Non-diabetic Pregnant Women Research Articles

Unveiling Macrosomia Risks of Non-Diabetic Women: Insights from Second Trimester Maternal Lipid Profiles.

Macrosomia, characterized by excessive fetal growth, is common in infants born to women with pre-gestational diabetes and gestational diabetes mellitus (GDM). However, macrosomia, which leads to birth-related maternal and fetal complications and metabolic complications in the adolescence of the affected fetuses, also occurs in the pregnancies of non-diabetic women. This study aims to identify the association between second-trimester lipid profiles and macrosomia in non-diabetic pregnant women to aid in early diagnosis. This retrospective cohort study included 8,956 patients who delivered at a tertiary care center between 2017 and 2019. Exclusion criteria encompassed pre-existing diabetes, GDM, preeclampsia (PE), intrahepatic cholestasis of pregnancy, obesity, fetal chromosomal or genetic abnormalities, tobacco, alcohol, or drug use affecting lipid metabolism. Participants were divided into two groups: 621 with macrosomia and 873 controls. Second trimester maternal lipid profiles and demographic variables such as age, pregnancy week, and gender were assessed. In the study cohort, maternal age (P=0.002), gestational week (P=0.003), and cesarean section rate (P<0.001) were higher in the macrosomic group. High-density lipoprotein-cholesterol (HDL-C) was significantly lower, while total cholesterol (TC), triglycerides (TG), and low-density lipoprotein-cholesterol (LDL-C) were significantly higher in the macrosomic group (P<0.001). Univariate analysis revealed positive associations between second-trimester TG (OR 1.023, 95% CI: 1.020‒1.033, P<0.001), TC (OR 1.023, 95% CI: 1.016‒1.030, P<0.001) and LDL-C (OR 1.036, 95% CI: 1.018-1.054, P<0.001) with macrosomia and a negative association with HDL-C (OR 0.954, 95% CI: 0.923‒0.976, P<0.001). However, after adjusted multivariable logistic analysis, only TG remained statistically significantly associated with macrosomia (OR 1.054, 95% CI: 1.033‒1.076, P<0.001). Our study emphasizes the importance of early recognition and prevention of macrosomia. Structured prospective studies are needed to enhance macrosomia prediction and implement preventive measures, such as dietary modifications. These strategies will be crucial in preventing birth-related complications and long-term health risks, including diabetes, obesity, and cardiovascular diseases, associated with macrosomia.

Histological Change of Placenta in Diabetic Pregnant Women in Comparison to Normal Pregnant Women

Background: The placenta is a foeto-maternal organ and its alterations is directly related to the disease’s length and severity. The human placenta experiences a number of functional and structural pathologic alterations when complicated by metabolic disorder such as diabetes mellitus. Methods: This cross-sectional comparative study was conducted over a period of threeyears from January 2019 to December 2021 at the Department of Anatomy, Rajshahi Medical College, Rajshahi, in collaboration with the Department of Obstetrics and Gynaecology, Rajshahi Medical College Hospital and Diabetic Hospital Rajshahi, Bangladesh. The study was carried out on 70 pregnant women, among them 35 diabetics and 35 non-diabetics. The fibrinoid necrosis, syncytial knot and immature villi of the placenta were studied in diabetic and non-diabetic pregnant women. SPSS software, version-24 was used for data analysis, with a p-value &lt; 0.05 indicating statistically significance for all tests. Results: The diabetic and non-diabetic pregnant women groups were almost identical in terms of attachment of umbilical cord to placenta with marginal attachment being more often found in either group (p = 0.829). Histological examination of placenta showed that fibrinoid necrosis was common in placenta of diabetic mothers than that of the normal mothers (p &lt; 0.001). Syncytial knot and immature villi were higher in the former group than those in the latter group, here p values were also less than .001. Conclusion: Histological findings (fibrinoid necrosis, syncytial knot and immature villi) were more in placenta of diabetic mother and they were highly significant different between the groups. EWMCJ Vol. 12, No. 1&amp;2, January-July 2024: 27-33

Impact of Diabetes in Pregnancy on Stage II Lactogenesis among Postpartum Diabetic Women Compared to Non-Diabetics

Abstract Background Diabetes in pregnancy -whether preexisting or gestational can have negative impact on pregnancy, labor and lactation. Infants of diabetic mothers benefit most from early establishment of breastfeeding as it helps them regulate their blood glucose levels on the short term and decrease their risk of developing diabetes later on life. Aim of the Work This study aims to compare diabetic and non-diabetic pregnant women regarding the onset of stage II lactogenesis at 72 hours postpartum and to associate the degree of diabetes control in antepartum period with the delay in stage II of lactogenesis. Subjects and Methods This study is an observational prospective cohort study, carried out on 203 pregnant women aged from 18 to 40 years old during their routine antenatal care visits in the third trimester of pregnancy at Ain-Shams University Maternity hospital outpatient clinic from December 2020 to August 2021, Cairo, Egypt. Results We found that Diabetes in pregnancy can cause a delay in the onset of Lactogenesis stage II regardless of the degree of control. We can also say that diabetes can affect lactation directly and indirectly. For example, Diabetes can cause higher rates of cesarean section, infant separation from mother and delayed initiation of first breastfeed which was found to cause DOLII. And early initiation of lactation can be a modifiable risk factor to protect from DOLII especially in Diabetic mothers. Conclusion Diabetes can cause series of unfortunate events in pregnancy, labor, and lactation. Many of diabetes implications on peripartum health can affect lactation directly and indirectly. For example, Diabetes can cause higher rates of cesarean section, infant separation from mother, delayed initiation of first breastfeed and other birth complications. All these can cause DOL II. Diabetes itself is a risk factor for delayed onset of lactogenesis II which can cause further neonatal hypoglycemia and/or early introduction of infant formula. The cascade of these events can hinder the breastfeeding establishment when it is most needed. The control of diabetes was not found to have impact on DOL II. Further research needs to be done in this regard. Early initiation of lactation can be a modifiable risk factor to protect from DOLII especially in Diabetic mothers.

Insulin Blood Levels in Gestational Diabetes Mellitus in Relation to Ethnicity and Age in the Kingdom of Bahrain: A Cross-Sectional Study.

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. It may be attributed to certain placental hormones during pregnancy which render insulin less effective. Our study aimed to focus on the levels of insulin in gestational diabetic women in the Kingdom of Bahrain as compared with non-diabetic pregnant women. Furthermore, we studied the correlation between insulin levels by ethnicity and age of the pregnant women. Methods: A cross-sectional study was conducted on 75 pregnant participants: 41 with GDM (test group) and 34 without GDM (control group). Insulin levels were determined in patients with GDM and compared to non-diabetic pregnant women. A comparison between Bahraini and non-Bahraini women was carried out in two different age groups: below and above 30 years of age. P values < 0.05 were considered significant. The results showed higher mean values of fasting blood glucose (FBG), random blood glucose (RBG), and insulin levels in the test group when compared to the control group. There was no significant difference in FBG, RBG, and insulin levels among Bahraini women with GDM and non-Bahraini women (Indian, Pakistani. Bengali, and Filipino) with GDM. Age, less than 30 vs more than 30 years, had no significant effect on women with GDM. Insulin levels were higher in pregnant women with GDM irrespective of their ethnicity or age. The lack of blood glucose control in GDM even in the presence of high insulin secretion may suggest loss of insulin effectiveness due to other factors such as stress and lactogenic placental hormones.

Investigation of Phosphorylated and O-Glycosylated Proteins in Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) is a common but temporary type of diabetes that develops among 10-20% of all pregnant women. It is a major cause of several pre- and post-pregnancy diseases in both mother and offspring. The main causative is altered pregnancy hormones that lead to deficient glucose metabolism. Complications can be preeclampsia, caesarean sections and cardiovascular diseases. This study was designed to determine the phosphorylated and glycosylated proteins present in GDM and to investigate the role of their post-translational modifications (PTMs) in the pathogenesis of GDM. The study was performed on 30 blood samples from pregnant diabetic women (diseased), 30 pregnant non-diabetic women (control) and 30 women without pregnancy and gestational diabetes (normal). Protein extraction was done from blood plasma, and phosphorylated and glycosylated proteins were determined by Enzyme-Linked Immuno-Sorbent Assay (ELISA) by use of specific antibodies. This study showed that proteins found in GDM are highly phosphorylated and O-glycosylated (p&lt;0.01). Furthermore, a bioinformatic investigation was done, which showed that blood coagulation proteins such as the Fibrinogen alpha chain and lipid metabolism-regulating proteins apolipoprotein E, L1 and C-III showed a high potential for phosphorylation, which suggests that phosphorylation can be used as a therapeutic marker in GDM.

Comparative Analysis of Abnormal Pregnancy Between Non-Diabetic Pregnant Women and Diabetic Pregnant Women by Using Nanobubbles-Based Ultrasound Images

Objective: ultrasound imaging based on nanobubbles was used as the examination method in this study. Abdominal examination was performed on patients with and without diabetes during pregnancy, and the examination data between patients in different groups were compared and analyzed. Methods: 74 pregnant women were selected and enrolled in this study. Thirty-five pregnant women with diabetes were enrolled in the experimental group (Exp group) and 39 pregnant women without diabetes were assigned to the control group (Ctrl group). Results: there were no significant differences in fetal abdominal circumference, femoral length, and biparietal diameter between the two groups. The liver length and head circumference in the Exp group were higher based on the Ctrl group, with a statistical significance. Moreover, the occurrence probability of abnormal fetal growth and development indexes in the Exp group was higher and exhibited a statistical significance to that in the Ctrl group. Conclusion: patients with diabetes were more likely to have abnormal pregnancies. It is necessary to adopt color examination for clinical screening of diabetic pregnant women, so that the life safety of pregnant women and fetus can be guaranteed, reflecting the good application prospect of ultrasound examination.

Association of maternal insulin resistance with neonatal insulin resistance and body composition/size: a prospective cohort study in a sub-Saharan African population.

We prospectively evaluated the association of the insulin resistance of third-trimester Nigerian pregnant women with their newborn infants' insulin resistance and birth size. Pregnancy-associated insulin resistance (IR), often assessed with homeostatic model assessment of IR (HOMA-IR), is associated, especially among women with gestational diabetes (GDM), with abnormal neonatal birth size and body composition, predisposing the baby to metabolic disorders like diabetes and obesity. The associations of maternal IR with neonatal IR, birth size and body composition are less studied in nondiabetic pregnant women, especially in sub-Saharan settings like Nigeria. We originally recruited 401 third trimester, nondiabetic pregnant women to a prospective cohort study, followed up until birth. Blood samples of mothers and babies were obtained, respectively, at recruitment and within 24 hours postbirth for fasting serum glucose (FSG) and insulin (FSI) assays, and HOMA-IR was calculated as [(FSI × FSG)/22.5)]. Complete data for 150 mother-baby dyads was analysed: the mothers, with a mean (standard deviation [SD]) age of 31.6 (4.5) years, had live births at a mean (SD) gestational age of 39.2 weeks. The proportions of infants with wasting, stunting, impaired fetal growth (either wasting or stunted), small-for-gestation-age, large-for-gestational-age, low birthweight, and macrosomia were 4.2% (95% confidence interval, 1.1-10.3), 19.7% (12.9-28.0), 23.1% (15.8-31.8), 10.1% (5.3-17.0), 12.6% (7.2-19.9), 0.8% (0.02-4.5), and 5.0% (1.8-10.5), respectively. Maternal HOMA-IR was not associated with neonatal HOMA-IR (p=0.837), birth weight (p=0.416) or body composition measured with weight-length ratio (p=0.524), but birth weight was independently predicted by maternal weight (p=0.006), body mass index (p=0.001), and parity (p=0.012). In this nondiabetic/non-GDM cohort, maternal HOMA-IR was not associated with neonatal IR, body size or body composition. Larger studies are required to confirm these findings, with addi-tional inclusion of mothers with hyperglycaemia for comparison.

Role of preoperative carbohydrate loading for prevention of perioperative ketoacidosis in elective cesarean delivery.

Starvation of long duration during third trimester of pregnancy is undesirable as it is associated with accelerated fasting leading to hypoglycemia, raised plasma free fatty acid (FFA) levels, and increased plasma/urinary ketones. Carbohydrate (CHO)-rich drinks given preoperatively may ameliorate these deleterious effects. The enhanced recovery after surgery (ERAS) guidelines for perioperative care recommend that oral CHO fluid supplementation 2 h before cesarean delivery may be offered to nondiabetic pregnant women. The aim of the study was to evaluate the role of preoperative oral CHO loading for the prevention of perioperative ketoacidosis in elective cesarean deliveries. One hundred and twenty American Society of Anesthesiologists (ASA) II/III parturients undergoing elective cesarean section under subarachnoid block (SAB) were divided into two groups of 60 each after they gave written informed consent. Group A parturients received 400 ml of filtered water 2 h before surgery. Group B parturients received 400 ml of nonparticulate CHO drink 2 h before surgery. The primary outcome was the incidence of ketonuria studied by the dipstick method. Secondary outcomes included hunger and thirst scores, anxiety score, dominant hand grip strength, and the quality of recovery score. The urine ketone levels were positive (+1) in 8.3% parturients in group A and 1.7% parturients in the CHO group (P value- 0.094). The hunger and thirst scores as well as the modified Beck's anxiety scores were significantly lower in the CHO group (P value- 0.002). Dominant hand grip strength was preserved in both the groups (P value- 0.827). The quality of recovery score was significantly improved in the CHO group (P value- 0.002). No serious adverse effects were noted in either group. Oral CHO drink is safe when administered 2 h before uncomplicated elective cesarean deliveries. It may have a positive influence on a wide range of perioperative markers of clinical outcome.

Impact of Iron Deficiency Anemia on Hemoglobin A1c Levels in Diabetic and Non-Diabetic Pregnant Women

Impact of Iron Deficiency Anemia on Hemoglobin A1c Levels in Diabetic and Non-Diabetic Pregnant Women

Risk Factors for Preeclampsia in Pregnant Women with Pregestational Diabetes

Purpose: To estimate the incidence of preeclampsia in pregnant women with pregestational diabetes and to identify risk factors for preeclampsia. Material and methods: A retrospective cohort study of pregnant women with pregestational diabetes was conducted and compared with a random sample of non-diabetic pregnant women from the population served in the period from January 2017 to August 2019 at the Obstetrics Service of the Women's Hospital. By means of multiple logistic regression the risk factors for preeclampsia were estimated. Results: 10% and 90% of the cases were type 1 and type 2 diabetes mellitus respectively. The incidence of preeclampsia in pregestational diabetes mellitus was 22.5%. Chronic hypertension (OR: 28, CI95%4.8,164) for global PE, nulliparity (OR:6.8, CI95%1.6,36.2) for PE with SF, metabolic disorder (OR:8.4, CI95%1.3,54) for early-onset PE. Conclusions: Chronic hypertension, nulliparity, and metabolic disorder were risk factors for preeclampsia in pregnant women with pregestational diabetes.

Neonatal Outcomes in Type 1 Diabetes Pregnant Women, A Single-Center Retrospective Study

Background: Pregnancy in women with type 1 diabetes mellitus (T1DM) is associated with an increased risk of congenital malformations, and obstetric complications including increased rates of cesarean section birth, prematurity, and neonatal adverse outcomes including large for gestational age (LAG), and hypoglycemia. Our aim of this study is to investigate and evaluate the prevalence and the different neonatal outcomes of T1DM pregnant women compared to nondiabetic healthy pregnant women in a single-center experience to improve the effectiveness of interventions for the treatment of pregnant women with T1DM. Methods: This is a retrospective cohort study of 113 pregnant women (43 pregnant patients with T1DM and 70 non-diabetic healthy pregnant women) who underwent regular follow-in the antenatal period and delivered at King Fahad Military Medical Complex (KMMC) - Dhahran between 2018 and 2023. Results: A total of 117 pregnant women (47 with Type-1 diabetes mellitus-T1DM and 70 healthy controls) were included in the study. The proportion of elective C-sections was significantly high in women with T1DM 21 (44.7%) and the proportion of neonatal hypoglycemia who need treatment was also significantly high in diabetic women 20 (42.6%). NICU/SCBU admission was significantly high in diabetic women 23 (48.9%). Conclusion: The high prevalence of neonatal adverse outcomes especially hypoglycemia and intensive care admission of T1DM pregnant women compared to non-diabetic pregnant women indicates that this model of antenatal diabetes care must be improved to enhance maternal and fetal outcomes, especially in such high-risk groups and challenging problems.

Breastfeeding Efficacy and Longevity in Scotland – Time to Think Outside the Box?

The World Health Organization (WHO) and Baby Friendly Initiative (BFI) recommend that infants are exclusively breastfed until six months of age. While there is a high initiation rate for breastfeeding at hospital discharge, the drop-off rate continues to increase. There have been many studies conducted into reasons behind the decreased longevity and exclusivity of breastfeeding and there is evidence from the literature that there needs to be more intervention antenatally to have a positive influence on infant feeding. Innovative thinking is required in how this can be facilitated and one intervention that requires further research is antenatal hand expressing. Antenatal hand expression of colostrum has been researched in pregnant diabetic women but there is a lack of evidence for non-diabetic pregnant women and the potential role it may have in influencing longevity and exclusivity of breastfeeding.

FRI628 Subnormal Fructosamine Levels In Non Diabetic Pregnant Women

Abstract Disclosure: U.M. Kabadi: None. S. Exley: None. Introduction: American College of Obstetrics and Gynecology (ACOG) and American Diabetes Association (ADA) recommend 2 step testing for diagnosis of Gestational Diabetes (GDM). The process is cumbersome and inconvenient. HbA1c levels are adopted as a screening test in nonpregnant adults but not during pregnancy. Alternatively, serum Fructosamine is not tested for diagnosis of DM in any population. We are in the process of examining utility of serum Fructosamine as a screening test for diagnosis of GDM. However, no data is available regarding Fructosamine concentrations in nondiabetic pregnant women. Therefore, we determined serum Fructosamine levels in pregnant women at 24 to 28 weeks at the time of 1 hour or 3 hour OGTT. Subjects and Methods: Random glucose (mg/dl), Fructosamine ( mcM/l) and HbA1c (%) were determined at 24-30 weeks in 200 pregnant women, age 24-40 years in whom the diagnosis of GDM was eliminated by either normal 1 hour OGTT or by normal 3 hour OGTT in presence of abnormal 1 hour OGTT according to criteria established by ACOG and ADA. 21 age matched nonpregnant women participated as controls. Normal reference ranges for all determinations were established by the local laboratory (Glucose, 60-139; Fructosamine, 200-285; HbA1c, 4.4-5.6). Statistical comparisons between 2 groups were conducted using Student’s ‘t’ test. Results: Fructosamine levels (182 ± 4) were significantly lower (p&amp;lt; 0.01) in non diabetic pregnant women when compared with age matched non pregnant women ( 224 ± 5). Cutoff Fructosamine between groups was 182. Glucose (96 ±7) and HbA1c (5.1 ± 0.2) were not significantly different amongst groups. Conclusion: In non diabetic pregnant women, Serum Fructosamine concentrations are subnormal whereas random glucose and HbA1c levels remain within normal range noted in age matched non pregnant women. Further studies are underway to assess the utility of serum Fructosamine as a screening test in diagnosis of GDM. Presentation: Friday, June 16, 2023

Trimester-specific reference intervals for hemoglobin A1c in non-diabetic pregnancy in a Chinese population

BackgroundPhysiological glycated hemoglobin (HbA1c) values in each trimester are not well defined. This study aimed to determine trimester-specific reference intervals for HbA1c levels in non-diabetic pregnant women in China.MethodsIn this cross-sectional study, 5,042 Chinese pregnant women from 6 to 41 weeks of gestation were screened. An inclusion of 4,134 non-diabetic women was made to determine the reference intervals, they were divided into three trimesters: trimester 1 (T1), 6 weeks to 13 weeks + 6 days, trimester 2 (T2), 14 weeks to 27 weeks + 6 days, and trimester 3 (T3), 28 weeks to 41 weeks + 6 days. A total of 4,134 women (T1 n = 760, T2 n = 1,953, and T3 n = 1,421) provided blood samples which were analyzed for HbA1c concentrations. HbA1c was measured using high-performance liquid chromatography. The median and percentile (2.5th to 97.5th) for the HbA1c reference intervals were calculated for each trimester.ResultsIn total, 8,732 HbA1c measurements were taken. Reference intervals for HbA1c expressed as median and percentile (2.5th to 97.5th) for each trimester were: T1: 4.7 (4.0–5.5%), T2: 4.5 (3.9–5.3%), and T3: 4.8 (4.1–5.7%) respectively. The HbA1c levels were significantly lower in the second trimester compared to those in the first trimester (p < 0.0001), and higher in the third trimester compared to the second trimester (p < 0.0001).ConclusionsThe reference intervals for HbA1c levels were 3.9–5.7% with upper limits of 5.5% in the first trimester, 5.3% in the second trimester, and 5.7% in the third trimester. These findings highlight the importance of considering trimester-specific reference intervals for HbA1c in non-diabetic pregnant women to promote maternal and fetal health.

Factors Associated with Cesarean Operations of Gestational Diabetic Mellitus and Diabetes Complications

Objective: To identify risk factors of cesarean delivery in pregnant women with diabetes mellitus and complications caused by gestational diabetes. Materials and Methods: A retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Phatthalung Hospital. The participants consisted of pregnant women who labored at Phatthalung Hospital between 2017 and 2021. The inclusion criteria comprised women who labored from 28 to 42 weeks and had complete medical records. Patients having previous cesarean sections, cesarean section on maternal demand, and twin pregnancy were excluded. The study group was diabetic mellitus pregnant women, while non-diabetic pregnant women was generated by random numbers at ratio of 1:1 as control group. The data collected were demographic data, age, body mass index (BMI), number of gestations, parity, abortion, type of diabetic mellitus, underlying disease, route of delivery, indications for cesarean delivery, and maternal and neonatal outcomes. Results: Two thousand twelve pregnant women consisted of 1,006 pregnancies with diabetes and 1,006 non-diabetic pregnancies. Pregnant women with diabetes significantly increased the risk of cesarean section 1.42 time (95% CI 1.19 to 1.70, p&lt;0.001). The greatest indication for cesarean section of both groups was cephalopelvic disproportion, but failure for induction of labor and macrosomia were found in the study group more than in the control group. Logistic regression analysis, adjusted for age group, number of gestations, and BMI, showed that pregnancy-induced hypertension and newborn weight of 4,000 g or more were risk factors for cesarean section among diabetic pregnancies. The maternal complications of the study group were preeclampsia, indicated preterm labor, and premature rupture of membranes. The common fetal complications were macrosomia and birth asphyxia. Conclusion: Risk factors of cesarean section among pregnant women with diabetes included preeclampsia and newborn weight of 4,000 g or more. Gestational diabetes increased significantly the maternal and fetal complications. Keywords: Gestational diabetic mellitus; Cesarean section; Complications

Umbilical cord diameter study on microscopic tissue in gestational diabetes mellitus and its correlation to fresh tissue diameter and fetomaternal parameters

Background: Umbilical cord is the only vital link between the mother and the fetus and is essential for maintaining the fetomaternal exchange of oxygen, nutrients, and waste products. Clinical studies have shown that umbilical cord diameter (UCD) is larger in gestational diabetes mellitus (GDM) and UCD analysis based on microscopic tissue (dry) provides more accurate information. Aims and Objectives: The present study was conducted to measure the UCD using microscopic tissue in GDM and normal cases and ascertain its correlation with fresh tissue (wet) diameter, fetal weight, maternal BMI, and gestational weight gain. Materials and Methods: The study included 111 subjects. They were divided into two groups. Group I consisted of umbilical cords obtained from non-diabetic pregnant women (n=52) and Group II comprised umbilical cords obtained from mothers with GDM (n=59). UCD was measured using Vernier calipers and all the other parameters were assessed through standard methods. Results: UCD in microscopic (P=0.005) and fresh tissues (P=0.0001) was significantly higher in GDM patients. Although microscopic tissue measurements tended to underestimate fresh-tissue measurements of UCD, these measurements had a positive correlation with each other in both groups. UCD also had a statistically significant positive correlation with maternal BMI and a negative correlation with gestational weight gain. Conclusion: UCD in GDM was statistically higher in both microscopic and fresh tissues and thus may be considered for GDM screening. The correlation of wet and dry specimens can also provide useful insights in clinical situations centered around variations in UCD.

The Accuracy of Third-Trimester Ultrasound in Predicting Large for Gestational Age or Macrosomic Fetuses in Diabetic and Non-Diabetic Pregnant Women: A Systematic Review and Meta-Analysis

The Accuracy of Third-Trimester Ultrasound in Predicting Large for Gestational Age or Macrosomic Fetuses in Diabetic and Non-Diabetic Pregnant Women: A Systematic Review and Meta-Analysis

A Comparison of the Human Umbilical Cord's Histomorphometric and Histological Structure in Pregnant Diabetic and Non-Diabetic Women

This study aimed to explore the histomorphometrical and histopathological alterations of umbilical cord (UC) vessels caused by gestational diabetes mellitus (GDM) and pre-gestational diabetes mellitus (PGDM). A total of thirty UC samples were obtained from full term pregnant women without any complications. Ten out of thirty UCs were obtained from non-diabetic pregnant women (normal group), 10 from GDM and 10 from PGDM pregnant women. Segments from the placental attachment, center and fetal side of UCs were taken for each group. These segments were processed for paraffin blocks, sectioned, and stained with H&amp;E, Masson trichrome (MT) and Periodic Acid Shift (PAS). The results of the histomorphometric study showed no significant differences in the UC mean weight among these three groups. In three different segments, GDM resulted in a significant decrease in artery and vein wall thickness compared to the control group. GDM and PGDM resulted in a non-significant difference in the diameter of artery and vein in fetal segment, the vein in placental segment, and artery in the central segment compared with normal. All the UCs in the three groups contained two arteries and one vein but only one cord recorded in the GDM group contained one artery and one vein. Histological study of diabetic UC segments showed extravasation of blood, artery discordance, degeneration of Warton’s jelly (WJ) fibers with formation of honeycomb like empty spaces, formation of multiple spaces between smooth muscle cells of tunica media and detachment of the umbilical arteries from surrounding WJ. In both diabetic groups, there was a marked decrease in collagen fibers in tunica intima and media with their irregular arrangement in both arteries and vein especially in placental segment. The results also showed there was a rich carbohydrate content in the intima and media in all three groups. In conclusion, the current results proved that GDM and PGDM have an adverse effect on the structure of UC and its vessels. Keywords: Umbilical cord; Diabetes mellitus; Histological study; Special stains; Blood vessels DOI: 10.7176/JBAH/13-6-04 Publication date: April 30 th 2023

Histological and Morphological Study of the Placenta in Gestational: Pregestational Diabetic, and Normal Women’s

This study was aimed at comparing the morphometric and histological features of the placenta in gestational diabetes mellitus (GDM), pre-gestational diabetes mellitus (PGDM), and non-diabetic normal pregnant women. Twenty-four placentas were obtained from non-diabetic pregnant women (control group), ten from women with GDM, and ten from PGDM women. Segments from the central part of the placenta were taken and processed for paraffin blocks, sectioned, and stained with H&amp;E, Masson trichrome, and periodic acid-Schiff. The results of morphometric measurement revealed that the mean weight and diameter of GDM and PGDM placentae were significantly higher than in the control; placental thickness was a significant increase in PGDM; the number of cotyledons and fetal weights showed no significant difference in all these groups; the fetoplacental ratio was significantly higher in the PGDM; discoidal placenta shape, followed by irregular, oval, and kidney as the most common shapes recorded in these groups; the central umbilical cord insertion was most common in all three groups; followed by noncentral (eccentric) and marginal insertions. Diabetes caused several histopathological changes in the placenta, including an increase in the number of different sizes of villi with a decrease in the intervillous spaces, an increase in the: number of big syncytial knots, and fibrinoid necrosis; chronogenesis in the intervillous spaces and villous capillary congestion. Diabetic groups showed the presence of dense collagen fibers within the villous stroma (villous stromal fibrosis) and around fetal blood capillaries. GDM showed a mild thickening of the basement membrane (BM) of chorionic villi and a mild increase in the collagen in the villous stroma. While PGDM showed a moderate increase in the BM of syncytiotrophoblast and villous stroma and mild thickening of the BM of capillary blood vessels. In conclusion, both GDM and PGDM caused adverse effects on the histological and morphometrical features of the placenta. Keywords: Placenta; Diabetes Mellitus; Morphometric analysis; Histopathology, Masson trichrome stain; Periodic acid shift reaction. DOI: 10.7176/JBAH/13-6-03 Publication date: April 30 th 2023

Antibiotic sensitivity pattern of uropathogens among diabetic and non-diabetic pregnant women in Dhaka, Bangladesh

Objective: To determine the urinary tract infections (UTIs)-causing bacterial profile and antibiotic susceptibility pattern for the proper and complete treatment of UTIs in pregnant women with diabetes mellitus (DM). Methods: We collected 300 urine samples from diabetic and nondiabetic pregnant women at various gestational ages. After isolating and identifying uropathogens, we conducted an antibiotic sensitivity assay against fourteen commonly used antibiotics: amikacin, amoxicillin, ampicillin, azithromycin, cefixime, ceftazidime, ceftriaxone, cefuroxime, ciprofloxacin, co-trimoxazole, gentamicin, levofloxacin, netilmicin, nitrofurantoin. Results: Among the participants, 70% had DM but only 37.3% had positive uropathogen growth. Five gram-negative bacteria (Escherichia coli, Klebsiella spp., Enterobacter spp., Citrobacter spp., and Pseudomonas spp.) and 3 gram-positive bacteria (Streptococcus spp., Staphylococcus spp. and Enterococcus spp.) were indentified. Escherichia coli was the most prevalent bacteria (57.1%), followed by Klebsiella spp. (19.6%). In the antibiotic susceptibility assay, we found 96.5% of the isolated organisms were highly susceptible to levofloxacin, 94.2% to netilmicin, 88.2% to nitrofurantoin, 85.1% to amikacin, 79.8% to gentamicin, respectively. On the other hand, 64.8%, 63.6%, 61.8% of the isolates demonstrated high-level resistance to ampicillin, ceftazidime and amoxicillin whereas 38.0%, 37.1%, 33.6%, 30.9% and 30.0% of the organisms were resistant to co-trimoxazole, azithromycin, ciprofloxacin, cefuroxime, cefixime, respectivey. Conclusions: Our results suggest that amikacin, levofloxacin, netilmicin, nitrofurantoin, and gentamycin can be used as first-line treatments for UTIs, whether the patient has DM or not. Contrarily, amoxicillin, ampicillin, ceftazidime, azithromycin, and co-trimoxazole should be avoided in treating UTIs.