatitis, 137, 138, 223 Parenteral, 207, 223 Parity, 10, 12, 13, 58, 103, 223 Particle, 223, 237 Parturition, 124, 222, 224, 228 Pathogenesis, 13, 33, 80, 164, 224 Pathologic, 40, 195, 203, 214, 224, 229, 231 Pathologic Processes, 195, 224 Pathophysiology, 21, 31, 41, 66, 146, 224 Patient Care Team, 142, 224 Patient Compliance, 20, 224 Patient Education, 10, 19, 20, 63, 122, 142, 172, 177, 182, 184, 189, 224 Patient Satisfaction, 79, 224 Patient Selection, 19, 224 Pediatrics, 27, 39, 43, 46, 49, 53, 97, 116, 171, 172, 221, 224 Penis, 224, 225 Pepsin, 224, 232 Peptide, 17, 52, 60, 145, 204, 217, 224, 226, 229 Perception, 4, 13, 224 Perfusion, 211, 214, 224 Perineal, 14, 121, 224 Perineum, 224 Periodontal disease, 56, 224 Periodontitis, 56, 224 Peripheral Nervous System, 225, 234, 235 Peripheral Vascular Disease, 63, 225 Phallic, 121, 225 Pharmacologic, 12, 29, 31, 52, 53, 225, 237 Phenotype, 34, 44, 45, 225 Phenylalanine, 225, 238 Phospholipases, 225, 233 Phospholipids, 209, 218, 225 Phosphorus, 198, 225 Phosphorylation, 42, 65, 76, 109, 225 Physical Examination, 30, 200, 211, 225 Physical Fitness, 61, 209, 225 Physiologic, 51, 192, 197, 209, 219, 225, 230, 231 Physiology, 41, 78, 99, 102, 206, 207, 225 Pigments, 197, 199, 225, 231

248 Gestational Diabetes

Piloerection, 214, 225 Pilot Projects, 55, 225 Pilot study, 33, 107, 225, 226 Pituitary Gland, 203, 226 Placenta, 20, 23, 33, 66, 77, 122, 148, 209, 226, 228, 229 Placental tissue, 57, 98, 116, 226 Plants, 199, 211, 221, 225, 226, 227, 237 Plasma cells, 194, 226 Plasma protein, 134, 192, 226 Platelet Activation, 226, 233 Polycystic, 43, 88, 98, 136, 137, 153, 226 Polycystic Ovary Syndrome, 43, 136, 137, 226 Polymerase, 35, 77, 226 Polymerase Chain Reaction, 35, 77, 226 Polymorphic, 32, 46, 205, 226 Polypeptide, 42, 193, 201, 210, 226, 228, 234, 240 Polysaccharide, 194, 226 Polyunsaturated fat, 9, 82, 98, 123, 124, 227, 236 Posterior, 196, 223, 227 Postmenopausal, 11, 55, 223, 227 Postnatal, 34, 39, 68, 146, 174, 227, 234 Postnatal Care, 174, 227 Postprandial, 17, 73, 146, 152, 227 Postprandial Blood Glucose, 17, 227 Postsynaptic, 227, 233 Potassium, 138, 139, 220, 227 Potassium Channels, 139, 227 Potentiation, 227, 233 Practice Guidelines, 143, 165, 177, 227 Precursor, 32, 195, 208, 225, 227, 238 Predisposition, 18, 227 Preeclampsia, 22, 24, 36, 66, 123, 126, 171, 227 Pre-eclamptic, 206, 227 Pregnancy Complications, 148, 227 Pregnancy Outcome, 8, 19, 21, 22, 38, 43, 58, 90, 97, 106, 118, 227 Pregnancy Tests, 211, 227 Prenatal, 12, 14, 22, 34, 40, 61, 72, 82, 90, 146, 170, 207, 210, 227 Prenatal Care, 62, 170, 227 Primary Prevention, 28, 29, 30, 51, 53, 58, 59, 135, 228 Progeny, 39, 228 Progesterone, 48, 103, 228, 234 Progression, 15, 18, 26, 29, 43, 52, 53, 54, 60, 145, 194, 228

Progressive, 18, 44, 55, 196, 200, 201, 206, 208, 212, 221, 226, 228 Proinsulin, 14, 204, 228, 229 Prolactin, 25, 139, 228 Prophase, 197, 222, 228, 236 Prophylaxis, 48, 228 Proportional, 63, 228 Prospective study, 36, 228 Prostaglandins, 195, 228 Protein C, 40, 94, 134, 192, 193, 195, 196, 201, 218, 228, 234, 238 Protein S, 144, 197, 211, 228 Proteinuria, 221, 227, 229 Protocol, 7, 8, 11, 14, 22, 23, 30, 46, 48, 50, 52, 58, 60, 96, 146, 229 Protons, 214, 229, 230 Proximal, 210, 217, 229 Pruritic, 206, 229 Psoriasis, 137, 229 Psychic, 222, 229 Psychotherapy, 201, 229, 230 Public Health, 60, 64, 147, 166, 229 Public Policy, 163, 229 Publishing, 66, 141, 229 Puerperium, 73, 222, 229 Pulmonary, 197, 203, 208, 217, 229, 239 Pulmonary Artery, 197, 229, 239 Pulse, 220, 229 Purified Insulins, 228, 229 Purines, 196, 229, 233 Pyelonephritis, 66, 229 Q Quality of Life, 13, 53, 230 R Race, 4, 23, 56, 63, 103, 230 Radiation, 230, 235, 240 Radioactive, 214, 215, 222, 230 Radiography, 211, 230 Radioisotope, 230, 237 Random Allocation, 230 Randomization, 58, 230 Randomized clinical trial, 50, 68, 114, 230 Reactive Oxygen Species, 44, 230 Reassurance, 24, 230 Receptor, 14, 25, 34, 46, 76, 81, 91, 109, 116, 191, 194, 230, 233 Rectum, 198, 205, 210, 217, 230 Recurrence, 15, 103, 104, 154, 230 Red blood cells, 100, 208, 230, 233 Reductase, 137, 230 Refer, 1, 202, 231

Index 249

Regimen, 3, 15, 16, 20, 58, 63, 145, 201, 206, 224, 231 Remission, 230, 231 Renal vein thrombosis, 6, 231 Reproduction Techniques, 227, 231 Research Design, 46, 231 Resorption, 26, 231 Respiration, 199, 209, 220, 223, 231 Respiratory distress syndrome, 5, 36, 135, 231 Response rate, 51, 231 Resting metabolic rate, 35, 231 Retina, 202, 217, 231, 232 Retinal, 91, 231 Retinol, 231 Retinopathy, 33, 63, 137, 231 Retrospective, 134, 232 Rheumatism, 232 Rheumatoid, 138, 232 Rheumatoid arthritis, 138, 232 Ribonucleic acid, 99, 232 Ribose, 191, 232 Risk patient, 54, 58, 232 Rod, 201, 232 Rural Population, 82, 232 S Salivary, 205, 232 Salivary glands, 205, 232 Sarcolemma, 39, 232 Satellite, 60, 232 Saturated fat, 30, 53, 232 Sclerosis, 195, 196, 232 Secretin, 26, 232 Secretory, 42, 204, 232 Sedentary, 12, 30, 55, 231, 232 Senile, 223, 232 Sequencing, 226, 232 Serine, 76, 232 Serum, 10, 11, 17, 51, 59, 74, 95, 110, 134, 152, 192, 202, 218, 220, 233, 238 Side effect, 157, 192, 197, 214, 233, 237 Signal Transduction, 34, 233 Skeletal, 34, 39, 41, 76, 109, 139, 194, 201, 233 Skeleton, 233 Skull, 207, 222, 233, 236 Sludge, 32, 233 Small intestine, 197, 201, 206, 207, 213, 216, 217, 233, 239 Smooth muscle, 99, 139, 198, 233, 235 Social Environment, 230, 233 Social Support, 3, 61, 233, 235

Social Work, 15, 53, 233 Sodium, 212, 220, 233, 235 Solid tumor, 194, 233 Somatic, 191, 207, 218, 220, 225, 234 Somatostatin, 42, 234 Soybean Oil, 227, 234 Specialist, 4, 179, 205, 234 Species, 25, 204, 208, 220, 230, 234, 235, 237, 238, 239, 240 Spectrin, 42, 234 Sperm, 93, 194, 200, 234 Spina bifida, 222, 234 Spinal cord, 200, 219, 221, 222, 225, 234 Spontaneous Abortion, 227, 234 Standard therapy, 60, 234 Steatosis, 209, 234 Steel, 201, 234 Stem Cells, 208, 234 Sterility, 216, 234 Steroid, 204, 234 Stillbirth, 6, 227, 234 Stimulant, 198, 234 Stimulus, 235, 236 Stomach, 191, 196, 205, 208, 210, 212, 213, 224, 232, 233, 235 Strand, 226, 235 Stress, 3, 4, 10, 13, 22, 26, 54, 56, 66, 86, 141, 204, 223, 227, 232, 235 Stress management, 141, 235 Stroke, 131, 137, 162, 199, 235 Subacute, 216, 235 Subclinical, 216, 235 Subcutaneous, 55, 117, 191, 206, 223, 235, 239 Subiculum, 213, 235 Subspecies, 234, 235 Substance P, 220, 232, 235 Substrate, 34, 208, 235 Sulfur, 138, 209, 220, 235 Sunburn, 137, 235 Superoxide, 26, 235 Superoxide Dismutase, 26, 235 Supplementation, 118, 125, 235 Suppression, 39, 203, 235 Sweat, 214, 235 Symptomatic, 223, 236 Synaptic, 233, 236 Synergistic, 228, 236 Systemic, 8, 158, 197, 208, 216, 236 Systolic, 214, 236 T Taurine, 138, 236

250 Gestational Diabetes

Temporal, 36, 49, 193, 213, 236 Temporal Lobe, 49, 193, 236 Testosterone, 230, 236 Therapeutics, 69, 158, 236 Thermal, 226, 236 Thigh, 55, 236 Thoracic, 196, 236 Threonine, 76, 233, 236 Threshold, 5, 6, 10, 25, 44, 96, 146, 214, 236 Thrombin, 210, 228, 236 Thrombomodulin, 228, 236 Thrombosis, 228, 235, 236 Thromboxanes, 195, 236 Thyroid, 236, 237, 238 Thyroid Gland, 236, 237 Thyroiditis, 138, 236 Thyroxine, 192, 225, 237 Time Management, 235, 237 Tolerance, 5, 6, 8, 11, 12, 13, 14, 17, 18, 19, 20, 21, 22, 23, 28, 29, 30, 32, 33, 36, 38, 39, 40, 41, 42, 44, 45, 50, 51, 52, 53, 54, 55, 57, 58, 60, 65, 68, 73, 76, 77, 78, 79, 85, 90, 92, 94, 101, 103, 107, 109, 111, 134, 137, 144, 145, 174, 188, 191, 211, 212, 237 Tomography, 55, 237 Tooth Preparation, 191, 237 Toxaemia, 227, 237 Toxemia, 6, 237 Toxic, iv, 139, 207, 237 Toxicity, 65, 206, 237 Toxicology, 164, 237 Toxins, 139, 194, 216, 237 Trace element, 200, 237 Tracer, 37, 237 Traction, 201, 237 Transduction, 34, 233, 237 Transfection, 197, 237 Transferases, 212, 237 Transgenes, 26, 237 Translocation, 39, 237 Transplantation, 43, 201, 207, 215, 237 Trauma, 213, 221, 223, 238, 240 Trophoblast, 66, 197, 238 Tuberculosis, 203, 238 Tumor Necrosis Factor, 33, 238 Tyrosine, 14, 76, 238 U Ulcer, 137, 238 Ultrasonography, 210, 211, 238 Unconscious, 215, 238

Uraemia, 223, 238 Urea, 37, 235, 238 Ureters, 238 Urethra, 224, 238 Uric, 212, 214, 229, 238 Urinary, 52, 106, 136, 199, 238 Urinary tract, 106, 136, 238 Urinary tract infection, 106, 136, 238 Urine, 16, 141, 148, 174, 175, 197, 206, 212, 229, 238 Uterus, 66, 200, 204, 207, 210, 214, 219, 223, 228, 239 V Vaccine, 229, 239 Vagina, 200, 215, 219, 239 Vaginal, 16, 109, 145, 152, 239 Vascular, 66, 91, 110, 153, 215, 216, 226, 236, 239 Vasculitis, 223, 239 Vasodilation, 139, 239 Vector, 237, 239 Vein, 194, 216, 222, 232, 239 Venous, 5, 10, 50, 204, 228, 239 Ventricle, 193, 213, 214, 229, 236, 239 Venules, 197, 199, 239 Veterinary Medicine, 163, 239 Villi, 239 Villous, 66, 239 Viral, 237, 239 Virulence, 237, 239 Virus, 196, 237, 239 Visceral, 55, 70, 218, 239 Visceral fat, 70, 239 Viscosity, 72, 239 Vitro, 239 Vivo, 41, 43, 239 W Weight Gain, 12, 15, 21, 23, 24, 35, 61, 67, 97, 127, 142, 154, 174, 175, 239 Womb, 239, 240 Wound Healing, 219, 240 Wound Infection, 124, 240 X Xenograft, 194, 240 X-ray, 55, 222, 240 Y Yeasts, 225, 240 Yolk Sac, 209, 240 Z Zygote, 43, 202, 240 Zymogen, 228, 240

Index 251

252 Gestational Diabetes

Gestational Diabetes - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Juvenile Diabetes - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Diabetes Mellitus - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Diabetes Insipidus - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Influenza A - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hepatitis A Vaccine: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Foot and Mouth Disease - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Butternut Squash: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Facial Paralysis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Wine - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Breast Augmentation - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Premenstrual Dysphoric Disorder - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Anagrelide: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Peanut Allergy: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Cauda Equina Syndrome - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Magnesium Citrate: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Lipomas - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Barbiturates - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Cephalexin - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

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Living Will - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hip Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Benzene - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

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Gestational Diabetes - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Juvenile Diabetes - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Diabetes Mellitus - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Diabetes Insipidus - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Influenza A - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hepatitis A Vaccine: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Foot and Mouth Disease - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Butternut Squash: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Facial Paralysis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Wine - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Breast Augmentation - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Premenstrual Dysphoric Disorder - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Anagrelide: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Peanut Allergy: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Cauda Equina Syndrome - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Magnesium Citrate: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Lipomas - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Barbiturates - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Cephalexin - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Body Dysmorphic Disorder: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Lymphedema - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Dermabrasion: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Septra: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Vaginitis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Feet - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Glioblastoma Multiforme - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Female Infertility - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Living Will - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hip Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Benzene - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Marburg Virus: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

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