Is insulin lispro associated with the development or progression of diabetic retinopathy during pregnancy?

OBJECTIVE: This study was designed to determine whether there is an association between the use of insulin lispro during pregnancy and the development or progression of diabetic retinopathy. STUDY DESIGN: This observational cohort study included women with type 1 diabetes mellitus (n = 12) who were enrolled in our diabetes mellitus in pregnancy program and were treated with insulin lispro during pregnancy. We compared these women with a historical cohort (n = 42) who were treated with regular insulin during pregnancy. All patients underwent ophthalmologic examinations before 24 weeks' gestation and post partum, and retinopathy was graded according to a previously defined scale. RESULTS: Whereas none of the patients in the insulin lispro group showed any change in retinopathy status, 6 patients in the regular insulin group (14%) demonstrated changes in retinopathy status. Mild background retinopathy (change from grade 0 to 1) developed in 3 of these patients, and extensive proliferative retinopathy developed in 1 patient after normal results of the baseline examination (change from grade 0 to 6). Two patients had progression of retinopathy--1 had progression from background retinopathy to mild proliferative retinopathy (change from grade 2 to 4) and 1 had progression from mild proliferative retinopathy to extensive proliferative retinopathy (change from grade 4 to 6). CONCLUSIONS: These preliminary findings provide no evidence that insulin lispro treatment during pregnancy is associated with the development or progression of diabetic retinopathy.     

Anti-Müllerian hormone in type 2 and gestational diabetes during the second half of pregnancy: relationship with sexual steroid levels and metabolic parameters

Hyperandrogenemia and hyperinsulinemia are observed in women with diabetes during pregnancy. The effect of diabetes on anti-Müllerian hormone (AMH) levels during pregnancy is unclear. The aim of this study was to determine the AMH levels in women with type 2 diabetes (T2D) and gestational diabetes (GD) compared to healthy (C) pregnant women during the second half of gestation. A prospective study of 69 pregnant women with T2D (N: 21), GD (N: 24) and C (N: 24) were followed up during the second half of pregnancy. Clinical assessments and blood samples were collected at 26.7 (25–27.8); 34 (32–34.9) and 37.5 (37–40) weeks of gestation. AMH, sexual steroids, insulin, homeostatic model assessment of insulin resistance, HbA1c levels were measured. AMH levels were similar between T2D, GD and C (p?=?.07). A decline of AMH levels during the second half of gestation was observed in the three groups (p?p?p?相似文献   

Cytomegalovirus non-primary infection during pregnancy. Can serology help with diagnosis?

Diagnosis of cytomegalovirus (CMV) primary infection is reliable, but diagnosis of CMV non-primary infection (NPI) is questionable. Our aim is to highlight the difficulties met in diagnosis of CMV NPI. We illustrate that in proven cases of CMV NPI, very different serologic and molecular patterns may be observed and that routine serologic testing may fail to help with diagnosis. These results point out that many data available in literature concerning the prevalence of NPI, materno-fetal transmission rates and consequences of NPI may be wrong. We need to know how frequently they occur, are transmitted and cause fetal damages. Diagnosis of NPI must be improved, along with our understanding of the mechanisms leading to intrauterine CMV transmission and congenital infection in babies born to women with preexisting immunity.     

Localization of leiomyoma with respect to the placenta--factor for complications during pregnancy?

We are presenting two cases of pregnant women with leiomyoma of the uterus, diagnosed antepartum. In both cases the patients were admitted on an emergency basis due to premature uterine contractions. In both cases preterm hemorrhage and fetal malpresentations were observed. The complications of pregnancy in both of the cases were primarily based on the location of the leiomyoma with respect to the placenta--intramural or submucosal disposition of the leiomyoma, retroplacentarily situated.     

Onset of Graves’ disease during pregnancy in a woman with established hypothyroidism

Background: Pregnancy strongly influences the thyroid gland and its function. Thyroid guidelines recommend a 30 to 50% increase of the preconceptional levothyroxine dose in women with hypothyroidism, when pregnancy is diagnosed.

Case: A 33 year-old, 8-week pregnant woman with hypothyroidism, presents with a 2-week history of palpitations, sweating, nervousness and fatigue. Physical examination shows tachycardia (108 bpm), distal tremors and diffuse goiter. After biochemical confirmation of hyperthyroidism, her levothyroxine dose is reduced and finally interrupted. Propylthiouracil is started and maintained until after the delivery of a healthy baby at week 40. Two weeks postpartum, hyperthyroidism worsens and propylthiouracil is replaced by methimazole. Eighteen months after delivery 7.5?mCi 131Iodine was given. Two months later, hypothyroidism developed and levothyroxine was initiated.

Conclusion: Although conversion of Hashimoto's hypothyroidism into Graves' disease is exceptional in pregnancy, pregnant women with autoimmune hypothyroidism should ideally have their TSH concentrations measured before empirically increasing their levothyroxine dose.     

Galanin in pregnancy: Is there an association with birth weight and gestational diabetes?

Objective: To review the actions of galanin during pregnancy and to examine the existence of an association between galanin and birthweight as well as with gestational diabetes mellitus (GDM).

Results: Galanin concentrations in maternal circulation are similar in pregnant and nonpregnant status and have been correlated with body mass index (BMI). There is evidence of an association between birthweight and galanin concentrations in amniotic fluid during second trimester and galanin concentrations in umbilical cord at term. Moreover, there is a positive correlation between maternal galanin concentrations and existence of GDM. However, galanin concentrations in fetal circulation have not been correlated with neonatal fat mass. Neonatal galanin concentrations do not differ among uncomplicated pregnancies and those complicated by GDM or intrauterine growth retardation (IUGR).

Conclusions: There is evidence for an association between galanin during pregnancy with birth weight and metabolic processes. Further studies are required in order to elucidate this role. Galanin could serve as a predictor of neonatal body weight, alternations of which contribute to the development of diseases during adulthood.     

Changing the diagnosis criteria of type 2 diabetes in pregnancy: do the ends justify the means?

Diabetes in pregnancy is a chronic disease that demands pharmacological therapy, time consuming, with frequent fetal testing and adherence to diet protocol. Given the consensus that glucose control is the key to maximizing outcome, how can the complication rate in the GDM and type 2 diabetes reveal a 3-5 fold rate of perinatal complication compared to the normal population? This review will address the scope of the problem reinforcing the need to address several issues. Should the diagnostic criteria for type 2 diabetes be altered or redefined, at least in pregnancy due to similarities that exist between GDM impaired glucose tolerance and type 2 diabetes.     

Large-for-gestational-age infants of type 1 diabetic mothers: An effect of preprandial hyperglycemia?

Objective. To determine how the frequency, timing and magnitude of hyperglycemia are associated with large-for-gestational-age (LGA) infants in pregnancies complicated by type 1 diabetes.

Methods. Charts from pregnant women with type 1 diabetes (n = 70) were reviewed. Indices of maternal glycemic control were determined for seven gestational periods (weeks 7–10, 11–15, 16–19, 20–24, 25–28, 29–32 and 33–38) and compared between women who delivered LGA infants and appropriate-for-gestational-age (AGA) infants.

Results. Of the 70 pregnancies, 57% of the infants were LGA (4.3 ± 0.4 kg) and 43% were AGA (3.2 ± 0.4 kg). Total maternal weight gain and rate of weight gain were significantly higher in mothers with LGA infants. The glycemic variables associated with an LGA infant were percentage of preprandial values above target for weeks 11–15, 25–28 and 29–32, and percentage of all values above target for weeks 33–38. For the entire pregnancy, the strongest predictors of an LGA infant were percentage of preprandial blood glucose values above target during weeks 29–32 and maternal weight gain.

Conclusions. In pregnant women with type 1 diabetes, frequent episodes of preprandial hyperglycemia in the third trimester significantly impact the development of LGA infants.     

Use of contraception by women with type 1 or type 2 diabetes mellitus: ‘It's funny that nobody really spoke to me about it’

ABSTRACT

Objectives To understand factors which promote or discourage use of contraception in women with diabetes mellitus (DM). To identify contraceptive knowledge, skills and attitudes of health professionals involved in diabetes care.

Methods The research formed part of a larger mixed methods study and included a questionnaire survey (107 women with DM) and semi-structured qualitative interviews with women with DM (n = 16) and diabetes specialists (n = 16). Analysis was by SPSS and NVivo 7.

Results Two main themes emerged: Contraceptive provision and advice and Choice of contraceptive methods. There was incongruence in views between the diabetes specialists and women with DM in relation to advice and use of contraception. Many diabetes specialists felt unqualified to give advice and saw general practitioners as contraception providers. There was low use of long-acting reversible contraceptives, and women used ‘natural’ methods in their wish to ‘avoid taking hormones or chemicals’.

Conclusions Despite awareness of the need to plan pregnancies to avoid poor outcomes, women with DM are likely to receive little advice about their contraceptive options. Contraception should evidently be a legitimate part of diabetes care and diabetes specialists require training to enable them to assist women in making their own informed choices.