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

Recent advances in antepartum fetal evaluation have contributed to a marked reduction in fetal deaths in pregnancies complicated by overt diabetes mellitus. To determine the effect of these changes on neonatal morbidity and mortality, a retrospective analysis of complications in 322 infants of diabetic mothers (IDM) in White classes B--R was undertaken. The majority (89 per cent) of the IDM were delivered at term with a mean gestational age of 38 weeks. Neonatal morbidity correlated significantly with gestational age, occurring in 80 per cent of the preterm and 40 per cent of the term infants. The overall incidence of complications was: hyperbilirubinemia 37 per cent, hypoglycemia 31 per cent, hypocalcemia 13 per cent, polycythemia 8 per cent, and necrotizing enterocolitis 2 per cent. Respiratory distress syndrome (RDS) occurred in 9 per cent and congenital malformations in 6 per cent of the infants. Nine infants died, and four of these deaths were due to anomalies. These data indicate that (1) a reduction in fetal mortality has been accompanied by a reduction in neonatal mortality; (2) neonatal morbidity has been decreased but remains significant in the IDM; and (3) congenital anomalies have replaced RDS as a major cause of neonatal death for the IDM.
Diabetes Care
PMID:Current patterns of neonatal morbidity and mortality in infants of diabetic mothers. 72 46

From May 1974 to March 1989, 48 cases of pregestational diabetes mellitus treated during the third trimester of pregnancy at the Obstetric Clinic of the National Taiwan University Hospital had complete maternal-fetal chart, and were enrolled into this retrospective review. Of these cases, 28 were class B, 13 were class C and seven were class D-R. The maternal complications and perinatal morbidities of each class were reviewed. The mean fasting, postprandial plasma glucose concentrations and the mean excursion of plasma glucose levels were calculated for statistical analysis. Among the maternal complications, urinary tract infections and preterm labor were significantly associated with mean fasting plasma glucose concentrations. Among perinatal morbidities, neonatal respiratory distress and metabolic problems (including neonatal hyperbilirubinemia, symptomatic hypoglycemia, hypocalcemia and polycythemia) were significantly associated with mean plasma fasting glucose concentrations, and perinatal asphyxia was associated with a mean excursion of plasma glucose levels. In view of the paucity of knowledge about the etiology of complications in diabetic pregnancies, it is necessary to conduct a prospective multi-center study with well-characterized morbidities to search for the role of glycemic control in obstetric and perinatal complications.
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PMID:The effect of third-trimester glycemic control on maternal and perinatal morbidities in pregestational diabetes mellitus. 136 27

Neonatal polycythemia is a frequent finding after pregnancies complicated by diabetes and by maternal hypertension with intrauterine growth retardation (IUGR). It is still unclear if the association of polycythemia with hypertension is the result of IUGR or of hypertension per se. To establish the incidence of neonatal polycythemia in populations at risk, we analyzed the results of hematocrit values obtained from 1592 neonates born consecutively at the Hospital de Clinicas, Buenos Aires. Capillary hematocrit values were obtained by heel stick before 6 h of age. When the values were 65% or greater, new samples were obtained from an antecubital vein. The risk of polycythemia in appropriately grown infants of hypertensive mothers was 12.6-fold greater than the risk in the general population. These data show that maternal hypertension poses a significant risk for polycythemia, regardless of fetal growth. We suggest that, to prevent possible sequela, hematocrit is measured routinely in all infants of hypertensive mothers for prompt diagnosis and treatment.
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PMID:Neonatal polycythemia in appropriately grown infants of hypertensive mothers. 142 3

A 62-year-old woman, long suspected of having heart disease, was admitted to our hospital for thorough examination. Her hemoglobin level was 17.7 g/dl and her 2.3-DPG level was 8.90 microM/ml RBC. The patient proved to have polycythemia, hemoglobin Kansas, and diabetes mellitus. To our knowledge, this is the third case of hemoglobin Kansas in the world.
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PMID:Hemoglobin Kansas found in a patient with polycythemia. 145 81

In 40 pregnancies complicated by maternal diabetes mellitus umbilical venous blood was obtained by cordocentesis within 24 hours of elective delivery at 36 to 40 weeks' gestation. The mean fetal hematocrit was significantly higher and the mean platelet count significantly lower than the corresponding values of our reference ranges. Furthermore, blood gas analysis demonstrated these fetuses to be normoxemic but acidemic. The degree of fetal acidemia was significantly associated with both maternal and fetal blood glucose concentrations. The fetal hematologic indices were significantly related to the maternal glycosylated hemoglobin percentage but not to the degree of fetal acidemia or to the maternal or fetal blood glucose concentration at the time of cordocentesis. Fetal acidemia, polycythemia, and thrombocytopenia may contribute to the increased incidence of late unexplained intrauterine deaths in pregnancies complicated by maternal diabetes mellitus.
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PMID:Fetal polycythemia and thrombocytopenia in pregnancies complicated by maternal diabetes mellitus. 156 86

Neonatal morbidity was assessed in the offspring of 878 mothers with gestational diabetes mellitus (GDM), 132 mothers with pre-GDM, and 380 control subjects. Compared with the control group, the GDM group had a higher incidence of complications, including macrosomia, hypoglycemia, hyperbilirubinemia, hypocalcemia, polycythemia, and major congenital anomalies (P less than 0.05). Although our GDM patients were stringently managed with diet or diet plus insulin, as indicated, and maintained almost euglycemic values, these neonatal complications could not be eliminated. Our data may be consistent with observations published during the last decade that even subtle degrees of maternal hyperglycemia can have a detrimental effect on perinatal outcome. Most neonatal complications readily respond to therapy if diagnosed and treated early and promptly. Macrosomia can have a detrimental effect on delivery (trauma) and later long-term implications during childhood. Tight metabolic control with diet and, when indicated, insulin treatment may be advantageous in reducing fetal birth weight. Criteria of how tight the metabolic control should be remain to be accurately defined.
Diabetes 1991 Dec
PMID:Gestational diabetes mellitus. A survey of perinatal complications in the 1980s. 174 70

A simplified model for management of women with gestational diabetes mellitus (GDM) that could be applied at the level of the primary antenatal care was evaluated. Two groups were compared: group I included 172 consecutive GDM subjects cared for at the hospital-based specialized antenatal clinic 1984-85. Group II included 149 consecutive GDM subjects cared for at the primary antenatal clinics 1985-86. Both groups were instructed in self-monitoring of blood glucose and were given dietary instructions. Insulin treatment was initiated if blood-glucose exceeded 9 mmol/l post-prandially three times a week. While women in group II mainly were cared for by midwives, following the routine antenatal program, women in group I were seen every two weeks by an obstetrician and non-stress tests were performed twice weekly from gestational week 35. There were no significant differences with respect to the number of women who required insulin treatment, rate of pregnancy complications or mode of delivery. There were two intrauterine deaths, one in each group, both were unrelated to GDM. There were no group differences regarding large-for-gestational-age infants, respiratory disturbances, neonatal hypoglycemia, hyperbilirubinemia or polycythemia. We conclude that an effective care of GDM-women can be achieved at the primary care level provided frequent self-monitoring of blood glucose is performed for early detection of insulin requiring diabetes.
Diabetes Res 1991 Aug
PMID:A simplified model for management of women with gestational diabetes at the primary care level. 182 38

Diabetes in pregnant Mexican-American women is a serious and expensive health problem. At the University of California, San Diego Medical Center, 44% of pregnant women are Mexican American. In the Diabetes in Pregnancy Clinic, only 7% of women with insulin-dependent diabetes are in this ethnic group compared with 66% of non-insulin-dependent diabetic patients and 51% of those with gestational diabetes mellitus (GDM). GDM is the most common complication of pregnancy in Mexican Americans with a prevalence approximately three times higher than that of whites (4.5 vs. 1.5%). Mexican-American obese GDM subjects had more frequent cesarean sections and were more likely to have complications of premature rupture of membranes and preterm labor (NS). Polycythemia and sepsis also occurred more often in their infants. Anthropometric measurements in infants of both lean and obese GDM subjects differed from those of infants of mothers without GDM. Infants of lean mothers with GDM were heavier and longer than those of lean mothers without GDM. In addition, they had increased waist-hip ratio and triceps and subscapular skin folds. Infants of obese mothers with GDM were heavier than those of lean mothers with GDM. Moreover, they were longer (P less than 0.04); had a higher body mass index (P less than 0.04); and larger waist and hip circumferences (P less than 0.03) and buccal (P less than 0.01), subscapular (P less than 0.01), and sum of skin-fold measurements (P less than 0.03). Our observations indicate that pregnant diabetic Mexican-American women have predominantly GDM and non-insulin-dependent diabetes. They represent a major public health problem because of increased maternal and neonatal morbidity.
Diabetes Care 1991 Jul
PMID:Diabetes in pregnancy in Mexican Americans. 191 21

The prevalence of diabetes in pregnancy and its fetal and perinatal consequences in a large population of Israeli pregnant women during the last decade are presented. The study population consisted of 878 gestational diabetic women, 132 pre-gestational diabetic women, and 380 healthy pregnant women who served as controls. Minor congenital anomalies ranging between 19.4 and 20.5%, major congenital anomalies between 1.80 and 6.82%, and neonatal complications, such as macrosomia (5.6-25.0%), hypoglycemia (0.9-7.8%), hyperbilirubinemia (8.2-16.7%), hypocalcemia (2.7-5.5%) and polycythemia (3.8-13.3%), were observed in the study population. Despite meticulous maternal glucose control, we could not entirely eliminate fetal and neonatal complications. The definition of the normal and abnormal fetal intrauterine metabolic environment remains to be elucidated.
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PMID:Prevalence of congenital anomalies and neonatal complications in the offspring of diabetic mothers in Israel. 196 47

Because chronic hypoxemia causes a redistribution of iron from serum and storage pools into an expanding erythrocyte mass, and because infants of diabetic mothers are often hypoxemic in utero and have a high prevalence of polycythemia at birth, we studied iron distribution in 43 term infants of diabetic mothers. Twenty-four infants were at an appropriate size for gestational age; 19 were large for gestational age. At birth, 28 infants (65%) had abnormal serum iron profiles; eight had decreased ferritin concentrations only (stage 1), nine had decreased ferritin and increased total iron-binding capacity values (stage 2), and 11 had these serum findings plus elevated free erythrocyte protoporphyrin concentrations (stage 3). The hypoglycemic infants who were large for gestational age (n = 14) had a higher prevalence of abnormal iron profiles than euglycemic infants who were appropriate in size for gestational age (n = 20; 93% vs 50%; p = 0.009). Progressively abnormal iron profiles were associated with higher glycosylated fetal hemoglobin values, greater degrees of macrosomia, increased hemoglobin and erythropoietin concentrations, and increased erythrocyte/storage iron ratios. Erythropoietin concentrations were inversely linearly correlated with serum iron values (n = 32, r = -0.54; p = 0.003). The combined erythrocyte and storage iron pools were significantly lower in infants with abnormal iron values whose mothers were diabetic, particularly in infants of women with confirmed diabetic vasculopathy. We speculate that these findings are likely due to (1) increased fetal iron utilization during compensatory hemoglobin synthesis in response to chronic hypoxemia and (2) reduced iron transfer during late gestation complicated by diabetes.
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PMID:Abnormal iron distribution in infants of diabetic mothers: spectrum and maternal antecedents. 239 4


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