BACKGROUND: Physiological pregnancy can affect routine laboratory tests, e.g., the erythrocyte sedimentation rate increases above the reference range for healthy non-pregnant adults and little is known about whether diabetes and pregnancy together can cause additional changes that require monitoring of blood-tests. OBJECTIVE: The purpose of this study was to investigate ...

The aim is to present a document, which is based on current evidence and serves as a guideline for use in clinical practice. The following questions are addressed: Is the use of antenatal corticosteroids (ACS) an effective therapy? Who are the candidates for antenatal corticosteroid therapy? Is there benefit after ...

OBJECTIVE: Preeclampsia (PE) and diabetes mellitus (DM) are associated with oxidative stress. DM is complicated with formation of advanced glycation end products (AGEs), which are associated with oxidative stress. We hypothesized that elevated serum AGE would be found in pregnancies complicated by PE or DM. METHODS: Circulating AGEs, 8-isoprostane, vitamin ...

BACKGROUND: We hypothesised that human fetal cardiac natriuretic peptide secretion is increased in type-1 diabetic pregnancies with normal placental hemodynamics, and this increase is related to the first trimester maternal glycemic control. METHODS: Thirty-two neonates of type-1 diabetic mothers and 60 neonates born after uncomplicated pregnancy and labour (control group) ...

We aimed to investigate the distribution pattern of proliferating cell nuclear antigen (PCNA) by immunohistochemistry and Western blot in placentas of control and diabetic rats at different stages of pregnancy. It is still not clear how proliferation is coordinated and how this coordination is affected by diabetes in the placenta. ...

BACKGROUND: The aim of this study was to investigate pathologic differences of the placenta in pregnancies complicated by gestational diabetes compared to non-diabetic pregnancies. METHODS: Forty singleton pregnancies complicated by gestational diabetes were recruited and compared to 40 consecutive normal pregnancies. A pathologist, blinded to all clinical data, reviewed all ...

PURPOSE: To examine the impact of gestational diabetes mellitus (GDM) on maternal-fetal outcomes in Manitoba. METHODS: The rates of macrosomia, stillbirth, cesarean section (C/S) and shoulder dystocia (S/D) in 324,605 births in Manitoba during 1985-2004, and their relationships with diabetes and demographical factors were analyzed. RESULTS: The incidence of macrosomia, ...

Our understanding of the world around us is derived from our observations. The accuracy of our inferences depends on the representativeness of those observations. Selection bias limits the accuracy of our inferences. Systematic selection bias occurs when the particular outcome observed caused the observation; this type of bias can lead ...

This commentary summarizes current knowledge on the pathophysiology of gestational diabetes, focusing on the role of the endocrine pancreas and the beta-cells, their adaptation in normal pregnancy, and recent insights in the molecular basis for deficient adaptation in diabetes occurring during pregnancy. Additionally, the effects of disturbed maternal glucose metabolism ...

During pregnancy crucial anatomic, physiologic, and metabolic changes challenge the mother and the fetus. The placenta is a remarkable organ that allows the mother and the fetus to adapt to the new metabolic, immunologic, and angiogenic environment imposed by gestation. One of the physiologic systems that appears to have evolved ...

To evaluate the effectiveness of continuous glucose monitoring during pregnancy on maternal glycaemic control, infant birth weight, and risk of macrosomia in women with type 1 and type 2 diabetes. Prospective, open label randomised controlled trial. Two secondary care multidisciplinary obstetric clinics for diabetes in the United Kingdom. 71 women ...

Evidence is accumulating for a role of vitamin D in maintaining normal glucose homeostasis. However, studies that prospectively examined circulating concentrations of 25-hydroxyvitamin D (25-[OH] D) in relation to diabetes risk are limited. Our objective is to determine the association between maternal plasma 25-[OH] D concentrations in early pregnancy and ...

OBJECTIVE: To provide a framework for the clinical presentation, evolution, treatment, and outcome of the unusual association between primary adrenal insufficiency (AI) during pregnancy and life-threatening complications for the mother and fetus. DESIGN: Case reports. SETTING: Pregnant women with AI treated in the Endocrine and Diabetes Department, Hospital Universitario de ...

OBJECTIVE: Insulin sensitivity and secretion during early and late pregnancy were assessed in women with normal glucose tolerance and gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: The oral glucose tolerance test (OGTT) was performed in 903 women at 16-20th gestational week, of whom 37 had GDM (GDM1 group), and ...

During embryo implantation, invasive trophoblast cells mediate embryo invasion into the decidualized stroma, forming a rich network of lacunae that connect the embryonic tissues to the maternal blood vessels. Placentation is probably guided by the composition and organization of the endometrial extracellular matrix. Certain pathological conditions that occur during pregnancy, ...

The roles of individual eukaryotic translation initiation factor 3 (eIF3) subunits are largely unclear, although some are essential, while others are thought to have regulatory roles. The 'e' subunit, also known as Int-6/Int6, is a candidate for a regulatory subunit as it is not essential for translation initiation in yeasts. ...

OBJECTIVE: To examine whether dietary trans fatty acids (TFAs) were associated with fetal loss (no. of pregnancies - no. of live births). The basis of our inquiry derives from the facts that the PPAR-gamma receptor plays a pivotal role in placental function and that TFAs down-regulate PPAR-gamma gene mRNA expression. ...

Pregnancies complicated by diabetes mellitus are associated with an increased risk of fetal and neonatal risks compared with pregnancies in the healthy gravida. Data suggest that stillbirth and perinatal mortality may be increased as much as 5 times for patients with insulin-dependent diabetes than in the general population. Pregnancies complicated ...

Diabetic nephropathy, the most common etiology for end-stage renal disease, complicates approximately 5% of insulin-dependent diabetic pregnancies. Assessment for vasculopathy is important before pregnancy because nephropathy can increase perinatal risks including potential for preeclampsia and preterm birth. Counseling women receiving renoprotective medications including angiotensin converting enzyme inhibitors has recently become ...

Idiopathic hydramnios is defined as hydramnios that is not associated with congenital anomalies of the central nervous system or gastrointestinal tract, maternal diabetes, isoimmunizaton, fetal infection (CMV or toxoplasmosis), placental tumors, or multiple gestations. Hydramnios is diagnosed when the AFI is > or = 24 or > or = 25 ...

During pregnancy, maternal pancreatic islets grow to match dynamic physiological demands, but the mechanisms regulating adaptive islet growth in this setting are poorly understood. Here we show that menin, a protein previously characterized as an endocrine tumor suppressor and transcriptional regulator, controls islet growth in pregnant mice. Pregnancy stimulated proliferation ...

BACKGROUND - Idiopathic normal pressure hydrocephalus (iNPH) is a reversible dementia in which fronto-striatal cognitive deficits and apathy may be present. OBJECTIVES - The study investigated structural volumetric changes in iNPH, apart from ventriculomegaly. MATERIALS AND METHODS - A full-brain voxel-based morphometric analysis between 11 iNPH patients and 14 healthy ...

PROBLEM: The human tumor-associated receptor-binding cancer antigen expressed on SiSo cells (RCAS1) is considered to play a role in the inhibition of the maternal immune response during pregnancy. The aim of our study was to investigate the expression of RCAS1 protein in the placenta and to compare its concentration in ...

OBJECTIVES: Intraductal papillary-mucinous neoplasm (IPMN) of the pancreas encompasses a spectrum of neoplasms with both morphological and immunohistochemical variations of mucin glycoproteins. Recently, a consensus nomenclature and criteria were histologically defined for classifying these variants of IPMNs into gastric, intestinal, pancreatobiliary, and oncocytic types. The purpose of this study was ...

A number of studies have recently addressed the correlationship between diabetic pregnancy/macrosomia and differentiation of T-cells into Th1 and Th2 subsets. Diabetic pregnancy has been found to be associated with a decreased Th1 phenotype and IL-4 mRNA expression. In macrosomic offspring, high expression of IL-2 and IFN-gamma mRNA, but not ...

OBJECTIVE: In pregnancy with type 1 diabetes, we evaluated occurrence of mild and severe hypoglycemia and analyzed the influence of strict metabolic control, nausea, vomiting, and other potential predictors of occurrence of severe hypoglycemia. RESEARCH DESIGN AND METHODS: A prospective observational study of 108 consecutive pregnant women with type 1 ...

Episodes of diabetic ketoacidosis (DKA) can represent a life-threatening emergency for mother and fetus. The cornerstones of treatment of DKA are aggressive fluid replacement and insulin administration while ascertaining which precipitating factors brought about the current episode of DKA, and then treating accordingly to mitigate those factors. The incidence of ...

OBJECTIVE: To prospectively assess whether metformin diet safely provides primary and secondary prevention of gestational diabetes (GD). DESIGN: Assess development of GD on metformin diet. SETTING: Outpatient clinical research center. PATIENT(S): One hundred forty-two nondiabetic women with polycystic ovary syndrome (PCOS) who had at least one live-birth (LB) pregnancy on ...

Maternal obesity increases the risk of numerous complications of pregnancy, labor, and birth for both mother and neonate, including diabetes and hypertensive disorders. As more women enter pregnancy with a body mass index (BMI) indicative of overweight or obesity, providers of obstetric care should be aware of the implications of ...

INTRODUCTION: The use of oral hypoglycaemic drugs in pregnancy is not recommended because of reports of foetal anomalies and other adverse outcomes in animal studies and in some human cases. However, recent studies have suggested that some oral hypoglycaemic drugs may be used in pregnancy. This review will examine these ...

Insulin-like growth factors (IGFs) constitute a system of peptides that promote mitosis, growth, and organ development by both paracrine and endocrine pathways, their bioavailability being modulated by at least six specific IGF-binding proteins (IGFBP). In type 1 diabetic pregnancies IGF-I and -II in maternal serum are associated with birth weight ...

The aim of the present study was to evaluate the effect of Ginkgo biloba treatment (EGb 761, 200 mg kg-1 day-1) administered from day 0 to 20 of pregnancy on maternal reproductive performance and on the maternal and fetal liver antioxidant systems of streptozotocin-induced diabetic Wistar rats. On day 21 ...

OBJECTIVE: To compare antenatal and obstetric costs for multiple pregnancy versus singleton pregnancy risk groups and to identify factors driving cost differentials. DESIGN: Observational study over 15 months (2001-02). SETTING: Four district hospitals in southeast England. POPULATION: Consecutive women with multiple pregnancy and singleton women with risk factors for fetal ...

OBJECTIVE: The principal aims of this study were to examine the current prevalence rate, clinical characteristics, and related factors of obsessive-compulsive disorder (OCD) in pregnant women during the third trimester of pregnancy. METHOD: The study data were gathered from 434 consecutive women in the third trimester of pregnancy who presented ...

OBJECTIVE: To provide a review of the background literature regarding the pharmacological management of gestational diabetes. RESEARCH DESIGN AND METHODS: This is a literature review. RESULTS: Information is available regarding the use of some, but not all, oral antidiabetes agents in pregnancy. CONCLUSIONS: Available evidence supports the use of glyburide ...

Women with preexisting diabetes are at increased risk of adverse pregnancy outcomes and birth defects. Women with gestational diabetes are at increased risk for adverse outcomes, including neonatal hypoglycemia, hyperbilirubinemia, macrosomia, increased risk of obesity and diabetes in the offspring later in life, and increased risk for other maternal comorbidities. ...

Pregestational diabetes is a common complication of pregnancy that can be associated with severe maternal and fetal morbidity. In addition, some women could have progression of diabetic complications secondary to pregnancy. Preconception care can significantly reduce pregnancy complications with a dramatic impact on the diabetic mother and her infant. For ...

OBJECTIVE: To identify the value for the 1-hour glucose tolerance test (GTT) that would maintain 100%, 90% and 75% sensitivity for identifying abnormal 3-hour GTT results in prenatal patients from an East Coast, urban, university hospital setting. STUDY DESIGN: Two hundred forty-two women who underwent the 3-hour GTT during pregnancy ...

It is overly simplistic to try to identify optimal glycemic thresholds, fetal growth characteristics, and methods of detection in the prevention of fetal overgrowth and its attendant morbidities that can be applied to all pregnancies. We can only hope that, as our understanding of the pathophysiology of diabetes in pregnancy ...

OBJECTIVE: To provide information on the use of oral antidiabetic agents in pregnancy and breast-feeding. DATA SOURCES: Primary articles were identified by a MEDLINE search (1966-March 2007) using the MeSH headings: pregnancy in diabetics, pregnancy, polycystic ovary syndrome, hypoglycemic agents, glipizide, glyburide, metformin, rosiglitazone, pioglitazone, clinical trial, controlled clinical trial, ...

OBJECTIVE: We sought to determine whether pregnancy outcome differs between obese and morbidly obese GDM patients and to assess pregnancy outcome in association with mode of treatment and level of glycemic control. METHODS: A cohort study of 4,830 patients with gestational diabetes (GDM), treated in the same center using the ...

Prior to the 1950s no effective therapy for coccidioidomycosis existed. The advent of amphotericin B ushered in the therapeutic era for coccidioidomycosis. Until this time amphotericin B and its lipid congeners have been regarded as the "gold standard" of therapy for severe pulmonary and disseminated coccidioidomycosis. The availability of azoles ...

OBJECTIVE: to explore the experiences of women with type 1 diabetes, living in rural Australia, while preparing for pregnancy and childbirth. Additionally, we aimed to describe the women's engagement with, and expectations of, health-care providers during this period, and subsequently highlight potential service and informational gaps. DESIGN: qualitative research using ...

Symptomatic hypoglycemia is a known consequence of gastric bypass surgery, which is being performed with increased frequency in reproductive-aged women. A 36-year old woman presented at 24 weeks' gestation, 39 months following Roux-en-Y gastric bypass (RYGBP), with new onset symptomatic hypoglycemia. Lightheadedness and syncope coinciding with postprandial glucose levels of ...

Progression of diabetic retinopathy (DR) occurs at least temporarily during pregnancy and postpartum. The pathogenetic mechanisms of DR progression during pregnancy are not fully understood. Several factors related to metabolic changes (hyperglycaemia), diabetes itself (duration of diabetes before conception, baseline status of DR), pregnancy physiology (hypervolaemia and hypercoagulation, impaired retinal ...

OBJECTIVE: The purpose of this study was to evaluate the presence of headache in women with a previous history or new-onset headache during the current gestation, classify the findings, and describe the clinical characteristics and outcome of the headache. METHODS: From January/1998 to June/2002 we prospectively evaluated 1101 pregnant women ...

OBJECTIVE: Opinions differ whether the rate of spontaneous preterm delivery (sPTD) increases in pregnancies complicated with GDM. We sought to characterize, which factors may influence the rate of sPTD in GDM. METHODS: We conducted a retrospective study with 1,526 GDM patients, all treated at the same center by the same ...

BACKGROUND AND AIM: To determine pregnancy outcome in women with type 1 and type 2 diabetes. METHODS AND RESULTS: A prospective study was conducted in 33 centers in Italy between 1999 and 2003, mainly recording preterm delivery, stillbirths, neonatal mortality, congenital malformations and birthweight. Of the 668 women examined, 504 ...

PURPOSE: The incidence and risk factors for progression of retinopathy during pregnancy in women with type 1 diabetes mellitus were retrospectively evaluated. METHODS: Fifty-four insulin-dependent diabetic patients at a teaching hospital in Saudi Arabia were followed throughout the pregnancy/puerperium with serial ophthalmic examination. Dilated fundus examination was performed in each ...

Prior-approval antimicrobial stewardship programs (ASPs) improve patient outcomes and decrease antimicrobial resistance. These benefits would be limited if physicians circumvented ASP efforts. We evaluated whether prescribers wait until after the prior-approval period to order restricted antimicrobial therapy that is in conflict with guidelines or unnecessary. A cross-sectional study design and ...