Fetal growth spurt and pregestational diabetic pregnancy

OBJECTIVE: To assess the timing of fetal growth spurt among pre-existing diabetic pregnancies (types 1 and 2) and its relationship with diabetic control. To correlate fetal growth acceleration with factors that might influence fetal growth. RESEARCH DESIGN AND METHODS: This retrospective study involved all pregestational diabetic pregnancies delivered at a tertiary obstetric hospital in Australia between 1 January 1994 and 31 December 1999. Pregnancies with major congenital fetal anomalies, multiple pregnancies, small-for-gestational-age pregnancies (<10th centile), and those that were terminated before 20 weeks were excluded. In this cohort, pregnancies delivered at term had at least four ultrasound scans performed. The first scans were performed before 14 weeks of gestation and were regarded as dating scans. Abdominal circumference measurements were retrieved from the ultrasound reports. The z-scores for abdominal circumferences, according to the gestational age, were calculated. The gestations when the ultrasound scans were performed were stratified at four weekly intervals beginning at 18 weeks and continuing through the rest of the study. Majority of these diabetic pregnancies had ultrasound scans performed at 18, 28, 32, and 36 weeks. The abdominal circumference z-scores for pregnancies with large-for-gestational-age (LGA) babies (>90th centile for gestation) were compared with babies with normal birth weights. RESULTS: A total of 101 diabetic pregnancies were included. Diabetic mothers, who had LGA babies, had significantly higher prepregnancy body weight and BMI (P < 0.05). There were no differences in maternal age or parity among the two groups. There were also no differences in the first-, second-, and third-trimester HbA(1c) levels between the two groups. The abdominal circumference z-scores were significantly higher for LGA babies from 18 weeks and thereafter. The differences increased progressively as the gestation advanced. Maximum difference was noted in the third trimester (30-38 weeks). CONCLUSIONS: Fetal growth acceleration in LGA fetuses of diabetic mothers starts in the second trimester, from as early as 18 weeks. In this study, glucose control did not appear to have a direct effect on the incidence of LGA babies, and such observation might result from the effects of other confounding factors.     

Audit on stillbirths in women with pregestational type 1 diabetes

OBJECTIVE: To audit stillbirth cases in women with type 1 diabetes to search for specific characteristics in order to improve antenatal care and treatment. RESEARCH DESIGN AND METHODS: Retrospectively identified cases of stillbirths in women with type 1 diabetes during 1990-2000 were analyzed regarding characteristics of the mother, the pregnancy, glycemic control, and the stillborn. The cause of stillbirth was categorized as explainable, likely, or without obvious cause. RESULTS: We found 22 women with 25 stillbirths among 1,361 singleton births by women with type 1 diabetes. In seven stillbirths the cause was categorized as explainable and in six as likely. In 12 cases no obvious cause was found; however, glycemic control was suboptimal in 9 of these cases. A total of 14 women reported daily smoking, and 10 of 19 with low education were unemployed. CONCLUSIONS: Women experiencing stillbirth were characterized by a high incidence of suboptimal glycemic control, diabetic nephropathy, smoking, and low social status.     

Risk of congenital anomalies detected during antenatal serum screening in women with pregestational diabetes

BACKGROUND: Most studies comparing women with and without pregestational diabetes mellitus have not systematically screened for fetal anomalies in early pregnancy, potentially leading to selection bias. AIM: To evaluate the risk for certain congenital anomalies in women participating in an antenatal maternal screening program. DESIGN: Retrospective cohort study. METHODS: We studied all women who underwent antenatal maternal serum screening in Ontario from 1994 to 2000. Fetal anomalies were documented antenatally by ultrasonography or at autopsy, and postnatally diagnosed birth defects were recorded after 20 weeks gestational age for all live- and stillborn affected infants. We compared the risk of open neural tube defects and urinary tract defects among women with and without pregestational diabetes. RESULTS: Of 413,219 women screened during pregnancy, 2069 (0.5%) had diabetes. Compared to non-diabetic women, the adjusted odds ratios (95%CI) for neural tube and urinary tract defects among women with diabetes were 2.5 (0.9-6.8) and 2.6 (1.4-4.9), respectively. DISCUSSION: Among women who undergo second trimester maternal serum screening, pregestational diabetes is associated with an increased risk of having a fetus with an open neural tube defect or urinary tract disorder.     

Hospitalization patterns of Ethiopians with diabetes mellitus

A survey of diabetic patients of all inpatient services in Yekatit 12 Hospital, Addis Ababa, Ethiopia, was made for 6 mo in 1984. There were 121 hospitalizations of 116 diabetics in 3453 admissions to this 305-bed general hospital. Only 39 of the 116 were already known to its diabetes clinic; there were 24 new cases. Mean duration of hospitalization was 21.3 days, and 19.7% of bed use on medical wards during the survey was by diabetics. More than one-third of known diabetics rarely or never saw a physician until incapacitating symptoms or intercurrent illness resulted in hospitalization. Twenty-one (18%) died, one-third of chronic renal failure. I conclude that diabetes mellitus is a frequent cause of morbidity and mortality in an Ethiopian hospital, indicating that efficient facilities for outpatient education and stabilization are needed for Ethiopia's diabetics, particularly because inpatient facilities are scarce and resources limited. This is the first report from an African nation of hospitalization patterns of diabetic subjects.     

Features of pregnant women with diabetes mellitus

It is about a quantitative study aimed at knowing the features of 105 pregnant women attended at Hospital de Clínicas de Porto Alegre, Brazil, from January 2000 to January 2001. The results allowed the analysis of the delivery as well as baby conditions in addition to the values of the glycemia profile during the gestation. Moreover, they supplied information regarding the completion of the gestations of diabetic women that have made their pre-natal care at the hospital. These results provide significant input for the health team that attend this group of pregnant women and safety for the team performance and, as a result, for the pregnant women.     

Early onset of subclinical atherosclerosis in women with gestational diabetes mellitus.

OBJECTIVE: Common carotid artery intima-media thickness (CIMT) is a non-invasively assessed marker of subclinical atherosclerosis. Our aim in this study was to investigate CIMT in women with gestational diabetes mellitus (GDM). METHODS: Thirty women with GDM and 40 unaffected women (as a control group) were included in the study. Blood samples were drawn from each woman in the morning after they had fasted for at least 8 h, and levels of fasting glucose, insulin, homocysteine, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and very low-density lipoprotein (VLDL) cholesterol were measured, along with the CIMT in the two groups. RESULTS: The mean triglyceride (P = 0.016) and VLDL cholesterol (P = 0.011) levels in the GDM group were significantly higher than those in the unaffected women. There were no significant differences between the groups with respect to plasma levels of total cholesterol, HDL cholesterol, LDL cholesterol and insulin. The mean homocysteine (P = 0.027) and fasting glucose (P = 0.019) levels in women with GDM were significantly higher than those in the control group. Patients with GDM had significantly higher CIMT than did the unaffected women (0.582 +/- 0.066 mm vs. 0.543 +/- 0.049 mm, P = 0.006). CIMT correlated positively with maternal age (r = 0.316, P = 0.008), body mass index (BMI) at the time of a 50-g oral glucose load test (r = 0.414, P = 0.001) and homocysteine levels (r = 0.332, P = 0.008), and fasting glucose (r = 0.265, P = 0.031) and 1-h glucose value (r = 0.410, P = 0.001) at the time of the oral glucose tolerance test. There was a positive correlation between the presence of GDM and CIMT (r = 0.372, P = 0.001). However, stepwise multiple regression analysis showed that GDM/no GDM (95% CI +0.012 to +0.076, P = 0.008) and BMI at the time of the 50-g test (95% CI +0.001 to +0.009, P = 0.011) were independent parameters related to CIMT. CONCLUSION: Women with GDM have increased CIMT compared with unaffected women.     

不同孕产妇代谢特性对妊娠期糖尿病妇女的胎儿生长发育的影响

目的探究不同孕产妇代谢特性对妊娠期糖尿病妇女的胎儿生长发育的影响。方法选取广州市增城区妇幼保健院于2011年6月至2014年12月收治的128例妊娠期糖尿病患者作为研究对象,选取同期入院检查的健康怀孕妇女140例作为对照组。详细记录产妇的年龄、胎儿出生体重、妊娠期糖尿病史、糖尿病家族史、孕前体重、孕期体重、BMI、孕龄、录入时胎龄、空腹血糖、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、低密度脂蛋白/高密度脂蛋白、胰岛素等,统计分析采用SPSS 17.0数据包,计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,相关分析采用Pearson相关分析法,P<0.05表示差异具有统计学意义。结果妊娠期糖尿病组和对照组糖尿病家族史和孕周的比较差异具有统计学意义(P<0.05);而妊娠期糖尿病组和对照组的年龄、胎儿出生体重、妊娠期糖尿病史、孕前体重、孕期体重、BMI、录入时胎龄比较,差异无统计学意义(P>0.05)。通过分析两组产妇28~32周、32~36周和>36周分娩的生化指标特征,结果表明,妊娠期糖尿病组和对照组空腹血糖、胰岛素和甘油三酯的比较差异具有统计学意义(P<0.05);而妊娠期糖尿病组和对照组产妇总胆固醇、低密度脂蛋白、高密度脂蛋白水平比较,差异无统计学意义(P>0.05)。比较28~32周、32~36周和>36周分娩,妊娠期糖尿病组总胆固醇、低密度脂蛋白、低密度脂蛋白/高密度脂蛋白、胰岛素和甘油三酯差异具有统计学意义(P<0.05)。对照组血糖、甘油三酯、总胆固醇、低密度脂蛋白差异具有统计学意义(P<0.05)。通过比较两组新生儿结局,结果表明,孕周、新生儿血糖、BMI、Apgar(1 min)、Apgar(5 min)、巨大儿及大于胎龄儿的比较,差异具有统计学意义(P<0.05)。相关分析表明,甘油三酯水平增高与胰岛素抵抗和胰岛素抵抗指数增加呈显著相关关系(P<0.001)。结论甘油三酯水平增高与胰岛素抵抗和胰岛素抵抗指数增加呈显著相关关系,甘油三酯水平可能预测妊娠期糖尿病孕产妇胰岛素水平变化情况。     

Cytokine secretion is impaired in women with diabetes mellitus

BACKGROUND: As women with diabetes mellitus (DM) have an increased prevalence of asymptomatic bacteriuria (ASB) and it is known that a correlation exists between the increased prevalence of genitourinary tract infection and impaired cytokine production in women infected with Human Immunodeficiency Virus (HIV), we studied urinary cytokine excretion in diabetic women and compared it with that of nondiabetic controls. MATERIALS AND METHODS: To evaluate the cytokine secretion capacity of women with DM, both whole blood and isolated monocytes of women with and without DM were stimulated in vitro with lipopolysaccharide (LPS). RESULTS: Lower urinary interleukin-8 (IL-8) and interleukin-6 (IL-6) concentrations (P = 0.1 and P < 0.001, respectively) were found in diabetic women than in nondiabetic controls. A lower urinary leukocyte cell count correlated with lower urinary IL-8 and IL-6 concentrations (P < 0.05). Lower tumour necrosis factor-alpha (TNF-alpha) and IL-6, but comparable interleukin-10 (IL-10) concentrations were found in whole blood (P < 0.04) and isolated monocytes (P = 0.03) of women with DM type 1 compared to women without DM. CONCLUSIONS: Diabetic women with ASB have lower urinary IL-6 concentrations than nondiabetic bacteriuric controls. In addition, monocytes of women with DM type 1 secrete lower pro-inflammatory cytokines after stimulation with LPS than monocytes of women without DM. This is not due to an inhibitory effect of the anti-inflammatory cytokine IL-10. This can have important consequences for both host defense, endothelial cell functioning and atherogenesis.     

Increased visfatin concentrations in women with gestational diabetes mellitus

The recently discovered adipocytokine visfatin has insulin-like properties. It lowers blood glucose and improves insulin sensitivity; however, clinical data on visfatin are limited. To evaluate the role of visfatin in GDM (gestational diabetes mellitus), we determined visfatin levels in women with GDM and in healthy pregnant controls. Furthermore, visfatin concentrations were investigated longitudinally during pregnancy and after delivery in a subgroup of women with GDM. Blood for measurement of visfatin and metabolic parameters was obtained from 64 women with GDM [median week of gestation, 34 (interquartile range, 27-36) weeks] and 30 healthy pregnant controls [median week of gestation, 34 (interquartile range, 28-36) weeks]. In a subgroup of 24 women with GDM, visfatin, leptin and metabolic parameters were investigated twice during pregnancy (28-30 and 38-40 weeks of gestation) and 2 weeks after delivery. In the cross-sectional analysis, median visfatin levels were significantly elevated in women with GDM [64.0 (interquartile range, 50.9-74.8) ng/ml] compared with controls [46.0 (interquartile range, 36.9-54.6) ng/ml; P<0.0001]. In women with GDM, visfatin correlated with week of gestation at the time of blood draw (R=0.35, P=0.005). No association with fasting glucose, insulin, homoeostasis model assessment-insulin resistance or body mass index was observed. According to the longitudinal analysis, visfatin increased during pregnancy (P=0.002) and rose further after delivery (P=0.014), whereas leptin and insulin levels decreased after parturition (both P<0.001). In conclusion, visfatin is elevated in women with GDM and increases during the course of pregnancy as well as after delivery. Furthermore, visfatin shows no association with insulin and leptin in women with GDM.     

速度向量成像评价妊娠期糖尿病胎儿左心室扭转运动的研究

目的 应用速度向量成像( VVI)技术观察妊娠期糖尿病(GDM)孕妇胎儿的左室扭转特点.方法 采集98例GDM胎儿和135例正常胎儿的左室短轴心尖和基底水平动态声像图,利用VVI软件测量心内、外膜心尖部和基底部旋转角度峰值,计算扭转角度,并与正常胎儿相应参数进行对比研究.结果 140例胎儿的图像被成功分析.GDM胎儿左室心尖和基底旋转方向可呈顺时针方向,也可呈逆时针方向,但心尖与基底呈反向旋转.左室心内膜旋转和扭转角度大于心外膜(P＜0.05),左室心尖水平旋转角度大于基底水平(P＜0.05).GDM胎儿左室心内膜和心外膜旋转和扭转角度均大于正常对照组(P＜0.05).结论 VVI技术可研究GDM胎儿左室扭转运动,有望成为临床检测胎儿心功能的一种新方法.     

妊娠期糖尿病妇女产后2型糖尿病发生及预防的研究进展

随着糖尿病(diabetes mellitus,DM)发病率及相关病死率在全球范围内的不断上升,严重威胁人类健康,DM预防已成为世界各国共同关注的健康问题。同时,文献显示妊娠期     

超声在妊娠期糖尿病孕妇胎儿检查中的应用

随着医疗诊断技术和人们生活水平的提高,妊娠期糖尿病(GDM)的发病率呈逐年上升趋势。通过超声对胎儿生长发育等方面的监测,可评估GDM对围生儿的影响,为GDM诊断、治疗提供一种更加直接、有效、无创的方法。     

Fetal heart rate in chromosomally abnormal fetuses.

OBJECTIVES: To determine the effects of chromosomal defects on fetal heart rate at 10-14 weeks of gestation. METHODS: Fetal heart rate at 10-14 weeks of gestation in 1061 chromosomally abnormal fetuses was compared to that from 25,000 normal pregnancies. The chromosomally abnormal group included 554 cases of trisomy 21, 219 cases of trisomy 18, 95 of trisomy 13, 50 of triploidy, 115 of Turner syndrome and 28 of sex chromosome abnormalities other than Turner syndrome. RESULTS: In the normal group, fetal heart rate decreased from a mean value of 170 beats per minute (bpm) at 35 mm of crown-rump length to 155 bpm at 84 mm crown-rump length. In trisomy 21, trisomy 13 and Turner syndrome fetal heart rate was significantly higher, in trisomy 18 and triploidy the heart rate was lower and in other sex chromosome defects it was not significantly different from normal. Fetal heart rate was above the 95th centile of the normal range in 10%, 67% and 52% of fetuses with trisomy 21, trisomy 13 and Turner syndrome, respectively. The fetal heart rate was below the 5th centile in 30% of fetuses with triploidy and 19% of those with trisomy 18. CONCLUSIONS: Trisomy 21, trisomy 13 and Turner syndrome are associated with fetal tachycardia, whereas in trisomy 18 and triploidy there is fetal bradycardia. Inclusion of fetal heart rate in a first-trimester screening program for trisomy 21 by a combination of maternal age and fetal nuchal translucency thickness is unlikely to provide useful improvement in sensitivity.     

标准化糖尿病护理路径在妊娠合并糖尿病孕妇围产期中的应用

目的:探讨标准化糖尿病护理路径在妊娠合并糖尿病孕妇围产期中的应用效果。方法:选取2011年5月~2014年5月妊娠合并糖尿病孕妇50例,将其随机等分为对照组和观察组,对照组予常规护理,观察组予标准化护理路径护理,观察护理后在围产期血糖、产程监护相关指标上变化情况。结果:观察组护理后空腹血糖、餐后2 h血糖、糖化血红蛋白、并发症发生率低于对照组(P0.05);两组患者妊娠结局比较,观察组优于对照组(P0.05)。两组新生儿并发症发生率差异无统计学意义(P0.05)。结论:标准化护理能降低妊娠合并糖尿病孕妇围产期血糖值,保证产程安全。     

Care of diabetic pregnant women by primary-care physicians. Reported strategies for managing pregestational and gestational diabetes.

OBJECTIVE--To ascertain the strategies used by primary-care physicians for treating pregestational and gestational diabetes mellitus (GDM) during pregnancy, because many women with pregnancies complicated by these types of diabetes are treated by physicians who have no special training in intensive diabetes management. RESEARCH DESIGN AND METHODS--Two hundred twenty-four family-practice (FP) physicians and 184 obstetrics/gynecology (OB/GYN) physicians were surveyed by mail. RESULTS--When compared with OB/GYNs, FPs were less likely to screen all pregnant women for GDM (P = 0.03), use multiple-injection insulin regimens (P = 0.004) or self-monitoring of blood glucose (SMBG) (P = 0.01) for Pre-GDM patients, and refer these patients to a specialist for medical (P = 0.01) or ophthalmologic (P less than 0.001) care. FPs were more likely to implement insulin therapy (P = 0.003), SMBG (P = 0.02), and examine eyes for retinopathy (P less than 0.001) when treating gestational patients. CONCLUSIONS--These data show that there are considerable discrepancies between the strategies used by FPs and OB/GYNs and also suggest that physicians in both groups are under-utilizing recommended treatment strategies described in publications targeted specifically to primary-care physicians. Increased exposure to and dissemination of guidelines for diabetes management and additional medical school and postgraduate education programs are recommended as methods to improve utilization of these strategies.     

妊娠糖尿病孕妇血管性假血友病因子检测的意义

目的探讨妊振糖尿病(GDM)孕妇血浆血管性假血友病因子(vWF)变化及意义。方法采用酶联免疫吸附测定(ELISA)法检测20例GDM、32例正常妊娠及22例非妊娠妇女血浆vWF浓度。结果与非妊娠对照组相比,正常妊娠组空腹血浆vWF浓度明显升高,GDM组血浆vWF浓度又显著高于正常妊娠组及非妊娠对照组[(329.43±83.67)%vs(205.14±49.25)%vs(108.62±37.58)%],其差异均有统计学意义(P<0.001)。结论GDM孕妇存在较正常孕妇更为严重的血管内皮功能受损。