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Query: UMLS:C0011849 (diabetes)
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Analysis of 16 486 obstetric and neonatal case histories of the years 1963--1972. 30.7% of all neonates of Austrian (A) mothers showed one or more signs of placentar insufficiency. Pronounced prenatal dystrophy (p.d.) occurs in similar numbers in women with or without EPH gestosis, but has other important causes as well. In p.d. excentric umbilical cord insertion is more common than in neonates without dystrophy (56.4 : 52.4). Very young mothers often have neonates with p.d. During the ten year period p.d. increased considerably until 1967. After that it decreased slightly but not to the numbers at the start. These changes in frequency apply to all maternal age groups equally. Pronounced and highgrade p.d. in foreign workers' (f.w.) children is significantly more common than with A mothers (p 0.0001). Cushing's syndrome as a symptom of fetal disease due to diabetes has become rarer by over 50% owing to more intensive preventive measures; at the same time still-births of those weighing 4000 g or more have disappeared. The frequency of Cushing's syndrome rises according to the age of the mother from 0.8% to 3.5%. In Austrian mothers the number of previous abortions has decreased during these 10 years, just as has the number of births. The chances of actual pregnancies are the worse the higher the number of previous abortions. In f.w. mothers previous artificial abortions are far more numerous, but the outcome of pregnancy does not deteriorate with an increase in previous abortions. In A mothers the effects of previous premature or still births are the same as after abortions but much more pronounced. The percentage of normal births following premature births has fallen somewhat in A mothers during the ten year period, also after one miscarriage from 86% to 71%, probably owing to effective prevention of late abortions. Of 173 pairs of twins the first-born was heavier than the second in 71 instances. It is confirmed that the second twin is still-born almost twice as often as the first-born and this in twins of whom the second is heavier than the first. 11% of individual twins weith more than 3000 g and 28% between 2501 and 3000 g. The heavier the twins the lower the average age of the mother (from 30.8 to 26.6). The mothers whose first twin weighs more than 2500 g, the second less, appear to be younger than those with an inverse ratio (27.6 : 30.7).
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PMID:[The influence on the outcome of pregnancies of sociologic and medical changes during 1963--1972. II. Special section: prenatal dystrophy, diabetogenic fetal disease, the impact of previous miscarriages and twins (author's transl)]. 117 91

127 specimens, obtained by different methods from the myometrium and the placental bed after parturition, are investigated histologically. This material includes normal pregnancies as well as cases of maternal diabetes with and without hypertension and cases of hypertension in EPH-gestosis. The different parts of the arterial system (spiral arteries, basal arteries, radial arteries) are separately investigated. Physiologically, the pregnancy induces changes in the wall of the decidual arteries and possibly in the distal part of the radial arteries. The fibromuscular layer including the elastic fibers were destructed and replaced by fibrin and connective tissue. For this reason, in these parts of arteries it is very difficult to separate pathological from physiological changes.
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PMID:[Morphology of myometrial and decidual arteries in normal pregnancy, in toxemia of pregnancy, and in maternal diabetes (author's transl)]. 122 14

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

In Basle in 1972 a diabetes survey was performed in subjects with increased risk of diabetes mellitus (overweight, age above 50, relatives of diabetics). For screening, the blood sugar was determined one hour after ingestion of 50 g of glucose. 404 males and 768 females (known diabetics excluded) were examined. One third of males and one quarter of females had a blood sugar value above 150 mg%. Blood sugar values of more than 200 mg% were found in 9% of the male and 7% of the female participants. A positive correlation existed between age and blood sugar values in males and females. Body weight and blood sugar value correlated only in females. However, in male subjects with pronounced obesity (Broca index greater than 1.23) there was a significantly higher incidence of blood sugar screening value above 150 mg% than in the rest of the males. It would appear that even slight overweight enhances glucose intolerance in females, whereas in males only marked overweight favours the manifestation of glucose intolerance. The cost of the detection of a new case of diabetes mellitus (blood sugar greater than 200 mg%) amounted to Sfr. 70.-. The Basle diabetes survey provides a model for successful conduct of a preventive program through cooperation of private organizations such as the local Medical Association and the local Diabetes Association.
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PMID:[Procedures for the early recognition of diabetics in Basle 1972. Contributions to the early diagnosis of diabetes mellitus by means of blood sugar analysis with special reference to the practical procedures under Swiss conditions]. 125 14

BB/Wor rats develop spontaneous autoimmune diabetes similar to human insulin-dependent diabetes mellitus. A T-cell-mediated pathogenesis for BB/Wor diabetes is indicated because disease is prevented by neonatal or adult thymectomy and treatment of diabetes-prone rats with monoclonal antibodies directed against CD5 or CD8 T-cell surface markers. Disease can be adoptively transferred with injections of concanavalin A-activated spleen cells from either acutely diabetic or RT6.1 T-cell-depleted diabetes-resistant BB/Wor rats. We used microbial superantigens to stimulate spleen cells from RT6.1 T-cell-depleted diabetes-resistant rats and demonstrated that such cells activated with staphylococcal enterotoxins (SEs) can also transfer diabetes. The diabetogenic effector T cells are readily activated by SEA, SEC3, and SEE, whereas SEB- and SEC2-activated cells are far less effective in the adoptive transfer of diabetes. These results demonstrate that microbial superantigens are capable of activating self-reactive and diabetes-inducing T cells in vitro in the BB/Wor rat. Ubiquitous microorganisms may be the environmental trigger for autoimmunity in susceptible individuals.
Diabetes 1992 Apr
PMID:Staphylococcal enterotoxin-activated spleen cells passively transfer diabetes in BB/Wor rat. 160 77

The introduction deals with the main characteristics of two representatives of high risk pregnancies: diabetes mellitus and EPH gestoses. Particular interest was shown in risks that may occur in pregnant diabetics, with which they must be acquainted. Some theories are given on the pathogenesis of EPH gestoses. The aim of our investigation was to determine the concentration at which immunoglobulins G, M and A pass in cord blood, amniotic fluid and urine, and whether there is a significant difference between control group and among pregnant diabetics or those with EPH gestoses. The investigation was performed by the nephelometric technique on the Immunochemistry Analyzer. Each group consisted of 20 women, with a total of 60. Immunoglobulins A, M and G were determined in the mothers' sera, cord blood or amniotic fluid. IgG was obtained in urine in measurable concentrations. A significant increase of IgG was found in the urine of pregnant diabetics. IgM was significantly increased in the sera of diabetic mothers. IgA was significantly increased in pregnant diabetics, while both high risk pregnancy groups had an increased IgA in cord blood. The values of IgA in amniotic fluid were decreased in the EPH gestoses group in comparison to the group of diabetics. The authors find these variations interesting and feel they should be followed in other high risk pregnancy groups.
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PMID:[Laboratory study of patients with endemic nephropathy]. 191 48

In Part IV of this review of placental pathology, reference is made to impaired maturation of the placenta under special clinical conditions. Foetal erythroblastosis is only of minor importance, in that context, today, while similar placental alterations may result from foetal hydrops of different genesis, including immunological causes. A detailed account is given of diabetic impairment of maturation together with possible placental diagnosis of diabetes. Cases of diabetes mellitus with concomitant EPH gestosis were found to be more strongly determined for placental differentiation by EPH gestosis. Reference, finally, is made to disturbed placental differentiation under conditions of EPH gestosis with or without concomitant impairment of intervillous circulation.
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PMID:[Pathology of the placenta. IV. Maturation disorders of the placenta under special clinical conditions]. 205 7

The cholecystokinin-tetrapeptide (CCK4) analogs Trp-Pro-Asp-Phe-NH2 (3) and Trp-Pro-Asp-Phe-(4'-NO2)-NH2 (4) were found to be nearly equipotent to cholecystokinin-octapeptide (CCK8) in potentiating glucose-induced insulin secretion from islets of Langerhans isolated from rat pancreas. This stimulatory action was found to be dose-dependent and, in the case of 4, to exhibit a biphasic dose-response curve; i.e., at concentrations greater than 1.0 nM, the stimulating effect of 4 is reversed. These results suggest that conformational restriction of CCK4 and/or modification of the phenylalanine residue could produce more potent analogs capable of stimulating insulin release. Such compounds could have potential therapeutic utility in the treatment of non-insulin-dependent diabetes mellitus (NIDDM).
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PMID:Stimulation of insulin secretion from pancreatic islets by the cholecystokinin-tetrapeptide analogs Trp-Pro-Asp-Phe-NH2 and Trp-Pro-Asp-Phe(4'-NO2)-NH2. 213 65

In this study, plasma levels of magnesium, calcium, zinc and copper were simultaneously determined in pregnancies complicated by either abortion, intrauterine growth retardation (IUGR), diabetes or EPH (edema, proteinuria, hypertension) gestosis. The levels of the four cations in non-pregnant women and in healthy, pregnant women were also determined. Compared with controls, a significant decrease in magnesium, with increase of the Ca/Mg ratio, was found in spontaneous abortions, but not when patients had a successful continuation of pregnancy. In EPH gestosis, total calcium was reduced, with a significant decrease of the plasma Ca/Mg ratio. A slight, but significant, increase in plasma zinc was observed in women affected by either diabetes or IUGR, probably as a result of reduced zinc uptake by the fetus. In addition, higher copper levels were found in the pathologies studied, with the exception of missed abortions. The possible role of an altered Ca/Mg ratio homeostasis in relation to gestational pathologies is discussed.
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PMID:Maternal plasma concentrations of magnesium, calcium, zinc and copper in normal and pathological pregnancies. 227 Apr 73

Although glucocorticoids have been universally implemented to stimulate fetal lung maturity, their effectiveness and side effects are still widely contested. In search of alternative drugs a double-blind study was conducted between June 1981 and June 1984 comparing betamethasone, a conventional corticoid, and ambroxol, a bromhexine metabolite for efficacy and tolerance in prenatal prevention of the respiratory distress syndrome (RDS) in premature infants and full-term neonates. The therapeutic efficacies of betamethasone and ambroxol for this indication proved to be comparable. Since the possible risks of corticoid therapy in abnormal pregnancies are repeatedly discussed in the literature and in daily clinical practice. 137 patients with EPH gestosis, placental insufficiency, diabetes mellitus, and premature rupture of the membranes were selected from the original group of 308 patients. Only minor side effects (e.g. nausea) were present in a few of the 137 cases undergoing treatment with the 2 test substances. No side effects were observed in the neonates. The incidence of fetal RDS was comparable in both groups (2.9% with ambroxol, 2.2% with betamethasone). Transient and mild RDS cases were slightly more frequent in the ambroxol group than in the betamethasone group. To date, contraindications to ambroxol treatment in abnormal pregnancies are unknown and since generally the rate of potential side effects is considered to be lower in comparison with corticoid treatment, the use of ambroxol especially in abnormal pregnancies corresponding indication can be recommended.
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PMID:[Ambroxol versus betamethasone for the promotion of antepartum lung maturity in pathological pregnancies]. 240 30


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