Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To evaluate the metabolic basis of gestational glucose intolerance (gestational diabetes), the response of normal pregnant women (N=6) and lean (N=23), and obese (N=12) gestational diabetics to the physiologic challenge of a 400-kcal mixed meal breakfast tolerance test was studied. Obese patients with gestational diabetes were more hyperglycemic than the lean gestational diabetics in both the fasting and postprandial periods. Women with gestational diabetes had a more prolonged glycemic response and a later insulin response to meal stimulation than normal control subjects. Fasting and postprandial insulin levels were higher in the obese gestational diabetes group, whereas those of lean subjects fell below the values of the control group. The percent specific binding of insulin to red blood cell receptors was lower in both gestational diabetes groups than in control subjects, with the most marked decrease in the obese group. Mean fasting plasma levels of total cholesterol and triglyceride and plasma glucagon levels during the meal tolerance test were not significantly different among the three groups. Obese gestational diabetics had significantly larger infants and placentas than lean gestational diabetics. These findings, taken together, suggest that the pathophysiology of gestational diabetes differs between obese and lean patients. Lean gestational diabetics appear to develop glucose intolerance on the basis of relative insulin deficiency in contrast to obese gestational diabetics who manifest glucose intolerance characterized by insulin resistance, hyperinsulinemia, and decreased insulin binding to red blood cell receptors.
 ...
PMID:Demonstration of heterogeneity in gestational diabetes by a 400-kcal breakfast meal tolerance test. 388 Aug 78

We have examined gravida with gestational diabetes mellitus (GDM), as defined by the National Diabetes Data Group (Diabetes 1979; 28:1039), for phenotypic and genotypic heterogeneity. Fasting plasma glucose (FPG) at diagnosis was used for further stratification of GDM according to putative metabolic severity into class A1 (FPG less than 105 mg/dl [N = 129]), class A2 (FPG 105-129 mg/dl [N = 47]), and class B1 (FPG greater than or equal to 130 mg/dl [N = 23]). All GDM classes tended to be older and heavier than consecutive gravida with documented normal glucose tolerance (controls, N = 148). Subdivision into "lean" and "obese" indicated that plasma immunoreactive insulin (IRI) was greater after overnight fast in the obese of all groups except B1. However, absolute increases in IRI above fasting levels in response to glucose during OGTT were significantly enhanced by obesity only in class A2 gravida. Adjustment for the effects of age and weight by covariate analysis indicated that the IRI response to glycemic stimulation is usually attenuated in all forms of GDM. Mean values for increases in IRI above fasting values during the first 15 min and IRI increments relative to the increases in plasma glucose throughout the 180-min OGTT were below control values in all GDM groups and progressively so, i.e., A1 less than A2 less than B1. The absolute insulinopenia was not invariable; a small number of gravida from all GDM groups displayed well-preserved IRI responses to oral glucose. Genotypic evaluation of the GDM population disclosed an increased occurrence of "markers" known to be associated with type I diabetes mellitus.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Gestational diabetes mellitus. Heterogeneity of maternal age, weight, insulin secretion, HLA antigens, and islet cell antibodies and the impact of maternal metabolism on pancreatic B-cell and somatic development in the offspring. 388 33

One hundred twelve women with impaired glucose tolerance (IGT) diagnosed by intravenous glucose tolerance test (IVGTT) after pregnancy were followed up for a period of up to 22 yr (mean 12.9 yr). About one-third have been treated with chlorpropamide and the others by diet only. At the final assessment, approximately 35% had abnormal intravenous glucose tolerance and less than 7% overt diabetes. Chlorpropamide did not prove significantly more effective than diet only. Factors associated with deterioration in glucose tolerance were age at diagnosis and follow-up and the initial fasting plasma glucose (FPG) level (greater than or equal to 5.8 mM), but obesity was less important, although it was associated with an increased rate of vascular complications. Tests for islet cell antibodies (ICA) were weakly positive in 12.5% of 72 subjects and in only 0.5% of an unselected population; they did not correlate with the final state of glucose tolerance. Only three patients developed insulin-dependent diabetes (IDDM) and did so before the ICA study was started. A comparison is made between the results reported by O'Sullivan in patients diagnosed as having gestational diabetes, only 2% of whom still had abnormal oral glucose tolerance postpartum, and the results of our patients, all of whom had IGT after pregnancy. In spite of differences of technique and in the populations studied, the prevalence of IGT and overt diabetes at follow-up was significantly less in the Aberdeen series, who were initially a higher risk group. It seems probable that this is mainly attributable to dietary treatment in the follow-up period as O'Sullivan's cases were treated only during pregnancy.
 ...
PMID:Long-range implications for the mother. The Aberdeen experience. 388 35

The maternal antepartum, intrapartum, and neonatal characteristics of 158 patients with gestational diabetes mellitus (GDM) attending a large teaching hospital between 1979 and 1983 were described and compared with a matched nondiabetic control group. The primary cesarean section rate in patients with GDM (18%) was significantly greater than in the control group (11%, P less than 0.04). Neonatal macrosomia, as reflected in mean birthweight (P less than 0.04), the number of neonates weighing greater than 4 kg (P less than 0.05) and large-for-gestational-age infants (P less than 0.05), and the birthweight adjusted for gestational age (K-score, P less than 0.01) was significantly increased in the diabetic group. The characteristics of patients with GDM treated with diet alone and diet and insulin together were examined. The insulin-therapy group was characterized by more patients older than 25 yr (P less than 0.01) and a higher mean birthweight (3743 +/- 677 g) (P less than 0.02) than the diet-alone group. This may reflect an increased magnitude of glucose intolerance in the insulin-treated group. Obese patients with GDM delivered heavier neonates than the nonobese patients with GDM (P less than 0.01). Although there was no difference between the groups, perinatal mortality was present in this study. These data indicate that the major perinatal morbidity in GDM included increased cesarean section for fetal macrosomia. Early diagnosis with strict diagnostic criteria and rigid antenatal surveillance may result in further improvements in outcome.
 ...
PMID:Gestational diabetes mellitus. Is further improvement necessary? 388 43

Most studies of gestational diabetes mellitus (GDM) have reported a marked reduction in perinatal mortality with appropriate dietary regimens and good medical and obstetrical surveillance. Nevertheless, fetal morbidity, including macrosomia, has remained high and appears to be linked to factors other than plasma glucose control. In a review of six investigations in which insulin therapy was combined with an appropriate diet, the incidence of fetal macrosomia was reduced in five studies as compared with diet-only treatments. Again, the improvement did not always correlate with altered plasma glucose profiles. Other studies suggest that maternal plasma substrate disturbances other than glucose may contribute to the development of fetal macrosomia. To what extent insulin administration reduces morbidity by containing circulating maternal fuels, such as lipids and amino acids, in a more normal range remains to be determined. Moreover, the role of diet, maternal obesity, and weight gain during pregnancy adds to the complexity of factors influencing obstetrical outcome in gestational diabetes. Until the relative importance of all of these variables is adequately assessed, criteria for selection of women with pregnancy-onset diabetes for insulin therapy are most likely to be based on fasting and postprandial plasma glucose concentrations.
 ...
PMID:Therapeutic results of insulin therapy in gestational diabetes mellitus. 388 49

The health consequences of obesity in adults encompass both metabolic and cardiovascular complications. Pregnancy in obese women also has a particular set of problems. For the obese pregnant woman, these include weight gain less than 5.4 kg, chronic hypertension and superimposed preeclampsia, gestational diabetes, multiple gestation, and the potential for a macrosomic child. The combination of obesity and maternal diabetes does not appear to have an additive effect on the excessive growth of infants of obese mothers. Furthermore, despite inadequate weight gain, hypertension, and multiple gestation, infants of obese mothers are usually born with a greater birth weight than those of nonobese women. In addition, the incidence of intrauterine growth retardation is lower after an obese pregnancy. Neonates born to obese mothers have increased risk for birth asphyxia and birth trauma. Recently infants born to obese women were noted to have transient neonatal fasting asymptomatic hypoglycemia. Hyperinsulinism is not present in the infants of obese mothers; thus, alternate fuel mobilization (free fatty acids, glycerol, ketones) may respond to the hypoglycemic stimulus. Suggestions and rationale for the management of the pregnant obese woman, fetus, and newly born infant are discussed in the text.
 ...
PMID:Perinatal problems of the obese mother and her infant. 389 77

Maternal obesity has been associated with both gestational diabetes mellitus (GDM) and neonatal macrosomia. Most studies of obesity in pregnancy have demonstrated an increased risk for GDM. However, the contribution of obesity as an added risk in GDM has not been examined. The purpose of this study was to examine the contribution of obesity as a risk factor to perinatal morbidity in gestationally diabetic women by comparing the maternal and neonatal outcome in obese and nonobese gestationally diabetic women. From 1979 to 1983, the maternal, intrapartum, and neonatal characteristics of all prepartum gravid patients with GDM were examined. Of the 158 patients with documented GDM, 62 (39%) were obese (weight greater than 90 kg). There was no difference in maternal age (obese 29.3 +/- 5.4 years, nonobese 28.7 +/- 6.5 years) parity, or prepartum risk score between the obese and nonobese patients. The incidence of prematurity, pre-eclampsia, fetal distress, and primary cesarean sections were not different between the groups. There were no differences in Apgar scores, gestational age, or perinatal morbidity. However, the obese patients delivered heavier neonates expressed as mean birthweight (obese 3667 +/- 682 gms, nonobese 3331 +/- 750 gms. P less than .01), the number of macrosomic (greater than 4 kg) neonates (obese 37%, nonobese 14%, P less than .001) and K-score, (obese 0.8 +/- 1, nonobese 0.4 +/- 9, P less than .05). These data indicate that obese patients with GDM have an increased risk of neonatal macrosomia.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Maternal obesity as a risk factor in gestational diabetes. 405 76

In this study of the effects of maternal diabetes on the growth of offspring, 52 diabetic mothers were enrolled prenatally in the Providence cohort of the Perinatal Collaborative Study during 1960-1963. Among the offspring, there were 12 perinatal deaths. We were able to enroll 34 survivors and 34 matched controls in an adolescent follow-up study. Of the 34 diabetic mothers, six were insulin dependent, six had chemical diabetes, 13 had gestational diabetes, and nine were suspects. As part of the Collaborative Project, sequential follow-up evaluations had been done at four months, one year, four years, and seven years. A positive relationship was found between maternal pre-pregnant weight, weight gain during pregnancy, and the neonatal weight/height index in both diabetic and control subjects. At 7 years of age, eight of 19 offspring of diabetic mothers who were large for gestation at birth were obese, whereas only one of 14 infants who were appropriate for gestation at birth were obese (P < 0.05). Adolescent obesity (weight/height index greater than or equal to 1.2) was more likely in infants who had been LGA at birth. These data suggest that macrosomia in infants of diabetic mothers may be a predisposing factor for later obesity.
 ...
PMID:Somatic growth of children of diabetic mothers with reference to birth size. 740 Aug 85

A high incidence (over 20%) of obesity was found in 250 neonates living in a rural area of Tunisia, by using weight and ponderal index per gestational age as the nutritional index. Maternal diabetes was probably excluded. Two surveys on nutritional habits--one on the general population and the other on pregnant women--showed a tendency to consume a high carbohydrate and low protein diet. The effect of a badly balanced maternal diet on the fetus is discussed.
 ...
PMID:Excessive carbohydrate intake in pregnancy and neonatal obesity: study in Cap Bon, Tunisia. 743 3

In order to establish the prevalence of gestational diabetes mellitus (GDM) among ethnic groups residing in the catchment area of one hospital in central London and to assess both the mode of delivery and the baby outcome, we studied retrospectively 703 women selected for screening for GDM during the years 1991 and 1992. While the prevalence of GDM was approximately 2% overall, within the ethnic groups a significant difference was found with Asians and Africans/Afrocaribbeans being four and two times more likely to have GDM, respectively, than Caucasians (P < 0.001). Both maternal obesity and the diagnosis of GDM influenced the time and the mode of delivery, but perinatal mortality and morbidity did not differ significantly between women with GDM and women with normal glucose tolerance. An association between the GTT glucose area and the gestational age and ethnicity adjusted birth weight was observed in women with normal glucose tolerance test, but was absent in the GDM pregnancies, providing indirect evidence that dietary treatment, with or without insulin treatment, altered the maternal milieu in the latter sufficiently to modify fetal growth.
 ...
PMID:Difference in prevalence of gestational diabetes and perinatal outcome in an innercity multiethnic London population. 765 9


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>