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

As a consequence of the increased prevalence of type 2 diabetes mellitus in younger age groups, the combination of this form of diabetes and pregnancy is seen more often. Three cases are described. A 31-year-old Caucasian woman with preconceptional type 2 diabetes mellitus presented at gestational week 8. She was receiving chronic treatment with oral hypoglycaemic drugs, and methyldopa due to the pregnancy. She was switched immediately to intensive insulin therapy, which resulted in reasonable glycaemic control. Delivery occurred prematurely at week 30 due to preeclampsia; the neonate died due to sepsis after 1 week. A 32-year-old Moroccan woman with previous gestational diabetes mellitus presented with hyperglycaemia during the first trimester, which suggested possible preconceptional type 2 diabetes mellitus. Insulin treatment was initiated, and the pregnancy continued without further consequence. A 34-year-old Moroccan woman with preconceptional type 2 diabetes mellitus was switched to intensive insulin treatment; conception was delayed until adequate glycaemic control was achieved. The pregnancy continued without further consequence. Insulin therapy should be initiated before conception in women with preconceptional type 2 diabetes mellitus that requires glucose-lowering therapy. Counselling and care are similar to that for women with type 1 diabetes mellitus. Women with a history of gestational diabetes should be counselled and tested before conception to detect silent type 2 diabetes mellitus. Given the high-risk nature oftype 2 diabetes mellitus and pregnancy, specialist team care is mandatory.
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PMID:[Management of type 2 diabetes mellitus during pregnancy]. 1854 46

We have evaluated the prevalence of the 25-hydroxy vitamin D (25VTD) deficiency in recently pregnant women and new mothers in the area of Liege, Belgium. The study took place in November 2006. Twenty four women who underwent a positive pregnancy test and 65 new mothers were enrolled. The level of 25VTD did not differ between the two groups. Only 12% of the pregnant women and 14% of the new mothers (>12 ng/ml) had an optimal level of 25VTD (>30 ng/ ml). We also observed a severe 25VTD deficiency in 21% of pregnant women and 32% of new mothers. Our results showed that more than 80% of pregnant women and new mothers in the area of Liege presented a deficiency in 25VTD. In Belgium, daily vitamin supplementation of pregnant women is common, but the level of vitamin D3 concentration range from 10 microg (400 UI) to zero microg. In our area, vitamin D production in the skin is not always important enough to achieve optimal levels. Our data show that vitamin D supplementation of pregnant women is not enough and that 25VTD deficiency is not diagnosed in this high-risk population. Children born from deficient mothers will present a higher risk of suffering from bone mineral diseases as well as other pathologies, as type 1 diabetes or neurological disorders. Of course, this insufficiency will also have an impact on mother's bone reserve, but these mothers will also be at higher risk for preeclampsia.
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PMID:[Vitamin D deficiency in recently pregnant women]. 1837 46

Pregnancy complications, such as preeclampsia (PEc), have an increased incidence among patients with type 1 diabetes (T1DM), possibly because of maternal vascular involvement. The prototypic long pentraxin, pentraxin 3 (PTX3) is an acute phase reactant critically associated with vascular injury. PTX3 concentrations selectively increase in pregnant women with PEc. Here, we measured PTX3 levels in 37 consecutive pregnant patients with T1DM. Compared with PTX3 levels in healthy pregnant women at identical gestational ages, PTX3 was significantly elevated in pregnant women with diabetes. Patients with pre-existing nephropathy, a well-characterized microvascular complication of diabetes, have even higher PTX3 concentrations and worse maternal and fetal outcomes. Six/thirty-four diabetic non-nephropatic patients developed PEc: PTX3 levels rose abruptly weeks before PEc manifested (p = 0.0375). PTX3 may represent a valuable marker for early detection and prediction of PEc in patients with T1DM.
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PMID:Elevation of plasma levels of the long pentraxin 3 precedes preeclampsia in pregnant patients with type 1 diabetes. 1981 Dec 81

Systemic sclerosis (SSc) pregnant women show a high frequency of premature births and occurrence of renal crisis. Some evidences showed the role of L-arginine in the prevention and treatment of preeclampsia. Here, we report our experience on the effect of L-arginine treatment in four consecutive SSc pregnant women. Two patients, who have planned the pregnancy, were treated with oral L-arginine; both delivered healthy babies without any prenatal complications. The other two, with high risk of pregnancy complications because of severe lung involvement and type 1 diabetes, respectively, underwent i.v. L-arginine: patient 3 had a premature delivery of a 2-kg healthy baby, while patient 4 developed preeclampsia and, at the 28th week, delivered a 1,050-g girl. The neonate had severe respiratory distress syndrome complicated by severe infection and died at day 28. Although limited, our pilot study suggests that L-arginine may be a useful therapeutic agent in pregnant SSc women.
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PMID:L-Arginine in pregnant scleroderma patients. 2021 28

We describe the feasibility of continuous glucose monitoring (CGM)-enabled insulin-pump therapy during pregnancy in a woman with type 1 diabetes, who was treated with CGM-enabled insulin-pump therapy in her third pregnancy. During her first pregnancy, the woman was treated with multiple daily injections and baseline HbA1c was 8.9%. Due to pre-eclampsia, the child was born preterm, and had neonatal hypoglycemia. In the planning of the second pregnancy, insulin-pump therapy was initiated, resulting in an HbA1c of 6.8% in early pregnancy. Due to pre-eclampsia, the second child was born preterm, but without neonatal morbidity. Before her third pregnancy, CGM-enabled insulin-pump therapy was introduced, and HbA1c was 6.4% in early pregnancy. The patient was satisfied with this therapy, pre-eclampsia did not occur, and the child was born at term without neonatal morbidity. CGM-enabled insulin-pump therapy appears feasible in diabetic pregnancies.
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PMID:Continuous glucose monitoring-enabled insulin-pump therapy in diabetic pregnancy. 2080 51

Vitamin D has historically been considered to play a role solely in bone and calcium metabolism. Human disease associations and basic physiological studies suggest that vitamin D deficiency is plausibly implicated in adverse health outcomes including mortality, malignancy, cardiovascular disease, immune functioning and glucose metabolism. There is considerable evidence that low maternal levels of 25 hydroxyvitamin D are associated with adverse outcomes for both mother and fetus in pregnancy as well as the neonate and child. Vitamin D deficiency during pregnancy has been linked with a number of maternal problems including infertility, preeclampsia, gestational diabetes and an increased rate of caesarean section. Likewise, for the child, there is an association with small size, impaired growth and skeletal problems in infancy, neonatal hypocalcaemia and seizures, and an increased risk of HIV transmission. Other childhood disease associations include type 1 diabetes and effects on immune tolerance. The optimal concentration of 25 hydroxyvitamin D is unknown and compounded by difficulties in defining the normal range. Whilst there is suggestive physiological evidence to support a causal role for many of the associations, whether vitamin D deficiency is a marker of poor health or the underlying aetiological problem is unclear. Randomised controlled trials of vitamin D supplementation with an appropriate assessment of a variety of health outcomes are required.
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PMID:Vitamin D and pregnancy: An old problem revisited. 2083 34

Until now, vascular complications in diabetic pregnancy are mainly related to hyperglycemia caused by type 1 diabetes (Type 1 DM). Progression of diabetic retinopathy (DR) occurs at least temporarily during pregnancy and postpartum. There is a short-term increase in the level of retinopathy during pregnancy that persisted into the first year postpartum. Nephropathy is associated with increased risk of preeclampsia, nephrotic syndrome, preterm delivery, fetal growth restriction, and perinatal mortality. Presence of retinopathy increases also risk of preeclampsia and also poor glycemic control. The pregnancy itself (first or subsequent) is not a long-term risk factor for developing microalbuminuria, any retinopathy, proliferative retinopathy, or neuropathy. The prevalence of type 2 diabetes (Type 2 DM) is rising leading to similar or even worse pregnancy outcome than in T1 DM. Micro- and macroangiopathic complications still rather rare in the mother will also become more prevalent with increasing age, obesity and more severe forms of Type 2 DM. Good glycemic control, normotension, lack of nephropathy as well as lack of pre-proliferative/proliferative changes of diabetic retinopathy and lack of signs of macroangiopathies are good prognostic factors as regards the progression of vascular complications during pregnancy. Women with diabetes should be evaluated before pregnancy for microangiopathies, treated and followed closely during pregnancy by obstetrician, internist/diabetologue, cardiologist and ophthalmologist and nephrologist.
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PMID:Vascular complications in diabetic pregnancy. 2126 42

Diabetes complicates up to 10% of all pregnancies in the United States. Of these, 0.2% to 0.5% are patients with type 1 diabetes mellitus (T1DM). Pregnancies affected by T1DM are at increased risk for preterm delivery, preeclampsia, macrosomia, shoulder dystocia, intrauterine fetal demise, fetal growth restriction, cardiac and renal malformations, in addition to rare neural conditions such as sacral agenesis. Intensive glycemic control and preconception planning have been shown to decrease the rate of fetal demise and malformations seen in pregnancies complicated by T1DM. Recent advances in insulin formulations and delivery methods have increased the number of options available to the obstetric team. Insulin regimens should be tailored to each individual patient to maximize compliance and ensure proper glycemic control. Intensive preconception counseling with frequent follow-up visits emphasizing tight glucose control is recommended for adequate management.
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PMID:Type 1 diabetes mellitus and pregnancy. 2136 60

Vitamin D plays a key role in calcium-phosphorus homeostasis and bone metabolism, but it is also involved in numerous others tissues. Vitamin D deficiency among pregnant women is frequent in many populations over the world. It is associated with an increased risk of preeclampsia, gestational diabetes mellitus, and caesarean section. Consequences in newborns are low birth weight, neonatal rickets, a risk of neonatal hypocalcemia, asthma and/or type 1 diabetes. Therefore, prevention of vitamin D deficiency among pregnant women is essential. The currently recommended supplementation amount of vitamin D is not sufficient to maintain a value of 25 hydroxy vitamin D above 30 ng/ml, during pregnancy. Randomized controlled trials during pregnancy are necessary to evaluate the amount of vitamin D sufficient to avoid the consequences of vitamin D deficiency.
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PMID:[Vitamin D and pregnancy]. 2200 74

Circulating maternal concentrations of hormonally active vitamin D [calcitriol, 1,25(OH)(2)D] rise early in the first trimester, doubling by the end of the third trimester. The early rise in calcitriol is believed to be necessary for enabling the immunological adaptation by the mother required for the maintenance of a normal pregnancy. This immunological adaptation is characterized by downregulation of the T helper type 1 (Th1) cytokine responses and a shift towards domination by the Th2 type responses. Attenuation of the Th1-mediated immune response is one of the influences of calcitriol on regulatory T cell activity and dendritic cell maturation. There is accumulating evidence that vitamin D supplementation may be able to prevent the immune maladaptation and loss of tolerance that occur in preeclampsia, with evidence for an association obtained from various types of observational studies and clinical trials. There is also evidence from observational studies for potential long-term programming effects of vitamin D supplementation on immunological diseases (such as type 1 diabetes and allergic diseases), with evidence supporting the role of active vitamin D as a potent immunomodulator. This paper highlights the complex effects of active vitamin D on immunomodulation with long-term implications for the risk of immunological diseases. It is suggested that it is essential to avoid vitamin D deficiency during pregnancy, and while accumulating evidence suggests important benefits of further increases in the intake, further research is required to fully establish the influence of high dosages.
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PMID:Preventing vitamin D deficiency in pregnancy: importance for the mother and child. 2212 34


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