Pregnant women with pre-existing diabetes: family support in managing the pregnancy process

In this paper, we report on findings from a Diabetes UK funded qualitative research project concerned to explore daughter/mother relationships during pregnancy and the transition to motherhood of women with pre-existing diabetes. In-depth qualitative interviews took place with 12 pregnant women with pre-existing diabetes and four of their mothers, three (male) partners and one father. The study was exploratory in nature and aimed to consider what support pregnant women felt they needed and what support they received from their mothers and other family members to discover policy and practice needs and identify further research concerns. Here, we focus on one theme from the data: management of the pregnancy process from planning for pregnancy and through pregnancy with specific reference to relationships with family members. Respondents reflect on the relationship between diabetes and pregnancy planning, on managing pregnancy and on their relationships with healthcare professionals. The data suggest overwhelmingly that pre-existing diabetes is a significant aspect of pregnancy planning and pregnancy for women and that managing the pregnancy process is a more positive experience if they have the support of family members.     

Birth outcome in incarcerated, high-risk pregnant women

OBJECTIVE: To compare birth outcomes in incarcerated women with a recent history of drug use to those of nonincarcerated women in a methadone maintenance program. STUDY DESIGN: We retrospectively analyzed pregnancy outcome in 149 women who delivered at full term between 1993 and 1996. Thirty-one patients incarcerated during pregnancy (group 1) were compared with 47 patients enrolled in our methadone maintenance program (group 2) and with a control group of 71 randomly chosen patients (group 3). Drug use, age, parity, number of visits, infant birth weight, low birth weight and Apgar scores were compared. RESULTS: The methadone maintenance group had significantly fewer clinic visits. All the patients in groups 1 and 2 were cigarette smokers, whereas 12.5% of the control group smoked. Over 78% of incarcerated women admitted using drugs immediately prior to imprisonment as compared to 4.11% in group 3 and 100% in group 2 (P < .001). The three groups differed significantly with respect to infant birth weight (P < .001). CONCLUSION: Cessation of drug use followed by adoption of a health-promoting lifestyle and adequate prenatal care of incarcerated women leads to an improvement in birth outcome. Furthermore, provision of prenatal care on site is a suitable alternative for the care of incarcerated pregnant women and eliminates the need to bring patients in chains to outside clinics.     

Evaluation of serum ischemia-modified albumin levels in pregnant women with and without gestational diabetes mellitus

Objective. To investigate serum ischemia-modified albumin (IMA) levels in gestational diabetes mellitus and the effect of treatment with continuous subcutaneous insulin infusion on the biomarker. Methods. The gestational diabetes mellitus women in the second trimester were evaluated before and after the two kinds of treatments with continuous subcutaneous insulin infusion and medical nutrition therapy for 6 weeks. Maternal serum ischemia-modified albumin and metabolic parameters were measured at baseline and at the 6th week. Results.Serum ischemia-modified albumin levels and metabolic parameters were higher in patients with gestational diabetes mellitus at baseline than in controls. Ischemia-modified albumin levels were correlated with plasma glucose (p < 0.05). Variables of glycemic control and ischemia-modified albumin levels were significantly reduced at the 6th week. The effect of insulin treatment was generally better than diet therapy. Linear regression analysis showed that fasting plasma glucose was an independent determinant for IMA levels (β = 0.611, p = 0.035).Fetal outcome was similar except for macrosomia and Apgar score at 5 min. Conclusion.Serum ischemia-modified albumin levels were higher in gestational diabetes mellitus compared to normal pregnancy. Continuous subcutaneous insulin infusion consistently improved metabolic disorder control. Gestational diabetes mellitus women were associated to a higher risk of oxidative stress and pregnancy complications.     

Effect of a gymnastics program on sleep characteristics in pregnant women

Objective

The quality and quantity of sleep represent important health issues in pregnant women. Sleep disturbances could be associated, beyond alteration of quality of life, with poor pregnancy outcome. Our aim was to investigate the effect of a regular, specific, medium-term physical training program on sleep characteristics in healthy pregnant women.

孕前糖尿病合并妊娠临床管理新进展

孕前糖尿病合并妊娠母儿不良结局增加。孕前糖尿病孕妇计划妊娠是避免和减少胎儿先天畸形等的重要一步。推荐的糖化血红蛋白控制目标孕前为<6.5%,孕期为<6.0%。糖尿病合并症的筛查及管理至关重要,血压控制目标应更谨慎,尤其是有糖尿病肾脏疾病者。对于1型糖尿病患者,孕期动态血糖监测有助于改善血糖控制水平。胰岛素是孕期糖尿病患者的一线治疗方案。优化血糖控制和药物治疗方案,并密切关注并发症,能够降低孕前糖尿病合并妊娠的母儿不良结局风险,并确保孕前、妊娠期间和产后的糖尿病管理质量。     

Sleep quality and its relationship with quality of life among high-risk pregnant women (gestational diabetes and hypertension)

Background: Sleep is one of the most basic human requirements. This research aims at determining the status of sleep quality and its relationship with quality of life among high-risk pregnant women in Tabriz, Iran, in 2015.

Materials and methods: This research was a sectional study done on 364 qualified women in 28–36 weeks of pregnancy suffering from mild preeclampsia and gestational diabetes. The sampling was done as convenience. Personal–social–midwifery questionnaire, Pittsburg sleep quality, and quality of life in pregnancy (QOL-ORAV) were used for gathering data. Multivariate linear regression model was used for determining the relationship between sleep quality and its subsets with quality of life and controlling confounders.

Findings: In the current study, the prevalence of sleep disturbance was 96.4%. Mean (SD) of the total score of sleep quality was 10.1 (4.1) and the total score of quality of life was 61.7 (17.3). According to Pearson’s correlation test, there was statistically significant relationship between quality of life and sleep quality and all its subsets except sleep duration and use of sleep medication (p?Discussion: The findings of current research show that sleep quality is low among high-risk pregnant women and quality of life is medium. So, it is necessary that required training is given by health cares for improving sleep quality and quality of life to mothers.     

Retrospective study of a pioneer antenatal screening program with 8,477 pregnant women in Brazil

PURPOSE OF INVESTIGATION: To analyze the results of a statewide screening program inaugurated in 2002 in Mato Grosso do Sul, METHODS: Retrospective audit of the screening results of 8,477 pregnant women for 11 diseases in 19 tests. Local health centers of the Brazilian Unified System of Health/State Program of Pregnant Protection (SUS/PEPG) and central reference processing laboratories, both in and out of state were involved. Pregnant women were referred to the program by medical staff principally at local health centers, between November 2002 and February 2003. Primary screening with filter-paper blood samples was carried out with positives being resampled and sera appropriately tested. RESULTS: The detailed test results are given below; the most frequent diseases serodiagnosed were hepatitis B, syphilis, HIV and Chagas' disease. One case of maternal phenylketonouria (PKU) was encountered. CONCLUSION: The diagnosis of 11 diseases of importance for mothers and their offspring provides an epidemiological profile of Brazil, but must be matched by opportunities to elaborate new control strategies and improve health care during pregnancy.     

Evaluation of pregnant women with scarred uterus in a low resource setting

AIM: Management of post cesarean pregnancy continues to be a dilemma. The present study was undertaken to evaluate the outcome of such pregnancies in a resource constrained setting so that an appropriate management protocol can be decided. METHODS: An observational study was conducted in the Department Of Obstetrics And Gynecology, King George's Medical University, Lucknow, India. The outcome of all of the women admitted with pregnancy with a previous cesarean section was noted. RESULTS: A total number of 447 women with a post cesarean pregnancy underwent delivery. These comprised 13.7% of total deliveries over the same period. 124 women (27.7%) had successful vaginal delivery while 323 (72.3%) had a repeat cesarean section. Maternal morbidity and perinatal mortality were both significantly higher in the vaginal delivery group (P = 0.00211 and P = 0.0426, respectively). CONCLUSIONS: Vaginal birth after cesarean (VBAC) is associated with higher maternal morbidity and perinatal mortality. Therefore the decision for VBAC must be taken only after proper consideration and counseling of the couple.     

Medical nutritional therapy in pregnant women with pregestational diabetes mellitus

OBJECTIVE: Diabetic women now can have the same chances as nondiabetic women to have a healthy infant. The reduction of risk associated with pregnancies complicated by diabetes can only be assured if normoglycemia is achieved before and during pregnancy. This review is intended to provide guidelines and scientific evidence for the optimal diet for the Type 1 or Type 2 diabetic woman. METHODS: The literature over the past 10 years is presented. Those diets which achieved the best outcome of pregnancies complicated by diabetes (as evidenced by term delivery of a healthy, normal weight infant) are then outlined. RESULTS: Diets which provide adequate calories without causing postprandial hyperglycemia or premeal ketosis are found to be based on body weight and gestational week of the pregnancy. Quantity of carbohydrate in the meal plan emerges as the most important component in achieving and maintaining glucose control. CONCLUSIONS: The medical nutritional therapy for the Type 1 and Type 2 diabetic woman is a necessary component of the overall strategy to achieve and maintain normoglycemia and thus achieve the best outcome of pregnancy.     

妊娠期糖尿病孕妇与正常孕妇血清铬含量的研究

目的　通过对血清铬含量的测定 ,探讨妊娠期糖尿病孕妇是否缺铬。方法　 2 0 0 0～ 2 0 0 1年 ,选择妊娠期糖尿病孕妇 5 0例 ,正常孕妇 4 7例 ,以电感耦合高频等离子体发射光谱法 (ICP AES)测定两组孕妇血清铬含量。结果　妊娠期糖尿病孕妇血清铬含量较正常孕妇明显降低 ,差异有显著性意义 (P <0 0 5 )。结论　建议妊娠期糖尿病孕妇适量补铬     

Use of umbilical artery Doppler velocimetry in the monitoring of pregnancy in women with pre-existing diabetes

BACKGROUND: The usefulness of umbilical artery Doppler velocimetry for the monitoring of diabetic pregnancies is controversial. The aim of the present study was to assess whether umbilical artery Doppler velocity waveform analysis can predict adverse perinatal outcomes for pregnancies complicated by pre-existing diabetes mellitus. METHODS: All diabetic pregnancies (type 1 and 2) delivered at Mater Mothers' Hospital, Queensland, between 1 January 1995 and 31 December 1999 were included. All pregnant diabetic women were monitored with umbilical artery Doppler velocimetry at 28, 32, 36, and 38 weeks' gestation. Adverse perinatal outcome was defined as pregnancies with one or more of the following: small-for-gestational age, Caesarean section for non-reassuring cardiotocography, fetal acidaemia at delivery, 1-min Apgar of 3 or less, 5-min Apgar of less than 7, hypoxic ischaemic encephalopathy or perinatal death. Abnormal umbilical artery Doppler velocimetry was defined as a pulsatility index of 95th centile or higher for gestation. RESULTS: One hundred and four pregnancies in women with pre-existing diabetes had umbilical arterial Doppler studies carried out during the study period. Twenty-three pregnancies (22.1%) had an elevated pulsatility index. If the scans were carried out within 2 weeks of delivery, 71% of pregnancies with abnormal umbilical Doppler had adverse outcomes (P < 0.01; likelihood ratio, 4.2). However, the sensitivity was 35%; specificity was 94%; positive predictive value was 80%; and negative predictive value was 68%. Only 30% of women with adverse perinatal outcomes had abnormal umbilical arterial Doppler flow. CONCLUSION: Umbilical artery Doppler velocimetry is not a good predictor of adverse perinatal outcomes in diabetic pregnancies.     

Impaired vascular reactivity in pregnant women with insulin-dependent diabetes mellitus.

OBJECTIVE: The purpose of this study was to investigate the vascular function of pregnant women with insulin-dependent diabetes mellitus, using a noninvasive method. STUDY DESIGN: This was a cross-sectional study that examined vascular function, which was assessed by flow-mediated dilatation of the brachial artery, in 37 pregnant women with insulin-dependent diabetes mellitus and in 37 healthy pregnant women at 20 weeks of gestation. The control of diabetes was also assessed by the measurement of glycosylated hemoglobin. Data were analyzed by 2-sided unpaired t test and multivariate regression analysis. RESULTS: In the pregnant women with insulin-dependent diabetes mellitus, flow-mediated dilatation of the brachial artery was significantly lower than in healthy pregnant women (6.43% +/- 3.66% vs 9.43% +/- 3.69%, respectively; P =.0008). This difference was apparent even after an adjustment was made for blood vessel diameter, which was different between the 2 populations (P =.01). Flow-mediated dilatation in diabetic women was significantly correlated with the duration of diabetes (P =.01) but not with the levels of glycosylated hemoglobin. CONCLUSION: Maternal insulin-dependent diabetes mellitus is associated with an impaired vasodilatory response to a blood flow stimulus. This vascular dysfunction is associated with the duration of the diabetes.