Pregestational Diabetic Women Research Articles

The effect of glycemic levels on Doppler indices and pregnancy outcome in pregestational and gestational diabetic pregnant women

Background Gestational diabetes mellitus (GDM) is characterized as a condition where there is a varying degree of intolerance to glucose, which occurs or is initially identified throughout pregnancy. Aim To evaluate the impact of glycemic control on Doppler indices of uterine, umbilical, and middle cerebral arteries (MCA) in pregestational and GDM women and to correlate alterations in maternal levels of glucose, glycosylated hemoglobin (HbA1c) and Doppler indices related to pregnancy outcome. Patients and methods This prospective comparative cross-sectional work was performed on 84 diabetic patients aged from 20 to 43 years old, pregnant women with singleton living fetus, at booking, gestational age (GA) 24–28 weeks gestation. The participants categorized into two groups equal: group A: Pregestational diabetes and group B: GDM. Results There was an insignificant correlation between mean HbA1c % and BMI, GA, and doppler velocimetry mean results pulsatility index (PI) of uterine artery (UtA), PI of umbilical artery (UA) and PI of MCA. Pregestational diabetic pregnant women was a significantly positive association with UtA PI. There was insignificant association with Age, UA PI, Middle cerebral artery PI, fasting blood sugar, 2 h postprandial blood sugar, HbA1c (%). Gestational Diabetic pregnant women had insignificant associations with age, UtA PI, UA PI, MSA PI, fasting blood sugar, 2 h postprandial blood sugar, HbA1c. Ultrasound findings, amniotic fluid index, weight, PI of UtA, PI of UA. Conclusion Pregestational and GDM were not correlated with irregularities in Doppler indices of uterine, umbilical, and MCA.

Title-Efficacy of metformin as monotherapy in gestational and pre-gestational diabetic pregnant women

Title-Efficacy of metformin as monotherapy in gestational and pre-gestational diabetic pregnant women

Effect of glycemic control on fetal hearts of pregestational diabetic women by tissue doppler and M-mode imaging.

To determine whether changes in fetal heart function according to glycemic control in pregnant women with Type 1 and Type 2 diabetes using spectral tissue Doppler imaging (TDI) and M-mode imaging. This study included 68 pregestational diabetic women (DM) at 30-32 gestational weeks. All participants were divided into two groups: type 1(n=17) and type 2(n=51), and then these groups were divided into the subgroups as well-controlled and poorly controlled, according to fasting glucose (FG) and 1-h postprandial glucose (PPG) values. Cardiac parameters were compared for well- and poorly-controlled groups with TDI and M-mode imaging. The correlation of cardiac parameters with FG, PPG, and HbA1c values was evaluated. Their roles in predicting neonatal outcomes were also assessed. Thickness measurements, early diastolic annular peak velocity (E'), late diastolic annular peak velocity (A'), tissue isovolumetric relaxation time (IRT'), and tissue myocardial performance index (MPI') were increased in both poorly controlled groups. Tissue ejection time (ET') was significantly reduced in the poorly controlled groups, while tissue isovolumetric contraction time (ICT') was not significantly changed in any group. Tricuspid, mitral, and septal annular plane excursions (TAPSE, MAPSE, and SAPSE, respectively) were significantly decreased in all poorly controlled subgroups. E', E'/A', MPI', IRT', ET', and M-mode imaging parameters significantly correlated with FG notably. Maternal hyperglycemia leads to subtle changes in systolic and diastolic functions both in the interventricular septum and ventricles, so it is essential to ensure glycemic control in both Type 1 and Type 2 DM.

Histological changes in the amniotic membrane structure of gestational diabetic women’s’ in comparison with pregestational diabetic and non-diabetic women

The main objective of this study was to compare the demographic characteristics and histological changes in the amniotic membrane (AM) of gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PGDM), and non-diabetic women. A total of thirty AM samples (n = 10 for each group) were obtained from full-term pregnant women without any complications. These samples were processed for paraffin blocks, sectioned, and stained with H&E. The results of demographic characteristics showed the mean maternal age of the PGDM and GDM groups was significantly higher compared with the control. Neonatal weight decreased significantly in the PGDM group, but both diabetic groups showed no significant differences between them in terms of maternal age and neonatal weight. A random blood sugar (RBS) test and WBC count showed a highly significant increase in GDM and a significant increase in PGDM. The highest significant value of RBC was recorded for PGDM. The thickness of the epithelial layer plus the basement membrane (BM) was significantly increased due to the PGDM. while the compact layer plus the fibroblast layer and the total thickness of AM showed a significant increase in GDM. The nucleus diameter of AM epithelial cells was significantly decreased in diabetic groups. The histological examination revealed that both diabetic groups caused several changes and damage in AM, including: hypertrophy and hyperplasia in epithelial cells associated with the formation of the vacuole between them; degeneration of some of these cells that pinched off from the lining epithelium; breakdown of the compact and fibroblast layers and caused damage to the stromal collagen fibril; epithelial cells and their nuclei became elongated and resembled columnar epithelium; and the basement membrane appeared thicker in comparison to the control group. In conclusion, GDM and PGDM induced various alterations and damage to the AM, which in turn delayed embryonic development and the delivery.

First trimester placental volume and vascular indices in pregestational diabetic compared to nondiabetic pregnant women.

Comparing placental volume (PV) and vascular indices in pregestational diabetic and nondiabetic pregnant women at 11 and 13 weeks gestation. A case-control study conducted at Ain Shams University Maternity Hospital in collaboration with Feto-maternal Unit for Ultrasound Assessment, Ain Shams University Maternity Hospital, Egypt. Ninety-two pregnant women divided into two groups: Group A included 46 women with pregestational diabetes mellitus and group B included 46 nondiabetic pregnant women as control. All participants had PV, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) calculated using three-dimensional (3D) ultrasonography and 3D power Doppler at 11 and 13 weeks of pregnancy. At 11 weeks, the mean VI, FI and VFI in diabetic group (17.70 ± 12.62, 40.72 ± 11.03 and 7.77 ± 6.37, respectively) were insignificantly higher than in nondiabetic group (12.14 ± 12.62, 34.59 ± 9.66 and 6.52 ± 14.20, respectively) while mean PV in diabetic group (26.90 ± 14.74) was insignificantly lower than in nondiabetic group (27.53 ± 17.46). Also at 13 weeks, the results were not different as the mean VI, FI and VFI in diabetic group (16.51 ± 9.81, 42.52 ± 7.47 and 8.12 ± 7.55, respectively) were insignificantly higher than in nondiabetic group (16.37 ± 14.17, 40.29 ± 17.52 and 7.08 ± 4.35, respectively), and mean PV in diabetic group (52.04 ± 17.95) was insignificantly lower than in nondiabetic group (54.46 ± 17.85). There was strong positive correlation between HbA1C level and VFI measured at 13 weeks gestation. Placental indices in early pregnancy do not seem to be useful markers to anticipate placental pathology in pregestational diabetes, however there might be a role for HbA1C level measurement to anticipate such complications.

The effect of fetal weight on the accuracy of sonographic weight estimation among women with diabetes

Objective The assessment of sonographic estimated fetal weight (EFW) enables identification of fetuses in the extremes of weight, thus aiding in the planning and management of peripartum care. There are conflicting reports regarding the accuracy of EFW in diabetic mothers. We aimed to study the factors associated with the accuracy of EFW at term, specifically the role of gestational and pre-gestational diabetes in this setting. Methods A retrospective study including all women carrying singleton term gestations who delivered within a week following a sonographic fetal weight estimation between 2011 and 2019. Accurate EFW was defined as within 10% of the actual birthweight. We allocated the study cohort into two groups: (1) Accurate EFW (2) inaccurate EFW. Both groups were compared in order to identify factors associated with the inaccuracy of EFW. Results Overall, 41,263 deliveries were available for evaluation, including 412 (1.0%) deliveries among women with pre-gestational diabetes and 4,735 (11.5%) among women with gestational diabetes. Of them, 7,280 (17.6%) had inaccurate EFW. Inaccurate EFW was associated with nulliparity, OR 0.82 [95% CI] (0.78–0.87), oligohydramnios, OR 0.81 [95% CI] (0.71–0.93), pregestational diabetes, OR [95% CI] 0.61 (0.50–0.79), and extremity of fetal weight; <2,500 grams–OR [95% CI] 0.37 (0.33–0.41) and >4,000 grams OR [95% CI] 0.52 (0.48–0.57). On multiple regression analysis, the following factors were independently associated with inaccurate EFW: pregestational diabetes, OR [95% CI] 0.58 (0.46–0.73), p < .001, nulliparity, OR [95% CI] 0.86 (0.82–0.91), p < .001 and higher fetal weight (for each 500 grams), OR [95% CI [1.25 (1.21–1.30), p < .001. On analysis of different weight categories, pregestational diabetes was associated with inaccurate EFW only in those with birthweight >3,500 grams, OR [95% CI] 0.37 (0.24–0.56) (p < .001). Conclusion Among pregestational diabetic women, the accuracy of sonographic EFW when assessed to be >3,500 grams is questionable. This should be taken into consideration when consulting women and planning delivery management. Synopsis Among pregestational diabetic women, the accuracy of estimated sonographic fetal weight higher than 3,500 grams is of limited accuracy.

Fetal Cardiac Function and Ventricular Volumes Determined by Three-Dimensional Ultrasound Using STIC and VOCAL Methods in Fetuses from Pre-gestational Diabetic Women.

To assess the fetal cardiac function and ventricular volumes by three-dimensional (3D) ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods in fetuses from pre-gestational diabetic women. This was a prospective and cross-sectional study that evaluated 53 fetuses from pre-gestational diabetic women and 53 fetuses from healthy mothers between 20 and 34weeks of gestation. Only fetuses with no structural or genetic abnormalities and singleton pregnant women were included in this study. The fetal cardiac volumes were assessed by STIC and VOCAL methods. The ejection fraction, stroke volume, and cardiac output were calculated from these measurements to evaluate fetal cardiac function. The Mann-Whitney U test was performed to compare the two groups. For calculation of intra- and interobserver reproducibility's, we used concordance correlation coefficients. The mean differences in the right atrial volumes between the diabetic and normal groups ranged from 0.05mL to 0.1mL (p = 0.917 and 0.355, respectively). The median of left atrium (LA) volume measurement in pre-gestational diabetic group was significantly lower than healthy mothers (LA: 0.62 vs. 0.68mL; p < 0.001). The fetal right and left ventricular volumes were similar in both groups. No significant differences in ejection fraction, stroke volume and cardiac output were observed (p value range 0.086-0.815). The majority of fetal atrial/ventricular volumes showed good intra- and interobserver reliabilities. Conversely, the majority cardiac function parameters showed poor intra- and interobserver agreements. STIC and VOCAL methods gave reproducible quantitative results for fetal atrial and ventricular volumes. Significant differences in fetal left atrial volumes were observed between the two groups, which be related to LA atrial dysfunction and /or left ventricle (LV) compliance, reflecting earlier stages of cardiac dysfunction.

Macrosomia as a Marker for Adverse Perinatal Outcomes in Pregnancy Complicated by Diabetes Mellitus [24D

INTRODUCTION: We sought to examine the strength of macrosomia as a marker for adverse perinatal outcomes associated with poor glycemic control in women with a pre-gestational diagnosis of diabetes mellitus. METHODS: A retrospective cohort study of 8,535 women in California with singleton, vertex, non-anomalous gestations was performed to assess prevalence of adverse perinatal outcomes in macrosomic pregnancies complicated by diabetes mellitus. Macrosomia was defined as a birth weight greater than 4000 g. Neonatal outcomes examined included respiratory distress syndrome (RDS), hypoglycemia, jaundice, neonatal death (NND) and intrauterine fetal demise (IUFD). Maternal complications included preeclampsia, post-partum hemorrhage and chorioamnionitis. Confounding variables were controlled for and Chi-squared analyses with a P-value of less than 0.05 were considered statistically significant. RESULTS: Overall, macrosomia in pre-gestational diabetic women proved to be a reliable marker for increased perinatal complications. Neonatal complications were most pronounced, with macrosomic neonates at a significantly increased risk for RDS (3.81% vs 1.81% P&lt;.001), hypoglycemia (1.24% vs 0.66% P=.007), jaundice (29.09% vs 23.06% P&lt;.001), NND (0.19% vs 0.04% P=.024) and IUFD (1.38% vs 0.43% P&lt;.001). Macrosomia characterized by birth weight of greater than 4500 g showed similar statistical significance in increased risk of each complication. Both classifications of macrosomia showed decreased incidence of chorioamnionitis (1.38% vs 2.52% P=.002, 1.06% vs. 2.36% P=.031). CONCLUSION: Macrosomia in diabetic women is a reliable marker for adverse neonatal outcomes, including increased risks for IUFD and neonatal death. Women should be counseled about these risks and managed accordingly throughout their pregnancies.

Effect of pregestational diabetes mellitus on fetal cerebral artery Doppler changes and its correlation with fetal weight

Background Pregestational diabetes mellitus (PDM) is one of the causes of many gestational complications. This study aimed to review the effect of maternal pregestational diabetes on fetal cerebral circulation through assessment of fetal middle cerebral artery (MCA) and vertebral artery (VA) Doppler study as well as cerebroplacental ratio using MCA pulsatility index (PI)/uterine artery PI and VA PI/uterine artery PI, and to find its correlation with fetal weight. Patients and methods This prospective study was conducted on 40 cases, comprising 20 pregestational diabetic women and 20 comparison pregnant nondiabetic women (comparison cases). Fetal Doppler studies were done twice for pregestational diabetic patients and the comparison group. The Doppler indices such as fetal MCA, VA, and umbilical artery were assessed along with the routine obstetric ultrasound examination. Results Statistically significant differences were detected between pregestational diabetic and comparison cases regarding MCA peak systolic volume and VA resistivity index at mid/end of the second trimester and VA resistivity index, VA PI, and VA cerebroplacental ratio at the beginning of the third trimester. There was no correlation in PDM cases between Doppler indices and fetal weight. Conclusion PDM was associated with VA and MCA Doppler changes. VA Doppler is recommended along with MCA Doppler in fetal screening in high-risk pregnancies.

421: Perinatal outcomes in a contemporary cohort of pregestational diabetic women with hemoglobin A1c values >10%

Because hemoglobin A1c (HbgA1c) values greater than 10% in the first trimester have been associated with increased rates of fetal anomalies in women with pregestational diabetes mellitus (DM), our aim was to examine perinatal outcomes according to HbgA1c values greater than 10% in the first trimester. This was a retrospective cohort study of pregnant women with pregestational DM at a single academic center. All women included in this analysis had a HbgA1c value obtained at presentation to prenatal care at less than 14 weeks gestation and delivered at our hospital. Maternal characteristics and perinatal outcomes were compared between women with HbgA1c values of ≤10% and those with HbgA1c values of >10%, and for specific perinatal outcomes an analysis across rising HbgA1c values was performed. Between May 2009 and December 2018, a total of 1,052 women met inclusion criteria. Of these, 273 (26%) had a first trimester HbgA1c of greater than 10%. When compared to women with HbgA1c < 10%, women with HbgA1c >10% were older (30+6 vs 32+6 years, P< 0.001) and had a longer duration of DM—6[3,10] vs 4 [2,7] years (P< 0.001). Selected perinatal outcomes are shown in the Table. Women with HbgA1c values >10% had significantly higher rates of preeclampsia (P=0.002), shoulder dystocia (P=0.045), neonatal death (P=0.042), and fetal anomalies (P< 0.001). As shown in the Figure, HbgA1c values above 10% were significantly associated with increased rates of preeclampsia—OR 1.16 (1.08, 1.23). Reflecting limited access to care outside of pregnancy, more than one-quarter of women with DM entered prenatal care with a HbgA1c of >10%. Such HbgA1c values >10% in early pregnancy were associated with increased rates of adverse perinatal outcomes to include preeclampsia, fetal anomalies, and neonatal death when compared to those with HbgA1c < 10%. Indeed, there appears to be a significant relationship between elevated HbgA1c values above 10% and increased rates of preeclampsia.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

References Values of Fetal Heart Myocardial Volume by Three-Dimensional Ultrasound using Spatiotemporal Image Correlation and Virtual Organ Computer-Aided Analysis Methods and Their Applicability in Pregestational Diabetic Women

To determine reference values for myocardial volume of the fetal heart using three-dimensional ultrasound with spatiotemporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) and to assess their applicability in women with pregestational diabetes. This retrospective cross-sectional study included 177 normal pregnant women with fetuses between 200/7 and 336/7 weeks of age. Fetal cardiac volumes were collected using the STIC method, and myocardial volume was obtained by subtraction of the intracavitary volumes using the VOCAL 30-degree method. Intra- and interobserver reproducibility values were determined using the concordance correlation coefficient (CCC). Sixteen women with pregestational diabetes mellitus were evaluated for validation. There was a strong correlation between fetal myocardial volume and gestational age (R 2 = 0.82). Intra- and interobserver reproducibility values were excellent and moderate, respectively, with CCCs of 0.99 and 0.83, respectively. There was no significant difference in mean fetal myocardial volume between normal pregnant women and those with pregestational diabetes (p = 0.64). Reference values for myocardial volume of the fetal heart were determined in normal pregnant women and were not statistically different from those in women with pregestational diabetes mellitus.

Reference range of fetal myocardial area by three-dimensional ultrasonography and its applicability in fetuses of pre-gestational diabetic women

Objective To determine the reference range for the myocardial area in healthy fetuses using three-dimensional (3D) ultrasonography and validate these results in fetuses of pregnant women with pre-gestational diabetes mellitus (DM). Methods This cross-sectional retrospective study included 168 healthy pregnant women between gestational weeks 20 and 33+6 days. The myocardial area was measured using spatio-temporal image correlation (STIC) in the four-chamber view. Polynomial regression models were used, and the goodness of fit of the models were evaluated by the coefficient of determination (R2). Intra- and inter-observer reproducibility was determined using the concordance correlation coefficient (CCC). Validation was performed in 30 pregnant women with pre-gestational DM. Results There was a strong correlation (R2=0.71, P<0.0001) between myocardial area and gestational age. There was good intra- and inter-observer reproducibility, with a CCC of 0.86 and 0.83, respectively. However, there was no significant difference in the mean myocardial area between healthy fetuses and fetuses of women with pre-gestational DM (0.11 cm2, P=0.55). Conclusion The reference range was determined for the myocardial area in fetuses, and there was no significant difference in this variable between healthy fetuses and the fetuses of women with pre-gestational DM.

Caudal regression associated with pre-gestational type 2 diabetes mellitus

Caudal regression syndrome is a spectrum of congenital structural defects associated with uncontrolled pre-gestational diabetes mellitus. Prevalence of this disease is 1 to 2.5 in 100,000 live births and background pre-gestational diabetes increases the risk by 200 fold. We present a case of caudal regression syndrome in a mother having type 2 diabetes mellitus with poor glycaemic control since preconceptional period and early gestation. The condition was diagnosed during anomaly scan at 20 weeks of gestation. Uncontrolled pre-existing diabetes is the most common aetiology for caudal regression syndrome. Therefore, proper preconceptional counseling is essential to optimize blood sugar levels in pre-gestational diabetic women. Carrying out anomaly scans around 20 weeks play a pivotal role in high risk cases in diagnosing foetal anomalies.

First Trimester Placental Volume and Vascular Indices by 3D Ultrasonography and 3D Power Doppler in Pregestational Diabetic and Non-Diabetic Pregnant Patients

Background: 3D power Doppler ultrasonography enables quantitative analysis of region observed through vascular indices as VI (vascularization index), FI (flow index) and VFI (vascularization flow index), which show quantity of vessels, local blood flow and their combination and placental volume. These indices can be calculated using VOCAL program. Aim of Study: This study aimed at comparing placental volume and vascular indices using 3D ultrasonography and 3D power Doppler in pregestational diabetic and non-diabetic pregnant women at first trimester (11th week and 13th week). Patients and Methods: This current study was conducted at Antenatal care Clinic in cooperation with the feto-maternal Unit for ultrasound assessment, Ain-Shams University Maternity Hospital during period between November 2015 and April 2017, on 46 women at eleventh 11th week and thirteen 13th week of gestation. They were divided into two groups: Group (A) included 23 women with pregestational diabetes mellitus and group (B) included 23 non-diabetic pregnant women as a control group after respecting certain inclusion and exclusion criteria. Results: There was no statistically significant difference between pregestational diabetic and non - diabetic group as regard placental volume and vascular indices (VI, FI and VFI). Conclusion: There was no statistically significant difference as regard placental volume and vascular indices (FI,VI and VFI) in pregestational diabetic compared to non-diabetic pregnant patients at first trimester of pregnancy especially with good glycemic control but changes may be present with poor glycaemic control. Recommendations: Further studies are recommend as regard evaluating placental volume and vascular indices (FI,VI and VFI) in pregestational diabetic at second and third trimester of pregnancy giving more time for pathological effect of diabetes mellitus to appear.

Placental peptides metabolism and maternal factors as predictors of risk of gestational diabetes in pregnant women. A case-control study.

BackgroundGestational diabetes is a risk factor for perinatal complications; include shoulder dystocia, birth injuries such as bone fractures and nerve palsies. It is associated with later development of type 2 diabetes, the risk of macrosomia and other long-term health effects of infants born to diabetic mothers. The study assesses placental peptides and maternal factors as potential predictors of gestational diabetes among pregnant women.Material and methodsA total of 200 pregnant women were recruited for the study, 150 pregnant women without pre gestational diabetes including 50 women with low risk factors of diabetes as controls and 50 other pregnant women with pregestational diabetes as control. Fasting blood glucose and the lipid profile were determined by enzymatic methods using Envoy® 500 reagents (Vital Diagnostics, USA). Glycated haemoglobin was assessed using the Cation Exchange resin method. Leptin and the Human Placenta Lactogen were assayed using the Sandwich-ELISA technique. Beta chorionic gonadotrophin, insulin, progesterone and estradiol were determined using chemilumiscence imunoassay technique on MAGLUMI 600 analyzer. Anthropometry, including BMI and blood pressure were also measured.ResultsFasting plasma glucose (FBG), insulin, insulin resistance, glycated haemoglobin and Human Placenta Lactogen(HPL)were significantly (p<0.0001) increased in the pregestational diabetic women whereas progesterone and estradiol were significantly decreased. In the second trimester however, there was no significant difference (p>0.05) in estradiol, insulin, insulin resistance and HPL between the pregnant women who developed gestational diabetes and those who did not. Leptin, progesterone and FBG were significantly increased in those who developed GDM. The risk of developing gestational diabetes increased with overweight (OR = 1.76, P = 0.370) and family history of diabetes (OR = 2.18, P = 0.282).ConclusionLeptin, progesterone, estradiol estimated in this study were increased in the gestational diabetes mellitus women and fairly predicted gestational diabetes in the non-diabetics pregnant women. Obesity, aging and family history of diabetes were strongly predictive of gestational diabetes.

Assessing White's classification of pregestational diabetes in a contemporary diabetic population.

To assess the validity of White's classification, including the role of chronic hypertension, in a contemporary diabetic population. We performed a retrospective cohort study of all singleton pregnancies with pre-existing diabetes mellitus from 2008 to 2013. Adverse outcomes were compared across classes B, C, D, and vascular disease (R, F, H) and further stratified by the presence or absence of chronic hypertension. Outcomes examined were a composite perinatal outcome (stillbirth, neonatal death, shoulder dystocia, birth injury, seizures, requiring chest compressions or intubation at delivery, blood pressure support), small for gestational age (SGA), large for gestational age (LGA), macrosomia, shoulder dystocia, preterm delivery at less than 37 weeks of gestation, preeclampsia, and cesarean delivery. Of the 475 patients, the 1980 White's classification was significantly associated with SGA, LGA, macrosomia, preterm delivery, preeclampsia, and cesarean delivery (P≤.01). Within each White's class based on age or time since diagnosis alone, hypertension was significantly associated with a higher incidence of preeclampsia in class B (16% without hypertension compared with 32% with hypertension, P<.01) and C (22% compared with 40%, P=.04), SGA in C (4.7% compared with 21%, P<.01), preterm delivery in B (25% compared with 46%, P<.01) and C (35% compared with 58%, P=.01), and the composite neonatal outcome in B (7.9% compared with 17%, P=.03). The incidence of adverse outcomes in classes B and C with hypertension resembles the incidence of adverse outcomes in those with diabetes one class higher. The 1980 White's classification system, taking into consideration the presence of chronic hypertension, remains a useful system for counseling pregestational diabetic women regarding adverse pregnancy outcomes. II.

Increased circulating heat shock protein 70 (HSPA1A) levels in gestational diabetes mellitus: a pilot study.

Recent data indicate that serum Hsp70 (HSPA1A) levels are increased in type 1 and 2 diabetes mellitus. However, there is no report in the literature on circulating Hsp70 levels in gestational diabetes mellitus. In this pilot study, we measured serum Hsp70 levels in 11 pregnant women with pregestational diabetes, 38 women with gestational diabetes, and 40 healthy pregnant women with ELISA. Plasma glucose levels, serum insulin concentrations, HbA1c values, and the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) index were also determined. According to our results, serum Hsp70 concentrations were significantly higher in women with pregestational and gestational diabetes mellitus than in healthy pregnant women. In addition, pregestational diabetic women had significantly higher Hsp70 levels than those with gestational diabetes. Furthermore, in the group of women with gestational diabetes mellitus, serum Hsp70 levels showed a significant positive correlation with HbA1c values. However, there was no other relationship between clinical features and metabolic parameters of the study subjects and their serum Hsp70 levels in either study group. In conclusion, we demonstrated for the first time in the literature that serum Hsp70 levels are increased and correlate with HbA1c values in women with gestational diabetes mellitus. Nevertheless, further studies are needed to determine whether circulating Hsp70 plays a causative role in the pathogenesis of gestational diabetes or elevated serum Hsp70 levels are only consequences of the disease.

Audit of blood sugar management in diabetic pregnancies

BackgroundDiabetes is the commonest medical disorder affecting pregnancy in the UK, affecting 1 in 250 pregnancies. Our aim in managing diabetic pregnancies should be to achieve a pregnancy outcome that...

Plasma visfatin levels in pregnant women with normal glucose tolerance, gestational diabetes and pre-gestational diabetes mellitus

Objective. Visfatin, an adipocytokine, is a peptide predominantly expressed in and secreted from visceral adipose. In this study, we aimed to compare visfatin levels in gestational (GDM) and pre-gestational diabetic (pre-GDM) women with healthy pregnant women. We also sought to determine whether there was a correlation between visfatin levels and serum glucose levels at 1 h after the 50-g oral glucose challenge test in pregnant women with GDM and normal glucose tolerance.Methods. The study consisted of 65 pregnant women: 21 patients with GDM (Group 1), 20 patients with pre-GDM (Group 2) and 24 gestational age and BMI-matched healthy pregnant women (Group 3) were enrolled.Results. Plasma visfatin levels in Groups 1 and 2 were significantly higher than in Group 3 (P < 0.001). Plasma visfatin levels in Groups 1 and 2 were similar (P > 0.05). There was no significant correlation between visfatin levels and serum glucose levels at 1 h after the glucose tolerance test in both Groups 1 and 3 (P > 0.05).Conclusions. Our results support the literature indicating higher visfatin levels in women with GDM compared to women with normal glucose tolerance. Interestingly, we found similarly high visfatin levels in women with pre-GDM.

Near-optimal glycemic control in Chilean women with pregestational type-2 diabetes: Persistent macrosomia relates to maternal pre-pregnancy overweight

After a 10-year program intending to improve glycemic control in diabetic pregnancies, we evaluated whether factors underlying macrosomia are similar for type-1 and -2 pregestational diabetic women. Patients and methods Twenty-three pregnancies in type-1 diabetics (PDM1, age 28.3 ± 1.1 years) and 51 pregnancies in type-2 diabetics (PDM2, age 32.8 ± 0.6 years) were followed and treated with intensified insulin therapy. Several factors potentially influencing macrosomia were evaluated. Statistics: chi-square, Fisher's exact, Student's “ t” and Mann–Whitney “ U” tests, and ROC analysis. Results In PDM1 and PDM2, respectively, large-for-gestational-age (LGA) frequencies were 26.08% and 37.25% (NS), antepartum HbA1c values were 6.5 ± 0.32 and 6.1 ± 0.16 (NS), and pre-pregnancy body mass indexes (BMI) were 23.03 ± 0.66 and 30.01 ± 0.89 (p < 0.0001). In PDM1 the main predictor of LGA was an antepartum HbA1c ≥ 6.8% ( p = 0.046), whereas in PDM2 pregestational BMI ≥ 24 the variable associated ( p = 0.032) with LGA newborns. Conclusions PDM1 and PDM2 differ in the underlying factors related to macrosomia. Whereas in PDM1 the antepartum HbA1c emerged as the most significant variable, suggesting that glycemic control largely determines macrosomia, in PDM2 with near-optimal glycemic control, macrosomia related to pregestational BMI.