Infants of mothers with a high and of mothers with a low insulin response to glucose infusion. Glucose tolerance, insulin response and clinical appearance during the early neonatal period.

Diabetic mothers affect their offspring during pregnancy, sometimes giving rise to the complete symptoms of diabetic fetopathia with the typical appearance of the child high birth weight, hyperinsulinism, etc. Some of these traits have also been reported to appear in the infants some time before the onset of diabetes in the mother, but no prospective study of infants born to truly prediabetic mothers has yet been reported. Thus it is not possible to say whether or not the previously reported effects are related to an undetected, subclinical diabetes in the mother. A prospective study of the insulin reponse to glucose during pregnancy [9] has been previously published, which included 11 women with a low insulin response to glucose infusion (GIT) - a prediabetic type of insulin response according to the definition of Cerasi and Luft [5] - and a control group of 14 women with a high insulin response to glucose infusion. In the following the neonatal findings in these 13 infants of low insulin responders (ILR) aand 14 infants of high responders (IHR) are reported...     

Cytogenetics of methadone-managed and heroin-addicted pregnant women and their newborn infants.

Chromosomal damage was assessed prenatally and at delivery from 99 addicted pregnant women (80 from a methadone maintenance program and 19 heroin addicts) and their 101 off-spring at delivery. About 10% of the 27,907 cells scored showed chromosomal abberations. Chromosome damage was random, affected all chromosomes, and was mainly of the acentric fragment type. The per cent of hypodiploidy was significantly higher than the per cent of hyperdiploidy. In the mothers, no significant differences were found with respect to dosage and duration of methadone treatment and years of heroin abuse. No significant association was found between maternal variables and infant chromosome damage. Infants with low Apgar scores (1 to 6) had cells with significantly higher levels of chromosome damage than infants with higher scores (7 to 10).     

Individual free fatty acids in amniotic fluid and in plasma of pregnant women.

Individual free fatty acids (FFA) were measured in 77 amniotic fluid samples and in 57 maternal plasma samples. Gestational age ranged from 16 to 40 weeks. Amniotic fluid FFA decreased from 20-4 +/- 6-0 mumol/l in the second trimester to 17-0 +/- 6-0 mumol/l in the last six weeks of pregnancy. This was almost entirely accounted for by a decrease in the concentration of free stearic acid, while oleic acid increased slightly. No correlation between amniotic fluid FFA and maternal plasma FFA was found in samples obtained on the same day. It is suggested that amniotic fluid FFA may partly derive from renal excretion by the fetus.     

Design of antiretroviral clinical trials for HIV-1 infected pregnant women and their newborn infants.

Antiretroviral therapy has been highly successful in reducing mother to child transmission of human immunodeficiency virus-1 infection in pregnant women. However, the treatment regimens are intensive, difficult to deliver in less developed countries, and there are limited pharmacology studies addressing critical questions regarding maternal safety and fetal risk. There are currently 3 pharmacologically diverse classes of antiretroviral agents with inadequate information available to define drug disposition necessary to determine appropriate dose regimens and limited data on long-term adverse events. This article summarizes representative clinical studies for selected antiretrovirals that provide a framework for continuing the necessary clinical research to extend successful outcomes in developed countries to human immunodeficiency virus-1 infected pregnant women and infants world-wide and minimize the risk of long-term adverse effects.     

Metabolic control in diabetic pregnancy. Variations in plasma concentrations of glucose, free fatty acids, glycerol, ketone bodies, insulin, and human chorionic somatomammotropin during the last trimester.

Metabolic control was evaluated under standard conditions in pregnant gestational and insulin-dependent diabetic patients and control subjects from: (1) changes during an 8 hour period in blood glucose, free fatty acids (FFA), glycerol, ketone bodies, chorionic somatomammotropin (HCS), and insulin during the last trimester and (2) changes from weeks 32 to 40 in fasting blood glucose, FFA, glycerol, and ketone bodies. Mean glucose levels calculated from five daily analysis 28 days before delivery were determined in insulin-dependent and gestational diabetic patients (pregnancy glucose level). Group mean 8 hour glucose levels were similar in diabetic patients and control subjects, but glucose swings were greater in diabetic patients. Gestational diabetic patients had delayed insulin response following meals. FFA, glycerol, and ketone bodies varied in parallel with a simmilar pattern in diabetic patients and control subjects. Insulin-dependent diabetic patients had suppressed lipid mobilization in the afternoon when glucose levels were almost normal. In control subjects, FFA, glycerol, and ketone bodies were not above normal nonpregnant values. Diabetic patients showed great individual variations in all parameters measured. FFA and ketone bodies were significantly above normal; glycerol and glucose were normal. Pregnancy glucose levels were significantly correlated to a mean amplitude of glycemic swings (MAGE) determined from the 8 hour glucose profiles. The glucose value 2 hours after breakfast correlated best to the MAGE value.     

Blood glucose and serum insulin levels in newborn infants of diabetic mothers during feeding with an oligosaccharide mixture

Macrosome newborns from mothers with an insulin-bound diabetes mellitus and also from mothers with a gestational diabetes show in the cord blood nearly always insulin levels additional to increased glucose values, which, compared with the normal controls are ten-fold higher in some cases. During the first three hours of life the blood glucose values decrease extremely. To prevent central injuries, caused by stronger hypoglycaemia, the early supply of oligosaccharides by continuous gastric infusion has proved as the most careful procedure. Stronger increases of blood glucose do not occur by this method and the insulin levels show a continuous tendency to normalisation.     

Seroprevalence of Bordetella pertussis antibodies in mothers and their newborn infants

BACKGROUND: Pertussis is a highly communicable, vaccine-preventable respiratory disease. Although the largest number of reported cases is among young infants, the most rapidly increasing incidence in the USA is in adolescents and young adults. Importantly, adult family members are the likely major reservoir, infecting susceptible infants before completion of childhood vaccination. We studied maternal-neonatal paired blood samples for the presence of pertussis-related antibodies to assess level of immunity and passive transplacental antibody passage. METHODS. Unselected maternal-neonatal cord blood samples were collected from 101 term deliveries in a single urban uninsured/underinsured hospital setting. Sera were analyzed for anti-pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (PRN) IgG antibodies by enzyme-linked immunosorbent assay (ELISA). Antibody titers were calculated using reference line methodology. Antibody values were log-transformed to establish geometric mean titers (GMT) for analysis. Student's t-test, Mann-Whitney, Pearson correlation and chi square were used for statistical comparisons as appropriate. RESULTS. Mean (SD) maternal age, gestational age and birth weight were 26.8 (6.8) years, 38.9 (1.4) weeks and 3239 (501) g, respectively. Detectable maternal levels of anti-PT, FHA and PRN were found in 34.7%, 95.0% and 80.2%, respectively. Maternal GMT (SD) for PT, FHA and PRN were 4.4 (2.6), 26.6 (3.1) and 12.3 (2.9), respectively. There was no significant relationship between PT, FHA or PRN detection or antibody GMT and maternal age. Maternal anti-PT, FHA and PRN were highly correlated with neonatal cord blood values. CONCLUSION: Despite previous childhood immunization, a large number of parous women have low or undetectable pertussis-related antibody levels, suggesting susceptibility to infection. Even with efficient transplacental passage of these antibodies, neonates similarly have limited measurable protection as detected by cord blood sampling. These data support the need for adolescent or adult vaccination against Bordetella pertussis. Healthcare providers and their clients should be aware of the risk for infant infection via family member transmission.     

Impaired growth hormone secretion after glucose loading in non-obese women with polycystic ovary syndrome,possibly related to androgen but not insulin and free fatty acids

Background. Secretion of growth hormone (GH) is known to be suppressed in women with polycystic ovary syndrome (PCOS). The suppression may be implicated in the pathogenesis of PCOS.

Objective. To investigate the cause of suppressive GH secretion in PCOS.

Methods. In order to eliminate the influence of obesity on the variables, all subjects were non-obese. Standard oral glucose tolerance tests (OGTT) were performed in 13 normal women and 15 patients with PCOS.

Results. The serum GH level decreased progressively during the OGTT, and the mean area under the curve (AUC) for the GH response was significantly smaller in the PCOS group than in the normal group. A reduction in the level of serum free fatty acids (FFAs) was observed during OGTT, but only the fasting level of FFAs was significantly higher in the PCOS group than in the normal group. The mean AUCs for glucose, insulin and FFA responses in the PCOS group were significantly greater than those in the normal group. There was a significant negative correlation only between AUC(GH) and testosterone (r = ?0.4557, p = 0.012).

Conclusion. Our findings suggest that the cause of susceptibility for GH secretion to be suppressed after glucose loading in non-obese PCOS patients may be hyperandrogenemia.     

妊娠期妇女糖耐量胰岛素 胰岛素抵抗变化规律的观察

目的：观察不同孕期孕妇的糖耐量、胰岛素释放、胰岛素抵抗，以了解妊娠期糖代谢变化的规律。方法：对早、中、晚孕期三组共１２４例正常孕妇及２３例健康非孕妇女作为对照组进行７５ｇ口服糖耐量试验（ＯＧＴＴ）。其中１３例自早孕期开始纵向跟踪。以胰岛素曲线下面积与血糖曲线下面积的比值反映胰岛素抵抗（ＩＳＲ）。结果：各个孕期的空腹血糖无明显差异，但均显著低于非孕期（Ｐ＜００５），服糖后血糖、胰岛素释放、胰岛素抵抗均随孕期延长逐渐上升。于中孕期开始出现显著性改变，至晚孕期进一步加重均显著高于孕早期（Ｐ＜００５）。结论：中孕期是妊娠期糖代谢开始出现根本性变化的时期，于此期对孕妇进行血糖监测，有助于妊娠期糖尿病（ＧＤＭ）的早期诊断。晚孕期是ＧＤＭ最容易发生的时期     

Metabolism of vitamin K dependent factors in mothers and their newborn infants

Little is known about the absorption, excretion and transplacental transport of vitamin K in the perinatal period. From this point of view, the following studies were carried out. 1) Hepaplastin tests were performed on 65 women in the last stage of pregnancy and each coagulation factor was estimated as well. 2) Correlations were made between mothers' and babies' Hepaplastin test values. 3) Transplacental transport of vitamin K2 was studied. The general activity of vitamin K dependent factors in pregnant women was much higher than in non pregnant women. As far as the correlation between mothers' venous blood during delivery and cord venous blood is concerned, in the group of mothers with Hepaplastin test value of less than 120% of the normal adult value, the value of the Hepaplastin test was less than 30% of normal adult value in the cord venous blood. We also established that vitamin K passed through the placenta but only in small qualities.     

妊娠期糖代谢异常孕妇血清瘦素水平及其与胰岛素和血糖关系的研究

目的　探讨妊娠期糖代谢异常孕妇血清瘦素水平及其与胰岛素和血糖的关系。方法　采用放射免疫法 ,测定 36例妊娠期糖代谢异常孕妇 (糖代谢异常组 )和 2 4例正常孕妇 (正常妊娠组 )的空腹及口服 50g葡萄糖后 3h的血清瘦素水平 ;采用电化学发光法测定两组孕妇的空腹血清胰岛素水平 ;采用低压液相色谱分析法测定两组孕妇的糖化血红蛋白 ;采用葡萄糖氧化酶法测定两组孕妇的口服 50g葡萄糖后 1h的血糖水平。结果　 (1 )糖代谢异常组孕妇血清瘦素水平为 (1 4 9± 4 3) μg/L ,正常妊娠组为 (1 0 0± 1 8) μg/L ,两组比较 ,差异有极显著性 (P <0 0 1 ) ;(2 )糖代谢异常组孕妇空腹血清胰岛素、糖化血红蛋白、服糖后 1h血糖水平分别为 (1 2 9± 4 3)mU/L、 (6 1± 1 1 ) %、(1 1 0±1 4)mmol/L ;正常妊娠组孕妇分别为 (8 6± 3 2 )mU/L、(4 5± 1 0 ) %、(7 8± 1 2 )mmol/L。糖代谢异常组孕妇血清瘦素水平与空腹血清胰岛素、糖化血红蛋白、服糖后 1h的血糖水平呈明显的正相关关系 ,相关系数 (r)分别为 0 835、0 758、0 561。结论　妊娠期糖代谢异常孕妇空腹血清瘦素水平升高 ,其瘦素水平的高低与空腹血清胰岛素及血糖水平相关     

Studies on Campylobacter and Salmonella in feces of pregnant women and newborn infants

Fecal cultures from five thousand four hundred and twenty-seven pregnant women, who were delivered at Osaka National Hospital from January 1, 1980 to December 31, 1984, were examined to detect intestinal Campylobacter and Salmonella during 30 and 36 gestational weeks. In addition, the feces of newborn infants were cultured three days after delivery to check for the presence of Campylobacter and Salmonella. During pregnancy, Campylobacter was detected in the feces of 116 women (2.14%), and Salmonella in 99 cases (1.82%). By administering antibiotics to the affected cases, the number of women whose fecal cultures were positive for Campylobacter and Salmonella at the time of delivery was reduced to 8 and 15, respectively. Neonatal fecal cultures revealed that Salmonella infection occurred in two among fifteen (13.33%) and Campylobacter infection in three among eleven (27.27%) infants whose mothers had been affected. These findings suggest the importance of adequate management for these bacterial infections during pregnancy and the perinatal period to prevent danger to the newborn.