Sonographic study of the relationship between gestational diabetes mellitus and fetal activity

Objective: To evaluate the relationship between gestational diabetes mellitus (GDM) and fetal activity. Materials and methods: We prospectively studied 18 pregnant patients with GDM and 20 pregnant patients with normal glucose screening test. An ultrasound equipmentwas used to perform a 30?min transabdominal sonographic recording for each patient. Each ultrasound exam was recorded using a DVD recorder. Fetal activity was analyzed using duration and number of episodes of fetal breathing and body movements. The recordings were analyzed using a stopwatch in order to accurately evaluate each recording. The data was statistically analyzed using the parametric and non-parametric t-test. Results: The results of the study indicated that there was a significant correlation (p?=?0.007) between the duration of fetal breathing movement and GDM. Fetuses of mothers suffering from GDM had a significantly longer duration of fetal breathing movements compared with fetuses of non diabetic mothers. In addition, the total duration of fetal activity (time of fetal body movements plus fetal breathing movements) was significantly higher (p?=?0.005) in GDM compared with non GDM pregnancies. The difference in fetal body movements between GDM and normal pregnancies was not statistically significant. Conclusion: The results of this study support the hypothesis that GDM has a direct influence on fetal activity. The significance of this finding should be further evaluated.     

Role of mean platelet volume and ischemia modified albumin in evaluation of oxidative stress and its association with postnatal complications in infants of diabetic mothers

Gestational diabetes mellitus (GDM) is accompanied by increased oxidative stress, causing many complications to pregnant women and their newborns. We aimed to determine cord blood levels of mean platelet volume (MPV) and ischemia modified albumin (IMA) as a reflection of oxidative stress in babies born to mothers suffering from GDM. Eighty pregnant women were enrolled in the study. They were divided into two groups: 40 with GDM and 40 healthy matched controls. Each group included twenty giving birth by normal vaginal delivery (NVD) and twenty by cesarean section (C.S). The MPV and the IMA levels were measured. Complete physical examination of babies was done at birth and follow up at age of one?week. Comparison between infants of diabetic mothers and of healthy mothers showed statistically significant difference in the levels of MPV (p?p?=?.001). Also, there was a statistically significant difference in MPV (p?p?=?.005) between diabetic females who gave birth by NVD and C.S. ROC curve analysis showed that IMA and MPV variables were related to the postnatal outcomes. MPV and IMA are useful markers of the potential oxidative stress in infants of diabetic mothers and of postnatal complications.     

体脂分布与体外受精-胚胎移植的妊娠结局相关性分析

目的 比较体脂定量分析、腰臀比及身体质量指数对IVF结局的影响.方法 本研究分析了自2017年1月至2018年1月于北京大学第一医院生殖中心进行IVF-ET治疗并接受体脂分布测量的109例患者.经过纳排标准选择后,比较体脂率、腰臀比及身体质量指数与体外受精胚胎移植结局的相关性.结果 ①体脂定量分析、腰臀比及身体质量指数...     

The impact of maternal age,body mass index and maternal weight gain on the glucose challenge test in pregnancy

Objective. The aim of this study was to determine whether maternal age, prepregnancy and mid-trimester body mass index (BMI), or excessive mid-pregnancy weight gain predict abnormal glucose challenge test (GCT) results.

Methods. A retrospective chart review of 75 consecutive singleton pregnancies was performed. Patients were screened at 24–28 weeks of gestation with a 50-g oral GCT. Prepregnancy BMI and pregnancy weight gain up to the time of GCT testing, as well as other demographic data, were recorded. Statistical analysis included regression analysis and Student's t-test, receiver–operator characteristic curve and multivariate logistic regression.

Results. Maternal age and prepregnancy and mid-trimester BMI were significantly higher in women with an abnormal GCT (p < 0.05). A direct correlation was found between these parameters and GCT results (R² = 0.08, R² = 0.102 and R² = 0.116, respectively; p < 0.05). Mid-trimester maternal BMI of ≥30 kg/m² and maternal age ≥32 years are the optimal predictors of abnormal GCT results.

Conclusions. Mid-trimester maternal BMI of ≥30 kg/m² and maternal age ≥32 years are useful predictors of abnormal GCT results. We suggest that these factors should also be considered when selective screening for gestational diabetes mellitus is practiced.     

妊娠期糖尿病诊断标准变迁及其对临床管理的挑战

妊娠期糖尿病的国际诊断标准不断变更,根据2008年孕妇高血糖与不良结局关系的研究,诸多国际学术和科研管理机构包括世界卫生组织以及我国卫生部均更改了标准,但新标准仍然存在争议。该文介绍了标准发展变更情况,讨论了我国临床管理对新标准提出的挑战和对策。     

The relationship between gestational diabetes mellitus and selenoprotein-P plasma 1 (SEPP1) gene polymorphisms

Our aim is to demonstrate any correlation between gestational diabetes mellitus (GDM) and polymorphism of the selenoprotein P (SEPP1) gene encoding the SEPP1 protein, having a role in the insulin resistance in GDM. Forty pregnant women with GDM and 40 healthy pregnant women were included in the study. In both groups, single nucleotide polymorphisms (SNPs), specifically, rs4987017, rs13154178, rs146125471, rs28919926, and rs16872762 were studied. There was no difference between the groups in terms of polymorphism rs146125471, rs28919926, or rs16872762 (p?>?.05). There was a significant difference in SNP rs13154178 polymorphism between the two groups (p?<?.01). When rs13154178 gene polymorphism was compared with AA homozygous individuals, fasting blood glucose levels were significantly higher in carriers of either polymorphism than in those with no polymorphism (p?<?.001). We suggest rs13154178 gene polymorphism may lead to GDM in the Turkish society.     

Still births – eight years experience at Aga Khan University Hospital Karachi,Pakistan

Objectives.?To examine the possible etiological causes of still births during 8 years of clinical experience at a tertiary referral center, The Aga Khan University Hospital Karachi Pakistan. In addition, to compare demographic and medical risk factors along with analysis of cause of fetal death in different groups.

Material and Methods.?This was a retrospective cohort study, conducted at the Aga Khan University Karachi, Pakistan over a period of 8-year period between January 2000 and January 2008. We reviewed 287 medical records of all women who had intrauterine fetal demise during study time period.

Results.?The prevalence of still births at our institution was 6.6?±?2.1 per 1000 total births. Congenital anamolies, maternal hypertension, and fetal growth restrictions were the three main causes of still births. About half of still births were among unbooked pregnant women. More than 90% of occurred during the ante natal period while 10% were intrapartum. Majority of stillborns were in macerated state when delivered.

Conclusion.?Most of still births were due to known causes such as hypertension, congenital anomalies, and fetal growth restriction. Improvement in the management of hypertension and diagnosis of congenital anomalies is necessary. Results of the analysis urge on the need for antenatal care and compliance for follow-ups.     

The effect of residual beta cell activity on menstruation and the reproductive hormone profile of insulin-dependent diabetics

Summary To investigate the cause of secondary amenorrhoea in insulin-dependent diabetes gonadotrophins, sex steroid hormone levels and residual beta cell activity (C-peptide index) were estimated in a group of 43 women with IDDM. Among 26 women with residual insulin secretion, the C-peptide positive (CpP) group, 5 had secondary amenorrhoea (CpP-Am); among 17 women without endogenous beta cell activity, the C-peptide negative (CpN) group 6 had secondary amenorrhoea (CpN-Am). In this study two different types of secondary amenorrhoea in insulin-dependent diabetics were observed. All CpP-Am women have the classical hormone profile of the polycystic ovary syndrome (increased (LH/FSH ratio, increased serum testosterone, decreased SHBG) together with a history of oligomenorrhoea and excess weight before the onset of diabetes. On the other hand, all CpN-Am women had decreased LH levels as well as low LH/FSH ratio and testosterone levels. These results strongly suggest that a lack of residual pancreatic beta cell activity influences hypothalamus-pituitary function in insulin-dependent diabetes. It might be concluded that PCOS is independent of diabetes while low LH amenorrhoea seems to be the consequence of diabetes and is strongly associated with a lack of residual insulin secretion.     

Obstetric outcomes and placental findings in gestational diabetes patients according to maternal prepregnancy weight and weight gain

Objective: We assessed clinical outcomes and placental pathology among pregnancies complicated with gestational diabetes mellitus (GDM) according to their pregestational body mass index (BMI) and weight gain during pregnancy.

Study design: Pregnancy outcome and placental pathological reports of all GDM deliveries, during 2009–2015, were reviewed. We compared women with pregestational BMI?>?30 and or gestational weight gain >20?kg (high-BMI group), and women with pregestational BMI?Results: Out of the 429 women with GDM, 221 (51.5%) were in the high-BMI group and 208 (48.3%) were in the normal BMI group. As compared to the normal BMI group, the high-BMI group displayed a higher rate of GDMA2 41.6 versus 30.2%, p?=?.01, higher birth weight, 3475?±?508?g versus 3242?±?503?g, p?p?p?=?.07, respectively. By logistic regression analysis, past CD and high BMI were independently associated with CD, while GDM type and birth weight were nonsignificant. Pathological reports were available for 143 of these patients. Placental weight was increased among the high-BMI group, but did not retain significance after adjustment for birth weight, and GDM type. No differences were demonstrated in other placental histological findings.

Conclusions: GDM pregnancies accompanied by increased weight gain or elevated pregestational BMI are associated with adverse obstetric outcomes, despite similar placental findings. Patient should be advised accordingly, as gestational weight gain may determine delivery mode.     

Associations between toxic metals in follicular fluid and in vitro fertilization (IVF) outcomes

Purpose

We previously reported associations between trace concentrations of Hg, Cd and Pb in blood and urine and reproductive outcomes for women undergoing in-vitro fertilization (IVF). Here we assess measurements in single follicular fluid (FF) specimens from 46 women as a presumably more relevant marker of dose for reproductive toxicity.

Methods

FF specimens were analyzed for Hg, Cd and Pb using sector field-inductively coupled plasma-mass spectrometry (SF-ICP-MS). Variability sources were assessed by nested ANOVA. Multivariable regression was used to evaluate associations for square root transformed metals with IVF outcomes, adjusting for confounders.

Results

An inverse association is detected for FF Pb and fertilization (relative risk (RR) = 0.68, P = 0.026), although positive for Cd (RR = 9.05, P = 0.025). While no other statistically significant associations are detected, odds ratios (OR) are increased for embryo cleavage with Hg (OR = 3.83, P = 0.264) and Cd (OR = 3.18, P = 0.644), and for embryo fragmentation with Cd (OR = 4.08, P = 0.586) and Pb (OR = 2.22, P = 0.220). Positive estimates are observed for Cd with biochemical (RR = 19.02, P = 0.286) and clinical pregnancies (RR = 38.80, P = 0.212), yet with very low precision.

Conclusions

We have identified associations between trace amounts of Pb and Cd in FF from a single follicle, and oocyte fertilization. Yet, the likelihood of biological variation in trace element concentrations within and between follicles, coupled with levels that are near the limits of detection suggest that future work should examine multiple follicles using a ‘one follicle-one oocyte/embryo’ approach. A larger study is merited to assess more definitively the role that these environmental factors could play with respect to egg quality in IVF programs.     

长效孕激素炔诺酮庚酸酯及复方18甲基炔诺酮对血清性激素结合球蛋白的影响

24例妇女肌注炔诺酮庚酸酯200 mg,肌注前血清性激素结合球蛋白(SHBG)为53.32±23.23 nmol╱L。注射后5天为41.99±17.06nmol/L(P<0.05),21天降至最低值14.72±10.01 nmol/L,以后逐渐回升,直至注射后84天仍未回复到原来水平(34.46±20.39 nmol/L)。10例妇女单次口服18甲基炔诺酮6 mg+炔雌醚3 mg,服药前血清SHBG水平为42.76±13.89 n mol/L,服药后7天为62.53±10.90 nmol/L(P<0.01),14天达峰值为71.33±5.77 nmol/L,以后持续此高水平,直至服药后56天;8例连续3次口服18甲+炔雌醚,每次间隔23天,服药前血清SHBG水平为44.94±15.36 nmol/L,第1次服药后9天为83.46±10.08 nmol/L(P<0.01),16天达峰值为91.74±2.28nmol/L,以后持续高水平直至第3次服药后30天,第2、3次重复给药对业已升高的SHBG水平无影明显响。第2、3次服药后LNG峰值明显高于首次服药后峰值6倍。     

甲状腺功能减退症与勃起功能障碍关系的初步探讨

甲状腺功能减退(HT)即甲状腺激素分泌不足的状态下,脂质代谢紊乱产生的高脂血症、血管内皮细胞功能障碍、血管平滑肌细胞舒张性下降等均可影响阴茎勃起功能。NO、CO、H2S及内皮素等在HT中起着重要作用。通过对高脂血症、高血糖、心血管病变的治疗及补充睾酮等,可明显改善阴茎勃起功能,因而积极治疗HT,对改善HT所致阴茎勃起功能障碍(ED)具有重要意义。内皮功能障碍被认为是ED的主要发病机制,因此治疗HT时同时改善内皮功能,也会对ED发挥治疗作用。同时HT引起的神经损伤也参与了ED。通过对这些物质、神经及其功能的深入研究,可为今后临床上治疗ED提供理论依据。     

脂质蓄积指数较腰围更好反映多囊卵巢综合征患者的胰岛素抵抗

目的:比较多囊卵巢综合征(PCOS)人群脂质蓄积指数(LAP)和腰围(WC)与胰岛素抵抗(IR)的相关性。方法:纳入121例PCOS患者和115例正常对照,测量人体参数及血液代谢指标,行75 g口服葡萄糖耐量试验,对其中20例对照及90例PCOS患者行高胰岛素-正葡萄糖钳夹术,并计算HOMA2-IR及LAP。结果:PCOS组LAP、WC等较对照组明显增高(P<0.05),胰岛素敏感性明显降低(P<0.05);匹配WC和年龄后,PCOS组LAP仍明显高于对照组(P<0.01),胰岛素敏感性明显低于对照组(P<0.05);与WC相比,LAP与M值(r=-0.66 vs r=-0.68,P<0.01)及HOMA2-IR(r=0.49 vs r=0.55,P<0.01)间关系更密切,校正WC后,LAP仍与M值(r=-0.37,P<0.01)及HOMA2-IR(r=0.26,P<0.01)相关;二项Logistic回归显示,高LAP患者发生IR的风险是正常LAP患者的6.05倍(OR=6.05,95%CI:1.67,21.90,P<0.05)。结论:在PCOS人群中,LAP与胰岛素敏感性相关,较WC更好地反映IR。     

高雄激素血症与多囊卵巢综合征中非酒精性脂肪性肝病的关系

目的:探讨高雄激素血症(HT)与多囊卵巢综合征(PCOS)患者非酒精性脂肪性肝病(NAFLD)发病的关系。方法:对306例PCOS患者进行基础内分泌、口服糖耐量试验及胰岛素释放试验、肝功能、血脂等检查,B超诊断脂肪肝。结果:306例PCOS患者中诊断出NAFLD94例,发病率为30.7%;其中NAFLD轻度56例(59.6%),中度34例(36.2%),重度4例(4.2%)。PCOS患者NAFLD的发病率与HA无明显相关性,与稳态模型评估胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)呈正相关。PCOS合并NAFLD组胰岛素抵抗(IR)发生率明显高于PCOS不合并NAFLD组,P<0.05;PCOS高雄激素血症(PCOS-HA)组IR发生率与PCOS非高雄激素血症(PCOS-NHA)组无明显差异,P>0.05。结论:PCOS患者NAFLD发病率较高,PCOS患者NAFLD的发生与IR、代谢异常密切相关,与HA无明显相关。     

Polycystic ovary syndrome and the single nucleotide polymorphisms of methylenetetrahydrofolate reductase: a pilot observational study

Polycystic ovary syndrome (PCOS), insulin resistance and overall mortality due to diabetes and coronary artery disease are higher in South Asians than in Caucasians. Aims: We compared the prevalence of the C677T and A1298C single nucleotide polymorphisms in the methylenetetrahydrofolate reductase gene in South Asian and Caucasian women, its association with folate and homocysteine (Hcy) metabolism, and its relevance to future atherogenic events. Methods and results: 71 women were recruited for the study: South Asian PCOS (21) plus controls (9) and Caucasian PCOS (25) plus controls (16). Anthropometric and laboratory parameters were compared. South Asian PCOS women were significantly hyperandrogenic and exhibited a greater degree of insulin resistance. Caucasian PCOS women had higher plasma Hcy concentrations with a 1.9 times higher frequency of the T allele than the South Asian PCOS group. In the presence of this variant allele, plasma Hcy levels appear to be higher in both PCOS groups. The South Asians had a 1.8 times higher frequency of the C allele than the Caucasians; however, the overall frequency was comparable in the two PCOS groups. The frequency of homozygosity, i.e. TT677 and CC1298, was 7.2% and 4.9% in the Caucasians and 0% and 16.6% in the South Asian recruits, respectively.

Dietary inadequacies in the South Asian women can influence their plasma folate and B12 concentrations resulting in hyperhomocysteinemia which, in combination with dyslipidaemia and insulin resistance, can lead to long-term atherogenic consequences. Conclusions: Current data suggests that the mechanisms of atherothrombosis have separate pathways in the two ethnic groups. Larger studies exploring the current theme need to be carried out in the PCOS groups to obtain adequate insight.     

新型左炔诺孕酮/炔雌醇复方避孕贴剂的家兔药代动力学研究

目的:探讨新型左炔诺孕酮(levonorgestrel,LNG)和炔雌醇(ethynylestradiol,EE)在家兔体内的药物动力学特征,评价多次给药后是否出现药物蓄积情况。方法:家兔在单次和多次给药及停止给药后不同时间点耳缘静脉采血,选择放射免疫分析(radioimmunoassay,RIA)法测定各时间点各组家兔雌/孕激素的血药浓度,使用药物动力学软件计算各药物动力学参数并对其进行统计分析。结果:单次给药后受试贴剂低(10cm2)、中(20 cm2)和高剂量(40 cm2)组血清LNG峰浓度(Cmax)分别为1.04±0.12 ng/ml、2.42±0.60 ng/ml和4.90±1.39 ng/ml,3组间有显著差异(P<0.05)。血药浓度-时间曲线下面积(AUC)分别为49.93±9.79h.ng/ml、115.14±34.25 h.ng/ml和251.22±80.55 h.ng/ml,3组间有显著差异(P<0.01);血清EE峰浓度(Cmax)分别为112.00±45.50 pg/ml、139.23±28.23 pg/ml和290.26±66.62 pg/ml,中、高剂量组间有显著差异(P<0.05),而中、低剂量组间无统计学差异(P>0.05)。EE血药浓度-时间曲线下面积(AUC)分别为4.70±1.34 h.ng/ml、6.59±1.23h.ng/ml和16.59±2.33 h.ng/ml,中、高剂量组之间有显著差异(P<0.01)。Evra参比避孕贴剂组血清LNG浓度的Cmax为3.16±1.00 ng/ml,AUC为155.29±46.14 h.ng/ml,与LNG/EE避孕贴剂中剂量组(拟采用的临床试验剂量)相比,两者无显著差异(P>0.05)。中剂量组血清EE浓度与Evra避孕贴剂的相比显著降低(P<0.05)。多次给药后LNG/EE避孕贴剂10 cm2组和20 cm2组在重复给药10次的过程中未出现LNG和EE血药浓度蓄积现象,Evra贴剂组在重复给药4次的过程中未出现LNG和EE血药浓度蓄积现象。结论:中剂量的LNG/EE避孕贴剂具有良好的避孕效果,同时其副作用可能小于Evra。     

鸟氨酸脱羧酶对人滋养细胞分泌绒毛膜促性腺激素的调控作用

本实验应用无血清短周期培养方法，研究了人滋养层细胞（ＣＴＣ）分泌ｈＣＧ的调节机制。实验发现：ＣＴＣ经８ｈ培养具有良好的ｈＣＧ分泌功能。这些细胞的匀浆液具有鸟氨酸脱羧酶（ＯＤＣ）的活性，而且对二丁酰ｃＡＭＰ、多胺、放线菌素Ｄ和二氟甲基鸟氨酸（ＤＦ－ＭＯ）呈现不同的应答效应。ＯＤＣ的活性与ＣＴＣ的数量及各试剂的剂量都有密切的相关性。ＯＤＣ活性的改变又与细胞分泌ｈＣＧ功能有关。它们在ＣＴＣ分泌的调控中可能是一个重要的因素．