Similar Pregnancy Outcomes Research Articles

Motor vehicle accidents during pregnancy: a population‐based study

This population-based cohort study of more than 600,000 Australian women describes the incidence of motor vehicle accidents (MVA) during pregnancy and the immediate and subsequent pregnancy outcomes. In this study, 3.5 women per 1000 maternities were admitted to hospital following an MVA. Immediate delivery was uncommon: 0.4% at <20 weeks of gestation and 3.5% at ≥ 20 weeks of gestation. Outcomes for those giving birth immediately were poor, with increased risk of antepartum haemorrhage, preterm birth, caesarean section and perinatal death. In contrast, women who remained undelivered following an MVA (96%) had similar pregnancy outcomes to women not involved in MVAs, and can be reassured.

Clinical application of in vitro maturation of human immature oocytes for infertile women with polycystic ovary syndrome

To investigate clinical effect and safety of in vitro maturation (IVM) of human immature oocytes in infertile women with polycystic ovary syndrome by comparing with conventional in vitro fertilization(IVF)and intracytoplasmic sperm injection(ICSI). From Jan. 2003 to Dec. 2009, 157 infertile women with PCOS underwent 162 cycles IVM in Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University. In the mean time, 109 patients with PCOS underwent 114 IVF/ICSI cycles as control group 1 and 106 patients with other factors underwent 106 IVF/ICSI cycles as control group 2. Treatment and outcome of pregnancy and infant were compared among those 3 groups. No statistically significant difference were found in terms of the positive rate of hCG in urine [35.7% (56/157), 42.2% (46/109), 44.3% (47/106)], the rate of clinical pregnancy [29.3% (46/157), 37.6% (41/109), 41.5% (44/106)], the rate of entopic pregnancy [1.9% (3/157), 1.8% (2/109), 0.9% (1/106)], the rate of miscarriage [18.6% (8/43), 12.8% (5/39), 20.9% (9/43)] and the rate of live-birth [22.3% (35/157), 31.2% (34/109), 32.1% (34/106)] among three groups (IVM group, control group 1, control group 2, P > 0.05). The rate of preterm labor, low weight newborn, mean birth weight, ratio of male to female did not show significantly difference among 3 groups (P > 0.05). The average control ovarian stimulation was 6 days, the median dose of gonadotropin (Gn) was 675 IU, and the total hospital cost was (8392 ± 1328) RMB in IVM group, which were statistically lower than those in the other two control groups (P < 0.01). The rate of multiple pregnancy was 4.7% (2/43) and ovarian hyperstimulation syndrome (OHSS) 0 in IVM group, which were significantly lower than those in the other control group (P < 0.01). In vitro maturation is an effective treatment in infertile women with PCOS, it could obtain the similar pregnancy outcome and reduce total cost, the dosage of gonadotropin-releasing hormone and rate of OHSS compared with conventional IVF/ICSI.

A Randomized Controlled Trial Investigating the Effects of a Low–Glycemic Index Diet on Pregnancy Outcomes in Gestational Diabetes Mellitus

OBJECTIVEThe prevalence of gestational diabetes mellitus (GDM) is rising. There is little evidence to demonstrate the effectiveness of one dietary therapy over another. We aimed to investigate the effect of a low–glycemic index (LGI) versus a conventional high-fiber diet on pregnancy outcomes, neonatal anthropometry, and maternal metabolic profile in GDM.RESEARCH DESIGN AND METHODSNinety-nine women (age 26–42 years; mean ± SD prepregnancy BMI 24 ± 5 kg/m2) diagnosed with GDM at 20–32 weeks’ gestation were randomized to follow either an LGI (n = 50; target glycemic index [GI] ~50) or a high-fiber moderate-GI diet (HF) (n = 49; target GI ~60). Dietary intake was assessed by 3-day food records. Pregnancy outcomes were collected from medical records.RESULTSThe LGI group achieved a modestly lower GI than the HF group (mean ± SEM 47 ± 1 vs. 53 ± 1; P < 0.001). At birth, there was no significant difference in birth weight (LGI 3.3 ± 0.1 kg vs. HF 3.3 ± 0.1 kg; P = 0.619), birth weight centile (LGI 52.5 ± 4.3 vs. HF 52.2 ± 4.0; P = 0.969), prevalence of macrosomia (LGI 2.1% vs. HF 6.7%; P = 0.157), insulin treatment (LGI 53% vs. HF 65%; P = 0.251), or adverse pregnancy outcomes.CONCLUSIONSIn intensively monitored women with GDM, an LGI diet and a conventional HF diet produce similar pregnancy outcomes.

Pregnancy outcome after 1st-trimester inadvertent exposure to barium sulphate as a contrast media for upper gastrointestinal tract radiography

Despite barium being used as a contrast media for decades, the specific assessment of its safety in pregnant women is scarce. We are reporting the favourable pregnancy outcome in women who were inadvertently exposed to barium swallow and associated ionising radiation, early in pregnancy. A control group of age- and gravidity-matched unexposed pregnant women was also included. There were 32 live-born babies in the exposed group and 94 in the control group. Women had undergone diagnostic upper gastrointestinal tract (UGT) fluoroscopic examination at 3.3 ± 1.5 weeks’ gestation. Estimated maternal radiation dose secondary to barium swallow varied widely, the maximum dose was estimated to be 2.45 mSv. Similar pregnancy outcomes were observed between the groups. The number of babies born with major malformations was not significantly different (p = 1.0) between cases and controls: one (3.1%) vs three (3.2%), respectively. In conclusion, our small prospective cohort study of women suggests no association between inadvertent exposure to ionising radiation and barium sulphate during fluoroscopic barium swallow and adverse fetal outcomes.

Gonadotrophin-releasing hormone agonist and antagonist: factors driving the pregancy outcomes – An exploratory analysis

ObjectiveA recent Cochrane review has demonstrated that gonadotrophin-releasing hormone agonists and antagonists have similar pregnancy outcomes, but a better safety profile for GnRH antagonists. Even so, little is known on how factors such as type of GnRH antagonist and flexibility in administration affects the pregnancy outcomes.DesignSystematic review/ meta-analysis.Materials and MethodsUsing data from recent Cochrane review (Al-Inany et al., 2011), RCTs comparing antagonist versus agonist were grouped according to the type of GnRH used (e.g. Cetrorelix or Ganirelix) and flexibility of the protocol (e.g. fixed or flexible protocol). Indirect comparisons were performed using the Bucher method and adjusted point estimates and confidence intervals were evaluated. The primary outcome was the live-birth rate. The secondary outcomes were the ongoing pregnancy and clinical pregnancy rates.ResultsTabled 1Clinical outcomes.Cetrorelix vs. AgonistGanirelix vs. AgonistCetrorelix vs. GanirelixFlexible protocol vs. AgonistFixed protocol vs. AgonistFlexible protocol vs. Fixed protocolLive-birth rate0.87 [0.63, 1.20]0.65 [0.26, 1.62]1.34 [0.51, 3.53]NANANAOngoing-pregnancy rate0.92 [0.72, 1.17]0.88 [0.74, 1.05]1.05 [0.78, 1.41]0.98 [0.79, 1.22]0.87 [0.71, 1.06]1.13 [0.84, 1.51]Clinical pregnancy rate0.86 [0.69, 1.07]0.91 [0.76, 1.09]0.95 [0.71, 1.26]0.96 [0.76, 1.20]0.88 [0.72, 1.07]1.09 [0.81, 1.48] Open table in a new tab ConclusionThe type of antagonist and flexibility of the antagonist protocol do not seem to be detriemental factors in the sucess of GnRH antagonists. ObjectiveA recent Cochrane review has demonstrated that gonadotrophin-releasing hormone agonists and antagonists have similar pregnancy outcomes, but a better safety profile for GnRH antagonists. Even so, little is known on how factors such as type of GnRH antagonist and flexibility in administration affects the pregnancy outcomes. A recent Cochrane review has demonstrated that gonadotrophin-releasing hormone agonists and antagonists have similar pregnancy outcomes, but a better safety profile for GnRH antagonists. Even so, little is known on how factors such as type of GnRH antagonist and flexibility in administration affects the pregnancy outcomes. DesignSystematic review/ meta-analysis. Systematic review/ meta-analysis. Materials and MethodsUsing data from recent Cochrane review (Al-Inany et al., 2011), RCTs comparing antagonist versus agonist were grouped according to the type of GnRH used (e.g. Cetrorelix or Ganirelix) and flexibility of the protocol (e.g. fixed or flexible protocol). Indirect comparisons were performed using the Bucher method and adjusted point estimates and confidence intervals were evaluated. The primary outcome was the live-birth rate. The secondary outcomes were the ongoing pregnancy and clinical pregnancy rates. Using data from recent Cochrane review (Al-Inany et al., 2011), RCTs comparing antagonist versus agonist were grouped according to the type of GnRH used (e.g. Cetrorelix or Ganirelix) and flexibility of the protocol (e.g. fixed or flexible protocol). Indirect comparisons were performed using the Bucher method and adjusted point estimates and confidence intervals were evaluated. The primary outcome was the live-birth rate. The secondary outcomes were the ongoing pregnancy and clinical pregnancy rates. ResultsTabled 1Clinical outcomes.Cetrorelix vs. AgonistGanirelix vs. AgonistCetrorelix vs. GanirelixFlexible protocol vs. AgonistFixed protocol vs. AgonistFlexible protocol vs. Fixed protocolLive-birth rate0.87 [0.63, 1.20]0.65 [0.26, 1.62]1.34 [0.51, 3.53]NANANAOngoing-pregnancy rate0.92 [0.72, 1.17]0.88 [0.74, 1.05]1.05 [0.78, 1.41]0.98 [0.79, 1.22]0.87 [0.71, 1.06]1.13 [0.84, 1.51]Clinical pregnancy rate0.86 [0.69, 1.07]0.91 [0.76, 1.09]0.95 [0.71, 1.26]0.96 [0.76, 1.20]0.88 [0.72, 1.07]1.09 [0.81, 1.48] Open table in a new tab ConclusionThe type of antagonist and flexibility of the antagonist protocol do not seem to be detriemental factors in the sucess of GnRH antagonists. The type of antagonist and flexibility of the antagonist protocol do not seem to be detriemental factors in the sucess of GnRH antagonists.

Pregnancy outcome in inflammatory bowel disease: prospective European case-control ECCO-EpiCom study, 2003-2006

Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Pregnancy outcome in women with IBD is well described, particularly in retrospective studies. To evaluate the pregnancy outcome in patients with IBD in a prospective European multicentre case-control study. Inflammatory bowel disease pregnant women from 12 European countries were enrolled between January 2003 and December 2006 and matched (1:1) to non-IBD pregnant controls by age at conception and number of previous pregnancies. Data on pregnancy and newborn outcome, disease activity and therapy were prospectively collected every third month using a standard questionnaire. Logistic regression analysis with odds ratio was used for statistical analyses. P value<0.05 was considered significant. A total of 332 pregnant women with IBD were included: 145 with Crohn's disease (CD) and 187 with ulcerative colitis (UC). Median age (range) at conception was 31 years (15-40) in CD and 31 (19-42) in UC patients. No statistically significant differences in frequency of abortions, preterm deliveries, caesarean sections, congenital abnormalities and birth weight were observed comparing CD and UC women with their non-IBD controls. In CD, older age was associated with congenital abnormalities and preterm delivery; smoking increased the risk of preterm delivery. For UC, older age and active disease were associated with low birth weight; while older age and combination therapy were risk factors for preterm delivery. In this prospective case-control study, women with either Crohn's disease or ulcerative colitis have a similar pregnancy outcome when compared with a population of non-inflammatory bowel disease pregnant women.

Comparison of in vitro fertilization/intracytoplasmic sperm injection outcomes in male factor infertility patients with and without spinal cord injuries

To determine if outcomes after invitro fertilization with intracytoplasmic sperm injection (IVF/ICSI) using sperm from men with spinal cord injury (SCI group) differ from those of other etiologies of male factor infertility (non-SCI group). In men with SCI, to determine if IVF/ICSI outcomes differ with sperm obtained by penile vibratory stimulation (PVS group) versus electroejaculation (EEJ group). Retrospective analysis. University medical center and major infertility center. Couples with male factor infertility due to SCI versus other etiologies. PVS, EEJ, surgical sperm retrieval, and IVF/ICSI. Rates of fertilization, pregnancy, and live birth. A total of 31 couples in the SCI group underwent 48 cycles of IVF/ICSI, and a total of 297 couples in the non-SCI group underwent 443 cycles of IVF/ICSI. The SCI group had lower fertilization rates but similar pregnancy and live birth rates compared with the non-SCI group. These rates, however, did not differ significantly when the PVS group was compared with the EEJ group. IVF/ICSI of sperm from men with SCI yield lower fertilization rates but similar pregnancy and live birth outcomes as IVF/ICSI of sperm from men with other etiologies of male factor infertility. Sperm collected by PVS versus EEJ in men with SCI appear to result in similar IVF/ICSI success rates.

The effect of marital status on pregnancy outcome in Israel: A retrospective case‐control study

Previous studies have observed an association between unmarried status of the mother and adverse perinatal outcome such as increased rate of preterm deliveries, low birthweight and small-for-gestational-age infants. In Israel, attendance of prenatal care is imposed by the state and is not related to socioeconomic status; therefore, unmarried women are expected to have a similar prenatal care as married women. The objective of this study is to test the hypothesis that unmarried and married pregnant women have a similar perinatal outcome. In a retrospective case-control study, analysis of the records of women who gave birth at the delivery ward of Edith Wolfson Medical Center (a tertiary health care center) over a one-year period (2005) with respect to marital status was performed. The cases group included 304 unmarried women who were matched with 1:1 ratio for maternal age, parity, and number of fetuses in the current pregnancy. Unmarried women (n = 304) were more likely to smoke during pregnancy (35.2% vs 15.2%, P < 0.001), had a longer second stage (44.4 ± 9.8 min vs 54.4 ± 4.4 min, P < 0.05) and a shorter first stage (484.0 ± 34.8 min vs 421.0 ± 25.3 min P < 0.05) of labor. The unmarried women had similar length of gestation, preterm delivery rate, mode of delivery, low birthweight rates, low Apgar scores or meconium passage during labor as married women. In Israel, unmarried and married pregnant women may have almost similar pregnancy outcomes on length of gestation, mode of delivery and Apgar score.

The Outcomes of Gestational Diabetes Mellitus after a Telecare Approach Are Not Inferior to Traditional Outpatient Clinic Visits

Objective. To evaluate the feasibility of a telemedicine system based on Internet and a short message service in pregnancy and its influence on delivery and neonatal outcomes of women with gestational diabetes mellitus (GDM). Methods. 100 women diagnosed of GDM were randomized into two parallel groups, a control group based on traditional face-to-face outpatient clinic visits and an intervention group, which was provided with a Telemedicine system for the transmission of capillary glucose data and short text messages with weekly professional feedback. 97 women completed the study (48/49, resp.). Main Outcomes Measured. The percentage of women achieving HbA1c values <5.8%, normal vaginal delivery and having a large for-gestational-age newborn were evaluated. Results. Despite a significant reduction in outpatient clinic visits in the experimental group, particularly in insulin-treated women (2.4 versus 4.6 hours per insulin-treated woman resp.; P < .001), no significant differences were found between the experimental and traditional groups regarding HbA1c levels (all women had HbA1c <5.8% during pregnancy), normal vaginal delivery (40.8% versus 54.2%, resp.; P > .05) and large-for-gestational-age newborns (6.1% versus 8.3%, resp.; P > .05). Conclusions. The system significantly reduces the need for outpatient clinic visits and achieves similar pregnancy, delivery, and newborn outcomes.

A Telemedicine system based on Internet and short message service as a new approach in the follow-up of patients with gestational diabetes

To evaluate the feasibility of a Telemedicine system based on Internet and short message service in the follow-up of patients with gestational diabetes. Compared to control group, Telemedicine group reduced 62% the number of unscheduled face-to-face visits, and 82.7% in the subgroup of insulin-treated patients, improving patient satisfaction, and achieving similar pregnancy and new born outcomes.

Continuous subcutaneous insulin infusion and multiple dose insulin injections in Type 1 diabetic pregnant women: a case-control study

The aim of this study was to evaluate the effects of continuous subcutaneous insulin infusion (CSII) on glycemic control and pregnancy outcomes in Type 1 diabetic pregnant women. We retrospectively evaluated 42 subjects, 20 treated with CSII and 22 with multiple dose insulin injections (MDI). The two groups were comparable for age, pre-pregnancy BMI, and primiparous rate, whereas women in the CSII group showed a tendency toward a longer diabetes duration (p = 0.06). Pre-pregnancy diabetic retinopathy and/or nephropathy were present in nine women of CSII and three of MDI. In all women metabolic control improved during pregnancy, without differences between the two groups and at the end of gestation HbA1c was 6.3 +/- 0.6 in CSII and 6.1 +/- 1.1% in MDI. Moreover, there were no differences in weight gain, whereas insulin requirement resulted significantly (p = 0.009) lower in CSII than in MDI. We recorded only one severe hypoglycaemic episode in both groups. No cases of deteriorations of the chronic diabetic complications were observed. The delivery occurred at 36.4 +/- 2.2 weeks; birth weight, the rate of large for gestational age, and the parameters of foetal morbidity were similar in both groups. In conclusions, CSII and MDI are both effective in improving maternal glucose control and have both similar pregnancy outcomes.

Ultrasound-predicated versus history-predicated cerclage in women at risk of cervical insufficiency: a systematic review.

The aim of this systematic review was to compare pregnancy outcomes and cerclage-related complications of ultrasound-predicated versus history-predicated cerclage in patients at risk of cervical insufficiency due to a history of preterm delivery (PTD). A structured search was performed in PubMed, Embase, and the Cochrane Library to identify potentially relevant articles from January 1980 through July 2007. Studies were included if ultrasound-predicated cerclage was compared to history-predicated cerclage in women with a singleton gestation and a history of PTD. The PubMed, Embase, and Cochrane search yielded 537, 643, and 42 articles, respectively. In addition, 1194 "Related articles" (PubMed) and 87 "Cited in/cited by" (ISI-WOS) from all potentially relevant articles were assessed. After critical evaluation for relevance and quality, 6 articles remained. Five of the 6 included studies showed no differences in pregnancy outcome (PTD or pregnancy loss <24 weeks) between the ultrasound-predicated and the history-predicated cerclage groups. In 1 prospective cohort study, PTD below 30 weeks was significantly lower in the ultrasound group. The included studies showed that in the ultrasound group, 40% to 68% of the patients did not require cerclage. The majority of studies provided insufficient data to draw conclusions regarding cerclage-related complications. In conclusion, using ultrasound to identify women at risk of cervical insufficiency because of a history of PTD reduces cerclage rates and results in similar pregnancy outcomes as cerclage placement on the basis of history alone. Obstetricians & Gynecologists, Family Physicians. After reading this article, the reader should be able to identify his or her own management of women with prior history of preterm delivery with respect to the possible use of cerclage, design a diagnostic strategy for his or her own patients to determine whether history or ultrasound-based decision making is appropriate in the practice setting, and translate best-practices with respect to definition of cervical shortening in his or her own practice.

Benefits of preventive transhisteroscopic metroplasty (THM) in septate uterus

Benefits of preventive transhisteroscopic metroplasty (THM) in septate uterus

Continuous quality improvement and assisted reproductive technology multiple gestations: some progress, some answers, more questions

The past decade has seen a fall in the number of embryos transferred accompanied by a reduction in the rate of higher order multiple pregnancies occurring from U.S. assisted reproductive technology (ART) cycles, which is temporally related to voluntary adherence to embryo transfer guidelines. The twin rate has remained relatively constant. The ability to continue the reduction in multiple pregnancies while maintaining advocacy positions for both patient couples and offspring will best occur with attention to scientific, sociologic, economic, and provider issues.

Pregnancy outcome in hyperemesis gravidarum and the effect of laboratory clinical indicators of hyperemesis severity

To determine pregnancy outcome in hyperemesis gravidarum and the effect of metabolic, biochemical, hematological and clinical indicators of disease severity on outcome. A retrospective study based on 166 women hospitalized for confirmed hyperemesis gravidarum from January 2004 to January 2005. For each woman, three controls matched for age, parity and ethnicity were obtained from our 2004 birth register. The effects of laboratory indicators of hyperemesis severity were separately analyzed within the hyperemesis gravidarum study group. Outcome measures include stillbirths, Apgar score, mode of delivery, low birthweight, preterm delivery, labor induction, pregnancy induced hypertension and gestational diabetes. Analysis was by t-test, Fisher's exact test and multivariable logistic regression analysis. Women with hyperemesis had similar pregnancy outcome compared to controls. In the analysis of laboratory indicators of hyperemesis severity and pregnancy outcomes, hypokalemia (adjusted odds ratio [AOR] 2.7: 95% confidence interval [CI] 1.0-6.8) was associated with emergency operative delivery, high creatinine (odds ratio 4.4: 95% CI 1.3-15) with labor induction and raised gamma glutamyltransferase (AOR 7.5: 95% CI 1.2-46) with the development of gestational diabetes. Hyperemesis gravidarum per se was not associated adverse pregnancy outcome. Hypokalemia, high creatinine and raised gamma glutamyltransferase in women with hyperemesis gravidarum were associated with adverse pregnancy outcome.

Is hysteroscopic correction of an incomplete uterine septum justified prior to IVF?

This retrospective study examined the effect of hysteroscopic correction of an incomplete uterine septum on IVF outcome. Measurement of the Fm (fundal myometrial thickness) and Cm (cornual myometrial thickness) was performed by sonohysterography. Group 1 included patients diagnosed with incomplete septum ( n = 119), fulfilling the two criteria of Fm >11 mm and Fm–Cm >5 mm, who underwent hysteroscopic incision of the incomplete septum. Group 2 consisted of 116 age-matched control patients with a normal uterine cavity who underwent IVF within the same time period. Main outcome measures were clinical pregnancy and spontaneous abortion rates. Patients in group 1 had a history of more spontaneous abortions than patients in group 2 (14.20 versus 6.03%, P = 0.04) as well as higher previous IVF failure (32.7 versus 20.6%, P = 0.04). After surgical correction of the septum in group 1, IVF pregnancy outcome was similar in both groups (clinical pregnancy and pregnancy loss of 47.80 versus 46.50% and 10.52 versus 20.3% respectively). A similar pregnancy outcome was found after the incision of the incomplete septum compared with a group with normal uterine cavity. Larger prospective and randomized controlled studies are needed to prove the positive effect of correction of an incomplete uterine septum on IVF outcome.

What is the optimal antiretroviral regimen for the prevention of perinatal HIV transmission?

OF PERINATAL HIV TRANSMISSION? AMANDA COTTER, LUNTHITA DUTHELY, VICTOR HUGO GONZALEZ QUINTERO, MARY JO O’SULLIVAN, University of Miami, Obstetrics and Gynecology, Miami, Florida, University of Miami, OB/GYN Research, Miami, Florida, University of Miami, Dept of Ob/ Gyn-MFM Division, Miami, Florida OBJECTIVE: To determine the optimal antiretroviral (ART) regimen for the prevention of perinatal transmission (PNT) of HIV in women who do not require ART for their own health. STUDY DESIGN: Using prospectively gathered data from our perinatal database, women diagnosed HIV positive prior to or during pregnancy with care at our prenatal clinic from 1999-2004 were identified. Inclusion criteria were women requiring ART only for prevention of PNT and neonatal HIV status. Women were categorized according to ART use in pregnancy: Trizivir, Combivir/Nevirapine (NVP), Combivir/Nelfinavir (NFV). RESULTS: The cohort comprised 634 deliveries of whom 155 women required ART only for prevention of PNT: Trizivir n = 61, Combivir/NVP n = 88, Combivir/NFV n = 6. A VL!1000 at delivery was achieved by 82% on Trizivir, 76% on Combivir/NVP and 83% on Combivir/NFV. The mean duration of therapy was 15.9, 15.3 and 20.9 weeks for Trizivir, Combivir/NVP and Combivir/NFV respectively.There was one case of hepatotoxicity associated each with Combivir/NVP and Combivir/NFV. All infants were liveborn except for 2 stillbirths and 2 spontaneous abortions in the Combivir/NVP group. There was only one case of PNT and this was in a woman on Trizivir. CONCLUSION: Although rarely utilized outside of pregnancy, Trizivir is an ideal ART regimen associated with similar pregnancy outcomes to other popular regimens without a significant risk of toxicity or adherence issues while reserving other ART regimens for later when required for maternal health.

Dichorionic twins conceived through assisted reproduction have similar pregnancy outcomes to spontaneous conceptions

Dichorionic twins conceived through assisted reproduction have similar pregnancy outcomes to spontaneous conceptions

Diabetes management in pregnancy

Diabetes in pregnancy is associated with significant morbidity and mortality and its prevalence is rising. The management of this condition involves the co-ordinated care of a multi-disciplinary team consisting of endocrinologists, obstetricians, midwives and dieticians. This review concentrates on the control of diabetes in pregnancy, by which both maternal and fetal complications can be minimised. The management of gestational diabetes centres on self-monitoring of blood glucose, diet control and if necessary, insulin treatment. Women with gestational diabetes have a high risk of developing type 2 diabetes later in life and should be counselled on the importance of lifestyle modification. In patients with pre-existing type 1 and 2 diabetes, pre-conception counselling is important to optimise pregnancy outcome. Such counselling also provides an opportunity to screen for pre-existing vascular complications such as retinopathy (which may worsen during pregnancy) and measure baseline markers of glycaemic control such as HbA 1C. Insulin requirements vary during pregnancy and hence daily assessment of blood glucose levels should be performed and the insulin dose adjusted accordingly. Conventional injections of insulin or insulin pumps are both effective in optimising glycaemic control, although the latter is generally used in patients for whom achieving normoglycaemia is challenging. Blood pressure should be regularly monitored and hypertension treated. The evidence for the efficacy of various treatment modalities has been examined in this review. By optimising diabetes management in pregnancy, it is hoped that the pregnant diabetic patient can look forward to a similar pregnancy outcome as that of a normal woman.

Serum sFlt1 concentration during preeclampsia and mid trimester blood pressure in healthy nulliparous women

The purpose of this study was to determine whether serum fms-like tyrosine kinase 1 (sFlt1) concentration during preeclampsia were associated with mid trimester blood pressure, other maternal characteristics, or pregnancy outcomes. We performed a nested case-control study within the Calcium for Preeclampsia Prevention study cohort. Each woman with preeclampsia (case) was matched to 1 normotensive control. A total of 120 pairs of women was chosen randomly. Serum concentrations of sFlt1 and placental growth factor were measured throughout pregnancy, but before labor and delivery. We focused on data from 40 women with blood specimens that were obtained after the onset of preeclampsia. After logarithmic transformation, we determined mean serum sFlt1 concentrations of all control specimens within gestational age windows during which case specimens had been obtained after the onset of preeclampsia. Within each of these gestational age windows, we computed an upper bound for the control specimens equal to 2 standard deviations above the mean. After the onset of preeclampsia, 16 women with log-transformed serum sFlt1 values greater than the upper bound of the control specimens were considered to have high preeclampsia serum sFlt1 levels. The 24 other women were considered to have low preeclampsia serum sFlt1 levels. Women with high or low concentrations of serum sFlt1 during preeclampsia (arithmetic means, 5746 and 3007 pg/mL, respectively) had similar pregnancy outcomes and similar maternal characteristics, except for blood pressure at Calcium for Preeclampsia Prevention study enrollment. Systolic and diastolic blood pressure at enrollment at 13 to 21 weeks of gestation were significantly higher in the 24 women with low serum sFlt1 concentrations during preeclampsia (systolic blood pressure, 114 mm Hg; diastolic blood pressure, 65 mm Hg) than in the 16 women who had preeclampsia at high serum sFlt1 concentrations (systolic blood pressure, 106 mm Hg; diastolic blood pressure, 59 mm Hg). Blood pressure at 13 to 21 weeks among the women with high preeclampsia serum sFlt1 concentrations was identical to the blood pressure among normotensive control subjects. In linear regression analyses of data from all 40 women, both systolic (P < .0001) and diastolic (P = .014) blood pressures at enrollment were correlated negatively with natural logarithm serum sFlt1 concentration after onset of preeclampsia. Women with higher mid trimester blood pressure had preeclampsia at lower serum sFlt1 concentrations. Because higher blood pressure may reflect occult endothelial damage, these observations may explain increased susceptibility to preeclampsia among women with pre-existing vascular disease.