子痫前期和正常妊娠代谢综合征变量的对比

目的:研究妊娠期高血压疾病中代谢综合征变量的发生情况。方法:前瞻性对比年龄、孕周、产次相匹配的65例妊娠期高血压,60例子痫前期,30例子痫及33例正常妊娠孕妇的各项指标。主要测量指标包括血压、血脂、血糖及尿酸水平。结果:患者年龄19～40岁,平均28.5±4.6岁;妊娠期高血压,子痫前期和子痫患者的血压较对照组明显增加(收缩压P0.01;舒张压P0.01);子痫前期组和子痫组的血浆总胆固醇、甘油三酯、血糖和尿酸均明显高于妊娠期高血压组及对照组(P0.05);妊娠期高血压组、子痫前期组及子痫组代谢综合征的发生率分别为13.8%、23.3%及26.7%。结论:妊娠期高血压疾病患者有代谢综合征的标志,推断两种情况相互关联。     

Elevated plasma endothelial microparticles: preeclampsia versus gestational hypertension

OBJECTIVE: Elevated plasma endothelial microparticle levels have been found to be elevated in women with preeclampsia. However, their role in distinguishing preeclampsia from gestational hypertension remains to be elucidated. The objectives of this study were to compare endothelial microparticle levels among patients with preeclampsia, gestational hypertension, and healthy pregnant control subjects and to evaluate the effect of plasma from women with preeclampsia and gestational hypertension on the release of endothelial microparticles by renal microvascular endothelial cells. STUDY DESIGN: A prospective study was conducted on 52 women with preeclampsia, 20 women with gestational hypertension, and 38 healthy pregnant control subjects. Endothelial microparticles were measured by flow cytometry with fluorescent monoclonal mouse anti-human antibodies against CD31, CD42b, and CD62E. RESULTS: CD31 + /42b - endothelial microparticle levels were 10497 +/- 5145 counts/microL in women with preeclampsia versus 6768 +/- 1810 counts/microL in women with gestational hypertension ( P < .01). In control subjects, CD31 + /42b - endothelial microparticle levels were 6119 +/- 3592 counts/microL. CD62E + endothelial microparticle levels were 1930 +/- 966 counts/microL in women with preeclampsia versus 822 +/- 150 counts/microL in women with gestational hypertension ( P <.01). In control subjects, CD62E + endothelial microparticle levels were 712 +/- 160 counts/microL. Incubation of renal microvascular endothelial cells with plasma from women with preeclampsia resulted in a rise in CD31 + and CD62E + endothelial microparticle levels as compared with women with gestational hypertension and control subjects. CONCLUSION: Endothelial microparticle levels are higher in women with preeclampsia than in women with gestational hypertension and control subjects. The measurement of endothelial microparticles may be useful as a diagnostic tool for preeclampsia in pregnant women.     

妊娠期糖代谢异常与妊娠期高血压疾病的关系

目的:探讨妊娠期糖代谢异常与妊娠期高血压疾病的关系。方法:回顾分析2003年至2007年在我院住院分娩的6748例孕妇的临床资料,分析不同程度糖代谢异常孕妇妊娠期高血压疾病的发生情况;将妊娠期糖代谢异常并发高血压疾病(PHD)患者分为妊娠期高血压组(Ⅰ组)、轻度子痫前期组(Ⅱ组)和重度子痫前期组(Ⅲ组),比较3组孕妇不同糖负荷后血糖水平(GCT、OGTT)、糖化血红蛋白水平及胰岛素抵抗指数的差异。结果:(1)6748例孕妇发生PHD252例,发生率3.7%(252/6748),妊娠期糖代谢异常孕妇1402例,发生率20.8%(1402/6748);妊娠期糖代谢异常孕妇82例并发PHD,发生率5.8%(82/1402);糖代谢正常孕妇PHD发生率为3.2%(170/5346),差异有统计学意义(P<0.001);(2)82例妊娠期糖代谢异常并发PHD患者中,糖尿病合并妊娠(DM)、妊娠期糖尿病(GDM)、妊娠期糖耐量降低(GIGT)、妊娠期50g葡萄糖筛查(GCT)(+)的PHD发生率分别为8.5%(12/141),7.9%(45/571),3.4%(9/265),3.8%(16/425);DM、GDM组与GIGT、GCT(+)组的差异有统计学意义(P=0.010、0.001);DM组与GDM组的差异无统计学意义(P=0.805);GIGT组与GCT(+)组相比及两组与糖代谢正常组的差异无统计学意义(P=0.801、0.535)。(3)82例妊娠期糖代谢异常并发PHD患者,妊娠期高血压(Ⅰ组)27例、轻度子痫前期(Ⅱ组)24例、重度子痫前期(Ⅲ组)31例,3组血糖(GCT、OGTT)、糖化血红蛋白水平及胰岛素抵抗指数无统计学差异。结论:妊娠期糖代谢异常的孕妇更易发生妊娠期高血压疾病;随糖代谢异常程度加重,妊娠期高血压疾病发病率呈增加趋势。     

Analysis of pulmonary function in high-risk pregnancies: a case-control study

Objective: To evaluate the pulmonary function in high-risk pregnant women.

Methods: This was a prospective cross-sectional study on 60 pregnant women, of whom 30 were high-risk and 30 were low-risk cases, with gestational age ≥28 weeks. For the high-risk group, preeclampsia and/or gestational diabetes were the conditions taken into consideration. To evaluate pulmonary function, the following parameters were assessed: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), Tiffeneau index (FVC/FEV1) and forced expiratory flow (FEF25–75%). Fisher’s exact test or the chi-square test was used to analyze the variables.

Results: There were no statistical differences in the pulmonary function parameters according to gestational age (p?>?0.05). Similarly, there were no statistical differences in the pulmonary function tests for the variables of smoking habit, birth weight, Apgar index, duration of gestation, childbirth type and need for the newborn to go to the intensive care unit (p?>?0.05). For the pregnant women with preeclampsia and gestational diabetes, only FEF25–75% presented statistical significance (p?=?0.01 and 0.034, respectively).

Conclusion: In high-risk pregnant women, pulmonary function suffered alterations characterized by limitations regarding airflow through the airways, although without repercussions on gestational outcome.     

Platelet activation in the hypertensive disorders of pregnancy

OBJECTIVE: The purpose of this study was to determine whether platelet activation occurs only in preeclampsia or also in normal pregnancy. STUDY DESIGN: Thirty women with preeclampsia, 30 women with gestational hypertension, 20 women with essential hypertension, 30 pregnant women with normotension, and 30 nonpregnant women were recruited at St George Hospital, Sydney, Australia. Platelet activation was determined by flow cytometry on whole blood samples. RESULTS: Platelet activation was similar in all groups, except the group with preeclampsia. Compared with normal pregnant women, women with preeclampsia had significantly greater CD62 expression (1.35% vs 0.61%; P =.002), CD63 expression (1.73% vs 0.95%; P <.0001) and annexin V binding (1.03% vs 0.66%;P =.03) and significantly fewer circulating platelet microparticles (33 vs 49 x10(9)/L; P =.001). This was unrelated to other parameters that included platelet counts. Women with gestational hypertension in whom preeclampsia developed did not have enhanced platelet activation profiles. CONCLUSION: Platelet activation is increased in preeclampsia but not in other hypertensive disorders or in normal pregnancy. This may be part of the pathophysiologic factors of preeclampsia complications but is not predictable by the platelet count and is not apparent in all women with preeclampsia.     

Leptin as a possible marker of augmented metabolic risk during pregnancy

AIM: Leptin is a proteic hormone, isolated in 1994, mainly synthetized in the white adipose tissue. Aim of this study was to compare leptin concentrations in normal pregnancies with those measured in pregnancies complicated by gestational diabetes or gestational hypertension or pre-eclampsia. METHODS: We enrolled 48 pregnant women: 18 with uncomplicated pregnancy, 11 with gestational diabetes, 19 with gestational hypertension or pre-eclampsia. Leptin concentrations were measured in maternal serum at enrollment, together with insulin and cortisol, at delivery and in the immediate postpartum. At delivery serum leptin was calculated in the cord blood too. RESULTS: Fasting plasma leptin and insulin were higher in the group of patients with gestational hypertension, than in the other groups. Third-trimester maternal leptin concentrations correlated significantly with insulin levels in the group of women with gestational diabetes and in the group with gestational hypertension or pre-eclampsia, but not in the women with an uncomplicated pregnancy. CONCLUSIONS: Leptin concentrations in pregnancies complicated by hypertensive disorders are significantly higher than in normal pregnancies. The increased leptin concentrations are independent of associated proteinuria, as women with simple gestational hypertension and preeclampsia showed comparable third-trimester leptin concentrations. In both women with gestational diabetes and women with hypertensive disorders, serum leptin correlated closely with serum insulin, suggesting that the association between leptin and insulin resistance is preserved in pregnancy. Whatever the reasons for an increased maternal leptin production in pregnancies complicated by hypertension, maternal leptin homeostasis does not seem to influence foetal serum leptin concentrations, which seems to be mainly related to birth weight.     

Maternal serum nitric oxide levels associated with biochemical and clinical parameters in hypertension in pregnancy

OBJECTIVES: To measure maternal serum concentrations of total nitrites, as an index of nitric oxide synthesis, in normal and hypertensive pregnant women, and to examine the correlation between these concentrations and several variables of clinical interest. STUDY DESIGN: A total of 60 women in four different groups were studied: 10 normotensive pregnant women, 17 pregnant women with preeclampsia, 18 pregnant women with gestational hypertension and 15 pregnant women with chronic hypertension. Serum nitrite levels were determined using the Griess reaction after reduction with nitrate reductase. RESULTS: Serum nitrite levels were higher in preeclamptic women (34.11+/-14 micromol/l, P=0.04), lower in chronic hypertensive women (19.56+/-6.46 micromol/l, P=0.04) and similar in women with gestational hypertension (26.97+/-9.44 micromol/l) in comparison to the control group (25.37+/-7.24 micromol/l). Serum nitrite levels in preeclamptic women had significant positive correlations with hematocrit, fasting insulinemia, and apolipoprotein B and negative correlations with platelet count, serum phosphorus and glucose:insulin ratio. In pregnant women with chronic hypertension a negative correlation was found between serum nitrite levels and active partial thromboplastin time. In pregnant women with gestational hypertension, serum nitrite levels had negative correlations with birthweight and 24-h urine calcium, and positive correlations with mean corspuscular hemoglobin, 24-h urine sodium and maternal age. CONCLUSIONS: We suggest that in women with preeclampsia, a higher maternal nitric oxide level may act as a compensatory mechanism against hemoconcentration and platelet aggregation and that nitric oxide production may be related to some metabolic events. In women with gestational hypertension, higher serum nitrite levels may be related to clinical and biochemical findings common in preeclampsia. In chronic hypertension, a lower maternal nitric oxide level is related to the status of coagulation.     

Insulin,insulin-like growth factor-1, and insulin resistance in women with pregnancy-induced hypertension

OBJECTIVE: The purpose of this study was to assess insulin, insulin sensitivity, and insulin-like growth factor-I in women with preeclampsia and gestational hypertension. STUDY DESIGN: Insulin resistance was measured with the short insulin-tolerance test in 20 women with preeclampsia, in 18 women with gestational hypertension, and in 20 normotensive control subjects. Sex hormone binding globulin, insulin-like growth factor-I, glucose, fructosamine, glycosylated hemoglobin, insulin, C-peptide, and lipids were measured in the fasting state. RESULTS: Women with gestational hypertension had a significant lower insulin sensitivity index (0.13 +/- 0.1) and a higher level of insulin-like growth factor-I (333.71 +/- 107.6 ng/mL) than women in the control group (0.21 +/- 0.1 [P <.05]; 218.11 +/- 82.3 ng/mL [P <.01]) and women with preeclampsia (0.21 +/- 0.12 [P <.05]; 234.78 +/- 92.76 ng/mL [P <.01]). There were no significant correlations between insulin sensitivity index and insulin-like growth factor-I. CONCLUSION: Insulin resistance is present in women with gestational hypertension but not in women with preeclampsia and did not correlate with insulin-like growth factor-I.     

Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome

OBJECTIVE: To assess whether metformin safely reduced development of gestational diabetes in women with the polycystic ovary syndrome (PCOS). DESIGN: Prospective and retrospective study. SETTING: Outpatient clinical research center. PATIENT(S): The prospective study included 33 nondiabetic women with PCOS who conceived while taking metformin and had live births; of these, 28 were taking metformin through delivery. The retrospective study included 39 nondiabetic women with PCOS who had live birth pregnancies without metformin therapy. INTERVENTION(S): Metformin, 2.55 g/d, throughout pregnancy in women with PCOS. MAIN OUTCOME MEASURE(S): Development of gestational diabetes in women with PCOS. RESULT(S): Before metformin therapy, after covariance adjustment for age, the two cohorts did not differ in height, weight, basal metabolic index, insulin, insulin resistance, or insulin secretion. Both cohorts had high fasting insulin, were insulin resistant, and had high insulin secretion. Among the 33 women who received metformin, gestational diabetes developed in 1 of 33 (3%) pregnancies versus 8 of 12 (67%) of their previous pregnancies without metformin. Among the 39 women who did not take metformin, gestational diabetes developed in 14 of 60 (23%) pregnancies. When all live births were combined, gestational diabetes occurred in 22 of 72 pregnancies (31%) in women who did not take metformin versus 1 of 33 pregnancies (3%) in those who took metformin. With gestational diabetes as the response variable and age at delivery and treatment group (metformin or no metformin) as explanatory variables, the odds ratio for gestational diabetes in women with metformin versus without metformin was 0.093 (95% CI: 0.011 to 0.795). With gestational diabetes in 93 pregnancies as the response variable and age at delivery and treatment group (metformin no metformin) as explanatory variables, the odds ratio of gestational diabetes in pregnancies in women taking metformin versus without metformin was 0.115 (95% CI: 0.014 to 0.938). CONCLUSION(S): In PCOS, use of metformin is associated with a 10-fold reduction in gestational diabetes (31% to 3%). It also reduces insulin resistance and insulin secretion, thus decreasing the secretory demands imposed on pancreatic beta-cells by insulin resistance and pregnancy.     

Perinatal HIV transmission: developing country considerations

Objective.?To examine the risk of obesity and metabolic syndrome in women with a history of gestational diabetes mellitus and in offspring born to mothers with gestational diabetes mellitus.

Methods.?A review of studies examining the development of obesity, hypertension, metabolic abnormalities, metabolic syndrome, and type II diabetes in mothers with a history of gestational diabetes mellitus and control mothers, and offspring of mothers with a history of gestational diabetes and control mothers.

Results.?Longitudinal studies demonstrate that women with a prior history of gestational diabetes mellitus and obesity are at significantly greater risk of developing metabolic syndrome than mothers with no history of gestational diabetes or obesity. The development of metabolic syndrome in children with increasing age is related to maternal gestational diabetes mellitus, maternal glycemia in the 3rd trimester, maternal obesity, neonatal macrosomia, and childhood obesity.

Conclusions.?The current prevalence of obesity in both adults and children and associated disorders of blood pressure and lipid metabolism, suggest a perpetuating cycle of increasing obesity, insulin resistance, and abnormal lipid metabolism, which has ominous consequences for future generations.     

The effects of polycystic ovary syndrome on gestational diabetes mellitus

The aim of this study was to explore the inter-relationship between polycystic ovary syndrome and gestational diabetes mellitus, and demonstrate maternal and fetal outcomes. This was a case-control study in 1360 pregnant women who received a diagnosis of gestational diabetes mellitus between 24 and 28 weeks of gestational age. Among all diagnosed with gestational diabetes mellitus, 150 pregnant women had received a polycystic ovary syndrome, and 160 women who did not have polycystic ovary syndrome were designated as controls. The incidence of pregnancy-induced hypertension was 26.3% and 12% in the case and control groups, respectively. Preeclampsia was seen at an incidence of 12% and 6% in case and in control groups, respectively. The difference in neonatal hypoglycemia between the two groups was statistically significant, with an incidence of 17% and 5% in the case and in control groups, respectively. This study demonstrated that the presence of polycystic ovary syndrome along with gestational diabetes mellitus increases the risk of pregnancy induced hypertension by 2.4 fold, preeclampsia by 2 fold and neonatal hypoglycemia by 3.2 fold, compared to gestational diabetes mellitus alone.     

Screening for gestational diabetes among women who have previously had a large baby or a stillborn infant

Summary In Baranya county, Hungary oral glucose tolerance tests were done according to WHO recommendations in pregnant women with a history of a previous baby weighing ≥4000 g and/or a previous unexplained intrauterine fetal death. The first oral glucose tolerance test was done at 16–20 weeks gestation, and it was repeated monthly if it was normal. Patients with impaired glucose tolerance or gestational diabetes were treated by diet and/or insulin. 152 patients were involved in the screening program. Twenty-six patients had gestational diabetes or impaired glucose tolerance. A total of 81 patients had a “lag” curve blood glucose still above 5.5 mmol/l at 180 min.     

The Impact of Parity on the Incidence of HELLP Syndrome and Small for Gestational Age Infants in Hypertensive Pregnant Women

Objectives: To determine whether maternal and fetal complications such as HELLP hemolysis, elevated liver enzymes, low platelets) syndrome and the incidence of small for gestational age infants in women with preeclampsia and gestational hypertension differ with both gravidity and parity.Study Design: The charts of 441 hypertensive women, 182 with preeclampsia and 259 with gestational hypertension, presenting for delivery at B.C. Women’s Hospital were retrospectively reviewed. Multiple clinical parameters, including gestational age at presentation the incidence of small for gestational age SGA infants, HELLP syndrome, and the severity of preeclampsia, were compared among three groups of women: (A) primigravid primiparous, (B) multigravid primiparous, and (C) multiparous. Mean values between the groups were compared using analysis of variance with pair-wise comparison using the Tukey test.Results: The incidence of HELLP syndrome among the women with preeclampsia was similar in groups A and B 35% and 50%, respectively), but significantly lower (p < 0.012) in group C (19%). The incidence of small for gestational age infants among the women with preeclampsia was similar for groups A, B, and C (27%, 31% and 19%) respectively). In the gestational hypertensive group the incidence of SGA infants was similar for groups A, B, and C (14%, 11%, and 12% respectively).Conclusions: The preeclamptic primigravid primiparous and multigravid primiparous groups behaved similarly in their clinical expression of hypertensive complications but differed from the multiparous group by having a higher incidence of HELLP syndrome. The incidence of complications in hypertensive pregnant women varied by parity but not by gravidity. The gestational hypertensive groups did not differ in their clinical expression of hypertensive complications.     

Investigation of adhesion molecules (sVCAM-1) in serum of nonpregnant women, normotensive pregnant women and in patients with pregnancy complications]

OBJECTIVE: An increased expression of endothelial adhesion molecules combined with neutrophil activation in the placental bed is to be assumed aetiopathogenetically relevant in preeclampsia. MATERIAL AND METHODS: Ranges of sVCAM-1 serum concentrations of both control persons (29 nonpregnant and 25 normotensive pregnant women) and patients with different complications of pregnancy (HELLP-syndrome n = 10, preeclampsia n = 12, gestational hypertension n = 38, diabetes n = 24, growth retardation n = 21) were determined by means of ELISA. Frozen placental samples of 5 normotensive and 10 hypertensive pregnant women were investigated immunhistochemically to study the distribution of VCAM-1 in the placenta. RESULTS: Significantly elevated sVCAM-1 serum levels (p < 0.05) were identified in samples of patients with HELLP syndrome, preeclampsia, diabetes and gestational hypertension compared with serum levels of normotensive pregnant women. The cut-off level (97.5% percentile of normotensive serum levels) was calculated (775 ng/ml). VCAM-1 was localized immunhistochemically at capillaries of villi and main villi. CONCLUSIONS: There are closed relations between elevated serum levels of sVCAM-1 during pregnancy and diseases with vasculopathies of placental bed.     

Obesity and adverse pregnancy outcomes in twin pregnancies

Abstract

Objective: To compare pregnancy outcomes in twin pregnancies based on maternal pre-pregnancy body mass index (BMI).

Methods: Historical cohort study of all twin pregnancies >24 weeks managed by one maternal-fetal medicine practice from 2005 to 2012. We compared pregnancy outcomes between pre-pregnancy obese (BMI ≥30?kg/m²) and normal weight women (BMI 18.5–24.99?kg/m²). We also compared pre-pregnancy normal weight women to overweight women (BMI 25–29.99?kg/m²) and underweight women (BMI <18.5?kg/m²). Chi square, Fisher’s exact test, Student’s t-test, and one-way ANOVA were used as appropriate. A p value of <0.05 was considered significant.

Results: Five hundred fourteen patients with twin pregnancies were included. Pre-pregnancy obesity was associated with gestational hypertension (34.1% versus 17.9%, p?=?0.011), preeclampsia (27.3% versus 14.4%, p?=?0.028), and gestational diabetes (22.2% versus 4.7%, p?<?0.001). Pre-pregnancy overweight was associated with gestational diabetes (13.7% versus 4.7%, p?=?0.002). Pre-pregnancy underweight was not associated with any adverse pregnancy outcomes. Comparing outcomes across normal weight, overweight, and obese women, the rates of gestational diabetes and gestational hypertension increased significantly across the three groups.

Conclusion: In patients with twin pregnancy, pre-pregnancy obesity is associated with adverse pregnancy outcomes, including gestational diabetes, gestational hypertension, and preeclampsia.     

Relative glucose tolerance and subsequent development of hypertension in pregnancy

OBJECTIVE: To test the hypothesis that relative carbohydrate tolerance, an indicator of insulin resistance, predicts subsequent risk for hypertension of pregnancy among previously normoglycemic, normotensive women. METHODS: We conducted a nested case-control study in women enrolled at a large Colorado urban health maintenance organization. Subjects were previously healthy pregnant women who tested abnormal on their initial 50-g glucose screens and subsequently completed 3-hour, 100-g oral glucose tolerance tests. Cases were 54 previously normotensive women who subsequently developed hypertension and controls were 51 subjects with normotensive pregnancies, matched to cases on parity. Subjects diagnosed with gestational diabetes (17 cases, six controls) were excluded from the main analyses. RESULTS: Among the 82 normoglycemic women (45 controls, 37 cases, 13 preeclampsia, 24 gestational hypertension), mean post-load glucose levels and total glucose area under the curve were significantly higher in cases than in controls (P < or =.04) and were positively correlated with peak mean arterial pressure. After adjustment for potential confounders, 2-hour post-load glucose levels remained strongly related to risk for hypertension (adjusted odds ratios = 1.48; 95% confidence interval 1.13, 1.92, per 10 mg/dL increase) and to peak mean arterial blood pressure (r =.23, P =.04), as did total glucose area under the curve (P < or =.04). Cases were also more likely to have had one abnormal glucose tolerance test (28% versus 5%, P =.004). Stratifying analyses by case severity (preeclampsia and gestational hypertension) yielded similar results. Among all subjects, more cases than controls were also diagnosed with gestational diabetes (31% versus 12%, P =.008). CONCLUSION: These findings are consistent with the hypothesis that insulin resistance precedes the clinical onset of hypertension in pregnancy, and may be important in the etiology of hypertension.     

Obstetrical and neonatal outcomes of gestational diabetes mellitus at Reunion Island (France)

OBJECTIVE: To assess maternal and fetal outcomes in patients with gestational diabetes mellitus. PATIENTS AND METHODS: A retrospective study was conducted at the Sud-Reunion Hospital's maternity (French overseas department located in the Indian Ocean), during the period from January 1, 2001, through December 31, 2004. During this period, 1172 pregnant women presenting gestational diabetes mellitus were compared with 1172 non-diabetic controls matched on the basis of age, parity. Student t test, Pearson chi-square test and logistic regression model were used for statistical analysis. RESULTS: Gestational diabetes mellitus complicates about 7.5% of pregnancies in Reunion Island. Its occurrence was associated with a significantly increased prevalence of pre-pregnancy obesity (27 versus 9.4%) and chronic hypertension (5.3 versus 3.3%). The prevalence of preeclampsia and obstetrical vascular disorders were not different between the two groups, respectively 2.2 versus 2.7% (P=0.43) and 6.2 versus 4.4% (P=0.06). The rate of caesarean sections and inductions of labour was increased in the study group. The term of delivery was inferior in the study group, consecutive to increased rate of labour induction at 38 week-gestation. Macrosomia and large for gestational age (LGA) newborns rate were significantly higher in the study group, respectively 8.9 versus 4.2% and 22.5 versus 10.1% (P<0.001) but the rate of admission into neonatal unit was not significantly different. DISCUSSION AND CONCLUSION: Active management of gestational diabetes mellitus is associated with low maternal and perinatal morbidity. While age and parity are controlled by the study design, the prevalence of preeclampsia and gestational hypertension are not increased in women presenting gestational diabetes mellitus.     

The role of continuing metformin therapy during pregnancy in the reduction of gestational diabetes and improving pregnancy outcomes in women with polycystic ovary syndrome

Objectives

To evaluate the value of continuing metformin therapy in women with PCOS throughout pregnancy and its role in reducing the development of gestational diabetes and improving pregnancy outcome by reducing spontaneous miscarriage rate.

Study design

Non randomized, controlled clinical trial.

Population

Fifty-seven infertile cases with polycystic ovary syndrome who became pregnant were classified into two groups: group 1 included 31 cases who conceived while taking metformin therapy with or without other ovulation inducing agents and continued metformin during pregnancy in a dose of 1000–1500 mg daily and group 2 included 26 cases who conceived without taking metformin and did not take it during pregnancy.

Outcome measures

Maternal outcome measures including; assessment of insulin resistance, incidence of gestational diabetes mellitus, the need for insulin therapy and incidence of preeclampsia. Fetal outcome measures include incidence of, spontaneous miscarriage, preterm birth, fetal growth abnormalities, suspected fetal asphyxia at birth, fetal anomalies and neonatal mortality.

Results

The incidence of gestational diabetes mellitus was significantly lower in cases who received metformin than those who did not receive metformin during pregnancy (3.2% versus 23.08%, respectively), and spontaneous miscarriage occurred in one case (3.2%) in patients who continued metformin compared to 7 cases (26.9%) in patients who did not take metformin. No significant differences between both groups in other outcome measures.

Conclusion

Continuous metformin therapy throughout pregnancy in women with PCOS improves pregnancy outcomes by decreasing spontaneous miscarriage rates and prevention of gestational diabetes mellitus with its co morbidity and mortality.     

Two-hour insulinemia after oral glucose overload and women at risk of pregnancy-induced hypertensive disorders

Objective: Pregnant women with impaired insulin sensitivity are at risk for developing pregnancy-induced hypertensive disorders (PIHD). We analyzed glucose and insulin circulating levels throughout a 2-h oral 75?g glucose tolerance test in pregnant women, and related the 2-h insulinemias to PIHD prevalence. Methods: Pregnant women (gestational week 24–28) were submitted to a glucose overload, and glucose and insulin plasma concentrations were measured throughout the test. These peripheral metabolite levels, the homeostasis model assessment (HOMA) values and the glucose to insulin ratio (G:Ir) were analyzed. Anthropometric parameters and pregnancy outcome were recorded. Results: Women with normal fasting glycemia, insulinemia and HOMA values, G:Ir and 2?h-glycemia but whose 2?h-insulinemia was higher than 215.25?pM were at greater risk for developing late pregnancy hypertension and preeclampsia compared to women of similar characteristics but whose 2?h-insulinemias were lower than 215.25?pM. Conclusion: 2-h insulinemias higher than 215.25?pM after a 75?g glucose overload could be highly indicative of women at increased risk of developing PIHD.     

Gestational diabetes mellitus diagnosed during early pregnancy

OBJECTIVE: This study was undertaken to compare pregnancy complications, obstetric outcomes, and perinatal outcomes between women with early-onset and late-onset gestational diabetes mellitus. STUDY DESIGN: Fifty-gram oral glucose challenge screening was conducted among 3986 pregnant women at the time of their first antenatal visit. Women without abnormal results underwent another test at 24 to 28 weeks' gestation. Patients with gestational diabetes mellitus in early pregnancy were compared with those who had a normal glucose tolerance at the time of this first test but in whom diabetes subsequently developed. RESULTS: Women with early-onset gestational diabetes mellitus (n = 65) were likely to be hypertensive (18.46% vs 5.88%; P =.006) and had higher glycemic values and need for insulin therapy (33.85% vs 7.06%, P =.0000) than those in whom diabetes developed later (n = 170). All the cases of neonatal hypoglycemia (n = 4) and all perinatal deaths (n = 3) were within this group (P =.005 and P =.01, respectively). CONCLUSIONS: Women with an early diagnosis of gestational diabetes represent a high-risk subgroup.