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A study was carried out to determine the effect of established and gestational diabetes on pregnancy outcome over a period of two years at Harare Maternity Hospital, Harare, Zimbabwe. During the period, 51 patients with established diabetes mellitus and 70 patients with gestational diabetes were treated. The perinatal mortality was higher among this group (124 per 1,000) compared with the rest of the total hospital population (44 per 1,000) who delivered during the same period.
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PMID:The effects of established and gestational diabetes on pregnancy outcome at Harare Maternity Hospital. 142 45

In a single practice during the 21 years 1971-1991, the incidence of gestational diabetes in pregnancies in which norethisterone was prescribed was 32.4% (22 of 69) in comparison with 7.1% in pregnancies in which the women did not take norethisterone (137 of 1,684) (p < 0.001). Gestational diabetes was no less severe (degree of hyperglycaemia, need for insulin therapy) when associated with norethisterone. However, follow-up revealed that gestational diabetes when associated with norethisterone had a lesser risk of emerging diabetes mellitus and impaired glucose tolerance. Masculinization of a female fetus occurred in 5 of 39 (12.8%) exposed to norethisterone; all were cases of clitoral hypertrophy not requiring surgical treatment. Norethisterone in these 69 pregnancies accounted for 33.3% (5 of 15) cases of clitoral hypertrophy diagnosed in 100,756 consecutive births.
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PMID:Norethisterone and gestational diabetes. 144 34

The only drugs which commonly cause diabetes during therapeutic use are the anti-hypertensive vasodilator diazoxide, and corticosteroids in high doses such as those used to palliate intracranial tumours. Thiazide diuretics have in the past been used in higher doses than necessary to treat hypertension, and the lower doses now used probably carry only a slight risk of inducing diabetes. The risk from beta-blockers is also quite small, but there is some evidence that thiazides combined with beta-blockers may be more likely to cause diabetes than either drug alone. The combination is probably best avoided in patients with a family history of non-insulin-dependent diabetes. The effect of the low-oestrogen combined oral contraceptive pill seems to be slight, and it presents a risk only to women who have had gestational diabetes. Bodybuilders who take enormous doses of anabolic-androgens can develop impaired glucose tolerance. Several drugs, including theophylline, aspirin, isoniazid and nalidixic acid can cause transient hyperglycaemia in overdosage, but only streptozotocin, alloxan and the rodenticide Vacor are likely to cause permanent diabetes.
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PMID:Drug-induced diabetes. 144 73

The characteristics and outcome of pregnancy complicated by gestational glucose intolerance are described in a consecutive series of 69 Bengali Asian patients and a parallel group of 22 Caucasian patients. The Bengali patients were older and of higher parity than the Caucasians and more frequently required insulin therapy. However, the outcome of pregnancy was similar in terms of antenatal clinic attendance, the number of antenatal hospital admissions, glycaemic control, birthweight and mode of delivery. Of those patients who attended for postnatal glucose tolerance test, 20% of the Bengali population demonstrated persisting abnormality of glucose tolerance, whereas no abnormalities were evident in the Caucasian group. These findings are consistent with the high prevalence and early age of onset of non-insulin-dependent diabetes in Asian populations. The World Health Organisation (WHO) criteria for the diagnosis of impaired glucose tolerance proved insufficiently sensitive for the diagnosis of gestational diabetes. This was particularly demonstrated by four patients with apparently normal glucose tolerance by WHO criteria who subsequently required insulin therapy.
Diabetes Res Clin Pract 1992 Oct
PMID:Outcome of gestational diabetes in Bengali Asians living in an east London health district. 144 77

Plasma lipoproteins were studied longitudinally at the 1st, 2nd, and 3rd trimester of gestation and at postpartum and postlactation in 12 age-matched PGDM women, 9 GDM women, and 12 healthy control subjects. FPG and HbA1c were higher in every case in PGDM women than in control subjects, whereas in GDM patients, glucose was augmented only after parturition. FFA and beta-hydroxybutyrate levels were higher in both PGDM and GDM patients than in control subjects during gestation but not after parturition. Total TGs and VLDL, LDL, and HDL TGs increased with gestational time in the three groups and declined at postpartum, and although total cholesterol and VLDL, LDL, and HDL cholesterol followed a similar trend, their rise was less pronounced, and the decline after parturition was slower than that of the TGs in the three groups, with no difference among them. The VLDL TG/cholesterol ratio declined in the three groups at the 3rd gestational trimester, whereas in both LDL and HDL, the TG/cholesterol ratio, but not the cholesterol/phospholipid ratio, increased during gestation in the three groups, indicating a specific enrichment of TGs in these particles. The increase in apoA-I and apoB with gestation was parallel to the respective changes in HDL and LDL cholesterol and, again, no difference was observed between the three groups. Plasma levels of beta-estradiol, progesterone, and prolactin increased sharply with gestation and declined at postpartum in the three groups, but absolute values of beta-estradiol and prolactin, at the three trimesters of gestation, were lower in PGDM patients, but progesterone levels were lower than controls in GDM women only at the 3rd trimester. (ABSTRACT TRUNCATED AT 250 WORDS)
Diabetes 1992 Dec
PMID:Longitudinal study of plasma lipoproteins and hormones during pregnancy in normal and diabetic women. 144 7

The fasting plasma glucose assay was compared with the one-hour post-glucose test as a screening test for identification of gestational diabetes. Of 4,561 consecutive patients screened with a 50-g glucose test, 968 (21.2%) had results > or = 135 mg/dL; 141 (14.6%, or 3.1% of the total) were found to have diabetes. In the 968 patients, the area under the fasting plasma glucose receiver operating characteristic curve was greater than that under the glucose screening test curve, indicating greater discriminatory value of the former test. Of the 116 patients who had sequential glucose screening tests and fasting plasma glucose assays performed twice during pregnancy, a significant correlation was found for fasting plasma glucose values, but not for glucose screening test values. We conclude that the fasting plasma glucose assay may perform better than the one-hour post-glucose test as a screening test for gestational diabetes. Based on these data, a population-based prospective study seems justified.
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PMID:Could the fasting plasma glucose assay be used to screen for gestational diabetes? 146 Jun 7

Regular exercise may diminish the risk for atherosclerotic vascular disease in patients with non-insulin-dependent (type II) diabetes and in the general population. The basis for this effect of exercise may be its ability to diminish or prevent hyperinsulinemia, insulin resistance, and/or increases in intra-abdominal adipose mass. These abnormalities are associated with premature atherosclerotic vascular disease, essential hypertension, type II diabetes, and certain dyslipoproteinemias, and most likely precede them. They also have been implicated in the pathogenesis of these disorders. We propose that the high prevalence of hyperinsulinemia and insulin resistance in individuals leading a western life-style accounts for the reported benefit of physical activity in preventing coronary heart disease in the general population. We also propose that exercise (and diet) are most likely to be effective when initiated in young individuals, before the onset of irreversible vascular alterations, and when life-style changes may be more acceptable. Early identification of such individuals may be possible on the basis of family history, the presence of components of the hyperinsulinemia-insulin resistance syndrome, and/or central obesity. One such group that may already have been identified is women with gestational diabetes.
Diabetes Care 1992 Nov
PMID:Diabetes, exercise, and atherosclerosis. 146 16

25 infants of diabetic mothers were studied from July to December 1988 at the St. Philomena, central, and University Teaching Hospitals in Benin City, Nigeria, over a 6-month period to assess the value of midarm circumference/head circumference (MAC/HC) ratio in the evaluation of outcome of diabetic pregnancies. Infants whose gestational ages ranged from 36 to 40 weeks and had been delivered consecutively to diabetic mothers were recruited. Each infant was weighed at birth by trained delivery-room staff. The weights were recorded to the nearest 0.05 kg. Gestational age was computed in completed weeks from maternal last menstrual period (LMP). MAC and HC were measured within the first 24 hours of birth using a nonelastic tape measure. For each infant, 3 readings of each parameter were obtained and only the mean recorded to the nearest 0.1 cm MAC/HC ratio was computed. 19 infants were born to mothers with non-insulin-dependent diabetes and 6 to mothers with gestational diabetes mellitus. Birth weights ranged from 3.25 kg to 4.7 kg. There were 15 males and 10 females and 14 preterm infants. 14 infants were born to mothers with good control, i.e., fasting blood glucose less than 120 mg% (about 6.7 mmol/L) and absence of glucosuria. 13 of them experienced normal intrauterine growth based on the MAC/HC standard; while 10 infants had abnormal intrauterine growth with 9 delivered to mothers with poorly controlled disease. The sensitivity of the MAC/HC standard was 81.8% and its specificity was 92.9%. The scattergram of the MAC/HC standard showed that 9 of the 10 infants above the 95% confidence belt were born to diabetic mothers with poor control. On the hand, 13 of the 15 infants within the confidence belt were born to mothers with good control. The standard was useful in identifying infants of diabetic mothers most likely at increased risks for neonatal morbidity, and it is recommended for routine evaluation particularly in developing countries.
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PMID:Assessment of infants of diabetic mothers by a simple body mass index. 147 14

We studied the cumulative incidence, concordance rate and heritability for diabetes mellitus in a nationwide cohort of 13,888 Finnish twin pairs of the same sex. The twins were born before 1958 and both co-twins were alive in 1967. Data on diabetes were derived through computerized record linkage from death certificates, the National Hospital Discharge Register and the National Drug Register. Records were reviewed in order to assign a diagnostic category to the 738 diabetic patients identified. Of these patients 109 had Type 1 (insulin-dependent) diabetes, 505 Type 2 (non-insulin-dependent) diabetes, 46 gestational diabetes, 24 secondary diabetes, 38 impaired glucose tolerance and 16 remained unclassified. The cumulative incidence of diabetes was 1.4% in men and 1.3% in women aged 28-59 years and 9.3% and 7.0% in men and women aged 60 years and over, respectively. The cumulative incidence did not differ between monozygotic and dizygotic twins. The concordance rate for Type 1 diabetes was higher among monozygotic (23% probandwise and 13% pairwise) than dizygotic twins (5% probandwise and 3% pairwise). The probandwise and pairwise concordance rates for Type 2 diabetes were 34% and 20% among monozygotic twins and 16% and 9% in dizygotic twins, respectively. Heritability for Type 1 diabetes was greater than that for Type 2 where both genetic and environmental effects seemed to play a significant role.
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PMID:Concordance for type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus in a population-based cohort of twins in Finland. 831 54

The prevalence of gestational diabetes mellitus by screening 25,997 pregnant women in Rajavithi Hospital during a two-year-period was 2.02 per cent. Of the 312 gestational diabetes patients available for the study, their mean age was 29 years. Risk factors included a BMI before pregnancy of more than 26 (26.5%), family history of diabetes mellitus (23.1%), history of abortion (14.4%), and history of fetal death in utero (3.2%). Macrosomia, congenital anomalies and cesarean delivery were found significantly more common in gestational diabetic patients compared to normal pregnancy.
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PMID:Gestational diabetes mellitus. 148 78


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