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Query: UMLS:C0011854 (type 1 diabetes)
 20,749 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To evaluate the possibility of autoimmune processes against pancreatic islets in fetal life, we tested islet cell antibody (ICA) reactivity with 14 fetal pancreata obtained after abortion at the 15th up to the 19th week of gestation. Pancreatic islets positive for a monoclonal proinsulin antibody but non-reactive with ICA negative control serum were found in 9/14 pancreata and all (9/9) of them showed a positive reaction with the ICA standard. It is concluded that ICA reactivity may be detected in fetal human pancreata. Further studies on fetal islet cell antibody reactivity in the development of insulin dependent diabetes mellitus (IDDM) are warranted.
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PMID:Islet cell antibody reactivity with human fetal pancreatic islets. 174 59

Perinatal mortality and morbidity in infants of diabetic mothers have declined continuously during the past decades, due to advances in prenatal care, obstetric management and intensive neonatal care. This retrospective study reports on complications during pregnancy and fetal outcome in those insulin-dependent-diabetic (IDDM) pregnancies admitted to our institution from 1978 to 1985. Age, weight, prepregnant weight and weight-gain of those patients are compared with normal uncomplicated pregnancies (of the same period). In the diabetic group we noticed a high incidence of abortion (30%) as well as a high frequency of previous stillbirths (19%). In the majority of cases delivery was achieved by the 38th week of gestation the mean birth weight and length being 3,144 g and 48.5 cm respectively. 22% of the cases were delivered by cesarean section. The diagnosis preeclampsia was made in 15 patients, in 4 cases we observed a placental insufficiency, 11 women presented with premature labor and there was one fetal death. 44 newborns (63.8%) had a birthweight between 2,500 g and 4,000 g, 15 infants were below 2,500 g (21.7%), 10 infants weighed more than 4,000 g (14.5%), 5 of them displayed cushingoid features. 3 cases were complicated by hypoglycemia, 3 infants were dystrophic at birth and there was one major congenital anomaly. The incidence of neonatal respiratory distress syndrome was extremely high, 12 milder cases could be managed without ventilation therapy, 4 severe cases had to be given full respiratory support.
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PMID:[Course of pregnancy of insulin-dependent diabetic patients 1978-1985 at the 1st Vienna University gynecologic clinic]. 244 Jan 94

The work is a clinical report of alpha-fetoprotein (AFP) estimations in maternal serum samples of patients with an insulin dependent diabetes mellitus (IDDM). Venous blood samples for AFP estimations wer taken between the 14th and 20th week of pregnancy. In the first line the AFP detections support the diagnosis of open neural tube defects (NTD). On the other side low maternal AFP serum values are suspicious regarding to fetal forms of trisomia. In the present study a radioimmunological method (RIA) was used for AFP determinations (CIS, Paris, France). The acceptance of high AFP concentrations was effected by the 2.5 X median; low concentrations were detected by using the 0.4 X median and 10 micrograms/l respectively. In two cases (0.9%) we found high maternal AFP levels (greater than 2.5 X median). After clinical observation these levels had been caused by an abortion and gemini respectively. There was not any correlation between AFP and glycosylated hemoglobin (HbA1), a standard parameter of metabolic control, and even no correlation to fetal macrosomia and diabetic fetopathia. Ther were no neural tube defects in the time of investigation. Regarding to relative large group of low AFP-levels without fetal chromosomal anomalies, these present results are directing to an enlarged screening programm of fetal forms of trisomia.
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PMID:[Maternal serum AFP screening in type I diabetic patients]. 247 82

The premise that unexplained fetal loss is associated with maternal intravenous glucose intolerance (IVGT) has been studied retrospectively in three pregnancy related groups. In 97 women (Group A) who had stillbirths inadequately explained by obstetrical or necropsy findings, 24 per cent had abnormal IVGT tested six weeks postpartum. In 115 women (Group B) with histories of two or more spontaneous abortions (recurrent abortion) tested late in a subsequent successful pregnancy 26 per cent were abnormal. In 465 pregnancies of women with abnormal IVGT diagnosed during pregnancy (Group C) there were 19 perinatal deaths (12 stillbirths and 7 first week deaths) (Perinatal Mortality Rate 41 per 1000). Perinatal mortality characteristics which are similar to those found in insulin dependent diabetes namely a high incidence of major fetal abnormality (37 per cent) and the occurrence of hyaline membrane disease in term infants were observed. A causal association is postulated between inadequately explained stillbirth and recurrent abortion and abnormal maternal IVGT.
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PMID:Fetal loss and maternal glucose intolerance. A retrospective study. 709 81

Postpartum thyroid dysfunction (PPTD) is a common autoimmune disorder. Type I diabetes mellitus (IDDM) is an autoimmune disease with a high incidence of concomitant autoimmune thyroid failure. We hypothesized that women with IDDM would have an increased incidence of PPTD. Women with IDDM in New York City, were followed prospectively during the second and third trimester of pregnancy and at 6 weeks, 3 months, 6 months, 9 months, and 1 yr postpartum. A long-term follow-up was performed at 31 months postpartum. Forty-one women with IDDM were recruited at their initial prenatal visit. Two women (4.8%) had thyroid function test abnormalities observed at screening, three (7.3%) had a spontaneous miscarriage, and eight (19.5%) women were noncompliant with follow-up. Twenty-eight women (68.2%) completed the study. Thyroid function tests and thyroid autoantibody determinations were obtained at all visits. PPTD was defined as a TSH greater than 5.0 or less than 0.2 mU/L in the postpartum period with documented normal thyroid function tests during pregnancy. The incidence of PPTD in women with IDDM was 25%. This is a 3-fold increase compared to a similar study by our group in a nondiabetic population. Forty-three percent of the women (3/7) who developed PPTD required treatment in the immediate postpartum period and at long-term follow-up. The remainder of the women with PPTD, as well as all women who did not develop PPTD were euthyroid at 31 months postpartum. Women with IDDM are at high risk for PPTD. We recommend that all women with IDDM be screened for thyroid hormonal abnormalities during pregnancy and at 3 months postpartum for postpartum thyroid dysfunction. Long-term follow-up did not reveal an increased incidence of hypothyroidism in women who did not require treatment in the first postpartum year.
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PMID:Long-term prospective study of postpartum thyroid dysfunction in women with insulin dependent diabetes mellitus. 802 56

We aimed to assess the impact of a preconceptional clinic (PC) on the perinatal outcome (PO) of diabetic pregnancies attended in our centre. We studied 185 pregnancies attended in the 1986-1996 period (152 in women with insulin dependent diabetes mellitus (IDDM) and 33 with non insulin-dependent diabetes mellitus (NIDDM)) and we analysed the perinatal outcome for both mother and fetus. Sixty-six women (36.1%) had enrolled in the PC, 41.4% for IDDM and 9.1% for NIDDM pregnancies, p < 0.01. First pregnancy HbA1c (in SD around the mean) was 3.98 +/- 3.00 in non-attenders (NA) vs 2.57 +/- 2.41 in attenders (A), p < 0.01. The final HbA1c was in the normal range in both groups. D-R class according to White classification was 33.0% for NA vs 54.5% for A, p < 0.01. There were no differences in the rates of abortion and major malformations (8.8% NA vs 3.6% A, ns). Both groups differed in the rate of cesarean sections (54.9% NA vs 71.0% A, p < 0.05) and in the rate of small for gestational age infants (SGA) (8.7% NA vs 1.8% A, p < 0.05). There were no differences between groups in maternal or neonatal outcomes. In this group of diabetic women with a moderate although less than optimal metabolic control at the beginning of pregnancy, the impact of PC on PO is less evident than described.
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PMID:Does preconceptional counselling in diabetic women influence perinatal outcome? 954 58

The association between maternal diabetes mellitus and congenital anomalies is well established. Congenital malformations in the offspring of diabetic mothers account for approximately forty percent of perinatal deaths. The aim of the study was to identify incidence of early embryonal delay in diabetic and normal pregnancies, and to examine relationship between the HbA1c values and early embryonal growth delay. One hundred twenty IDDM and fifty and four healthy women enrolled into the study. Pregnancy duration was confirmed by beta-HCG measurements within a fortnight from the missed menstrual period. No statistical difference was detected between the studied groups for gestational age, prepregnancy weight, newborns' birthweight and sex. The risk of spontaneous abortion in IDDM pregnancy with delayed embryonal growth was eight times higher than in IDDM pregnancies with normal growth pattern. No fetal malformations were determined in fetuses or newborns of either groups. The mean value and standard deviation of HbA1c in the IDDM patients with normal embryonic growth was 7.3 +/- 1.5%, and in the group of early embryonic growth, delay 9.39 +/- 2.37% respectively (F = 7.79; p = 0.006). This study confirmed the relationship between embryonal growth, spontaneous abortions and abnormal metabolic control of IDDM pregnancies.
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PMID:Influence of hyperglycemia on early embryonal growth in IDDM pregnant women. 1040 21

Iodine plays a decisive role in metabolism and the process of early growth and development of most organs, especially of the brain. Effects of iodine deficiency include goiter, stillbirth and miscarriage, neonatal and juvenile thyroid deficiency, dwarfism, mental defects, deaf mutism, spastic weakness and paralysis. In this study, the application of a mathematical model (derived from Machaelis-Menten enzyme kinetics) to iodine measured in urine samples from a randomly selected group derived from the Egyptian village of West El-Mawhoub in the Dakhlah Oasis resulted in the conclusion that iodine excretion parameters can be used to characterize iodine utilization and accurately predict the level of salt iodination required to maintain proper physiological functions. The four parameter saturation kinetics model analysis indicated that a salt iodination level of 63 mg/kg reduced the severity of IDD, with 83% of the studied subjects having urinary excretion levels of 1.18 micromol/L. This gives a convenient mechanism for providing adequate dietary iodine with a non-invasive index for the avoidance of IDD. Commercially available salt was analyzed using standard iodiometric titration methods to determine iodination levels. Analysis revealed that only 20% of the commercially available salt complied with the manufacturer's label and revealed the presence of large individual variability between batches amounting to -95 to +150% of the claimed iodine level. Therefore, salt iodination requires careful supervision to ensure that promised iodine levels are being delivered and consumed.
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PMID:Human iodine requirements determined by the saturation kinetics model. 1283 32

The purpose is to identify maternal and prenatal risks factors for placental vascular disorders. We excluded biologic and epidemiological data which are discussed in another chapter. Maternal risks factors are pre-existing vascular systemic diseases. Systemic lupus erythematosus (antiphospholipid antibodies are studied in another chapter) is a classical disease associated with unfavorable outcome, particularly when the disease is not quiescent and if the patient has a history of previous poor outcome. Obstetricians' awareness of the influence of inflammatory bowel diseases on pregnancy and fetal outcome is quite poor. These diseases, if they are not quiescent, can induce deleterious perinatal effects. Type 1 or even type 2 diabetes mellitus increases the risk of preeclampsia or hypertension in pregnancy, particularly when there is poor glycemic control early in pregnancy. The duration of type 1 diabetes affects the outcome of pregnancy more than type 2. Smoking during pregnancy is associated with many adverse events including spontaneous abortion, low birth weight and placental abruption. There are data about the dose-response relationship between the number of cigarettes smoked per day and the risk of abortion. Smoking during pregnancy is also protective against preeclampsia and this apparent paradox suggests the complexity of what is called vascular placental pathology. There is a significant relationship between pejorative perinatal vascular outcome and the non quiescence of renal disease. Mid-trimester uterine artery Doppler combining bilateral notches and increased uterine resistance index is the best criterion to predict the placental vascular risk of the pregnancy. Some promising studies suggest the feasibility of uterine Doppler ultrasound screening early in the pregnancy during the first trimester. Large studies are required to confirm this practice. Uterine artery Doppler in combination with other tests (elevated maternal serum hCG or ambulatory 24-hour blood pressure monitoring at 22 weeks gestation) could be a more efficient predictor of vascular complications. A large-scale evaluation is necessary before recommendations can be made. Multiple pregnancies increase the risk of preeclampsia 2- or 3-fold (RR 2.62; 95% CI: 2.03-3.38). A history of preeclampsia is the strongest predictor of unfavorable outcome for the second pregnancy.
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PMID:[Maternal and obstetrical risk factors of placental vascular pathology (biologic and epidemiological data excluded)]. 1502 85

Antithyroid antibodies are classified to immunoglobulin G. It is a varied group of antibodies as there are antibodies against TSH-receptor, against thyroid peroxidase and also against thyroglobulin. Pregnancy is a period in which the titres of antibodies decrease to protect fetus from abortion; but just after delivery they increase again. The clinical implications of this fact are varied and concern not only the thyroid gland but also other organs. Postpartum thyroid dysfunction (PPD) is one,possible disturbance due to presence of antithyroid antibodies. It can be divided into two various types: a) postpartum thyroiditis, b) Graves'-Basedow disease after delivery. Postpartum thyroiditis (PPT) is an example of autoimmune disease connected with many different factors such as genetic or environmental, but the most important factor is the presence of antibodies against thyroid peroxidase. PPT occurs in 50% of women with high titre of these antibodies. Higher risk of PPT also occurs within women with type I diabetes mellitus in comparison with the population, as well as within women-smokers. It is also proved that women with high titres of antibodies against TSH-receptor are more likely to suffer from Graves'-Basedow disease after delivery. The pathogenesis of postpartum depression is multifactorial. The occurrence of stressful life events (marital disharmony, housing and socioeconomic problems) and some biological factors (e.g. previous psychiatric illnesses) are strongly associated with postpartum depression. Some authors also said that postpartum depression depends on the presence of antithyroid antibodies during pregnancy. It is believed that cytokines which are released during the autoimmune process can affect the central nervous system and can determine changes in behavior. Some authors suggest that changes in concentration of thyroid hormones during the natural history of PPT can be connected with depression after delivery. It is also reported that high titres of antithyroid antibodies are linked with pregnancy loss but the results are not uniform.
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PMID:[Clinical implications of occurrence of antithyroid antibodies in pregnant women and in the postpartum period]. 1578 19


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