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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A variety of gestational factors have been reported to increase or decrease the incidence of hyaline membrane disease in newborn infants. The purpose of the current study was to determine if some of these factors influence the rate at which fetal lung structures mature. Histologic measures of lung maturation were retarded in some infants with Rh erythroblastosis and in some whose mothers had diabetes mellitus. By contrast, such maturation was accelerated in offspring of some toxemic gestations and in those whose membranes had ruptured before the onset of labor. Congenital bacterial pneumonia with intact membranes did not accelerate maturation. None of the factors that altered lung maturity influenced renal maturation.
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PMID:Fetal lung and kidney maturation in abnormal pregnancies. 124 51

Two hundred and sixty three pregnant diabetic mothers' perinatal outcome was evaluated. Two hundred and twenty five infants were born to gestational diabetic mothers (IGDM) and 38 infants to mothers with established diabetes mellitus (IDM). In IGDM group, 34 babies (15%) were preterm and 45 (20%) were low birth weight (less than 2500 g). Thirty eight babies (17%) were large-for-dates (LFD) and 14 (6.2%) were small-for-dates (SFD). Among IDM group, 8 (21%) babies were preterm and 8 (21%) were low birth weight (less than 2500 g). Fifteen babies (39.5%) were LFD and 3 (8%) were SFD. Out of all babies, hypoglycemia occurred in 43 (16%), birth asphyxia in 24 (9%) and respiratory distress in 21 (8%). Nearly half of respiratory distress were due to hyaline membrane disease. Perinatal mortality rate was significantly higher (p less than 0.001) in IDM (237/1000 live birth) as compared to IGDM (40/1000 live birth).
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PMID:Perinatal outcome of infants born to diabetic mothers. 180 47

A study of 60 amniotic fluids obtained by amniocentesis shows that the measurement of total surfactant phospholipids by the TDX Fetal Lung Maturity assay makes it possible to predict accurately fetal lung maturity. A sensitivity of 100% is similar to that of other tests currently used but with a higher specificity (93% instead of 65% for the L/S ratio and 55% for the phosphatidylglycerol). The phospholipid/albumin ratio is carried out automatically by means of a fluorescence polarization method with the TDX Abbott apparatus. A cut off value of 50 mg/g should be considered as a good fetal lung maturity indicator. The population studied was composed of women with an arterial hypertension (n = 6), diabetes (n = 9) preterm premature rupture of the membranes (n = 8), gemellary pregnancy (n = 5) or with a risk of premature outcome (n = 10). In all cases delivery occurred within 24 hours after the amniocentesis. The average gestational age was 36 weeks. Seven newborns (11%) presented hyaline membrane disease. In conclusion, this simple and rapid test seems to be adequate to evaluate with accuracy the fetal lung maturity in abnormal pregnancies. It must however, be associated with the determination of phosphatidylglycerol, when the fluid is contaminated by blood or meconium.
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PMID:[Fast determination of pulmonary surfactant in amniotic fluid using fluorescent polarization (FLM test Abbott)]. 186 89

The purpose of the present study was to determine the risk of neonatal morbidity in infants of diabetic mothers in relation to birth weight percentiles, maternal White classification and metabolic control during pregnancy. The subjects consisted of 51 infants of gestational and Type II diabetic women and 148 infants of insulin-dependent diabetic women. The following neonatal symptoms commonly associated with maternal diabetes were analyzed: macrosomia, hypoglycemia, erythremia, hyperbilirubinemia, hypocalcemia, prematurity and hyaline membrane disease. The incidence of the symptoms was as follows: hypoglycemia in the first hour of life 34.3% macrosomia 24.6%, hyperbilirubinemia 23.7%, prematurity 18.1%, hypoglycemia after the first hour of life 16.6%, hypocalcemia 11.1%, erythremia 7.6%, and hyaline membrane disease 2.0%. There were statistically significant differences in the symptoms "hypoglycemia after the first hour of life" and "erythremia" between the birth weight percentile groups, i.e. the incidence of these symptoms increased with higher birth weights. The risk of neonatal morbidity among infants of insulin-treated gestational diabetics was higher than that of infants of diet-controlled gestational diabetic women. The incidence of macrosomia and hypocalcemia was significantly higher in the first group. Newborns of insulin-dependent diabetic women with proliferative retinopathy and/or nephropathy (White class FR) had an increased risk of neonatal morbidity in comparison to infants of White classes B, C, and D, especially with regard to prematurity and associated problems. Neonatal morbidity varies with the quality of metabolic control in women with insulin-dependent diabetes. Infants of poorly-controlled mothers were more often macrosomic and premature than infants of well-controlled mothers.
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PMID:[Neonatal morbidity of children of diabetic mothers]. 234 9

Surfactant-associated protein of Mr 28,000 to 35,000 (SAP-35) is an abundant glycoprotein present in the alveolus of the lung, which imparts both structural organization to surfactant phospholipids and provides regulatory information controlling surfactant phospholipid secretion and metabolism. SAP-35 expression is enhanced by 3'-5'-cyclic adenosine monophosphate and epidermal growth factor during perinatal differentiation of type II epithelial cells. Its synthesis and RNA are also controlled by a variety of inhibitory factors, which include transforming growth factor and insulin. Glucocorticoids both enhance and inhibit SAP-35 expression in fetal lung explants. There is evidence that fetal hyperinsulinemia or hyperglycemia, or both, inhibit the morphologic differentiation of the type II epithelial cell in association with decreased phospholipid surfactant synthesis or secretion. Insulin is also a potent inhibitor of SAP-35 expression in fetal lung tissue, and decreased SAP-35 was previously noted in amniotic fluid of patients with diabetes during pregnancy. Recent progress in the management of diabetes in pregnancy, characterized by more rigorous metabolic control, has decreased the risk of hyaline membrane disease for the infant of the diabetic mother and is associated with normal levels of SAP-35 in amniotic fluid. Hyaline membrane disease remains a major cause of morbidity in infants of diabetic mothers but may also reflect a higher incidence of premature delivery, cesarean section, and asphyxia at delivery as well as inhibition of pulmonary surfactant phospholipid synthesis or expression of the surfactant protein SAP-35.
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PMID:Hyaline membrane disease and surfactant protein, SAP-35, in diabetes in pregnancy. 304 86

Using 1984 perinatal mortality rates as indicators of the level of maternal and newborn health care service quality and efficiency, Libya's high perinatal loss is compared to perinatal losses of 9 other developing countries. Timely antenatal care is identified as the essential component needed to reduce perinatal loss. Libyan perinatal, still birth, and early neonatal death rates were 26.3, 11.4, and 14.9/100, respectively. Perinatal death rates of other countries in the study ranged from 18.8 to 100/thousand. The major causes of still births in Libya included antepartum hemorrhage, cord accidents, maternal diabetes mellitus, and fetal malformations. The effect of timely obstetric care in reducing still birth rates (SBR) is evidenced by comparing SBRs of 16.8 to 63.8 in pregnant women receiving or not receiving minimal antenatal care at a peripheral health center, respectively. The clinical causes of early neonatal death were major congenital malformation (24.9%), hyaline membrane disease and aspiration syndrome (26.1%), birth asphyxia and injury (17.9%), very low birth weight (17.2%), and sepsis/meningitis (13.1%). High general fertility rates of developing countries leads to increased proportions of women under 20 and over 35 years of age bearing children. These women are prone to bearing offspring comparatively more vulnerable to early neonatal death. Consanguineous marriages leading to congenital malformation, and lack of maternal immunization with tetanus toxoid are also cited as factors contributing to high perinatal mortality. In closing, the authors call for future community-based studies, and recognize socioeconomic level as a main determinant in obtaining obstetric care.
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PMID:Perinatal outcome at Benghazi and implications for perinatal care in developing countries. 316 32

The major fetal risk associated with elective delivery is unexpected fetal lung immaturity and the development of hyaline membrane disease soon after birth. Prior to elective vaginal or abdominal delivery it has become standard obstetric practice to predict fetal lung maturity by the analysis of amniotic fluid obtained by amniocentesis or vaginal pool sample following preterm rupture of membranes. A correlation between third-trimester fetal biparietal diameter and the lecithin/sphingomyelin (L/S) ratio has been established by several investigators. In order to determine if a threshold BPD could be consistently correlated with fetal lung maturity, we retrospectively examined the hospital and laboratory records of a group of 115 nondiabetic parturients in whom BPD measurements and amniotic fluid analysis for L/S ratio had been performed for various clinical indications. A threshold BPD of greater than or equal to 9.2 cm in all parturients who underwent elective repeat cesarean delivery was associated with no hyaline membrane disease (HMD). Two of the three neonates who developed HMD had mature L/S ratios but were products of pregnancies complicated by third-trimester hemorrhage. A review of our present data suggests that about one-third of clinically-indicated amniocenteses in the absence of maternal diabetes or third-trimester hemorrhage could potentially be avoided without adverse neonatal impact. Possible therapeutic application of this finding requires further prospective study.
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PMID:Third-trimester biparietal diameter as a predictor of fetal lung maturity. 330 Jun 78

A radiographic pattern associated with respiratory distress, distinct from hyaline membrane disease and transient tachypnea of the newborn, is described in eight infants of diabetic mothers. The radiographic findings demonstrate a regional distribution of reticulogranular densities accompanied by increased lung volumes. Clinical features were gestationally mature infants in moderate respiratory distress with tachypnea, hypercapnia, and hypoxemia requiring supplemental oxygen, with steady improvement and uneventful recovery within 2 weeks. There was no bacteriologic evidence of infection or radiographic evidence of delayed lung fluid absorption. The mothers had mild diabetes. These features characterize a newly recognized entity in diabetes-related idiopathic lung disease of the newborn. Possible causative factors are discussed.
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PMID:A newly recognized profile in neonatal lung disease with maternal diabetes. 387 61

Ultrasonically diagnosed maturity changes in the placenta, Grades 0 to III, have been previously shown to correlate with fetal lung maturity. In a prospective study of 230 term and preterm complicated pregnancies, we compared the relationship between sonographic placental grading, amniotic fluid phospholipids, and neonatal outcome. The frequencies of gestational age less than 38 weeks, lecithin/sphingomyelin (L/S) ratio less than 2.0, negative phosphatidylglycerol, and neonatal hyaline membrane disease were found to decrease as placental grade advanced from 0 to III. Patients were divided into subgroups on the basis of maternal complications. In patients with Grade III placentas, the frequencies of gestational age less than 38 weeks and L/S ratio less than 2.0 were significantly increased when the subgroup of patients with chronic hypertension was compared individually to both of the subgroups, repeat cesarean section deliveries, and Classes A, B, and C diabetes mellitus (both with p less than 0.05) All three infants who developed hyaline membrane disease in association with Grade III placentas were from pregnancies of less than 38 weeks complicated by chronic hypertension. These findings suggest that the presence of a Grade III placenta is affected by both gestational age and pregnancy complications. Hence, when an elective cesarean section delivery is being planned near term gestation, a Grade III placenta is a reliable predictor of lung maturity. In preterm complicated pregnancies, an ultrasound-diagnosed Grade III placenta may still be associated with hyaline membrane disease.
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PMID:The relationship of placental grade, fetal lung maturity, and neonatal outcome in normal and complicated pregnancies. 669 81

Fetal lung maturity was assessed in 486 consecutive elective cesarean deliveries. Two hundred forty-seven cases met the ultrasound criterion of a biparietal diameter of 9.2 cm or a grade III placenta. All patients were screened for diabetes. There was one case of hyaline membrane disease. This approach thus reflects fetal lung maturity in 99.6% of patients.
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PMID:Use of ultrasound to predict fetal lung maturity in 247 consecutive elective cesarean deliveries. 670 25


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