Non-diabetic Pregnant Women Research Articles

Diurnal glycemic profile in obese and normal weight nondiabetic pregnant women

A paucity of data exists concerning the normal glycemic profile in nondiabetic pregnancies. Using a novel approach that provides continuous measurement of blood glucose, we sought to evaluate the ambulatory daily glycemic profile in the second half of pregnancy in nondiabetic women. Fifty-seven obese and normal weight nondiabetic subjects were evaluated for 72 consecutive hours with continuous glucose monitoring by measurement interstitial glucose levels in subcutaneous tissue every 5 minutes. Subjects were instructed not to modify their lifestyle or to follow any dietary restriction. For each woman, mean and fasting blood glucose values were determined; for each meal during the study period, the first 180 minutes were analyzed. For the study group, the fasting blood glucose level was 75 +/- 12 mg/dL; the mean blood glucose level was 83.7 +/- 18 mg/dL; the postprandial peak glucose value level was 110 +/- 16 mg/dL, and the time interval that was needed to reach peak postprandial glucose level was 70 +/- 13 minutes. A similar postprandial glycemic profile was obtained for breakfast, lunch, and dinner. Obese women were characterized by a significantly higher postprandial glucose peak value, increased 1- and 2-hour postprandial glucose levels, increased time interval for glucose peak, and significantly lower mean blood glucose during the night. No difference was found in fasting and mean blood glucose between obese and nonobese subjects. Glycemic profile characterization in both obese and normal weight nondiabetic subjects provide a measure for the desired level of glycemic control in pregnancy that is complicated with diabetes mellitus.

Relation between Maternal Recreational Physical Activity and Plasma Lipids in Early Pregnancy

The authors examined the relation between recreational physical activity and plasma lipid concentrations in early pregnancy. Between 1996 and 2000, 925 normotensive, nondiabetic pregnant women in Washington State were interviewed at approximately 13 weeks' gestation regarding type, frequency, and duration of physical activity during the previous 7 days. Plasma triglyceride, total cholesterol, and high density lipoprotein cholesterol concentrations were measured in contemporaneous blood samples. After adjustment, mean triglyceride concentration was 12.7 mg/dl lower in women performing any physical activity versus none (95% confidence interval (CI): -22.7, -2.6). Mean triglyceride concentration was lower in women in the highest tertiles of time performing physical activity (-23.6 mg/dl, 95% CI: -34.9, -12.2), energy expenditure (-23.6 mg/dl, 95% CI: -35.1, -12.2), and peak intensity (-18.1 mg/dl, 95% CI: -29.5, -6.8) versus inactive women. Reductions in mean total cholesterol were also observed for women with the highest levels of time performing physical activity, energy expenditure, and peak intensity. Linear relations were observed across levels of physical activity measures for triglyceride and total cholesterol. No association was found between physical activity and high density lipoprotein cholesterol. These data suggest that habitual physical activity may attenuate pregnancy-associated dyslipidemia.

Inflammatory markers and retinopathy in pregnancies complicated with type I diabetes.

The relation of maternal cytokine levels to retinopathy progression during diabetic pregnancy is a less studied subject. Therefore, we investigated levels of systemic proinflammatory markers, C-reactive peptide (CRP), interleukin-6 (IL-6) and circulating vascular cell adhesion molecule-1 (VCAM-1) during pregnancy and postpartum in relation to the progression of diabetic retinopathy (DR). A prospective follow-up study of 39 pregnant women with Type I diabetes and eight nondiabetic pregnant women was performed. DR was graded from fundus photographs. Plasma levels of systemic proinflammatory markers were measured by immunofluorometric assay (CRP) and by enzyme-linked immunosorbent assay (IL-6 and VCAM-1) in the first, second (diabetics only), third trimester of pregnancy, and 3 and 6 months postpartum (diabetics only). Our diabetic women had good glycaemic control (HbA1c 6.9 +/- 0.8). The levels of IL-6, VCAM-1, and CRP did not differ between diabetic and nondiabetic women throughout pregnancy and postpartum (repeated measures ANOVA between the groups). An association between CRP and progression of retinopathy was observed in diabetic women (P = 0.037). Additional evidence of inter-relationship could be revealed as CRP was higher in those diabetic women with worse glycaemic control (HbA1c) (P = 0.038). During pregnancy and postpartum, levels of proinflammatory factors (IL-6, CRP, VCAM-1) seem to be generally similar in Type I diabetic women compared to nondiabetic controls. However, CRP levels were higher in those diabetic women with progression of retinopathy and in those with worse glycaemic control.

The effect of carbohydrate intolerance on neonatal birth weight in pregnant women without gestational diabetes mellitus.

BackgroundThere is still no consensus on screening, threshold levels and treatment of gestational diabetes mellitus. Furthermore, the importance of a positive 50-g glucose screening test in patients who had a negative 100-g oral glucose tolerance test remains controversial. We investigated the impact of the 50-g glucose screening test results on neonatal outcome in pregnant women with uncomplicated pregnancies, who had no risk factors according to ACOG criteria.Patients and MethodsThree hundred eighty-six pregnant women with singleton pregnancies were prospectively screened with 50-g glucose challenge test between 24 and 28 weeks. If the test result was >140 mg/dl, a 100-g 3-hour oral glucose tolerance test was performed. Patients with a positive screening test, but not diagnosed as gestational diabetes mellitus constituted the study group, and patients with a negative screening test constituted the control group. Cesarean rates, neonatal birth weights and complications were compared between these groups.ResultsThe cesarean delivery rates were not statistically different between the study and control groups (8.3% vs. 6.4%, P>0.05). The rates of macrosomic births were 10.0% in the study group, and 6.4% in the control group (P>0.05), but the mean birth weight (3451.67 ± 355.70 g) in the study group was significantly higher than the mean birth weight (3296.29 ± 365.14 g) in the control group (P=0.003). Neonatal hypoglycemia and hyperbilirubinemia was also encountered more often in babies of pregnant women with a positive 50-g glucose challenge test but negative 100-g glucose tolerance test.ConclusionBecause of similarities with gestational diabetes mellitus on the basis of perinatal outcomes, the non-diabetic pregnant women with 50-g glucose screen test result over 140 mg/dl but a negative 100-g OGTT should be followed closely.

Role of lamellar body count for the prediction of neonatal respiratory distress syndrome in non-diabetic pregnant women.

Lamellar body count is a new and fast technique to establish the presence of fetal lung maturity. We have assessed the predictive ability of lamellar body count for neonatal respiratory distress syndrome (RDS) in a non-diabetic population. We accessed a cohort of amniocenteses in non-diabetic women from 1998 to 2002 (n=102). Neonatal RDS was defined as need for surfactant, intubation, or continuous positive airway pressure (CPAP) in the setting of chest X-ray findings consistent with RDS. The predictive ability of lamellar body count was compared with those of lecithin/sphingomyelin (L/S) ratio and presence of phosphatidylglycerol (PG) using logistic regression analysis. The optimal threshold value of lamellar body count for prediction of neonatal RDS was established with receiver operating characteristic (ROC) curve analysis. Lamellar body count ROC curve analysis identified a lamellar body count >37,000 microl(-1) as optimal diagnostic threshold for diagnosis of lung maturity, having a negative predictive value of 98%. Lamellar body count and PG, but not L/S ratio, added significantly to the prediction of RDS. Lamellar body count is a reliable predictor of fetal lung maturity in non-diabetic women and it can replace the L/S ratio.

Activity of hydrolytic enzymes in fungi isolated from diabetic pregnant women: Is there any relationship between fungal alkaline and acid phosphatase activity and glycemic control?

Ability to respond to environmental changes and secretion of hydrolases are considered to be important for Candida virulence. In this study we determined and compared the activities of 19 different hydrolases of the fungal strains isolated from diabetic and non-diabetic pregnant women. We also looked for the presence of a relationship between hydrolase activities and glycemic control, and, furthermore, evaluated the influence of gestational age on the activity of hydrolases. Mycological examinations were performed for 119 diabetic pregnant women: 47 with diabetes mellitus type I (DM), 72 with gestational diabetes (GDM), and for 132 healthy women (CON). Samples were collected from the vagina, rectum and oral cavity and cultured on Sabouraud media. The fungal hydrolase activities were evaluated using the API ZYM test (bioMerieux). For the 19 different fungal hydrolases tested, 13 activities were present in the isolated fungal strains. The activity of alkaline phosphatase (ALP) in vaginal strains (p=0.028) and acid phosphatase (ACP) in strains from the vagina (p=0.006) and rectum (p=0.049) was significantly lower in DM than in GDM and CON women. In conclusion, we describe for the first time that fungi isolated from pregnant diabetic women have lower activity of both phosphatases compared to fungi isolated from healthy women. Furthermore, similar differences of mean ALP and ACP activities were observed in the course of pregnancy in strains from the vagina and rectum of DM and CON women. However, strains from DM had lower activity at each stage of pregnancy. The highest activity of ALP and ACP was detected at the beginning, then declined, and had the lowest values between the 24(th) and 33(rd) week of gestation. After that period the activity of both phosphatases increased.

Angiopoietic factors and retinopathy in pregnancies complicated with Type 1 diabetes.

To evaluate the role of systemic angiopoietic factors in the progression of diabetic retinopathy during pregnancy. In a prospective study of 26 pregnant women with diabetes and eight non-diabetic pregnant women, retinopathy was graded from fundus photographs. Plasma levels of angiopoietin-1, angiopoietin-2, human vascular endothelial growth factor A (hVEGF-A), and total soluble receptor of vascular endothelial growth factor (sVEGF) receptor-1 were measured during the first and third trimester and 3 months postpartum. In diabetic women, levels of angiopoietin-2 were 26.5 ng/ml (12.1-47.7) (median and range) during the first trimester, 2.9 ng/ml (0.6-3.5) during the third trimester, and 0.5 ng/ml (0.3-0.7) 3 months postpartum, compared with 44.3 (38.3-61.9), 5.7 (3.1-8.4) and 0.9 (0.6-4.9) ng/ml, respectively, in non-diabetic women (P = 0.002 between groups). Levels of angiopoietin-1 and sVEGF receptor-1 did not differ between the groups. Postpartum hVEGF-A levels were lowest in women with progression of retinopathy. In logistic regression analyses, progression of retinopathy during pregnancy was not explained by the levels of the angiopoietic factors. The circulating levels of angiopoietic factors in pregnant diabetic women were either lower than (Ang-2) or similar to (Ang-1, hVEGF-A, VEGFR-1) those levels observed in non-diabetic pregnant women. The levels of angiopoietic factors measured here appear not to be connected with the progression of retinopathy during pregnancy.

Twenty-four-hour blood pressure monitoring in normoalbuminuric normotensive type 1 diabetic women during pregnancy

We monitored blood pressure (BP) for a 24-h period in type 1 diabetic women at each trimester of pregnancy (10–13, 20–22, and 30–33 weeks of gestation) to identify early alterations of BP profile in pregnancies complicated by hypertension. Patients and methods: We prospectively studied 71 type 1 diabetic pregnant women and 48 nondiabetic pregnant women (homogeneous by age and pre-pregnancy BMI) consecutively recruited at 10±2 weeks of pregnancy in the space of 2 years (1999–2000). They were all normotensive (<130/80 mm Hg) and normoalbuminuric (AER<20 μg/min) at entry to the study. Statistics: Analysis of variance (ANOVA) and simple regression and χ 2 were applied as appropriate by an Apple software program (Stat View). Results: In diabetic women, we recorded higher levels of diastolic BP (even if within a normal range) at each time point; diabetic vs. nondiabetic women: first trim daytime diastolic BP: 71.35±8.75 vs. 67.7±9.7, P=.01; second trim nighttime diastolic BP: 62.15±6.45 vs. 58.05±6.7, P=.05; third trim nighttime diastolic BP: 66.03±8.72 vs. 60.7±6.5, P=.01. Among diabetics, those who later developed pregnancy-induced hypertension (36.6%) showed significantly higher values of BP at the first and third trimester compared to those who remained normotensive. In the two groups, there were no differences in age and pre-pregnancy BMI by contrast of diabetes duration (hypertensive vs. normotensive, 19.18±7.3 vs. 14.35±9.1 years, P=.03) and age of diagnosis (hypertensive vs. normotensive, 9.6±5.5 vs. 14.7±8.6 years, P=.01). Positive correlation was found between fasting blood glucose and diastolic BP at each trimester of pregnancy.

Maternal metabolic control and perinatal outcome in women with gestational diabetes treated with regular or lispro insulin: comparison with non-diabetic pregnant women

Objective: To compare maternal glucose levels and neonatal outcome, achieved in women with gestational diabetes (GDM) receiving either regular insulin or insulin lispro, with those of a control group of non-diabetic pregnant women. Study design: We enrolled 49 pregnant women with GDM, randomly allocated to the treatment with either insulin lispro ( n=25) or regular insulin ( n=24), and 50 pregnant women with normal GCT, matched for age, parity, pre-pregnancy weight and BMI, who formed the control group. All the women were caucasian, non-obese, with a singleton pregnancy and delivered term live born infants. Women of both groups were requested to perform a blood glucose profile (consisting of nine determinations: fasting/pre-prandial, 1 and 2 h post-prandial) every week from the time of diagnosis to 38 weeks (study subgroups) or every 2 weeks from 28 to 38 weeks’ gestation (control group). Results: Overall pre-prandial blood glucose values in diabetic women were significantly higher than those of controls; at the 1 h post-prandial time point, blood glucose values of GDM women receiving insulin lispro were similar to those of controls, whereas in the regular group they were significantly higher. Overall, both the lispro and regular insulin obtained optimal metabolic control at the 2 h post-prandial time point, although near-normal blood glucose levels 2 h after lunch could be observed only in the lispro group. There were no statistically significant differences between the groups in neonatal outcome and anthropometric characteristics; however, the rate of infants with a cranial–thoracic circumference (CC/CT) ratio between the 10th and the 25th percentile was significantly higher in the group treated with regular insulin in comparison to the lispro and control groups. Conclusions: Fasting/pre-prandial and 1 h post-prandial maternal blood glucose levels in non-diabetic pregnant women fell well below the currently accepted criteria of glycemic normality in diabetic pregnancies. In women with GDM, the use of insulin lispro enabled the attainment of near-normal glucose levels at the 1 h post-prandial time point and was associated with normal anthropometric characteristics; the use of regular insulin was not able to blunt the 1 h peak post-prandial response to a near-normal extent and resulted in infants with a tendency toward the disproportionate growth. Insulin lispro can be regarded as a valuable option for the treatment of gestational diabetes.

Free fatty acids, insulin resistance, and pregnancy.

Acute elevation of plasma free fatty acid (FFA) levels causes insulin resistance to rise dose dependently in pregnant and nonpregnant women. Plasma FFA levels are commonly elevated during late pregnancy, partly due to rising blood levels of lipolytic placental hormones, and are a likely cause for much of the increase in insulin resistance occurring at that time in all pregnant women. Plasma FFA levels are similar or higher and the insulin resistance is comparable or more severe in women with gestational diabetes mellitus (GDM) than in nondiabetic pregnant women. In contrast to healthy pregnant women, insulin secretion in women with GDM is defective and, therefore, is unable to rise adequately to compensate for the insulin resistance; the result is hyperglycemia. The mechanism by which elevated plasma FFA levels cause insulin resistance in skeletal muscle includes intramyocellular accumulation of diacylglycerol, which activates protein kinase C (the b II and d isoforms). This results in reduction of tyrosine phosphorylation of the insulin receptor substrate-1 and inhibits activation of phosphoinositol-3 kinase, an enzyme that is essential for normal insulin-stimulated glucose uptake.

Retinal capillary blood flow in diabetic and nondiabetic women during pregnancy and postpartum period.

To evaluate the response of retinal capillary circulation to pregnancy in women with diabetes and to correlate microcirculatory changes with progression of retinopathy during pregnancy. A prospective follow-up study of 32 pregnant women with insulin-dependent diabetes and 11 nondiabetic pregnant women. Perimacular capillary blood flow measured noninvasively by retinal flowmetry in the inferior perimacular retina. Eleven nonpregnant diabetic women served as diabetic control subjects. In diabetic women, blood flows, measured by small-box analysis, were 233 +/- 69 (mean +/- SD) arbitrary units (AU) during the first trimester, 248 +/- 55 AU during the third trimester, and 238 +/- 46 AU 3 months postpartum, compared with 204 +/- 32, 195 +/- 22, and 196 +/- 34 AU in nondiabetic pregnant women (P = 0.007 between groups). A difference of the same magnitude was evident between the two groups when the mean of the 50th (P = 0.032), 75th (P = 0.004), and 90th (P = 0.007) percentiles of the individual pixel flow values were used in point-wise analysis. In nonpregnant diabetic women, the small-box mean value was 201 +/- 36, and the mean of the 75th percentile value in point-wise analysis was 316 +/- 49. Blood flow was lower in nonpregnant than in pregnant diabetic women during the third trimester (P = 0.023 and P = 0.012, respectively). Compared with nondiabetic pregnant women, retinal capillary blood flow was higher in diabetic women during pregnancy and after delivery. Together with the hormonal and metabolic changes occurring during pregnancy, hyperdynamic retinal capillary circulation may contribute to the progression of retinopathy in pregnant diabetic women.

The Relationship among Circulating Insulin-Like Growth Factor (IGF)-I, IGF-Binding Proteins-1 and -2, and Birth Anthropometry: A Prospective Study

Fetal IGF-I is a determinant of birth weight, but whether maternal IGF-I plays a significant role is controversial. We sought to examine the relationships among maternal IGF-I, IGF-binding protein (IGFBP)-1, and IGFBP-2, with maternal and newborn anthropometry, in a cohort of 325 nondiabetic pregnant women of African origin. Blood was collected for IGF-I, IGFBP-1, and IGFBP-2 at 9, 25, and 35 wk gestation and in cord blood at delivery. In the second and third trimesters, maternal IGF-I was significantly correlated (P < 0.005) with maternal body mass index and triceps skinfold thickness. Maternal IGFBP-1 and -2 had an inverse correlation (P < 0.0001), with maternal anthropometry. Maternal IGF-I at 35 wk, and fetal IGF-I by cord blood were significantly correlated with birth weight (P = 0.001 and 0.048, respectively). IGFBP-1 in the third trimester and cord blood were negatively correlated with birth weight (P = 0.012 and 0.002). In multiple regression analyses, maternal IGF-I at 35 wk, fetal IGF-I, maternal weight at the first antenatal visit, gender, and gestational age were significant independent factors in the determination of birth weight. In conclusion, maternal IGF-I levels, especially during late pregnancy, positively influence birth weight.

Factors affecting perinatal morbidity and mortality in pregnancies complicated by diabetes mellitus in Sudan

To investigate the influence of obstetric factors and indices of maternal metabolic control on perinatal morbidity and mortality, 88 diabetic pregnant Sudanese women (type 1, n=38; type 2, n=31; gestational diabetes, n=19) and 50 non-diabetic pregnant control women were studied. The mean fasting blood glucose was 11.1±2.8 mmol/l and the mean HbA 1c at booking interview was 8.8±2.1% in the diabetic women. Pregnancy complications such as Caesarean sections, urinary tract infections, pregnancy-induced hypertension and intrauterine foetal death were higher among diabetic compared with control women ( P<0.0001) and varied with the type of diabetes. Infants of diabetic mothers had a higher incidence of neonatal complications than those of non-diabetic women (54.4% vs. 20.0%; P<0.0001). Infants without complications and who were born to diabetic mothers had better Apgar scores at 5 min (9.8±0.5 vs. 8.9±1.6; P<0.01) and lower cord C-peptide when compared to infants with complications ( P<0.05). In conclusion, the prevalence of maternal and neonatal complications among Sudanese diabetic women and their infants is high. Maternal hyperglycaemia is an important factor affecting maternal wellbeing and neonatal morbidity and mortality.

The prevalence of the HNF-1alpha G319S mutation in Canadian aboriginal youth with type 2 diabetes.

To investigate the prevalence of the unique HNF-1alpha G319S mutation in a population of aboriginal youth with type 2 diabetes and to describe the relationship between clinical and historical characteristics and the presence or absence of the HNF-1alpha G319S mutation. Participating youth were genotyped for the G319S mutation of the HNF-1alpha gene. Clinical, laboratory, and historical data were collected via chart review (blinded to genotype results). Comparison data were derived from another study involving young nondiabetic pregnant aboriginal women. A total of 51 youth seen sequentially in a type 2 diabetes clinic participated in this study. Of these, 21 (41.2%) had at least one copy of the mutant allele. The allele frequency in the study population was 0.29 (95% CI 0.20-0.38), which was significantly different from the allele frequency of 0.13 in the comparison population (chi(2) = 6.78, P = 0.009). The frequency of the homozygous mutation (S319/S319) was 0.18. Mean BMI was significantly lower (P = 0.002), mean HbA(1c) was significantly higher (P = 0.02), and acanthosis nigricans was significantly less frequent (P = 0.004) in those with the mutation compared with the wild type. Mean insulin levels were lower and insulin sensitivity (assessed by homeostasis model assessment [HOMA]) was greater in the homozygote group compared with the wild-type group (P = 0.002 and P = 0.0007, respectively). A dose-dependent gradient was observed for these characteristics. These data support the association between the HNF-1alpha G319S mutation and early-onset type 2 diabetes in this population. Those with the mutation lacked clinical characteristics of insulin resistance (e.g., obesity and acanthosis nigricans) and had lower insulin levels, suggesting that an insulin-secretory and/or -production defect plays an important role in the development of diabetes in this group. Further investigation of the pathophysiology of the S319 homo- and heterozygote is needed because it may impact treatment and/or prevention of this disease.

Amniotic fluid glucose at the time of genetic amniocentesis: correlation with duration of pregnancy and birthweight

Objective: To test whether amniotic fluid (AF) glucose levels in 15–18 weeks of pregnancy can predict birthweight and duration of pregnancy. Study design: In this prospective study, 66 non-diabetic pregnant women underwent amniocentesis between 15 and 18 weeks of pregnancy and glucose levels were measured immediately by using the enzymatic method of hexocinase. They were all followed up and delivered in our department and neognological parameters were recorded. Results: AF glucose values ranged from 12 to 69 mg/dl (mean 44.2 mg/dl, S.D. 11.6 mg/dl). No linear relationship was found between AF glucose and either birthweight or duration of pregnancy. Conclusion: AF glucose values between 15 and 18 weeks of pregnancy did not correlate with either birthweight or duration of pregnancy. A single measurement of this value cannot be used for the prediction of the factors studied.

Endothelial function is preserved in pregnant women with well-controlled type 1 diabetes.

Pregnant women with diabetes mellitus have a higher incidence of adverse pregnancy outcomes. Vascular, and in particular, endothelial function may be significantly modified in diabetes resulting in impaired endothelium-dependent relaxation. This study aims to investigate endothelium-dependent relaxation in pregnant women with pre-existing type I diabetes mellitus. Small arteries (mean luminal diameter approximately 295 microm) were isolated from biopsies of subcutaneous fat from pregnant women with pre-existing type I diabetes mellitus, non-diabetic pregnant women, and non-diabetic non-pregnant women. Endothelial and smooth muscle function were determined using wire myography, and the contributions of nitric oxide, vasodilator prostanoid and endothelial hyperpolarisation were studied using specific inhibitors. Arteries obtained from the diabetic pregnant women did not demonstrate any difference in either endothelial or smooth muscle function when compared with non-diabetic pregnant women. The contribution of nitric oxide to endothelium-dependent relaxation was approximately 20% in the pregnant women regardless of whether they were diabetic, and approximately 11% in the non-pregnant women. Endothelial hyperpolarisation appeared to contribute largely to vasorelaxation in human subcutaneous arteries, and was at least twice that of nitric oxide in pregnant women and fivefold greater in non-pregnant women. This study provides evidence that pregnant women with well-controlled pre-existing type 1 diabetes mellitus have both normal endothelial and smooth muscle function. Endothelium-dependent hyperpolarisation appears to play a large role in vascular relaxation in human subcutaneous resistance arteries. This study suggests that the problems associated with diabetic pregnancies are unlikely to be due to vascular dysfunction.

Endothelial function is preserved in pregnant women with well-controlled type 1 diabetes

Objective Pregnant women with diabetes mellitus have a higher incidence of adverse pregnancy outcomes. Vascular, and in particular, endothelial function may be significantly modified in diabetes resulting in impaired endothelium-dependent relaxation. This study aims to investigate endothelium-dependent relaxation in pregnant women with pre-existing type 1 diabetes mellitus. Methods Small arteries (mean luminal diameter ∼295 μm) were isolated from biopsies of subcutaneous fat from pregnant women with pre-existing type 1 diabetes mellitus, non-diabetic pregnant women, and non-diabetic non-pregnant women. Endothelial and smooth muscle function were determined using wire myography, and the contributions of nitric oxide, vasodilator prostanoid and endothelial hyperpolarisation were studied using specific inhibitors. Results Arteries obtained from the diabetic pregnant women did not demonstrate any difference in either endothelial or smooth muscle function when compared with non-diabetic pregnant women. The contribution of nitric oxide to endothelium-dependent relaxation was ∼20% in the pregnant women regardless of whether they were diabetic, and ∼11% in the non-pregnant women. Endothelial hyperpolarisation appeared to contribute largely to vasorelaxation in human subcutaneous arteries, and was at least twice that of nitric oxide in pregnant women and fivefold greater in non-pregnant women. Conclusions This study provides evidence that pregnant women with well-controlled pre-existing type 1 diabetes mellitus have both normal endothelial and smooth muscle function. Endothelium-dependent hyperpolarisation appears to play a large role in vascular relaxation in human subcutaneous resistance arteries. This study suggests that the problems associated with diabetic pregnancies are unlikely to be due to vascular dysfunction.

Perinatal Complications in Women With Gestational Diabetes Mellitus: Significance of a Diagnosis Early in Pregnancy

Background. The aim of the study was to examine the outcome of the pregnancy and neonatal period in 1) women with gestational diabetes mellitus and non-diabetic pregnant women, and 2) in women with early and late diagnosis of gestational diabetes mellitus. Methods. Included were 327 women with gestational diabetes mellitus and 295 non-diabetic women, who were screened with a 75 g oral glucose tolerance test because of risk factors for gestational diabetes. Women with gestational diabetes mellitus were treated with low-caloric diet and insulin when appropriate, while women in the control group received routine antenatal care. Results. Gestational age at delivery was significantly lower in the group with gestational diabetes mellitus, both when considering all deliveries (39.1”1.7 weeks versus 39.8”2.0 weeks, p,0.05) and only those with spontaneous onset of labor (38.8”2.0 weeks versus 40.0”1.6 weeks, p,0.05). The frequency of macrosomia was increased, although not statistically significant (8% vs. 2%, p‰0.07), and the rate of admission to the neonatal ward was significantly increased (18% vs. 9%, p,0.05) in the group with gestational diabetes. Women with early diagnosis of gestational diabetes mellitus had a significantly increased need for insulin treatment during pregnancy (36% vs. 9% p,0.05) and a significantly higher occurrence of diabetes mellitus at follow-up from two months until three years postpartum. Conclusions. This study of women with gestational diabetes mellitus and non-diabetic pregnant women showed that gestational diabetes mellitus was associated with a significantly lower gestational age at delivery and an increased rate of admission to the neonatal ward. Women diagnosed with GDM before 20 weeks of gestation had an increased need for insulin treatment during pregnancy and a high risk of subsequent overt DM, compared with women diagnosed with GDM later in pregnancy.

Response to Fraser

In relation to our recent paper (1) on third trimester glucose levels in nondiabetic pregnant women, Dr. Fraser (2) reports some data on glucose profiles from nondiabetic nonobese pregnant women in the third trimester. We believe that these data are interesting first because there are few contributions on this topic and second because Dr. Fraser’s study relies on glucose profiles consisting of 17 determinations per day. However, there are some important differences in the two studies. Our study involved 51 pregnant women undergoing home …

Ultrasonographic prediction of birth weight in diabetic pregnancies

OBJECTIVE: To compare diabetic and nondiabetic pregnant women near term regarding the accuracy of predicted birth weight by the gestation-adjusted projection method using ultrasonographic measurements. METHODS: Patients with singleton pregnancies who had diabetes and who underwent sonograms between 34.0 weeks and 36.9 weeks formed the study group. The control group was comprised of nondiabetic women who had sonograms in the same gestational age range. The absolute birth weight errors and absolute percent errors in the study group and the controls were compared with t tests. RESULTS: A total of 133 diabetic women and 1690 controls were included in the study. The mean (± standard deviation) absolute error of the predicted birth weight was 265 ± 210 g in the diabetic women and 261 ± 204 g in the control group ( P = .87). The mean (± standard deviation) absolute percent error was 7.4% ± 6.3% for diabetic women compared with 8.3% ± 6.6% for the controls ( P = .14). CONCLUSION: Prediction of birth weight using the gestation-adjusted projection method is as accurate in diabetic women as in controls.