Overt diabetes in pregnancy.

Of 45 diabetic pregnancies, 80% were Class C, D, or R. The perinatal mortality rate was 4.4% (corrected 2.2%); however, neonatal morbidity was high. Of the infants, 28% developed respiratory distress syndrome (RDS); 18%, asphyxia; and 42%, hypoglycemia. Thus, the woman with overt diabetes needs delivery in an institution where neonatal expertise and modern neonatal facilities exist. Of the mother 28% had a family history that was negative for diabetes mellitus. Four neonates developed RDS despite mature lecithin/sphingomyelin ratios.     

Insulin analogues in the treatment of diabetes in pregnancy

This review reports the literature on the safety and efficacy of insulin analogues in pregnancy and thereby enables the clinician to choose the optimal insulin treatment protocol to achieve and maintain normoglycemia throughout pregnancies complicated by diabetes. This article also reviews the literature on the insulin analog during pregnancy and presents the authors' opinion as to the safety and efficacy of insulin analog treatment for the pregnant diabetic woman.     

妊娠合并糖尿病的围产期监护

1986年1月至1992年11月期间该院孕产妇中有妊娠合并糖尿病者107例(10.13‰),包括妊娠期糖尿病37例,White分类B～D级70例,平均年龄31岁,初产妇比经产妇为1.23:1,有不良孕产史者占43％,1/3患者并发妊高征,大于孕龄儿占39.25％,胎儿畸形3例(2.8％),剖宫产率82.24％,产母因并发症死亡1例(9.35‰),宫内死胎7例(65.42‰)。本文认为加强孕妇管理是降低母儿并发症和围产儿死亡之关键。     

Gestational diabetes diagnosed in third trimester pregnancy and pregnancy outcome.

BACKGROUND: The clinical significance of gestational diabetes diagnosed in the third trimester is unclear. A prospective observational study was performed on a cohort of women without pre-existing gestational diabetes or other medical disorders to examine the effect of gestational diabetes on pregnancy complications and infant outcome. METHODS: Four hundred and eighty-nine consecutive women were assessed at 28-30 weeks by random glucose screening and/or a 75 g oral glucose tolerance test. The subsequent management was according to established departmental protocols. The outcome of pregnancy was compared among the groups with negative screening, positive screening but normal glucose tolerance, and gestational diabetes which was controlled with diet therapy. RESULTS: Women with gestational diabetes (n=67 or 13.7%) had significantly increased maternal age, pre-pregnancy weight and body mass index, hemoglobin levels at booking and at 36-38 weeks, and incidences of parity >1, pre-eclampsia, and female infants, while the gestational age was shorter and there was no significant difference in the birthweight outcome or neonatal morbidity. CONCLUSIONS: Despite diet treatment, gestational diabetes diagnosed in the last trimester is associated with increased risk of pre-eclampsia and shorter length of gestation, and this is likely to reflect a pathological process rather than the physiological effect of pregnancy on maternal glucose tolerance.     

Metronidazole treatment in pregnancy.

Vaginal trichomoniasis was treated with standard courses of oral metronidazole in 597 pregnant women. In 283 other pregnant women, the infection remained untreated. The incidences of low-birth-weight infants, stillbirths and congenital abnormalities were not affected by metronidazole treatment of trichomoniasis in pregnancy.     

Glycosylated hemoglobins and diabetes mellitus in pregnancy.

The glycosylated hemoglobins (HA1) were measured in the blood of normal nonpregnant (n = 50) and pregnant (n = 29) volunteers and pregnant diabetic patients (n = 21). HA1 in normal pregnancy (6.7% +/- 1.03%) did not differ significantly from values in nonpregnancy (7.5% +/- 0.73%) and did not vary with the stage of gestation. HA1 was increased in diabetic pregnancy (8.4+ +/- 2.15%) and was positively correlated with serial fasting blood sugar (FBS) mean values in samples drawn up to 16 weeks (r = 0.57) prior to the measurement of HA1, although the highest correlation (r = 0.73, p less than 0.001) was with FBS levels over the prior 8 weeks. A large standard error of the estimate (26.9 mg/100 ml) showed HA1 to be insensitive as an indicator of prior FBS. There was a large overlap of HA1 from known diabetic patients with the normal range for pregnancy. There was no correlation of third-trimester HA1 and newborn birth weight. It was concluded that (1) normal pregnancy does not alter HA1; (2) HA1 is proportional to prior mean FBS; (3) marked elevations of HA1 (greater than 10%) reliably predict poor diabetic control, but HA1 is not useful for fine control of FBS; (4) HA1 is not useful as a screen for diabetes mellitus; (5) HA1 is not predictive of newborn birth weight.     

Care of diabetes in pregnancy

Diabetes, whether existing before pregnancy or brought on by changes in maternal physiology, poses risks to the mother and developing fetus. Excellent preconceptional and pregnancy care can help to minimize, or even to eliminate, these risks. This article reviews the problems that are associated with diabetes in pregnancy and evidence-based strategies to avoid them.     

妊娠合并糖尿病并发症的诊断及处理

妊娠合并糖尿病包括两种情况，即妊娠前已有糖尿病和妊娠后才发生或首次发现的糖尿病。后者又称妊娠期糖尿病（GDM）。GDM发病率逐年上升，国内外报道1％-14％。目前已受到广泛重视，但由于国内系统管理起步晚，各地区及各级别的医院管理规范不统一，妊娠合并糖尿病所致母婴近期远期并发症仍较高，应引起临床医师的重视。     

Three cases of diabetes insipidus complicating pregnancy.

Diabetes insipidus (DI) is a rare complication of pregnancy. In cases related to pregnancy, the condition is thought to result from enhanced placental clearance of arginine vasopressin secondary to placental vasopressinase production. In such cases careful monitoring of the patient's fluid balance during and after pregnancy is essential. If treatment is necessary, desmopressin is the drug of choice. In the present article, we present three cases of pregnancy complicated by DI.     

Noninsulin dependent diabetes mellitus and pregnancy in Mexico.

We analyzed 215 consecutive patients with diabetes mellitus and pregnancy, 118 (54.83%) with noninsulin dependent diabetes mellitus (NIDDM), 90 (41.86%) with gestational diabetes mellitus (GDM) and 7 (3.26%) with insulin dependent diabetes mellitus (IDDM). NIDDM and GDM patients had no significant difference in age and body mass index. There were no maternal deaths, nor episodes of ketoacidosis. Maternal and neonatal complications occurred with a similar frequency in NIDDM and GDM. We concluded that in our population, diabetes associated with insulin-resistance occurred in over 96% of our pregnant diabetic patients and was associated with an increased prevalence of maternal and neonatal complications. Earlier perinatal care has to be established in NIDDM patients, and obese young women should be screened to detect GDM from early gestation and advised to reduce weight before pregnancy ensues.     

Management of chemical dependence in pregnancy

Although the percentage of pregnant patients who use illicit drugs is relatively low, the effects can be devastating on both mother and fetus-loss of custody, growth restriction, placental abruption, and death. The practicing obstetrician may be unfamiliar with the various presentations of chemical dependency in pregnancy, including intoxication and withdrawal, and difficulty in making the diagnosis. The obstetrician is in the unique situation of being responsible for the safety of both mother and fetus, which may involve engaging the unwilling patient in treatment.