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

Sonographic measurement of fetal humeral soft tissue thickness (STT) was performed in 93 women with gestational diabetes mellitus during the third trimester. STT measurements revealed accelerated growth in large for gestational age infants at 31 wk gestation. This new measurement proved to be the most accurate predictor of excessive fetal size compared with other standard ultrasound parameters (sensitivity 82%, specificity 95%, positive predictive value 90%). Asymmetrical growth was more evident in infants with large STT measurements in utero. Humeral STT measurement may distinguish large fetuses with truncal obesity from those that are symmetrically large, thereby allowing prediction of risk for birth trauma before delivery.
Diabetes 1991 Dec
PMID:Sonographic measurement of fetal humeral soft tissue thickness in pregnancy complicated by GDM. 174 68

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

Obstetric complications recorded prospectively were assessed retrospectively in 150 women with gestational diabetes mellitus (GDM) and 305 control subjects matched for age, parity, and ethnicity. Intensive diet therapy and self-monitoring of capillary blood glucose were used to obtain postprandial euglycemia; 22% of GDM subjects required insulin. GDM and control subjects were grouped by body mass index to detect any influence of maternal prepregnancy weight on outcome. Polyhydramnios, preterm labor, and pyelonephritis were not more frequent in GDM, but hypertension without proteinuria (7.3 vs. 3.3%) and preeclampsia (8 vs. 3.9%) were more frequent in GDM. The frequency of hypertensive complications in GDM was not totally attributable to being overweight. Abnormalities of labor, birth trauma, and fetal macrosomia were not more common in GDM; 6.7% of the infants of mothers with GDM weighed greater than 4200 g at birth compared with 3.6% of control infants (NS), and 10% were large for gestational age and sex compared with 6.6% of control infants (NS). Despite this, cesarean delivery was more common in GDM (35.3 vs. 22%, P less than 0.01), mostly due to significantly more cesarean births without labor.
Diabetes 1991 Dec
PMID:Obstetric complications with GDM. Effects of maternal weight. 174 71

More than a decade ago, Norbert Freinkel postulated that alterations in the maternal metabolic milieu at any time during gestation can influence intrauterine development and also may have long-term consequences for certain tissues such as adipocytes, myocytes, pancreatic beta-cells, and neurons. This review illustrates that metabolic alterations early in gestation, such as those that occur in diabetes mellitus, may impair growth of the embryo and increase the risk of dysmorphogenesis. Such delayed growth of the embryo may in turn influence size at birth. In midgestation, metabolic perturbations may accelerate functional maturation of fetal pancreatic beta-cells. Fetal beta-cell development is very sensitive to alterations in the nutrient milieu and may be enhanced in gestational diabetes mellitus (GDM) with only minimal elevations of plasma glucose and minor alterations in other nutrient fuels, including insulinogenic amino acids. Data are reviewed that suggest that the ensuing fetal hyperinsulinemia may promote the development of macrosomia even if metabolic control is satisfactory during late gestation. The overall potential influences of metabolic alterations on intrauterine growth are different in pregnancies complicated by diabetes mellitus throughout gestation (pregestational) and GDM. However, the implications in an individual pregnancy may be defined by the degree of metabolic control at the specific stages of gestation when growth of the embryo, development of fetal beta-cell function, and growth of insulin-sensitive tissues are most critically influenced by the metabolic milieu.
Diabetes 1991 Dec
PMID:Biphasic effects of maternal metabolism on fetal growth. Quintessential expression of fuel-mediated teratogenesis. 174 76

Pacific populations have some of the highest prevalences for diabetes in the world. Whilst universal screening for diabetes in pregnancy does yield the best pick-up rate it is not economically feasible in developing countries. Traditional risk factors have increasingly been shown to miss most gestational diabetes, particularly in populations for whom family history is unknown and obstetrical history not recorded. This study shows genetic origin to be a potent marker for gestational diabetes in a Pacific Island population. It is recommended that in Port Moresby 'at-risk ethnicity' (urban Motuan or Marshall Lagoon origin) be added to the list of indications for antenatal glucose tolerance testing in Papua New Guinean women.
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PMID:Gestational diabetes in Papua New Guinea. 175 Feb 50

Antecedents of high birthweight (macrosomia) were studied using the state birth certificates of White singleton infants born in three large metropolitan counties of Washington State from 1984 to 1986. Cases consisted of 2082 live-born macrosomic infants, defined by a birthweight of over 4.5 kg. A random sample of 4440 live births with birthweights of 2.5-4.0 kg was selected as a comparison group. Estimates for the independent risks associated with gestational and established diabetes, male sex, parity, duration of gestation, maternal smoking during pregnancy, maternal age, and median income of maternal residential area were obtained and combined in a single logistic model. Maternal smoking was associated with a decreased risk of macrosomia (OR 0.4, 95% CI 0.3-0.5). Established diabetes (OR 6.4, 95% CI 2.7-15.4), gestational diabetes (OR 3.2, 95% CI 2.1-5.1) and male sex of the infant (OR 2.4, 95% CI 2.2-2.7) were associated with an increased risk. Increasing parity was related to an increasing risk from para one (OR 1.4, 95% 1.2-1.6) to para six and greater (OR 3.3, 95% CI 1.5-7.4). Increasing duration of gestation was associated with an increasing risk from 33-36 weeks (OR 0.8, 95% CI 0.5-1.2) to 43-45 weeks (OR 3.3, 95% CI 2.5-4.2). Maternal age, median income of maternal area of residence, and maternal marital status were not significantly associated with macrosomia.
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PMID:Antecedents of macrosomia. 175 98

We have previously demonstrated insulin resistance in the liver and peripheral tissues of the adult offspring of rats made diabetic with streptozotocin (SDF rats). In this study, a euglycaemic hyperinsulinaemic clamp was used to test the hypothesis that insulin resistance is further aggravated during pregnancy in SDF rats. Normal pregnancy was accompanied by a decrease in the sensitivity of the liver and peripheral tissues to insulin, with a normal responsiveness to insulin. In SDF rats no further decrease in the sensitivity of peripheral tissues to insulin occurred during pregnancy when compared with non-pregnant rats, and the dose-response curves of the glucose metabolic clearance rate during hyperinsulinaemia were similar in pregnant control and pregnant SDF rats. There was, however, a modest decrease in the sensitivity of the liver to insulin during pregnancy in SDF rats. The normal increase in plasma insulin levels during pregnancy was blunted in SDF rats: this resulted in increased glucose levels in maternal and fetal rats and increased fetal insulin concentrations, features compatible with mild 'gestation diabetes'. In conclusion, gestational diabetes develops in pregnant SDF rats, although there is no further deterioration in peripheral insulin resistance.
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PMID:Absence of pregnancy-induced alterations in tissue insulin sensitivity in the offspring of diabetic rats. 178 85

Gestational diabetes mellitus (GDM) is associated with increased risk of poor outcomes for the pregnancy. It is a strong risk factor for subsequent diabetes. The epidemiology of GDM in African-American women is not well known. It has not been demonstrated that their risk factors are similar in character and weight to those among White women. There is considerable multicollinearity among GDM risk factors such as age, parity, obesity, hypertension, and family history of diabetes, and this needs to be sorted out. This review is based on the results of a nested case-control study to evaluate the frequency of, and the relationships of the known risk factors with, the onset of GDM among African-American women. All cases of GDM within a cohort of women seen at any of the county health department clinics in Jefferson County, Alabama from 1981 to 1987 were identified. The cohort represents approximately 63% of all African-American pregnancies in the county during the period. With few exceptions (5.1% based on fasting plasma glucose greater than or equal to 120 mg/dl), potential GDM cases (7.1%) were selected on the basis of a 2 h post 100 g carbohydrate meal screening plasma glucose measure at their second prenatal visit and again at 28-32 weeks greater than or equal to 115 mg/dl and diagnosed on the basis of the results of an oral glucose tolerance test (OGTT) using the criteria of O'Sullivan and Mahan. Women with any prior history of diabetes (even in pregnancy), 1.6%, were excluded. The frequency of the new diagnosis of GDM among African-American women in this pregnancy in the cohort was 2.5% of pregnancies and 3.4% of women, which is similar to the values reported in the other studies. Controls were selected from women with negative screening tests who delivered after a GDM subject. The results reported in this paper reflect 358 cases (86% of all eligible GDM cases identified) and 273 controls. Cases were significantly older (28.3 vs. 21.7 years), of higher gravidity (2.7 vs. 1.9), more obese (76.7 vs. 61.7 kg), gained weight more rapidly (0.34 vs. 0.28 kg/week), had more hypertension in this pregnancy (28.2 vs. 2.6%), and there was a higher proportion with a family history of diabetes (41.3 vs. 16.5%) (p less than 0.001 for all comparisons). Because there were significant correlations among the risk factors in both cases and controls, multivariable logistic regression analyses were performed.(ABSTRACT TRUNCATED AT 400 WORDS)
Diabetes Metab Rev 1991 Jun
PMID:Gestational diabetes mellitus among African-American women. 179 60

During 3 years of continuous screening for gestational diabetes mellitus in the county of Uppsala, 133 pregnant women (1.2%) were given this diagnosis. Maternal characteristics and the perinatal outcome of the pregnancies were examined retrospectively. Maternal overweight [body mass index greater than 23.9 kg/(m)2] was noted in 54.9% of the 133 women. Insulin therapy, with a mean daily dose of 42 U, was given to 62.4% of the patients, whereas the others were given dietary instructions alone. The frequency of infants with a birth weight greater than 2 SD was 24.1% and was significantly (p less than 0.025) related to pre-pregnancy overweight and also to pregnancy weight gain 18kg (p less than 0.01). Caesarean section was performed in 27% of the pregnancies complicated by diabetes, compared with the overall figure of 11% in Uppsala during the study period. Neonatal hypoglycaemia (blood glucose greater than or equal to 1.6 mM) was noted in 17.3% of the infants and was significantly (p less than 0.01) related to maternal sympathomimetic therapy. Despite liberal and intensive insulin therapy, there was a considerable rate of perinatal complications. Although not severe, they indicate a need for further improvement in the care of women with gestational diabetes.
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PMID:Gestational diabetes-perinatal outcome with a policy of liberal and intensive insulin therapy. 181 78

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


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