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Query: UMLS:C0011849 (diabetes)
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25 years old pregnant women with dysrtophia musculorum progresiva was observed in The Ludwik Rydygier Medical University in Bydgoszcz (Poland). Pre-term activity of uterus and diabetes gravidarum were complicated pregnancy. In 36 week of pregnancy forceps operation was make of obstetric indications and maternal myopathy.
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PMID:[Pregnancy and labor in patients with myopathy]. 1022 73

Pregnancies complicated by insulin-dependent diabetes mellitus (IDDM) pose significant health risks to both the mother and her developing fetus. Congenital malformations in the offspring of diabetic mothers have an incidence which is 2-5 times that seen in the background. Euglycemia in the first trimester of pregnancy can reduce this incidence, but achieving euglycemia with conventional exogenous insulin therapy is both costly and difficult. Even with intense insulin dosage adjustments, the blood glucose profile of the diabetic pregnant patient does not mimic that seen in nondiabetic patients. Both the difficulties and inadequacies of conventional therapy for IDDM-complicated pregnancy provide a stimulus for research to develop improved therapeutic modalities. Islet transplantation holds great promise as a treatment for pregnancies complicated by IDDM. This article reviews the current status of islet transplantation including the use of immunomodulation and immunoisolation techniques and their potential use for the treatment of IDDM pregnancies.
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PMID:Present and future perspectives on the use of free or encapsulated pancreatic islet cell transplantation as a treatment of pregnancy complicated by type 1 diabetes. 1075 35

This study aims to determine the effectiveness of exclusive breastfeeding of newborns in maintaining a normal blood glucose level in the first 48 hours of life. One hundred and twelve consecutive newborns were initially recruited and 91 completed the study. All neonates of mothers with complicated pregnancy such as diabetes, hypertension and infections were excluded from the study. Maternal and cord glucose estimation were carried out within 30 minutes of delivery. All mothers were assisted in positioning and attaching their babies to the breast. All newborn were weighed and glucose levels were measured at 24 and 48 hours of life before breastfeeding. All mothers were euglycaemic while seven neonates had plasma glucose level less than 1.7 mmol/l at birth. Only one neonate had persistent hypoglycemia from birth to 12 hours of age and required treatment. All other neonates had blood glucose level above 1.7 mmol/l at 24 and 48 hours of life. The weight loss was 0.176 +/- 0.134 kg and 0.211+/-0.157 kg at 24 and 48 hours respectively. We therefore conclude that the exclusively breastfed newborns have adequate glucose supply and are not at risk of having hypoglycemia in the first 48 hours of life.
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PMID:Plasma glucose levels in exclusively breastfed newborns in the first 48 hours of life in Ile-Ife, Nigeria. 1169 68

To investigate the influence of obstetric factors and indices of maternal metabolic control on perinatal morbidity and mortality, 88 diabetic pregnant Sudanese women (type 1, n=38; type 2, n=31; gestational diabetes, n=19) and 50 non-diabetic pregnant control women were studied. The mean fasting blood glucose was 11.1+/-2.8 mmol/l and the mean HbA(1c) at booking interview was 8.8+/-2.1% in the diabetic women. Pregnancy complications such as Caesarean sections, urinary tract infections, pregnancy-induced hypertension and intrauterine foetal death were higher among diabetic compared with control women (P<0.0001) and varied with the type of diabetes. Infants of diabetic mothers had a higher incidence of neonatal complications than those of non-diabetic women (54.4% vs. 20.0%; P<0.0001). Infants without complications and who were born to diabetic mothers had better Apgar scores at 5 min (9.8+/-0.5 vs. 8.9+/-1.6; P<0.01) and lower cord C-peptide when compared to infants with complications (P<0.05). In conclusion, the prevalence of maternal and neonatal complications among Sudanese diabetic women and their infants is high. Maternal hyperglycaemia is an important factor affecting maternal wellbeing and neonatal morbidity and mortality.
Diabetes Res Clin Pract 2003 Apr
PMID:Factors affecting perinatal morbidity and mortality in pregnancies complicated by diabetes mellitus in Sudan. 1263 64

We used Minnesota birth certificate data from 1993-2003 to test 2 hypotheses: rates of diabetes-complicated pregnancy are increasing, and disparities between more and less socially advantaged groups are widening. Significant increases occurred in rates (per 1000 live births) of prepregnancy and gestational diabetes mellitus (from 2.6 to 4.9 and 25.6 to 34.8, respectively). Increases were significant in all demographic groups except gestational diabetes among American Indian mothers, and disparities worsened among all groups. Targeted interventions and surveillance improvements are needed.
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PMID:Trends and disparities among diabetes-complicated births in Minnesota, 1993-2003. 1804 97

Pregnancy complications, such as preeclampsia (PEc), have an increased incidence among patients with type 1 diabetes (T1DM), possibly because of maternal vascular involvement. The prototypic long pentraxin, pentraxin 3 (PTX3) is an acute phase reactant critically associated with vascular injury. PTX3 concentrations selectively increase in pregnant women with PEc. Here, we measured PTX3 levels in 37 consecutive pregnant patients with T1DM. Compared with PTX3 levels in healthy pregnant women at identical gestational ages, PTX3 was significantly elevated in pregnant women with diabetes. Patients with pre-existing nephropathy, a well-characterized microvascular complication of diabetes, have even higher PTX3 concentrations and worse maternal and fetal outcomes. Six/thirty-four diabetic non-nephropatic patients developed PEc: PTX3 levels rose abruptly weeks before PEc manifested (p = 0.0375). PTX3 may represent a valuable marker for early detection and prediction of PEc in patients with T1DM.
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PMID:Elevation of plasma levels of the long pentraxin 3 precedes preeclampsia in pregnant patients with type 1 diabetes. 1981 Dec 81

Pregnancy encompasses substantial changes in vascular function to accommodate dramatic increases in blood volume and uteroplacental blood flow to the growing fetus. Despite increased hemodynamics, decreased peripheral resistance results in a reduction in mean arterial blood pressure. Vascular tone, and hence peripheral resistance, is determined by a delicate balance of constrictor and dilator capacities. In the normal physiological response to pregnancy, endothelial-derived hyperpolarization (EDH) has been shown to be a major contributor; both EDH and nitric oxide (NO) are predominantly involved in providing an increased vascular capacity for vasodilation. The ability of EDH and NO to adequately accommodate increased blood volume is tested in pathological states such as placental insufficiency or diabetes and both EDH and NO-dependent mechanisms seem to be impacted in these situations. Pregnancy complications also have an impact on the cardiovascular health of the offspring. In adult offspring born from complicated pregnancies, the data suggest that EDH mechanisms are largely maintained, whereas NO is commonly reduced. A diversity of EDH mechanisms may be useful in providing many targets for potential therapeutic avenues for compromised pregnancies; however, further research delineating the mechanisms of EDH and the interactions of NO and EDH, in normal and pathological pregnancies is required.
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PMID:Arterial endothelium-derived hyperpolarization: potential role in pregnancy adaptations and complications. 2318 31

Pregnancy complications such as preeclampsia and diabetes affect approximately 5 to 10 % of all pregnancies and compromise maternal and fetal health during gestation. Complications during pregnancy may also contribute to the development of hypertension and future cardiovascular risk in the mother. Moreover, fetal exposure to hypertension and diabetes during pregnancy can program hypertension and cardiovascular disease in the offspring. Transgenerational transmission of programmed cardiovascular risk highlights the importance of understanding the mechanisms that link complications during pregnancy with later hypertension in her offspring and subsequent generations. However, experimental studies are needed to investigate the cause and effect of increased blood pressure in the mother following a complicated pregnancy and provide insight into the development of preventative measures that may improve the long-term cardiovascular health of women and their offspring.
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PMID:Pregnancy Complications and Later Development of Hypertension. 2391 79

Viral infections are known to adversely affect pregnancy, but scant attention has been given to human papilloma virus (HPV) infection. We aimed to determine the molecular and histopathological features of placental HPV infection, in association with pregnancy complications including fetal growth restriction, pre-maturity, pre-eclampsia, and diabetes. Three hundred and thirty-nine placentae were selected based on the presence or absence of pregnancy complications. Five independent methods were used to identify HPV in the placenta, namely, immunohistochemistry for L1 viral capsid, in situ hybridization to high-risk HPV DNA, PCR, western blotting, and transmission electron microscopy. Pregnancy complications and uterine cervical smear screening results were correlated with placental HPV histopathology. In this study, which was deliberately biased towards complications, HPV was found in the decidua of 75% of placentae (253/339) and was statistically associated with histological acute chorioamnionitis (P<0.05). In 14% (35/253) of the HPV positive cases, HPV L1 immunoreactivity also occurred in the villous trophoblast where it was associated with a lymphohistiocytic villitis (HPV-LHV), and was exclusively of high-risk HPV type. HPV-LHV significantly associated with fetal growth restriction, preterm delivery, and pre-eclampsia (all P<0.05). All cases of pre-eclampsia (20/20) in our cohort had high-risk placental HPV. A further 55 cases (22%, 55/253) of HPV positive placentae had minimal villous trophoblast HPV L1 immunoreactivity, but a sclerosing pauci-immune villitis, statistically associated with diabetes (49.1%, 27/55, P<0.05). For women with placental HPV, 33% (69/207) had an HPV-related positive smear result before pregnancy compared with (9.4% 8/85) of women with HPV-negative placentae (P=0.0001). Our findings support further investigations to determine if vaccination of women and men will improve pregnancy outcomes.
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PMID:A clinicopathological study of episomal papillomavirus infection of the human placenta and pregnancy complications. 2629 78

Nowadays metabolic syndrome represents a real outbreak affecting society. Paradoxically, pediatricians must feel involved in fighting this condition because of the latest evidences of developmental origins of adult diseases. Fetal programming occurs when the normal fetal development is disrupted by an abnormal insult applied to a critical point in intrauterine life. Placenta assumes a pivotal role in programming the fetal experience in utero due to the adaptive changes in structure and function. Pregnancy complications such as diabetes, intrauterine growth restriction, pre-eclampsia, and hypoxia are associated with placental dysfunction and programming. Many experimental studies have been conducted to explain the phenotypic consequences of fetal-placental perturbations that predispose to the genesis of metabolic syndrome, obesity, diabetes, hyperinsulinemia, hypertension, and cardiovascular disease in adulthood. In recent years, elucidating the mechanisms involved in such kind of process has become the challenge of scientific research. Oxidative stress may be the general underlying mechanism that links altered placental function to fetal programming. Maternal diabetes, prenatal hypoxic/ischaemic events, inflammatory/infective insults are specific triggers for an acute increase in free radicals generation. Early identification of fetuses and newborns at high risk of oxidative damage may be crucial to decrease infant and adult morbidity.
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PMID:Fetal programming and early identification of newborns at high risk of free radical-mediated diseases. 2717 Sep 27


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