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

From 1978 to 1986 a total of 189 pregnant diabetic women gave birth at our hospital. In this randomized prospective study the influence of maternal diabetes treatment in normoglycemic patients, continuous subcutaneous insulin infusion (n = 48) versus intensified conventional treatment (n = 41), is evaluated. These two groups of patients are further compared to patients (n = 28) who underwent conventional diabetes treatment during pregnancy. It can be shown from our data that the rate of complications such as preeclampsia, intrauterine growth retardation, premature labor and premature delivery can be reduced by intensified conventional and insulin pump treatment as compared to conventionally treated patients with late onset of pregnancy care. As expected, in the groups of CSII and ICT patients no difference in the rate of pregnancy complications nor in fetal outcome could be demonstrated. Among CSII pregnancies 12/48 were complicated, in the ICT population the respective figure was 13/41 (CT: 20/28). The mean gestational age at the time of delivery ranged between 38 and 40 weeks, depending on the severity of maternal diabetes. CT patients were delivered earlier in all White classes. Fetal morbidity was nearly equal in CSII and ICT children, in CT patients it was greatly enhanced. Also the mortality (perinatal and neonatal) was considerably larger in CT patients (6/28), again, in the CSII and ICT population the mortality was nearly identical (2/48 and 3/41). We conclude, from our prospective information, that insulin pump therapy during pregnancy is indicated if intensified conventional treatment does not lead to normoglycemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Complications and fetal outcome in diabetic pregnancy. Intensified conventional versus insulin pump therapy. 306 58

A population based case-control study of the association between dissimilar race of parents and risk of pre-eclampsia was undertaken. Data on singleton births in Washington State in 1981 were available for analysis from birth certificates. All mothers recorded as having pre-eclampsia and a sample of mothers who did not have pre-eclampsia were eligible for comparison with regard to racial dissimilarity between parents. Women with previously diagnosed cardiovascular disease and diabetes were excluded. After the confounding effects of maternal parity and race had been controlled for, racial dissimilarity of parents was associated with a 1.9-fold increased risk of pre-eclampsia (95% confidence interval = 1.3-2.8; number of cases = 973, of controls = 1480). This finding supports the theory that genetic dissimilarity of father and mother has a role in pre-eclampsia and is consistent with an immunogenetic aetiology.
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PMID:An epidemiological study of the immunogenetic aetiology of pre-eclampsia. 308 Jan 75

Numerous investigations in animals and humans on the role of eicosanoids in pregnancy yielded the following results. During normal pregnancy, there is an increased production of eicosanoids with a vasodilatory action, prostaglandin E2 (PGE2) and prostacyclin (PGI2), especially in the uteroplacental and renal regions. This additional production contributes to a reduction in peripheral resistance so that the increase of blood volume which is specific for pregnancy can occur without increase in blood pressure. The fact that eicosanoids participate in this mechanism is shown by administration of prostaglandin synthesis inhibitors, thus producing a rise in blood pressure. In the autoregulation of the vessels, interactions between renin angiotensin and PGE2 and PGI2 are thought to play an important role also in pregnancy. In support of this concept it has been shown that the pregnancy-specific reduction in vasoconstrictor action of angiotensin, is abolished when prostaglandin synthesis inhibitors are given. It is assumed that PGE2/PGI2 production and the renin angiotensin production influence each other physiologically. Another important factor in the control of the haemodynamics and blood coagulation is represented by the prostacyclin-thromboxane system. In normal pregnancy there should be a production equilibrium between the two antagonistic eicosanoids. In preeclampsia this equilibrium, which is particularly marked in the placenta and region of the foetal vessels, is disturbed with decreasing PGI2. The main symptoms of preeclampsia--increase in blood pressure, coagulation disturbances and diminished placental circulation--can be derived from this. In diabetes and foetal growth retardation, both of which predispose to preeclampsia, similar changes in eicosanoid production have been observed. Hence, in case of preeclampsia with disturbed eicosanoid production the administration of prostaglandin synthesis inhibitors such as peripherally acting analgesics and corticoids is contraindicated. Approaches to a rational therapy such as administration of thromboxane synthesis inhibitors, a diet with prostaglandin precursors and infusions of PGI2 appear promising according to preliminary results. Further advances may be expected after the function of eicosanoids of the lipoxygenase paths in preeclampsia has been elucidated.
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PMID:[Significance of prostaglandins and other eicosanoids in the physiology and physiopathology of pregnancy]. 308 7

Failure of the shoulders to deliver after delivery of the head is known as shoulder dystocia. The risk factors associated with its occurrence were examined in women delivering vaginally at Jordan University Hospital. The profile of the patient most likely to present with shoulder dystocia was determined to be a multiparous, obese patient, over 42 weeks' gestation in a pregnancy complicated by preeclampsia or diabetes with an infant weighing 4,500 g or more. Neonatal complications were noted to be high. There was no maternal death but 4 stillborn infants were delivered and 1 died in the immediate neonatal period.
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PMID:Shoulder dystocia: risk factors and prevention. 322 2

Previous studies have shown that diabetic women more commonly have complications of pregnancy and adverse infant outcomes than do other women. However, most of the studies have not evaluated women with gestational diabetes separately. The purpose of this study was to evaluate pregnancy complications and infant morbidity and mortality among births to women with gestational diabetes and women with established diabetes. Birth certificate data from 1984 in Washington State linked with death certificate data provided information on complications of pregnancy and infant outcome for 422 gestational diabetics and 144 established diabetics. A comparison group of 856 non-diabetic women who delivered a child was selected at random. Both established and gestational diabetic women were more likely to be reported to develop pre-eclampsia (relative risk (RR) = 4.0 and 9.6). Established and gestational diabetic women were also at increased risk of delivery by Caesarean section (RR = 2.1 and 5.0). Infants of established diabetics had a higher risk of congenital anomalies (RR = 7.6) than infants of non-diabetics and were at increased risk of death in the first 4 weeks (RR = 7.9) and the first year of life (RR = 5.0). Gestational diabetics were more likely to have high birthweight babies (greater than 4000 g) (RR = 2.1) while established diabetics were more likely to have babies at either extreme of birthweight (greater than 4000 g, RR = 1.7; less than 2500 g, RR = 3.2). We conclude that both gestational and established diabetes are associated with important increases in risk of pregnancy complications and adverse infant outcomes.
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PMID:Diabetes in pregnancy: maternal and infant outcome. 324 51

The amniotic fluid lecithin/sphingomyelin (L/S) ratio from 128 cases of high risk pregnancies were measured by using high performance liquid chromatography (HPLC). The L/S ratio was found to be increased in patients with pre-eclampsia, hypertension, intrauterine growth retardation (IUGR), prolonged rupture of membranes (PROM), and twin gestation, but decreased in patients with diabetes from gestational diabetes to class C. In patients with placenta previa, the L/S ratio was not affected.
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PMID:Amniotic fluid lecithin/sphingomyelin ratio in high risk pregnancy. 324 20

In Bahrain, the Ministry of Health (MOH) medical facilities, which included 1 main maternity hospital, 2 peripheral hospitals, and 3 maternity units under the direction of midwives, reported 29,644 births during January 1985-December 1987. 355 of these were stillbirth and 228 infants died within the 1st week which made up a perinatal mortality rate of 19.6/1000 births. The leading causes of perinatal deaths included, in descending order, low birth weight, mainly due to prematurity (29.3%); congenital malformations (24.9%); mechanical problems, especially cord complications (12%), antepartum hemorrhage, most caused by abruptio placentae (9.1%), and preeclampsia (9.1%). Of the 438 normally formed infants that died, 185 (42.2%) of these were antepartum, 115 (26.3%) intrapartum, and 138 (31.5%) postpartum. 45 (10%) of the normally formed infants that died weighed above the 10th percentile for their gestational age and there were no maternal complications. The researchers classified 101 of all the infant deaths (17.3%) as avoidable perinatal deaths--70% due to poor patient compliance, 28% due to medical mismanagement, and 2% due to a combination of these factors. The MOH must emphasize health education and regular prenatal visits for pregnant mothers. Health practitioners need to reevaluate present prenatal and intrapartum clinical methods and to routinely screen for diabetes and other possible high risk factors.
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PMID:Perinatal mortality in Bahrain. 325 Apr 47

Corticotropin-releasing hormone was discovered in the placenta, and its concentration in the maternal plasma was found to increase greatly during the latter half of pregnancy. We studied the concentration of immunoreactive corticotropin-releasing hormone in amniotic fluid in 59 uncomplicated and in 73 complicated pregnancies. The mean (+/- SE) value of corticotropin-releasing hormone in amniotic fluid in uncomplicated pregnancies was significantly higher in the third (24.1 +/- 3.3 pmol/L) than in the second (9.1 +/- 0.7 pmol/L) trimester, but no change was found during labor. In groups matched by gestational age, larger mean values of corticotropin-releasing hormone and cortisol were observed in the group in which the lecithin/sphingomyelin ratio was greater than 2 or the phosphatidylglycerol test was positive than in the group with a lecithin/sphingomyelin ratio less than 2 or a negative phosphatidylglycerol test result. In samples taken at an interval of 1 to 3 weeks, concomitant increases in corticotropin-releasing hormone and cortisol levels were found with the appearance of phosphatidylglycerol. Concentrations of corticotropin-releasing hormone in amniotic fluid were elevated in patients with diabetes and in women with preeclampsia and intrauterine growth retardation. We conclude that the intrauterine release of corticotropin-releasing hormone increases during the last trimester. This may stimulate the fetal pituitary-adrenal axis and promote fetal maturation.
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PMID:Corticotropin-releasing hormone in amniotic fluid during gestation and labor and in relation to fetal lung maturation. 326 45

Human placental villi from normal and pathological material from the eighth to the 40th week of gestation were examined by light, scanning and transmission electron microscopy. Trophoblastic specializations--such as syncytial sprouts of early and late pregnancy, syncytial knots and syncytial bridges--were classified into proliferative and degenerative processes or artefacts caused by tangential sectioning. In early pregnancy and in diabetes mellitus most syncytial sprouts represent the initial phases in the development of villi. In late pregnancy, in particular in pre-eclampsia, most syncytial knots, sprouts and bridges are histological artefacts, caused by tangential sectioning of the trophoblastic surface. The chance of producing such artefacts is increased with increasing section thickness and with increasing branching and tortuosity of the villi. However, a small proportion of the syncytial knots, sprouts and bridges in the last-trimester placenta, those containing coarse pyknotic nuclei, are trophoblastic specializations of a probably degenerative character.
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PMID:Interpretation of syncytial sprouts and bridges in the human placenta. 330 29

A clinical study was undertaken to assess gynecologic-obstetric changes in morbidly obese women who lost greater than or equal to 50% of their excess weight with bariatric surgery. The 138 females (109 of reproductive age), age 35 +/- 9 SD yr, weighed 124 +/- 23 kg before surgery and 79 +/- 13 kg after weight loss had stabilized. Menstrual irregularities were present in 40.4% of premenopausal patients preoperatively; after massive weight loss, cycles were abnormal in 4.6% (p less than 0.001). Infertility problems were present preoperatively in 29.3% Of these, nine tried to conceive after weight loss and were successful. During past pregnancies, medical complications were frequent (hypertension 26.7%, pre-eclampsia 12.8%, diabetes 7.0%, and deep vein thrombosis 7.0%). After weight-loss stabilization, these obstetric complications did not occur. Incidence of urinary stress incontinence decreased from 61.2% to 11.6% (p less than 0.001). Gynecologic-obstetric changes tended to normalize after loss of massive body weight.
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PMID:Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery. 336 Oct 39


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