Non-diabetic Pregnant Women Research Articles

Oxidative DNA Damage in Gestational Diabetes Mellitus: Correlation with Antioxidants in an Iraqi Cohort

Aims: This study aimed to evaluate the degree of oxidative stress in gestational diabetes mellitus when compared to non-diabetic pregnant women. Methodology: This cross-sectional study included 73 participants (29 gestational diabetic women and 44 control pregnant women) attending the Maternal and Childhood Unit, Al-Husayniya Medical Centre, Baghdad, Iraq. The data was analyzed using SPSS (Version 14) and Microsoft Excel (Office2007, Microsoft). All values were expressed as mean ± standard deviation (M ± SD). Results: Serum 8-Hydroxy-2-Deoxyguanosine was significantly (P < .001) greater in the gestational diabetes mellitus group compared to control group (57.2 ± 17.6 ng/dl versus 19.8 ± 7.8ng/dl respectively). The increase in 8-Hydroxy-2-Deoxyguanosine was associated with a significant (P < .001) elevation in serum malondialdehyde level (2.1 ± 0.8 nmol/ml versus 1 ± 0.4 nmol/ml) and a significant (P = .05) reduction in plasma reduced glutathione in the gestational diabetes mellitus group compared to the control group (20.6 ± 5 mg/dl compared to 24.1 ± 4.4 mg/dl). A significant change in total cholesterol (5.4 ± 1.1mmol/L) and low density lipoprotein cholesterol (3.3 ± 0.9mmol/L) were also noted in gestational diabetes mellitus group compared to the control group (4.7 ± 1.3mmol/L and 2.8 ± 1mmol/L respectively) at P = .05. Conclusion: An increase in 8-Hydroxy-2-Deoxyguanosine is associated with higher levels of malondialdehyde and a significant reduction in reduced glutathione in gestational diabetes mellitus group, suggesting that significant oxidative stress associated with lipid peroxidation is occurring. Measuring these markers is useful in monitoring gestational diabetes mellitus to prevent the negative outcomes of gestational diabetes mellitus such as increased risk of diabetes and fetal morbidity.

Evaluating Markers of Oxidative Stress in Managing Gestational Diabetes Mellitus: A Cross Sectional Study in Iraq

Aims: The objective of the present study was to evaluate the association of oxidative stress markers and antioxidants in gestational diabetes when compared to non-diabetic pregnant women. Methodology: This is a cross-sectional study, conducted in Al-Husayniya Medical Centre, Baghdad, Iraq and included 73 participants attending the Maternal and Childhood Unit for the period between January 2008 and May 2010. Results: Serum 8-Hydroxy-2-Deoxyguanosine was significantly greater in the gestational diabetes mellitus group compared to control group (57.2 ± 17.6ng/dl versus 19.8 ± 7.8ng/dl respectively, P Conclusions: The current study proves the importance of measuring markers of oxidative stress (expressed by serum 8-Hydroxy-2-Deoxyguanosine & serum lipids) and antioxidants (expressed by serum superoxide dismutase) in managing cases of gestational diabetes mellitus and provides a useful way of assessing the disease progression and/or remission in response to the treatment.

First trimester maternal BMI is a positive predictor of cord blood c-peptide levels while maternal visfatin levels is a negative predictor of birth weight

The role of first trimester maternal body mass index (BMI) and adipocytokines in cord blood c-peptide and birth weight in pregnancy was investigated. Seventy non-diabetic pregnant Caucasian women were recruited. Anthropometry and measurements of fasting adipocytokines (visfatin, leptin, adiponectin), insulin and glucose were performed in each of the three trimesters. At birth, birth weight and cord blood c-peptide, glucose, insulin, visfatin, leptin, adiponectin and IL6 in each neonate were measured. First trimester maternal BMI correlated positively with cord blood c-peptide (p=0.035, r=0.74) and negatively with cord blood visfatin (p=0.049, r=-0.67). First trimester HOMAR was negatively correlated with cord blood visfatin (p=0.037, r=-0.90) and negatively with cord blood leptin (p=0.031, r=0.90). First trimester maternal BMI was a positive predictor of cord blood c-peptide (p=0.007). First trimester maternal visfatin levels were negative predictors of birth weight (p=0.017). We conclude that first trimester maternal BMI and serum visfatin seem to be strongly associated with fetal insulin secretion and final birth weight, respectively, suggesting a role of early-pregnancy maternal adipose tissue in the pregnancy metabolic environment.

Evaluation of thyroid dysfunction in pregnant women with gestational and pre-gestational diabetes

The aim of this study was to investigate thyroid function tests in Gestational Diabetes Mellitus (GDM) and pre-gestational DM and control group. Methodology : There were 61 pregnant diabetic women in study group and 35 pregnant women in control group. Serum T4, T3, T3RU, FTI, TSH and Anti TPO Ab were assessed in each person. Results : About 36% of patients had GDM and 64% pre-gestational DM. Thyroid dysfunction was detected in 18% of study group compared with 8.6% of control group (P = 0.2). There was Thyroid dysfunction in 4.5% of GDM and 25.6% of pregestational DM (P = 0.045). There was no statistically significant difference between thyroid dysfunction in GDM group and control group (P=0.99).27% of GDM and 36% of pregestational DM and 23% of control group had positive titer of Anti TPO Ab without statistically significant differences among the three groups. Conclusion : Thyroid dysfunction is prevalent in women with pre-gestational DM so, thyroid function should be evaluated in these patients during pregnancy. Rate of thyroid dysfunction in GDM patients is similar to normal pregnant control women. High prevalence of positive titer of TPO Ab was seen in diabetic and non-diabetic pregnant women.

Ritodrine Should Be Carefully Administered during Antenatal Glucocorticoid Therapy Even in Nondiabetic Pregnancies

Aim. Antenatal glucocorticoid therapy (AGT) has been commonly used recently. However, this therapy has severe harmful effects such as maternal hyperglycemia. In Japan, ritodrine hydrochloride has been used as a tocolytic agent. In this study, we performed retrospective casecontrol study to clarify whether concomitant use of ritodrine and glucocorticoid was safe to pregnant women without diabetes mellitus. Methods. We reviewed the computerized records of pregnant women with pregestational diabetes (n = 9) and nondiabetes (n = 45) who gave birth at our hospital between 2002 and 2011. Cases and controls received AGT. Blood glucose after the therapy was analyzed, and additional volume of insulin was compared to that before the therapy. Results. From this study, 30 units of insulin were necessary when performing AGT in diabetic pregnant women. And also, an increase in blood glucose of 40 mg/dL was seen after the therapy even in nondiabetic pregnant women. Blood glucose increased significantly in the group that also received ritodrine, and it was shown that the number of pregnant women who might develop ketoacidosis might increase 11-fold. Conclusions. Ritodrine should be carefully administered during antenatal glucocorticoid therapy. It may be necessary to adequately monitor blood glucose, when performing the therapy, even in nondiabetic pregnant women.

Adipokines and their relation to maternal energy substrate production, insulin resistance and fetal size

The role of adipokines in the regulation of energy substrate production in non-diabetic pregnant women has not been elucidated. We hypothesize that serum concentrations of adiponectin are related to fetal growth via maternal fat mass, insulin resistance and glucose production, and further, that serum levels of leptin are associated with lipolysis and that this also influences fetal growth. Hence, we investigated the relationship between adipokines, energy substrate production, insulin resistance, body composition and fetal weight in non-diabetic pregnant women in late gestation. Twenty pregnant women with normal glucose tolerance were investigated at 36 weeks of gestation at Uppsala University Hospital. Levels of adipokines were related to rates of glucose production and lipolysis, maternal body composition, insulin resistance, resting energy expenditure and estimated fetal weights. Rates of glucose production and lipolysis were estimated by stable isotope dilution technique. Median (range) rate of glucose production was 805 (653-1337) μmol/min and that of glycerol production, reflecting lipolysis, was 214 (110-576) μmol/min. HOMA insulin resistance averaged 1.5 ± 0.75 and estimated fetal weights ranged between 2670 and 4175 g (-0.2 to 2.7 SDS). Mean concentration of adiponectin was 7.2 ± 2.5mg/L and median level of leptin was 47.1 (9.9-58.0) μg/L. Adiponectin concentrations (7.2 ± 2.5mg/L) correlated inversely with maternal fat mass, insulin resistance, glucose production and fetal weight, r=-0.50, p<0.035, r=-0.77, p<0.001, r=-0.67, p<0.002, and r=-0.51, p<0.032, respectively. Leptin concentrations correlated with maternal fat mass and insulin resistance, r=0.76, p<0.001 and r=0.73, p<0.001, respectively. There was no correlation between maternal levels of leptin and rate of glucose production or fetal weight. Neither were any correlations found between levels of leptin or adiponectin and maternal lipolysis or resting energy expenditure. The inverse correlations between levels of maternal adiponectin and insulin resistance as well as endogenous glucose production rates indicate that low levels of adiponectin in obese pregnant women may represent one mechanism behind increased fetal size. Maternal levels of leptin are linked to maternal fat mass and its metabolic consequences, but the data indicate that leptin lacks a regulatory role with regard to maternal lipolysis in late pregnancy.

Relationship between maternal red cell index in early pregnancy and gestational diabetes mellitus in Kunming

Objective To investigate the role of hemoglobin (Hb),red blood cell count (RBC) and hematocrit (HCT) during the first trimester in predicting the occurrence of gestational diabetes mellitus (GDM) in the third trimester in nonanemic women in Kunming.Methods A prospective study was carried out.Routine blood tests were performed in 1189 nondiabetic singleton pregnant Chinese women at their initial prenatal healthcare before 14 gestational weeks in the First Affiliated Hospital of Kunming Medical University from January 1,2008 to December 31,2009.They were divided into four groups by quartiles of Hb,RBC and HCT levels respectively.Differences of GDM incidence at the third trimester were compared among groups.Kollmogorov Smirnov test was used to detect normal distribution of Hb,RBC and HCT results.Differences between rates of groups were detected by Chi-square test.Independent risk factors of GDM were screened by Logistic regression analysis.Results The incidence of GDM at the third trimester increased as quartile categories of Hb,RBC and HCT ascended.The GDM incidence (13.1 ％,34/259) of ≥75th Hb group was higher than that of ＜ 25th group (5.9 ％,18/304,x2 =8.53,P＜ 0.0 1),25th ～ group (9.2 ％,30/326,x2=4.18,P＜0.05) and 50th～ group (9.3％,28/300,x2=3.96,P＜0.05).The GDM incidence (11.7 ％,34/290) of 50th～ RBC group (RBC≥4.44 × 1012/L) was higher than that of ＜25th group (6.3％,19/304,x2=5.30,P＜0.05),25th～ group (7.0％,21/298,x2 =3.93,P＜0.05); and the GDM incidence (12.1％,36/297) of ≥75th group was also higher than that of ＜25th group (6.3％,19/304,x2 =6.49,P＜0.05),25th～ group (7.0％,21/298,x2=3.85,P＜0.05).The GDM incidence of ＜25th HCT group (5.3％,16/303) was lower than that of 25th～ group (9.3％,29/311,x2=7.04,P＜0.01),50th～ group (10.8％,31/287,x2=3.93,P＜0.05) and ≥75th group (11.8％,34/288,x2=6.49,P＜0.05).Logistic regression analysis showed that Hb (OR=1.031,95％ CI:1.010-1.052),RBC (OR=2.286,95％CI:1.318-3.963) and HCT (OR=1.106,95％ CI:1.037-1.179) were independent risk factors of GDM (all P＜0.05).Conclusions High maternal Hb,RBC and HCT levels in the first trimester could be used in predicting GDM in pregnant women in Kunming area. Key words: Pregnant women; Hemaglobins; Erythrocyte count; Hematocrit; Diabetes,gestational

Role of fetal echocardiography in the evaluation of structure and function of fetal heart in diabetic pregnancies

Objective: To detect the structural and functional changes of fetal hearts in diabetic pregnancies by using Doppler echocardiography. Methods: This prospective study included 119 pregnant women divided into three groups. Group 1 included 47 pregnant patients with pre-existing diabetes mellitus (DM), group 2 included 40 patients with gestational diabetes and group 3 included 32 non-diabetic pregnant women. M-mode echocardiography was used to measure the thickness of the fetal ventricular walls and interventricular septum. The mitral and tricuspid early (E) and late (A) diastolic velocities and the ventricular shortening fraction were measured. Results: HbA1c % was significantly lower in gestational diabetes group compared with the pre-existing diabetes group. The interventricular septum was significantly thicker in the pre-existing diabetes group compared with other groups. Tricuspid and mitral E/A ratios were significantly lower in the pre-existing diabetes group compared with gestational diabetes and control groups. Moreover, there were no significant differences in the tricuspid and mitral E/A ratios between gestational diabetes group and the control group. The right and left ventricular shortening fractions were similar in the three groups. Conclusion: Fetuses of women with well-controlled gestational diabetes lack the diastolic dysfunction that is present in fetuses of women with pre-existing diabetes

Correlation between maternal inflammatory markers and fetomaternal adiposity

Outside pregnancy, both obesity and diabetes mellitus are associated with changes in inflammatory cytokines. Obesity in pregnancy may be complicated by gestational diabetes mellitus (GDM) and/or fetal macrosomia. The objective of this study was to determine the correlation between maternal cytokines and fetomaternal adiposity in the third trimester in women where the important confounding variable GDM had been excluded. Healthy women with a singleton pregnancy and a normal glucose tolerance test at 28weeks gestation were enrolled at their convenience. Maternal cytokines were measured at 28 and 37weeks gestation. Maternal adiposity was assessed indirectly by calculating the Body Mass Index (BMI), and directly by bioelectrical impedance analysis. Fetal adiposity was assessed by ultrasound measurement of fetal soft tissue markers and by birthweight at delivery. Of the 71 women studied, the mean maternal age and BMI were 29.1years and 29.2kg/m2 respectively. Of the women studied 32 (45%) were obese. Of the cytokines, only maternal IL-6 and IL-8 correlated with maternal adiposity. Maternal TNF-α, IL-β, IL-6 and IL-8 levels did not correlate with either fetal body adiposity or birthweight. In this well characterised cohort of pregnant non-diabetic women in the third trimester of pregnancy we found that circulating maternal cytokines are associated with maternal adiposity but not with fetal adiposity.

Subcutaneous NPH Insulin for Severe Hypertriglyceridemia in a Pregnant Patient with Type V Hyperlipoproteinemia: a Case Report.

An increase in triglyceride levels in familial hyperlipidemia during pregnancy has been reported. Severe hypertriglyceridemia can lead to complications such as acute pancreatitis, preeclampsia, maternal and fetal complications. Because of the teratogenic effects associated with fibrate therapy in pregnancy, alternative treatment strategies such as insulin as a rapid and potent activator of lipoprotein lipase are required during pregnancy. We report a case of hypertriglyceridemia in a 33-year-old pregnant woman in whom treatment with merely single one time administration of Neutral Protamine Hagedorn insulin was accompanied by a reduction in the serum triglyceride level; to the best of our knowledge, this has never been reported in the literature. Her triglyceride level was 3616 mg/dL before insulin treatment and 1246 mg/dL after insulin treatment. Although this regimen was used safely and effectively in our patient, comprehensive studies are required to evaluate the effectiveness and safety of subcutaneously intermediate-acting Neutral Protamine Hagedorn insulin for the treatment of severe hypertriglyceridemia in non-diabetic pregnant women.

Influence of iron metabolism indices on HbA1c in non-diabetic pregnant women with and without iron-deficiency anemia: Effect of Iron supplementation

AimsCondition that influence erythrocyte turnover also affect HbA1c. Although many forms of anemia are associated with lowering of HbA1c, iron-deficiency anemia (IDA) tends to increase HbA1c. In this study, we examined the relationship between HbA1c and erythrocyte indices in non-diabetic pregnancy and assessed the effect of iron supplementation on HbA1c. Materials and Methods150 women were studied (30 non-diabetic), non-pregnant, non-anemic women in child bearing women with varying parity as controls (Gp 1); 30 non-diabetic, non-anemic pregnant women in first trimester of pregnancy (Gp 2a); 30 non-diabetic, non-anemic pregnant women in second trimester of pregnancy (Gp 2b); 30 non-diabetic, non-anemic pregnant women in third trimester of pregnancy (Gp 2c) and 30 non-diabetic pregnant women with IDA (Gp 2d). HbA1c, OGTT, erythrocyte indices and iron metabolic indices were determined in Gp 2d subjects not supplemented with iron and repeated these indices after 3 months of iron-supplementation. ResultsThe mean fasting and postprandial blood glucose levels (79.9±8.0mg/dl, 108.1±14.1mg/dl) in Gp 1 were found to be significantly lower in first trimester among Gp 2a (74.4±5.3mg/dl and 97.2±11.1mg/dl), in second trimester among Gp 2b (76.2±5.2mg/dl and 103.4±7.9mg/dl) followed by increase in IIIrd trimester among Gp 2c (82.3±5.7mg/dl and 112.5±8.5mg/dl) subjects. A significant difference in HbA1c was also observed among the groups (HbA1c 4.7±0.3% in Gp 1; 4.6±0.4% in Gp 2a; 4.5±0.3 in Gp 2b; 4.7±0.3 in Gp 2c). Among Gp 2d subjects, HbA1c was 5.2±0.3% and the level decreased after iron supplementation to 5.1±0.3%. Significant correlation between erythrocyte indices, iron metabolic indices and HbA1c was also observed. ConclusionWe conclude that consideration should be given for performing glucose testing in patients with IDA to ascertain the reliability of HbA1c in the diagnosis of diabetes. HbA1c concentrations in diabetic patients with IDA should be interpreted with caution.

Higher incidence of emergency caesarean section for delay in first stage of labour in diabetic compared to non-diabetic pregnant women

BackgroundDiabetes in pregnancy accounts for a disproportionately high caesarean section (CS) rate. Pursuant to our previous in vitro laboratory findings of impaired uterine contractility in diabetics (DM), we hypothesised that...

Macrosomic infants of nondiabetic and diabetic mothers: The challenges for obstetric practices in low resource community

To estimate and compare the obstetric outcome of fetal macrosomia in both diabetic and non-diabetic mothers as challenges in obstetrics practice Karachi, Pakistan. Study Design: comparative cross sectional, Study duration: From June 2008-May 2009, Study population: All singleton pregnant women, Sample size: 229. Neonates with birth weight of 3,500 gms or greater born to diabetic and non-diabetic mother. Babies with 3,500 gms birth weight and more were considered as macrosomic. The major outcome measures were obstetrics outcome: live births, perinatal mortality, mode of delivery and APGAR scores of both groups. We compared demographic, obstetric and neonatal outcomes on diabetic & non-diabetic mothers delivering macrosomic babies. Data were entered and analyzed using SPSS windows version 15. Significance of difference was calculated using t test, Chi square test as applicable. There were 72 diabetic and 157 non-diabetic pregnant women. Uncomplicated diabetic and non-diabetic women of single index pregnancy had age range of 19–35 years. Overall incidence of macrosomia ( ≥ 3,500 gms) in this study was 72(31.4%). In this study there were significantly more macrosomic newborns in diabetic women; (52.8%) compared to (47.2%). Fetal macrosomia in our study was 31.4% in both diabetic and non-diabetic mothers. The obstetric challenges of diagnosis and management of fetal macrosomia in low resource country like Pakistan require screening for macrosomia as an integral part of antenatal care.

Accuracy of Fetal Weight Estimation in Women with Diet Controlled Gestational Diabetes.

Purpose: To evaluate whether ultrasound accuracy of estimated fetal weight (EFW) differs in women with diet controlled gestational diabetes mellitus (GDM) compared to nondiabetic pregnant women. Material and Methods: We included 363 patients, 121 patients with diet controlled GDM and 242 patients with a normal oral glucose tolerance test (oGTT). Each case of diet controlled GDM was matched with 2 unaffected controls. All patients were screened/diagnosed for GDM by means of an oGTT. Both groups received ultrasound examination including fetal biometry, using Hadlock's Formula, within 7 days to delivery. After birth, gestational age, birthweight and Apgar scores were collected from each newborn. Results: There was a good correlation between EFW and birth weight (coefficient = 0.747, p < 0.001 by Pearson correlation, even after adjustment for glucose status). Regression analyses, including noGDM/GDM, maternal age, maternal body mass index, birth weight and time interval between ultrasound and delivery revealed that only fetal birth weight significantly influences weight difference between ultrasound EFW and actual birth weight at term. Conclusion: Our data suggests that ultrasound accuracy of EFW using Hadlock's Formula at term does not differ in women with diet controlled GDM compared to women with normal glucose tolerance.

A comparative study of the different diagnostic criteria of gestational diabetes mellitus and its incidence

BackgroundHigh prevalence of diabetes and genetic predisposition to metabolic syndrome among Indians places Indian women at risk to develop gestational diabetes mellitus (GDM) and its complications. Literature defines multiple criteria for GDM. This prospective study compares available diagnostic criteria for GDM in Indian women and their correlation with perinatal morbidity. MethodNine hundred and forty-eight consecutive voluntary nondiabetic pregnant women were recruited for the study. Seven hundred and twenty-three of these (mean age 23.45 years; 75.7% < 25 years) who reported for the follow-up were screened for GDM at 24–28 weeks gestation by American College of Obstetrics and Gynaecology (ACOG) guidelines and World Health Organization (WHO) criteria. Glycated haemoglobin (HbA1c) and fasting and two-hours postglucose plasma insulin levels were also analysed. Pregnancy outcome was known for 291 of these. Concordance of risk factors and perinatal complications was analysed with respect to GDM. ResultsPrevalence of GDM at 24–28 weeks gestation was found to be 4.8% by WHO criteria, 6.36% by Carpenter and Coustan's criteria, and 3.5% by O'Sullivan's criteria. Prevalence was marginally higher in women of higher age, having past history of abortion or family history of diabetes mellitus (DM) (P > 0.05). None of these women had HbA1c > 6%. Relative risk of abnormal delivery (pregnancy outcome) was 1.93, 1.39, and 1.17 in women with GDM by O'Sullivan's, WHO, and Carpenter's criteria, respectively (P > 0.05). Abnormal deliveries were marginally higher in women with high postglucose load insulin levels. Mean weight of the newborns was essentially the same in GDM and nonGDM women by any of the criteria. One-hour and two-hours postglucose values were more sensitive in diagnosing GDM by O'Sullivan's criteria while fasting plasma glucose value had the poorest specificity with 2.5% of nonGDM women having values above the cut-off. Modifications of these criteria did not im-prove their predictive value for abnormal delivery over that of O'Sullivan's criteria. ConclusionPrevalence of GDM and abnormal delivery in women < 35 years of age is low. Therefore, global screening for GDM may not be very useful in women < 25 years of age unless family history of DM or past history of abortion is present. Existing evidence is inadequate to justify the switchover from O'Sullivan's criteria for diagnosis of GDM.

Prediction of gestational diabetes mellitus at 24 to 28 weeks of gestation by using first-trimester insulin sensitivity indices in Asian Indian subjects

The aim of the present study was to predict the development of gestational diabetes mellitus (GDM) after 24 weeks of gestation by using first-trimester insulin indices. A total of 298 nondiabetic pregnant women underwent 3-hour oral glucose tolerance test (OGTT) in the first trimester of pregnancy. The normoglycemic women underwent second OGTT between 24 and 28 weeks. Insulin sensitivity and resistance indices were calculated by using the Matsuda index (composite insulin sensitivity from OGTT), quantitative insulin sensitivity check index, and homeostasis model assessment for insulin resistance and sensitivity by using the results of the first-trimester OGTT. These indices were compared between subjects who were diagnosed as having GDM and subjects with normal glucose tolerance in the second OGTT. The overall prevalence of GDM was 15.49% (24 in the first trimester and 16 between 24 and 28 weeks). First-trimester fasting plasma insulin greater than 7.45 μU/mL was able to predict GDM with sensitivity and specificity of 80% and 57.4%, respectively. The negative predictive value for this parameter was 0.97. Values of first-trimester composite insulin sensitivity from OGTT less than 5.5 had sensitivity and specificity of 71.4% and 62.5% for the prediction of GDM. First-trimester hyperinsulinemia preceded the onset of hyperglycemia between 24 and 28 weeks of gestation and would predict the development of GDM with limited sensitivity and specificity.

Aiming at New Targets to Achieve Normoglycemia During Pregnancy

In a recent issue of Diabetes Care , Hernandez et al. (1) from the University of Colorado presented a comprehensive review of the 24-h glucose profile during pregnancy in women without diabetes. In the current issue, Harmon et al. (2) from the same institution present new observations on the glycemic profile of pregnant nondiabetic women, examining differences between obese and normal-weight mothers and between different trimesters of pregnancy. Why are articles about women without diabetes being published in a journal whose very title declares that it is about the care of diabetes? The answer is that these two reports give us an idea of what is truly “normal” glucose during pregnancy, and this has important implications for the way we all manage diabetes during pregnancy. The articles are startling in that they both show that normal glucose values are substantially lower than the target values currently recommended for treatment of diabetes during pregnancy. Hernandez et al. (1) propose that we ought to change these targets to more closely approximate nondiabetic norms. Contemporary management of diabetes during pregnancy is guided by the Pedersen Hypothesis, which holds that diabetic fetal macrosomia and various newborn metabolic sequelae are caused by endogenous fetal hyperinsulinemia, which is a response to fetal hyperglycemia. This, in turn, is a direct reflection of maternal hyperglycemia because glucose readily traverses the placenta whereas insulin does not (3). The corollary is that diabetic fetopathy should largely be preventable by preventing maternal hyperglycemia. The cornerstone of diabetes management in pregnancy, then, is to attempt to keep maternal glucose as close to normal as possible. But what exactly is a “normal” glucose during pregnancy? The articles by Hernandez et al. (1) and Harmon et al. (2) help us to answer this question. The review by Hernandez et al. (1) reported on literature …

Erratum to: Metformin pharmacokinetics in nondiabetic pregnant women with polycystic ovary syndrome

Erratum to: Metformin pharmacokinetics in nondiabetic pregnant women with polycystic ovary syndrome

Preserved structural and functional characteristics of common carotid artery in properly treated normoglycemic women with gestational diabetes mellitus

Women with gestational diabetes mellitus (GDM) are at high risk of subsequently developing type 2 diabetes mellitus which is an important cardiovascular risk factor. We have evaluated whether preclinical morphological and functional arterial changes are present in GDM. Diameter, intima-media thickness (IMT), intima-media cross-section area (IMCSA) and elasticity features (compliance, distensibility coefficient, circumferential strain, stiffness index (SI) α and β, incremental elastic modulus) of the common carotid arteries (CCA) were studied in the 3rd trimester in 25 women with GDM, and 17 normal pregnant women matched for age and body mass index using an ultrasonographic vessel wall-movement tracking system and applanation tonometry. Mean IMT, IMCSA and SI α tended to be larger, whereas compliance was smaller in women with GDM but none of these differences were significant. Serum glucose (4.99 ± 0.51 vs. 4.79 ± 0.61 mmol/L, p=0.37) and HbA1c (5.33 ± 0.27 vs. 5.36 ± 0.47 mmol/L, p=0.85) proved normoglycemia in both groups. In conclusion, by the combination of methods we applied in this case control study, neither morphological nor functional characteristics of large elastic arteries differ significantly between well-treated normoglycemic women with GDM and non-diabetic pregnant women in the 3rd trimester.

14- DIABETES MELLITUS IN PREGNANCY; MATERNAL &amp; PRENATAL OUTCOME

This is a case-control comparative study carried out over the period (July 2007-July 2008) to identify the frequent type of D.M., analyze demographic features of diabetic cases as well as to identify maternal, fetal & neonatal complications of D.M. during pregnancy. This study included 160 diabetic pregnant women as (cases) compared to 180 nondiabetic pregnant women as (control) who were admitted to three known hospitals with obstetrical & Gynecology department during same period of study. Such controls had approximated age & parity to that of cases. Type 2 DM was the commonest type among cases who tend to be more advanced in their age with higher BMI compared to controls. Three major risk factors that predispose to develop GDM were family history of type 2 or GDM, advanced maternal age & obesity. Diabetic pregnancy was more likely complicated by abortions, hypertensive disorders, polyhydramnious and preterm delivery with high C/S rate as well as P.P.H. & birth tract injury in comparison to controls. Cephalo-pelvic disproportion consequent to macrosomia was main indication for C/S in diabetic cases in whom not only macrosomic newborns were more but also stillbirth rate was higher with lower Apgar score & more admission to NICU. Diabetic newborns were more likely to be affected by RDS, hypoglycemia & congenital malformation. In conclusion, D.M. is a major medical disorder that exhibit burden on health of both mother & fetus with high maternal morbidity, prenatal & neonatal morbidity & mortality.