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There is still controversy concerning the reference ranges for glucose tolerance tests in pregnancy. The WHO has recommended the universal use of the 75 g oral glucose load with 2-h post-load values of greater than 6.7 mmol l-1 to be considered impaired glucose tolerance (IGT) in the non-pregnant, and equivalent to gestational diabetes in the pregnant. Some data are available for pregnant Caucasians but little information is available for other ethnic groups. Oral glucose tolerance tests (75 g) have therefore been performed in 189 pregnant women in rural Tanzania. Mean fasting blood glucose values were 4.0 mmol l-1 in non-pregnant women, and 3.7, 3.5, and 3.3 mmol l-1 in pregnant women in the first, second, and third trimesters, respectively. Two-hour OGTT values were 4.7 mmol l-1, and 4.6, 4.5, and 4.2 mmol l-1 while the upper limit of normal values (mean + 2SD) were 7.1 mmol l-1, and 6.8, 6.8, and 6.1 mmol l-1. The 2-h glucose levels are therefore close to WHO recommendations but lower than those reported for Caucasians. By contrast with reports for Caucasians, glucose tolerance did not deteriorate during pregnancy. The prevalence of diabetes and IGT was zero in the pregnant group.
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PMID:No deterioration of oral glucose tolerance during pregnancy in rural Tanzania. 182 41

Diabetes in pregnancy has an influence on the development of the fetus. There are strong indications that the intrauterine diabetic milieu has long-lasting consequences. In the rat, mild diabetes during pregnancy induces decreased insulin secretion in later life, whereas severe diabetes is responsible for insulin resistance. In the human, data are available showing a long-term consequence in the offspring of type I diabetes and gestational diabetes mellitus.
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PMID:The effects of maternal diabetes on the offspring. 183 33

Preexisting maternal diabetes and gestational diabetes (GDM) create challenges for health care providers to avoid complications for both mother and infant. Poor control of preexisting diabetes during the first trimester of pregnancy predisposes the infant to major congenital anomalies. Infants born to mothers with GDM are at increased risk for macrosomia as well as other perinatal morbidity and mortality. This article discusses the role of the NP in diagnosing, managing, and treating pregnant women with preexisting and gestational diabetes.
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PMID:Role of the nurse practitioner in diabetes and pregnancy management. 184 Sep 75

Some features as well as pathological findings in 63 infants born to diabetic mothers (IDM) under control in a diabetes unit of a general hospital at metropolitan Santiago, Chile, from 1985 through 1988 are presented. Out of 63 newborns, 22 came from mothers with pregestational diabetes mellitus (PGDM) and 41 were born to mothers with gestational diabetes mellitus (GDM). Significant differences were detected among PGDM and GDM groups of newborns in the following features: mean gestational age (GE) premature (54.5% vs. 26.8% 37 weeks GE or less), jaundice (40.9% vs. 17.1%) and congenital malformations (18.2% vs. 0%). No significant differences were found in fetal distress, hypoglycemia, respiratory distress syndrome and birth trauma although as a whole these last were more frequently recorded among infant born to insulin dependent diabetic mothers. It is concluded that in spite of an appropriate control, morbidity remains higher in IDM, particularly in IDM PGDM.
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PMID:[Newborn infants of diabetic mothers]. 184 60

The study compares 156 newborns whose mothers had an endocrinological diagnosis of various glucose metabolism disorders, and a control group of 42 newborn whose mothers had no glucose metabolism disorder. The entire sample including the control group had 98 males and 100 females. The study group with 156 newborns was divided into 4 groups, depending on the degree of the mother's disorder. In group 1, the baby's mothers suffered diabetes mellitus type 1; group 2, diabetes type 2; group 3, gestational diabetes; and group 4, pregnancy disorders of glucose. We observed that there were no differences among the groups in the weight/height ratio. Nevertheless there was great variability in the correlation between height and weight among the study groups. Multiplex box and whisker plots conform that intergroup dispersions in the weight height ratio was greater for the experimental group than for the control group. The pattern results was similar for the weight-head circumference ratio. We concluded that adequate control of glucose metabolism disorder during pregnancy results in product with normal growth indices.
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PMID:[Anthropometry at birth of the child of a mother with a change in glucose metabolism]. 187 57

There is not sufficient information about the follow up of children belonging to mothers with some degree of glucose metabolism disorder. At The National Institute of Perinatology were studied 151 newborn. The babies were divided into four groups. The group 1 consisting of babies born from mothers with diabetes mellitus type I; group 2 of babies born from mothers with diabetes mellitus type II; group 3 including babies from mother with gestational diabetes and group 4 babies from mothers who presented alteration in glucose metabolism during pregnancy. After the evaluation of the somatic indicator we found an harmonic behavior in group 3 in weight, height and head circumference again. The most important finding was the low correlation in anthropometry at birth and one year of age. Finally we conclude that a strict control on the follow-up of the somatic growth of children, must be achieved because the hypertrophy during the first year of age depends on sociocultural and economic patterns.
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PMID:[The evolutionary anthropometric profile of the child of a mother with a change in glucose metabolism]. 187 58

A 12-month prospective study was carried out in 120 Chinese patients with gestational diabetes who were found to have persistent carbohydrate intolerance at 6 weeks postpartum. The 75 g OGTT and WHO diagnostic criteria were employed for both antepartum and postpartum assessment. By 12 months, persistent carbohydrate intolerance was found in 13.3% of the patients only, 6 patients were diabetic while 10 had impaired glucose tolerance. Of those whose carbohydrate tolerance reverted to normal, 85% did so within the first 6 months. The clinical variables were analysed by multiple discriminant analysis using the logistic model. Five prognostic variables which were predictive of persistent carbohydrate intolerance at 12 months were identified. In order of decreasing predictive value, these included a high fasting glucose during pregnancy and at the first postnatal visit, a high antepartum 2 h blood glucose, the requirement of insulin during pregnancy, and a high postpartum 2 h blood glucose. Macrosomia, gestational age at diagnosis and a family history of diabetes were not predictive of persistent carbohydrate intolerance. Multiparity, maternal age and body mass index were of marginal significance only. The fitted logistic model provides a mechanism to estimate the probability of persistent carbohydrate intolerance. Such information will be helpful in patient counselling and in the efficient planning of postpartum medical follow-up.
Diabetes Res Clin Pract 1991 Jul
PMID:Prediction of persistent carbohydrate intolerance in patients with gestational diabetes. 188 47

We have previously reported a decrease in gluconeogenesis from alanine in normal pregnant women at term gestation as compared with nonpregnant women. In the present study, the effect of diabetes on alanine metabolism was examined in five gestationally diabetic (GDM) women and seven women with type I (insulin-dependent) diabetes (IDDM) during the third trimester of pregnancy. The hemoglobin A1c (HbA1c) concentrations in all subjects were within normal range, indicating good metabolic control. After an overnight fast, each subject was infused simultaneously with L-[2,3, 13C2]alanine and D-[6,6,2H2]glucose tracers as prime constant rate infusion. Plasma alanine and glucose isotopic enrichments were measured by gas chromatography-mass spectrometry. Alanine and glucose turnover rates were quantified by tracer dilution. In five subjects, the contribution of alanine carbon to CO2 was quantified by respiratory calorimetry and by measurement of 13C enrichment of expired CO2. Data from 15 previously reported normal pregnant subjects were used for comparison. The rate of alanine turnover was similar in the GDM and IDDM subjects and was not different from the normal subjects (GDM, 4.6 +/- 1.9; IDDM, 5.4 +/- 2.5; normals, 4.4 +/- 0.8 mumol/kg.min, mean +/- SD). The rate of glucose turnover was significantly reduced (P less than .05) in IDDM as compared with GDM and normal subjects (IDDM, 8.1 +/- 0.8; GDM, 11.5 +/- 3.5; normals, 12.2 +/- 2.2 mumol/kg.min). The contribution of alanine C to glucose C and expired CO2 was similar in the three groups. These data demonstrate that rigorous metabolic control results in normal glucose and alanine metabolism in diabetic pregnancy during fasting.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Glucose-alanine relationship in diabetes in human pregnancy. 190 12

Diabetes in Mexico is a public health problem with considerable medical, social, and economic consequences. Although detailed data on the prevalence of diabetes and its complications are not available, health services utilization data of the Social Security organization (Instituto Mexicano del Seguro Social) indicate increasing use of primary and tertiary care for diabetes over a recent 10-yr period. A health interview survey conducted in 1988 indicated that, in different areas, from 3.5 to 12.7% of people aged greater than or equal to 65 yr are believed to have diabetes, and that rates are higher in many of the states bordering the United States. Diabetes ranks among the leading 10 causes of death throughout the country. Although the ranking varies from state to state and the diagnosis may not appear on the death certificate when death results from a complication of the disease, in 1983 diabetes was the leading cause of death in Mexico and the first or second leading cause in many of the states bordering the U.S. Gestational diabetes contributes to perinatal mortality, and in view of the high birth rates, represents an important facet of the disease in Mexico. The impact of specific complications of diabetes on morbidity and mortality in Mexico are not well delineated. The relative frequency and impact of insulin-dependent and non-insulin-dependent diabetes in Mexico are not known.
Diabetes Care 1991 Jul
PMID:Diabetes mellitus in Mexico. 191 17

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


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