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Based on the glucose infusion test, we find with 17.9 per cent of a group of anamnestically tainted pregnant women gestational diabetes, and with 5.7 per cent of this group a carbohydrate tolerance with disturbed boundaries. With probands having a carbohydrate tolerance with disturbed boundaries we find a significantly more frequent IRI-high-response. This coincidence of a carbohydrate tolerance in the border range and of an IRI-high-response might correspond to the early asymptomatic stage of diabetes. In the following stages, there will take place a depression of the early insulin phase with a pathological carbohydrate tolerance of the pregnant women in the sense of a gestational diabetes. With probands exhibiting a disturbed carbohydrate tolerance, a diminished depression of free fatty acids is found. The total lipid content and cholesterol are not essentially changed. With women suffering from gestational diabetes urinary sugar excretion is significantly higher than with probands showing a normal carbohydrate tolerance.
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PMID:[Incidence of gestational diabetes as well as changes in insulin secretion during pregnancy. 1. Studies on pregnant women suspected of diabetes using the glucose infusion test (GIT)]. 74 51

The present status of oral contraceptive steroids and the IUD, the 2 most effective and increasingly popular contraceptive methods (used by 41.6% of all U.S. married couples practicing contraception in 1970), is presented. Oral steroid contraceptives with varying quantity and activity of estrogen (ethinyl estradiol or mestranol) and progestogen (norethindrone, norethynodrel, ethynodiol diacetate, or norgestrel), are of 3 types: combination, sequential, and minidose progestogen alone. The most effective contraceptive available is the combined oral pill with a pregnancy rate of less than .2 % per 100 women after 1 year. Contraceptive action is exerted primarily through inhibition of ovulation and secondarily by alterations in cervical mucus, endometrial glands, the ovary, and in the oviduct and uterine muscle. In comparison, sequential oral contraceptives are less effective with greater side effects, and should only be used in women with amenorrhea. Effects of oral contraceptives other than contraception include those on the (1) the primary targets of the female reproductive system, (2) on other endocrine oragans and (3) on the remainder of the body. In the first group, changes may include transitory stromal fibrosis in the ovary, enlarged fibromyomata, intermenstrual bleeding or amenorrhea, increased amount of cervical mucus, polypoid hyperplasia of the endocervical glands, breast tenderness, and changes in lactation. Changes in the second category which may occur affect the adrenal glands, hypothalamus, the thyroid (increased thyroid-binding globulin), and pancreas (alterations in glucose metabolism). Effects on the rest of the body may include increase in serum lipids and changed atherogenic index, abnormalities in liver function, thromboembolism (incidence in oral contraceptive users 4.4 times that in non-users), melasma, alterations in the central nervous system with increased incidence of cerebral vascular accidents, hypertension, and increased body weight. Absolute contraindications to oral contraceptive therapy include cancer of the breast and uterus, pregnancy, active liver disease, hyperlipidemia, and history of gestational diabetes, thromboembolic phenomena or coronary artery disease. Relative contraindications include depression, migraine, myomata of the uterus, hypertension, epilipsy, oligomenorrhea and amenorrhea. Reliable epidemiologic data on IUDs from the Cooperative Statistical Program indicated first year pregnancy rate of 2.5%. Problems with the IUD include: 1) pregnancy with device in situ, which is associated with a higher incidence of spontaneous abortion; 2) ectopic pregnancy, which is prevented at a rate of only 90% compared with intrauterine pregnancies prevented in 97-98%; and 3) expulsions (20% of which are unnoticed), the expulsion rate being higher with decreasing age and parity, higher in the first than second year of use, and higher with smaller than larger devices. A major problem is discontinuation for medical reasons (15% rate in the first year), mainly bleeding and pain. Perforation, another serious complication, occurs initially at time of insertion with an incidence of 1 per 2500 insertions for the loop. IUDs were found to produce a sterile inflammatory tissue reaction, which is postulated as the primary causative factor for their contraceptive effect in humans.
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PMID:Current status of contraceptive steroids and the intrauterine device. 459 80

Physical training and activity during pregnancy is very common today, and many women even continue training after the 25th week of gestation. Irrespective of its level of intensity, training has not proved to be associated with manifest risk. Moderate training seems to be beneficial, by increasing the peripheral effect of insulin among those possibly at risk of gestational diabetes. Gravidae who train not only tend to be characterised by better health and self-esteem, and a lower incidence of depression during pregnancy, but also find delivery less strenuous. The offspring of women who train during pregnancy manifest fewer signs of stress during delivery, and are usually characterised by better general condition (e.g., higher Apgar scores).
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PMID:[Training and sports competition during pregnancy and after childbirth. Physical training is beneficial for mother and child]. 1035 74

Since thiamin plays a role in glucose metabolism we wanted to know if blood thiamin influx from gravida to neonate was influenced by treatment of gravidas having gestational diabetes mellitus (GDM). In this study we found thiamin hypovitaminemia in 19% of the 77 pregnancies despite vitamin supplementation and treatment for GDM; neonates born to mothers with hypovitaminemia were also thiamin hypovitaminemic. All neonatal blood had significantly higher thiamin concentration than gravidas. Indeed, cord blood from neonates born to mothers treated with insulin for GDM had significantly higher thiamin concentration than other neonates in the study. A significant weight depression was noted in neonates born to treated GDM mothers. Healthy gravidas giving birth to macrosomia neonates, had significant thiamin hypovitaminosis, but only macrosomic neonates of treated diabetic mothers had significantly depressed blood thiamin concentrations. We noted that subclinical thiamin hypovitaminemia is prominent during pregnancy despite vitamin supplementation. Perhaps increased thiamin supplementation during pregnancy seems warranted to avoid metabolic stress in mother and fetus due to thiamin hypovitaminemia.
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PMID:Thiamin status of gravidas treated for gestational diabetes mellitus compared to their neonates at parturition. 1121 58

HEALTH ISSUE: Diabetes mellitus (DM) is a chronic health condition affecting 4.8% of Canadian adults >/= 20 years of age. The prevalence increases with age. According to the National Diabetes Surveillance System (NDSS) (1998-1999), approximately 12% of Canadians aged 60-74 years are affected. One-third of cases may remain undiagnosed. The projected increase in DM prevalence largely results from rising rates of obesity and inactivity. KEY FINDINGS: DM in Canada appears to be more common among men than women. However, among Aboriginal Canadians, two-thirds of affected individuals are women. Although obesity is more prevalent among men than women (35% vs. 27%), the DM risk associated with obesity is greater for women. Socio-economic status is inversely related to DM prevalence but the income-related disparities are greater among women. Polycystic ovarian syndrome affects 5-7% of reproductive-aged women and doubles their risk for DM. Women with gestational diabetes frequently develop DM over the next 10 years. DATA GAPS AND RECOMMENDATIONS: Studies of at risk ethnic/racial groups and women with gestational diabetes are needed. Age and culturally sensitive programs need to be developed and evaluated. Studies of low-income diabetic women are required before determining potential interventions. Lifestyle programs in schools and workplaces are needed to promote well-being and combat obesity/inactivity, together with lobbying of the food industry for needed changes. High depression rates among diabetic women influence self-care ability and health care expenditures. Health professionals need further training in the use of effective counseling skills that will assist people with DM to make and maintain difficult behavioural changes.
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PMID:Diabetes in Canadian Women. 1534 79

Clinical evidence indicates the influence of viewing ultrasound on women's investment in health during pregnancy. Ongoing work on the effects of ultrasound consultation (UC) include: establishing a replicable UC and demonstrating validity of the UC by examining effects of UC on behavioral and physiological indicators of increased resilience in maternal health and pregnancy outcome. The study indicated that UC significantly increased maternal-fetal attachment, decreased maternal anxiety, and increased positive attitudes toward health during pregnancy. Ongoing research involves using UC in two protocols with pregnant women, for instance, those experiencing moderate-to-severe depression and those at risk for noncompliance in treatment for gestational diabetes.
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PMID:Ultrasound consultation to reduce risk and increase resilience in pregnancy. 1734 59

We report the case of a paradoxical air embolism during a scheduled cesarean section for fetal macrosomia (7.010 kg) in a 38-year-old woman with a history of gestational diabetes and preeclampsia. Spinal anesthesia was satisfactory and well tolerated. After approximately 30 minutes (coinciding with uterine exteriorization), the patient presented a sudden episode of dyspnea, confusion, hypotension, and ST segment depression. The episode lasted approximately 10 minutes and resolved spontaneously with no sequelae. Neurological status and the electrocardiogram were normal at the end of surgery and no postoperative lesions were observed. In the immediate postoperative period, the patient presented a massive hemorrhage due to uterine atony. Echocardiography revealed a patent foramen ovale. The clinical signs in this patient are highly suggestive of a paradoxical cerebral and coronary air embolism.
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PMID:[Air embolism during elective cesarean section, and uterine atony due to fetal macrosomia]. 1866 91

We evaluated the effect of a telemedicine system on maternal and fetal outcome in women with diabetes. A total of 276 pregnant women were enrolled in the study. Women were sequentially assigned to a telemedicine or a control group. There were 88 women with gestational diabetes in the telemedicine group and 115 in the control group; there were 17 women with type 1 diabetes in the telemedicine group and 15 in the control group. Women in telemedicine groups were asked to submit their blood glucose data every week, and had a medical examination at the diabetes clinic once a month. Women in the control groups had a medical examination every two weeks. Subjective outcomes were investigated using the following questionnaires: CES-D for depression, SF-36 for health-related quality of life (QoL), Stress and Distress for the impact of diabetes. Clinical variables and pregnancy outcomes were no different between the two telemedicine groups, whereas women with gestational diabetes in the telemedicine group had a better metabolic control in the 3rd trimester and a lower rate of caesarean sections and macrosomia. As for QoL, women in the telemedicine groups showed lower levels of frustration and concerns about their diabetes, and a better acceptance of their diabetic condition. A questionnaire on the use of the telemedicine system showed a high degree of acceptance (85%). Both telemedicine groups had fewer check-ups at the diabetes clinics. The use of a telemedicine system for glucose monitoring improved pregnancy outcome in women with gestational diabetes and improved QoL in all diabetic pregnancies.
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PMID:The effect of telemedicine on outcome and quality of life in pregnant women with diabetes. 1959 29

Diabetic men have benefited in the last 30 years from a significant improvement in total and cardiovascular mortality, whereas diabetic women have had no improvement at all. Moreover, recent research focused on the role of sex hormones in glucose homeostasis, and might account for different pathophysiologic mechanisms in the development of diabetes-related complications. Thus, care of diabetic women is a challenge that requires particular attention. The available data regarding gender-specific care of diabetes mellitus are uneven, rich in some domains but very poor in others. The large prospective trials performed in the last 20 years have assumed that the natural history of diabetes mellitus in men and women, as well as the efficiency of glucose-lowering therapies and management of hyperglycemic-related complications, could be attributable without distinction to men and women. We propose in this paper to analyze the published medical literature according to the specific management of diabetes mellitus in women, and to try to distinguish some particular features. We found important distinctions between diabetic men and women regarding the patterns of abnormalities of glucose regulation, epidemiology, development of diabetes-related complications, ischemic heart disease, morbidity and mortality, impact of cardiovascular risk factors, development of the metabolic syndrome, depression and osteoporosis, as well as the impact of lifestyle modifications or primary and secondary preventions on cardiovascular risk factors, and finally medical therapeutics. Moreover, special considerations were given to some particular aspects of the medical life in diabetic women, such as the features of gestational diabetes mellitus and the management of pregnancy in pregestational diabetic women, use of contraception, hormone-replacement therapy and polycystic ovary syndrome.
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PMID:Gender-specific care of diabetes. 1980 83

Health problems can develop during a pregnancy, turning it into a high risk. The aim of this study was to explore the influence of hypertensive disorders, gestational diabetes, and preterm birth as risk factors for health-related quality of life (HRQL) and depressive symptoms during late pregnancy and postpartum. A prospective, longitudinal study was performed with three assessments. Ninety women were recruited in the study including 29 controls. HRQL was measured using the WHO-QOL-BREF questionnaire. Depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS). Statistical analyses were performed using ANOVA and the chi-square test to explore HRQL and depressive symptoms between three pregnancy risk groups and controls. Women of the preterm group had statistically significant higher depression scores and lower HRQL scores on the physical domain during pregnancy than those without complications. Women with hypertensive disorders showed the second most depressive symptoms. Physical and global HRQL improved and depressive symptoms decreased significantly from late pregnancy and early postpartum period to late postpartum. Pregnant specific health problems, especially the risk for preterm delivery is associated with more depressive symptoms and decreased HRQL in pregnancy. Guidance and communication for these women is important. The counseling should be multi professional to reduce childbirth burdens.
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PMID:Quality of life outcomes in pregnancy and postpartum complicated by hypertensive disorders, gestational diabetes, and preterm birth. 1984 93


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