Glycemic control and spontaneous abortion in insulin-dependent diabetic women

Insulin-dependent diabetic women without adequate glucose control have a higher spontaneous abortion rate when compared with the general population. The present study examined whether the increased rate of spontaneous abortions in insulin-dependent diabetic women was associated with poor glycemic control in the early postconceptional period or close to the abortive event itself. Measurements of glycohemoglobin A1 at eight to nine weeks' gestation provide retrospective indexes of glucose control during the early postconceptional period, whereas measurement of glycosylated serum albumin and serum protein at the same time reflects short-term glycemic control before the abortive event. This study evaluated 84 consecutive pregnancies occurring in 68 insulin-dependent diabetic women; 66 pregnancies progressed beyond 20 weeks with no malformation or death, and 18 pregnancies terminated in spontaneous abortions before 20 weeks' gestation. The mean glycohemoglobin A1 concentrations of women experiencing spontaneous abortions were significantly greater than that of women who did not abort (P less than .05). In contrast, maternal glycosylated proteins and glycosylated albumin concentrations did not differ between groups. The authors suggest that poor control of diabetes in the early conceptional period, rather than that just before abortion, increases the risk of spontaneous abortion.     

Hypertension during pregnancy in insulin-dependent diabetic women

Insulin-dependent diabetic patients are at increased risk for hypertensive disorders of pregnancy. This study was designed to study prospectively the rate of pregnancy-induced hypertension (PIH) in 175 insulin-dependent diabetic pregnancies (88 White classes B-C, 87 classes D-RT). Pregnancy-induced hypertension was defined as two or more occurrences after 20 weeks' gestation of a mean arterial pressure (MAP) of 105 mmHg or greater or an increase of 20 mmHg or greater from the baseline MAP. The rate of PIH in the diabetic population was 15.4% and was significantly associated with nulliparity, poor glycemic control in the first and second trimesters, and advanced White class. Neonatal outcome was not significantly altered in the presence of PIH. We speculate that improved glycemic control throughout pregnancy might reduce the rate of this complication in diabetic patients.     

Predictive value of early pregnancy glycohemoglobin in the insulin-treated diabetic patient

The influence of early pregnancy glycemic control as measured by hemoglobin A1c concentration and the incidence of congenital anomalies and spontaneous abortions were evaluated in women presenting for prenatal care with insulin-treated diabetes in a population whose glycemic control was poor. Thirty-one abnormal outcomes were seen in 83 pregnancies (37%). There were 22 spontaneous abortions and nine major congenital anomalies. No woman with an early pregnancy hemoglobin A1C value less than 9.5% had an infant with a congenital anomaly and a single woman experienced a spontaneous abortion (4%). Conversely, in women with an early pregnancy hemoglobin A1C value greater than or equal to 9.5%, congenital anomalies occurred in 24% and spontaneous abortion in 35%. Outcomes of pregnancies in type 1 and type 11 diabetic women were comparable. A strong statistical relationship between hemoglobin A1C and adverse pregnancy outcomes was demonstrated. These results strongly suggest that poor glycemic control during early pregnancy adversely influences pregnancy outcomes; the greater the degree of poor control, the greater the impact on pregnancy outcome. The data further justify the need for preconceptional control in diabetic woman and for careful evaluation of the fetus during pregnancy in the woman with insulin-treated diabetes.     

Periconceptional metabolic status and risk for spontaneous abortion in insulin-dependent diabetic pregnancies

The rate of clinically apparent spontaneous abortions in insulin-dependent diabetic pregnancies has been prospectively determined to be twice as frequent as for the general population (29.5% versus 10 to 15%). In a series of several successive studies, we have shown that spontaneous abortions are associated with poor metabolic control around conception and/or in the early weeks of pregnancy, but not in the 1 to 2 weeks preceding the abortive event itself. There is also a significant relationship between decreased maternal magnesium status (as assessed by maternal serum magnesium concentration) and adverse fetal outcome (spontaneous abortion and/or major congenital malformations) in insulin-dependent diabetic women. We speculate that improvement of glycemic control and of magnesium status before conception and in the very early phases of organogenesis might improve embryonic and fetal survival.     

Serum CA 125 levels in early pregnancy and subsequent spontaneous abortion

CA 125 has been found in high concentrations in human amniotic fluid throughout gestation, with significant quantities seen in the decidua and chorion. Because disruption of the epithelial basement membrane of the fetal membrane or the decidua could theoretically lead to a rise in maternal CA 125 levels, this increase may be a predictor of subsequent spontaneous abortion of the fetus. A study was initiated to investigate whether a sudden rise in the serum CA 125 level might predict spontaneous first-trimester abortions. CA 125 levels of 101 pregnant women were evaluated 18-22 days from conception and 6 weeks from conception (a frequent time for spontaneous abortion) to determine whether there is a sudden increase (from baseline or early trimester levels) during the middle or late first trimester immediately before or at the time of abortion. The results indicated that although there was a definite correlation found between elevation of CA 125 and spontaneous abortion, the higher levels occurred early in the first trimester whereas the majority of abortions did not occur until much later, after fetal viability was established. Six of ten women with CA 125 levels of 150 U/mL or greater aborted, compared with four of 92 women with CA 125 levels less than 150 U/mL. One of 11 women pregnant after in vitro fertilization had a CA 125 level above 150 U/mL, and she aborted.     

Decreased maternal serum magnesium concentration and adverse fetal outcome in insulin-dependent diabetic women

Insulin-dependent diabetic pregnant women are at risk for magnesium deficiency, predominantly because of increased urinary magnesium losses. They also have a high incidence of spontaneous abortion, possibly related to major lethal malformations. We tested the hypothesis that adverse fetal outcome (fetal loss before 20 weeks' gestation and/or congenital major malformations) is related to magnesium status (as assessed by determining serum magnesium levels) in insulin-dependent diabetic pregnant women, even after sonographic documentation of fetal viability. Eighty-four insulin-dependent diabetic women (class B to RT) with 96 pregnancies were recruited prospectively in a program project. Serum magnesium and blood glycohemoglobin were measured at about nine weeks' gestation. Blood glycohemoglobin was higher (P = .039) and serum magnesium concentration lower (P = .05) in the 21 pregnancies that ended in adverse fetal outcome, compared with the other (75) successful pregnancies. When compared with the "successful pregnancy" group, blood glycohemoglobin was higher (P = .012) and serum magnesium lower (P = .037) in the subgroup of nine pregnancies with fetal cardiac activity present by ten weeks and ending in adverse fetal outcome, compared with the 64 equivalent pregnancies in the "successful" group. We speculate that decreased magnesium status may contribute to the high spontaneous abortion and malformation rate in insulin-dependent diabetic pregnant women.     

Prognostic value of the pregnancy zone protein during early pregnancy in spontaneous abortion

The concentration of pregnancy zone (PZ) protein in maternal serum during early normal pregnancy was followed in a prospective study of 261 pregnant women. A marked increase which followed an exponential function was found and a theoretic onset of induction at the time for implantation was calculated. Women with a later spontaneous abortion had low values. The prognostic relevance of PZ determinations was studied and values from women who later had a spontaneous abortion were compared to those from normal pregnancies. The prognostic value of PZ protein was compared to that of hCG and progesterone. PZ and hCG assays had the same prognostic accuracy concerning the outcome of pregnancy while determinations of progesterone were less valuable.     

Human chorionic gonadotropin in maternal plasma after induced abortion, spontaneous abortion, and removed ectopic pregnancy

Human chorionic gonadotropin (hCG) in maternal serum was analyzed by a hCG-beta-subunit, radioimmunoassay (hCG-beta-RIA) in 36 cases after induced first-trimester abortion, 35 cases of spontaneous abortion in the first trimester, and in 35 cases of ectopic pregnancy to determine the time between the apparent removal of all trophoblastic tissue by surgical intervention and the disappearance of hCG from the blood. In the cases with induced abortion, hCG was detectable from 16 to 60 days, with a median of 30 days after uterine evacuation, in those with spontaneous abortion from nine to 35 days with a median of 19 days, and in the cases of ectopic pregnancy from one to 31 days with a median of eight, five days after laparotomy d. In the cases with induced abortion, hCG was detectable from 16 to 60 days, with a median of 30 days after uterine evacuation, in those with spontaneous abortion from nine to 35 days with a median of 19 days, and in the cases of ectopic pregnancy from one to 31 days with a median of eight, five days after laparotomy d. In the cases with induced abortion, hCG was detectable from 16 to 60 days, with a median of 30 days after uterine evacuation, in those with spontaneous abortion from nine to 35 days with a median of 19 days, and in the cases of ectopic pregnancy from one to 31 days with a median of eight, five days after laparotomy and removal of the affected tube. There was a significant correlation between the initial hCG levels and the disappearance time in each series. The demonstrated disappearance times are longer than previously recognized, which should be appreciated when hCG is analyzed after termination of early pregnancy.     

Thyroid hormone binding in early pregnancy and the risk of spontaneous abortion

Serum thyroxine (T4), free thyroxine (FT4) and thyroxine binding globulin (TBG) were measured at 6, 8, 10, 12, 14 and 16 weeks menstrual age (MA) in 32 pregnant females, who had been selected for a high risk of spontaneous abortion on account of previous abortion (18 cases) or ovulation induction (14 cases). Eight of these subjects experienced a spontaneous abortion occurring between 8 and 20 weeks. The other women, who carried to term, served as controls. In the abortion group, mean pre-abortion TBG and T4 levels were lower than in the control group from the 6th week on. In spite of this, the way T4 changes with TBG was very similar in both groups. No detectable change or difference with respect to control values were observed for FT4. These observations are taken as evidence against impaired maternal thyroid function playing a role in the unsuccessful outcome of pregnancy. Decreased TBG was detected on the average at 5.2 (range 0-13) weeks before abortion. Diagnostic sensitivity and positive predictive value were estimated as about 70 and 80%, respectively, for the high-risk group, indicating that serum TBG might only play a minor role as a predictor of the outcome of pregnancy.     

Afibrinogenemia in early spontaneous abortion

A case of afibrinogenemia complicating spontaneous early abortion in the ninth week of pregnancy is presented. It is the first report of this complication occurring so early in gestation.The treatment of this condition is described. It includes (1) restoration of effective plasma fibrinogen levels, (2) correction of the shock state, and (3) prevention of subsequent infection.Possible causative factors in the development of afibrinogenemia accompanying abortions are discussed.     

History of biochemical pregnancy was associated with the subsequent reproductive failure among women with recurrent spontaneous abortion

Abstract

The aim of this study was to evaluate whether the presence of history of biochemical pregnancy (BP) was associated with clinical characteristics and the subsequent pregnancy outcome among women with recurrent spontaneous abortion (RSA). One-hundred and seventy-five RSA women with two or more clinical pregnancy losses were enrolled. The clinical characteristics were compared between 164 women with history of 0–1?BP (Group A) and 11 women with two or more BP (Group B). The frequency of previous pregnancy loss and history of in vitro fertilization and embryo transfer in Group B was higher than that in Group A; while frequency of secondary RSA in Group B was lower than Group A. The subsequent pregnancy outcome was assessed prospectively; and live-birth rate in Group A (72.9%) was higher (p?<?0.05) than that in Group B (41.7%). The incidence of reproductive failure (58.3%, p?<?0.05) and spontaneous abortion with normal chromosome (25.0%, p?=?0.050) in Group B was higher than those (27.1 and 5.9%, respectively) in Group A. RSA women with two or more BP had higher risk of reproductive failure and spontaneous abortion with normal chromosome together with lower chance of live-birth. The results of the present study involve important information and are helpful for clinical practitioners.     

Substance use measures among women in early pregnancy

OBJECTIVE: Our purpose was to compare self-reported and biochemical measures for tobacco, marijuana, and cocaine exposures among women early in pregnancy. STUDY DESIGN: Women who were in the early stages of pregnancy and were examined in an inner-city emergency department were enrolled. Tobacco, marijuana, and cocaine use was measured by self-report and urinalysis. Cocaine use was also assessed by hair analysis. RESULTS: Data were available for 789 women. Among those reporting past use of tobacco, marijuana, and cocaine, 25.2%, 23.9%, and 22.7%, respectively, had positive results of urinary assays; among those reporting current use, 77.2%, 86.6%, and 75.9% had positive findings, whereas among those reporting never use 5.6%, 5. 7%, and 3.6% of results were positive. Hair analysis, in comparison with urine testing, for cocaine identified 4 times as many exposures among women who reported never using cocaine. CONCLUSIONS: Urinary assays were equally likely to be positive among women reporting never use and those reporting past use of tobacco, marijuana, or cocaine. Thus women with a positive biologic assay result were as likely to deny use of tobacco as they were to deny marijuana, or cocaine.