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

Congenital anomalies are two to four times more frequent in the offspring of diabetic mothers than in those of non-diabetic mothers, and represent an increasingly important cause of perinatal mortality. These anomalies involve multiple organ systems more often than those found in the children of non-diabetic mothers. The excess of anomalies associated with maternal diabetes occurs in many organ systems. Anomalies are no more frequent in the offspring of diabetic fathers and pre-diabetic mothers than among those of non-diabetics, suggesting that non-genetic factors are the important determinants. Anomalies are most frequent in the offspring of mothers who have developed diabetes at an early age, many of whom have diabetes of long duration, are insulin-treated, and may have vascular complications. The relative importance of each of these factors in the pathogenesis of anomalies is unknown, but present evidence is consistent with a hypothesis that anomalies are the result of metabolic disturbances in the intrauterine environment during the first trimester of pregnancy. Whether or not their incidence can be reduced by optimum metabolic control of maternal diabetes during this period is unknown.
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PMID:Congenital anomalies and the diabetic and prediabetic pregnancy. 25 42

In a 4-year retrospective review of 801 pregnancies that resulted in the delivery of an infant weighing 4100 g (9 lb) or more, increased incidence of both maternal and perinatal complications was noted. There were no maternal deaths, and ther perinatal mortality rate was 0.49%. The second stage of labor was prolonged in 9.7% of primigravidas and in 2.2% of multiparas. Shoulder dystocia and perineal lacerations were related to increasing birthweight. Difficult deliveries resulting in clavicle fracture or brachial plexus injuries, and facial trauma contributed to the 11.4% perinatal morbidity rate. Asphyxia was observed in 7.7% and hypoglycemia in 5.2% of the neonates. Congenital anomalies (1.5%) were not increased in the large fetus group. Close surveillance for diabetes mellitus and anticipation of the potential complications associated with delivery of a large infant may reduce maternal and neonatal morbidity rates and maintain low mortality rates.
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PMID:The large fetus. Management and outcome. 68 26

Congenital anomalies occur up to four times more frequently in diabetic pregnancy than in the nondiabetic population. Although past work has shown that maternal hyperglycemia and hyperketonemia may increase embryonic abnormalities, recent experimental evidence suggests that low insulin levels may also contribute to diabetic embryopathy. This study investigated the effects of guinea pig serum (whose insulin is inactive in rat systems) on rat embryonic growth and development in culture. Supplementation of guinea pig serum with pork insulin at low (1 ng/ml) and high (5 ng/ml) physiological concentrations and insulinlike growth factors (IGF) I and II were also studied. Culture of rat embryos from the early headfold stage in guinea pig serum resulted in poor embryonic growth and development with a 92% rate of anomalies. Supplementation of guinea pig serum with zinc-binding pork insulin significantly improved rat embryonic growth and development (46% anomaly rate) especially between the first 5 and 21 h of the period of organogenesis. This evidence supports our most recent findings that low insulin levels, as encountered in untreated diabetic pregnancy, may contribute to the increased risk of congenital abnormality. Insulin at low physiological concentrations improved growth, whereas higher physiological concentrations were required to increase growth and development. IGF-I or IGF-II supplementation improved rat embryonic growth and development but failed to match that of the controls, indicating that other growth factors including insulin may also be required.
Diabetes 1992 Mar
PMID:Insulin and insulinlike growth factors in embryonic development. Effects of a biologically inert insulin (guinea pig) on rat embryonic growth and development in vitro. 155 91

A retrospective analysis was undertaken of 128 pregnancies (131 infants) complicated by diabetes; 66 (51 per cent) were Class A and 62 (49 per cent) Class B-D-F-R. 53.9 per cent of all infants were large for gestational age (LGA) and there were no differences between the classes of diabetics. LGA infants occurred with equal frequency in those diabetic patients with pregnancy-induced or chronic hypertension. Congenital anomalies occurred in 9.7 per cent with 11/12 in Class A, B, or C. Major neonatal morbidity included: 1) hypoglycemia: two (3 per cent) Class A and 21 (32.8 per cent) insulin-dependent mothers (P less than 0.01); and 2) respiratory distress syndrome: seven (5.3 per cent) and all were in classes B-F (P less than 0.05). Modern management of diabetes in pregnancy has, for unknown reasons, increased the incidence of LGA infants.
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PMID:Large for gestational age: dilemma of the infant of the diabetic mother. 350 63

Forty-four of 75 pregnant women with juvenile-onset insulin-dependent diabetes, who attended a preconceptional clinic, were seen regularly by a diabetologic team. Glycemic control was obtained by intensified insulin therapy and monitored by blood glucose self-monitoring. When these patients were compared with a group of 31 nonattenders of the preconceptional clinic, in the former normoglycemia and normal hemoglobin A1 values were achieved before conception, whereas in the latter good control was reached by the second trimester. This group had also more maternal complications, such as preeclampsia, and higher cesarean section rates. Congenital anomalies were 9.6% among offspring of nonattenders, while none occurred in those with preconceptional counseling. We confirm the evidence accumulated in the recent literature that congenital malformations in pregnancy complicated by diabetes may be linked to disturbances in maternal metabolism during the period of embryogenesis. Consequently we concur with the recommendation that tight diabetic control is required before the patient attempts to conceive.
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PMID:Pregnancy outcome in patients with insulin-dependent diabetes mellitus with preconceptional diabetic control: a comparative study. 374 Jan 44

To assess the effects of an educational program emphasizing detection and tight control of maternal glucose levels during pregnancy, the management and outcome of all pregnancies complicated by diabetes mellitus delivered at a county hospital during two time periods, 1978-1980 and 1981-1983, are compared. The prevalence of diabetes during pregnancy was 1.4% between 1978 and 1980 and 2.6% between 1981 and 1983 (P less than 0.01). The perinatal death rate decreased for infants of diabetic mothers from 100 per thousand deliveries in 1978-1980 to 32 per thousand in 1981-1983 (P less than 0.02). The perinatal death rate for infants of mothers with gestational diabetes was nearly the same as the perinatal death rate for all neonates born in the state in 1981-1983. Congenital anomalies followed by stillbirths were the most frequent causes of perinatal death.
Diabetes Care
PMID:Neonatal mortality in infants of diabetic mothers. 404 99

All 995 persons with Down's syndrome who died in the United States during 1976 and whose death certificates listed Down's syndrome as the underlying or a contributing cause of death were identified. This allowed the underlying causes of death of 793 affected persons to be analysed and compared to deaths in the whole US population for that year. Mortality ratios provided evidence that the excess risk of leukemia mortality continues into adulthood and that deaths from other hematopoietic malignancies also occur excessively among Down's syndrome adults. Congenital anomalies of all kinds in infancy and congenital defects of the heart in infancy and later were also excessive. Respiratory tract infections and pneumonia showed persistently high ratios. Diabetes was raised only at ages 24 to 34 years. Ischemic heart disease, non-hematopoietic cancers, accidents, suicides and violence were under-represented among the causes of death. Methodological limitations of proportional mortality analysis are discussed.
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PMID:Leukemia and other cancers, anomalies and infections as causes of death in Down's syndrome in the United States during 1976. 621 2

The radiographic findings of a series of infants of diabetic mothers and a review of the literature are presented to illustrate the wide spectrum of abnormalities that may be seen with this condition. Congenital anomalies of the spine and skeletal, genitourinary, and cardiovascular systems and visceral situs inversus are significantly more frequent among infants of diabetic mothers than normal. The most specific anomaly is sacral agenesis. Renal vein thrombosis and adrenal hemorrhage are also more common and may be diagnosed by sonography. Over one-half of the cases of the small left colon are associated with maternal diabetes and may be diagnosed and treated with a contrast enema. The incidence of the respiratory distress syndrome is higher in infants of diabetic mothers than other premature infants, and the disease may occur in the presence of reliable indicators of lung maturity. Other common causes of dyspnea include cardiomyopathy, congenital heart disease, wet lung syndrome, hyperviscosity syndrome, and persistence of fetal circulation. Echocardiography is the most valuable adjunct in differentiating cardiac from pulmonary problems.
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PMID:Infants of diabetic mothers: radiographic manifestations. 678 62

During the period from 1 June 1984 to 1 June 1991, 988 pregnant diabetic patients were treated by a team of physicians and obstetricians in Benghazi Diabetic Clinic. Twelve patients were insulin-dependent (type 1) and 976 patients were non-insulin-dependent (type 2). Ninety patients were diagnosed for the first time during pregnancy. Thirty-nine patients defaulted. Eight hundred and seventy-six patients were treated with insulin and 112 patients were controlled by diet. The average daily insulin dose was 40.12 units. The majority, 64.5%, delivered vaginally and 35.5% by caesarean section. Rates of abortion, intra-uterine death and still birth were 7.99%, 3.28% and 2.6%, respectively. The mean birth weight was 3.78 +/- 0.89 kg. Congenital anomalies of infants were 3.4%. Perinatal morality was 11.44%. Poor metabolic control has been associated with increased rates of abortion, intra-uterine death and congenital anomalies. It was concluded that team approach and multiple insulin injections could improve the outcome of pregnancy in developing countries to near current western standards.
Diabetes Res Clin Pract 1993 Jul
PMID:Outcome of pregnant diabetic patients in Benghazi (Libya) from 1984 to 1991. 825 20

431 newborns of diabetic mothers (NDM) were studied between the years 1980 and 1990. They were divided into two groups: a first group of 227 patients born from mother with gestational diabetes mellitus; a second group of 204 patients born from mother with pregestational diabetes mellitus. The first and the second group were subdivided into two subgroups: the A, referring to the period 1980-85, and the B, referring to the period 1986-90. Subgroups B were characterized by a better metabolic control of pregnancies. Our protocol consisted of anamnestic study, clinical, metabolic, instrumental examinations and clinical follow-up for a period ranging from 1 to 10 years. The study of our data suggests that embryo-feto-neonatal mortality doesn't show significantly difference between the first and the second group and between subgroups A and B. The percentage of preterm infants was significantly more elevated in the second group, the percentage of full-term newborns was significantly higher in the first group. The incidence of cesarean sections was significantly higher in subgroups B. Mean birthweight was more elevated in the first group and the incidence of macrosomia was higher in subgroups A. The incidence of asphyxia, hypotonia, seizures, transient cardiomegaly, transient hypoglycaemia and hypocalcemia, was higher in subgroups A, without significant difference between the first and the second group. Congenital anomalies were heterogeneous and there were no significant difference between the first and the second group. Only the incidence of congenital cardiopathies was significantly more elevated in the second group. At follow-up neurologic sequelae were mainly characterized by behavioural anomalies.
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PMID:[The newborn infant of the diabetic mother: the clinical findings in 431 subjects]. 841 73


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