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Query: UMLS:C0011849 (diabetes)
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In German speaking countries peridural anesthesia in obstetrics has been introduced 25 years ago by Anselmino. Because of the increase of operative delivery and the--however rare--serious complications in the mother the technique has been employed less and less. Now, with the introduction of the catheter technique, which renders lower doses of the anesthetic effective and with improved treatment of complications due to it, the technique has become safer for the mother. Anomalies of the position of the fetal head are not more common than in deliveries without peridural anesthesia. But the more frequent need for low forceps delivery remains, since the strain-reflex is abolished, although motorfunction of lower limbs and abdomen are intact. The safe use of peridural anesthesia requires a considerably increased personnel, since the doctor conducting the delivery is only rarely sufficiently qualified in anesthetics and even then should not have to take the responsibility for both delivery and anesthesia. Since we can consider the technique safe for the mother, its effect on the child is predominant interest. Examination of the acid-base metabolism in the fetal blood from the scalp and umbilical cord post-partum has shown favorable results. The effect of complete painlessness on respiration and blood-gases of the mother is of interest (Strasser, Huch, Huch). Further investigations of the effects on fetal heart frequency and its assessment in supine or constant lateral positioning and of the maternal circulation with modern cardiologic techniques have not yet been concluded. On their results will depend, at least in part, the indication for peridural anesthesia in pregnancies and deliveries at risk. Clinical observations and comparison with deliveries under general anesthesia indicate that catheter peridural anesthesia may be advantageous for the child with diabetes, EPH gestosis and prematurity.
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PMID:[Peridural anesthesia in obstetrics (author's transl)]. 124 49

Among 58,187 women tested, 1002 had a maternal serum alpha-fetoprotein measuring greater than or equal to 2.5 multiples of the median after correction for race, weight, and insulin-dependent diabetes. They were stratified into three groups: group 1, 2.5 to 2.9; group 2, 3.0 to 5.0; group 3, greater than or equal to 5.0 multiples of the median. The initial risk of a serious abnormality detected by ultrasonography or amniocentesis was 17% (5%, 12% and 65% in groups 1, 2, and 3, respectively). After correction for twins and dates, this risk became 23% (7%, 18%, and 71% in groups, 1, 2, and 3, respectively). Among the women with high maternal serum alpha-fetoprotein levels, 556 (77%) had normal ultrasonographic and amniocentesis studies, and the risk of adverse pregnancy outcome ws 27% (19%, 29%, and 70% in groups 1, 2, and 3, respectively). There was a statistically significant increase in late fetal and perinatal death, prematurity and growth retardation, oligohydramnios, abruptio placentae, preeclampsia, and congenital abnormalities. The overall risk for abnormality or adverse outcome was 24% in group 1, 41% in group 2, and 91% in group 3.
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PMID:Risks associated with an elevated maternal serum alpha-fetoprotein level. 171 19

Before the discovery of insulin in 1921, pregnancies in women with diabetes mellitus were a rarity because most reproductive-age patients died soon after diagnosis of this illness. In the limited number of pregnancies reported in the pre-insulin era, both perinatal and maternal mortality were approximately 50%, with stillbirths being the primary cause of perinatal deaths. Insulin treatment restored the fertility of women with diabetes and was associated with a marked reduction in maternal mortality. Women with more severe disease had the opportunity to become pregnant; however, their pregnancies frequently resulted in neonatal death due to prematurity. Therefore, perinatal mortality was not substantially reduced.
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PMID:A story of two miracles: the impact of the discovery of insulin on pregnancy in women with diabetes mellitus. 173

Although the enamel defects of low birthweight prematurely-born children have been well investigated clinically the ultrastructure has not been studied in detail. Using scanning electron microscopy this investigation examined the enamel surface of 4 representative teeth from a group of exofoliated teeth from prematurely-born, very-low birthweight children compared to an equal number of control teeth from normal birthweight children. The results showed that all 4 teeth from the prematurely-born group had enamel defects at the ultrastructural level even though the defects were evident only macroscopically in 2 teeth. By contrast all the control teeth from normal children did not show abnormalities of surface structure. Thus this investigation further confirms that birth prematurity and low birthweight adversely affect the activities of ameloblasts. Previous clinical investigations have reported that prematurely-born children show high prevalences of enamel hypoplasia of around 20-100%. The etiological factors involved in the pathogenesis of enamel defects are unclear, but are likely to be related to many systemic illnesses occurring during the neonatal period. These include respiratory distress syndrome, hyperbilirubinemia, maternal diabetes as well as neonatal rickets. Furthermore, Seow et al. (1989) showed recently that deficiency of calcium and phosphate mineral in the neonatal period is related directly to enamel hypoplasia in very-low birthweight, prematurely born children. In addition to systemic factors, local factors such as laryngoscopy and endotracheal intubation have also been implicated in the etiology of enamel hypoplasia in these children. While the enamel defects have been well studied at the clinical level, there is a paucity of information on the ultrastructural nature.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Enamel hypoplasia in prematurely-born children: a scanning electron microscopic study. 209 77

Mortality and morbidity of diabetic pregnancy have decreased markedly during the last decades. Abortions occur more frequently than in control women. Perinatal mortality has declined, especially in large centers. Morbidity remains important: two thirds of the infants experience some morbidity, mainly due to prematurity and malformations. Among factors of prognosis, careful control of maternal diabetes before conception until delivery is the main point. For each period of pregnancy, a bad glycemic control in the mother is associated with a complication in the infant. Hypertension and diabetic neuropathy are risk factors of prematurity. Congenital malformations become in the large centers the main source of mortality and morbidity in infants of diabetic mothers.
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PMID:[Maternal and fetal prognosis during pregnancy in diabetic women]. 219 59

A review of the literature concerning sport during pregnancy is presented. The mother's heart rate, arterial blood pressure, systolic ejection fraction and cardiac output undergo the same changes during exercise in the pregnant and non-pregnant patient. The increase in the fetal heart rate during maternal physical exercise does not adversely affect the fetal outcome. The uterine blood flow is diminished during exercise. The respiratory rate increases equally in pregnant and non-pregnant women. The maternal response to effort is also modified by weight gain during pregnancy, by changes in the musculo-skeletal system, and by maternal temperature control during exercise. Weight gain, uterine contractility, duration of pregnancy, labour and neo-natal conditions are not altered by sport during pregnancy. Contra-indications to sport during pregnancy include threatened premature labour, and conditions associated with an increased risk of prematurity. A previous history of fetal growth retardation, acute fetal distress, or the presence of diabetes or arterial hypertension is a contra-indication to sport during pregnancy. The advice which should be given to a pregnant woman wishing to continue her sporting activities during pregnancy is outlined.
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PMID:[Sports and pregnancy. A review of the literature]. 208 69

To determine the values of individual and combined biophysical fetal surveillance tests in a general high-risk population, we examined 1000 consecutive pregnancies complicated by either postdatism, hypertension, intrauterine growth retardation, or diabetes mellitus. Nonstress tests, amniotic fluid pocket measurements, and umbilical artery Doppler velocimetry were performed on each patient; each test was rated against gestational age-adjusted standards. Clinical end points included perinatal mortality, intrapartum fetal distress, 5-minute Apgar score less than 7, and neonatal acidosis in pregnancies without major anomalies or extreme prematurity (age at birth greater than 32 weeks), delivered within 72 hours of final tests. Each testing method had specificity greater than 90%. Sensitivities ranged from 69% (nonstress test) to 21% (Doppler velocimetry). Negative predictive values of each method exceeded 85%; positive predictive values ranged from 81% (nonstress test) to 42% (amniotic fluid measurements). The positive predictive value for any abnormal test was 54% and increased to 100% when all tests were abnormal; this latter condition occurred in only 2% of the total population. Amniotic fluid measurements or Doppler velocimetry, when compared with the nonstress test, appeared to be less powerful "stand-alone" screening tests. The performance of all tests in a single session confers little improvement in detection of fetal compromise if the nonstress test is normal; however, this approach may aid decision-making in the management of pregnancies when fetal maturity is not established.
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PMID:The diagnostic values of concurrent nonstress testing, amniotic fluid measurement, and Doppler velocimetry in screening a general high-risk population. 220 56

The purpose of the present study was to determine the risk of neonatal morbidity in infants of diabetic mothers in relation to birth weight percentiles, maternal White classification and metabolic control during pregnancy. The subjects consisted of 51 infants of gestational and Type II diabetic women and 148 infants of insulin-dependent diabetic women. The following neonatal symptoms commonly associated with maternal diabetes were analyzed: macrosomia, hypoglycemia, erythremia, hyperbilirubinemia, hypocalcemia, prematurity and hyaline membrane disease. The incidence of the symptoms was as follows: hypoglycemia in the first hour of life 34.3% macrosomia 24.6%, hyperbilirubinemia 23.7%, prematurity 18.1%, hypoglycemia after the first hour of life 16.6%, hypocalcemia 11.1%, erythremia 7.6%, and hyaline membrane disease 2.0%. There were statistically significant differences in the symptoms "hypoglycemia after the first hour of life" and "erythremia" between the birth weight percentile groups, i.e. the incidence of these symptoms increased with higher birth weights. The risk of neonatal morbidity among infants of insulin-treated gestational diabetics was higher than that of infants of diet-controlled gestational diabetic women. The incidence of macrosomia and hypocalcemia was significantly higher in the first group. Newborns of insulin-dependent diabetic women with proliferative retinopathy and/or nephropathy (White class FR) had an increased risk of neonatal morbidity in comparison to infants of White classes B, C, and D, especially with regard to prematurity and associated problems. Neonatal morbidity varies with the quality of metabolic control in women with insulin-dependent diabetes. Infants of poorly-controlled mothers were more often macrosomic and premature than infants of well-controlled mothers.
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PMID:[Neonatal morbidity of children of diabetic mothers]. 234 9

Prematurity, neonatal asphyxia, hypomagnesemia, and advanced maternal diabetes are traditional risk factors for hypocalcemia in infants of diabetic mothers (IDMs). The aim of this study was to determine the relative contribution of these factors separately and combined in a cohort of diabetic pregnancies managed prospectively in the recent 9 years and to find accurate predictors of neonatal hypocalcemia in infants of diabetic mothers. We hypothesized that these factors plus low cord blood calcium (Ca) concentration allow prediction of IDMs who develop neonatal hypocalcemia. We studied 186 IDMs (White class B-RT); gestational age (GA, weeks) was by last menstrual period, confirmed +/- 2 weeks by Ballard score. The goals of glycemic control were: preprandial blood glucose less than 100 mg/dl and 90-minute postprandial blood glucose less than 140 mg/dl. Apgar scores, and cord, 24-, 48- and 72-hour serum calcium (Ca) (mg/dl) and magnesium (Mg; mg/dl) were determined. In univariate analysis, lowest serum Ca correlated with cord blood Ca (r = 0.48, p less than 0.001), GA (r = 0.37, p less than 0.001), and 1-minute Apgar score (r = 0.18, p = 0.09), but did not correlate with cord Mg or with advanced White class. In multiple regression, cord Ca and GA were dominant effects and other variables became insignificant. Lowest Ca (mg/dl) was predicted as follows: lowest Ca = 34.05 - 3.22 (Ca cord) - 0.84 (GA) + 0.10 (GA) (Ca cord). This equation predicts neonatal hypocalcemia (lowest Ca less than 8 mg/dl) with a sensitivity of 72% and a specificity of 75%. Thus, GA and cord Ca allow determination of IDMs at risk for neonatal hypocalcemia.
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PMID:Early neonatal predictors of neonatal hypocalcemia in infants of diabetic mothers: an epidemiologic study. 237 24

The present study was undertaken to evaluate the magnitude of risk factors associated with brachial plexus in infants born in hospital in Benghazi. A total of 7829 babies were examined over a period of 6 months. Twenty-eight had brachial palsy, giving an incidence of 3.6 per 1000 livebirths. Significant (P less than 0.001) perinatal risk factors observed were maternal parity greater than or equal to 6, maternal diabetes, instrumental deliveries, shoulder dystocia and foetal macrosomia. Other risk factors observed included breech extraction, postmaturity and prematurity (P less than 0.02). Complete brachial plexus injury was seen in 12 cases and six infants had residual handicap on follow-up at 18-24 months.
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PMID:Brachial plexus injuries in babies born in hospital: an appraisal of risk factors in a developing country. 240 8


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