1/12. Are conventional targets for metabolic control sufficient to prevent fetal macrosomia during diabetic pregnancy?We report the case of a 26 year-old woman, with an uncomplicated type 1 IDDM of 17 yr duration followed for her first pregnancy. At conception, HbA1c (measured by HPLC) was 6.5% and fructosamine was 280 u.mol.l (normal range below 285). During the follow-up, 15-days-interval frutosamine never exceeded the normal range and HbA1c values were under 6.5% excepted in the third trimester (7.0 /- 0.8%) coinciding with a bad control of the 2 hours post-prandial blood glucose. A fetal macrosomy was discovered at 34 weeks of gestation and a heavy-for-date 4680 g baby was delivered by caesarean section at 38 weeks of gestation. Our case report outlines again the need to achieve the recommended target of metabolic control for the diabetic pregnant woman (blood preprandial glucose: 3.9-5.6 mM; post-prandial 2 h < 6.7 mM) specially during the third trimester of pregnancy. The use of computer databases might be helpful for precise monitoring during this narrow window period.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
2/12. Diabetes in pregnancy: the midwifery role in management.Although the primary focus of midwifery is on uncomplicated pregnancy, all midwives must screen for and, in some cases, comanage the care of women with diabetes mellitus and gestational diabetes. This article will review the types of diabetes, implications for preconceptional and pregnancy care, the changing recommendations relative to diabetes in pregnancy, and the role of the midwife in providing antepartal and intrapartal care for women with diabetes in collaboration with other health care professionals and in accordance with the philosophy and standards of the American College of Nurse-Midwives. A specific case study will highlight the role of the midwife, with an overall focus on medical consultation, collaboration, and referral, as well as client involvement in the planning of care.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
3/12. Infants of diabetic mothers are at increased risk for the oculo-auriculo-vertebral sequence: A case-based and case-control approach.OBJECTIVES: To determine if infants of diabetic mothers (IDM) are at increased risk for dysplastic ears and the oculoauriculo-vertebral spectrum (OAVS). STUDY DESIGN: Cases of IDM with dysplastic external ears seen at Cedars-Sinai Medical Center were combined with case series in medical literature describing similar patients. Data from a large congenital birth defects registry in spain were analyzed, and odds ratios (OR) for infants born to either a gestational or preconceptionally diabetic mother to have one of the studied malformations were calculated with 95% confidence intervals. RESULTS: Among the 30 patients in the case series, 50.0% (15) had hemifacial microsomia; 46.7% (14) had hearing loss; 33.3% (10) had facial nerve palsy; 33.3% (10) had vertebral anomalies; 36.7% (11) had cardiovascular defects, of which 45% (5) were conotruncal defects; 26.7% (8) had renal anomalies; 13.3% (4) had limb defects (all radial ray hypoplasia); 10% (3) had DiGeorge sequence; 6.7% (2) had laterality defects; and 6.7% (2) had imperforate anus. Within the cases from the birth defects registry, the odds ratio for OAVS in infants of mothers with gestational diabetes mellitus was 2.28 (95% CI, 1.03-4.82, P =.03), and the OR for ear anomalies in these infants was 1.21 (95% CI, 0.94-1.56, P =.13). When infants of mothers with preconceptionally diagnosed type 1 or 2 diabetes were considered, the OR for OAVS was 1.50 (95% CI, 0.08-9.99, P =.49), and the OR for dysplastic ears was 0.94 (95% CI, 0.48-1.81, P =.85). CONCLUSIONS: Our data indicate that OAVS occurs with a higher incidence in IDM than in the general population. Associated problems include hearing loss, athymia, and cardiac, renal, and limb malformations. Therefore, we recommend that an IDM with features consistent with OAVS undergo a workup including hearing evaluation, skeletal survey, echocardiogram, renal ultrasonogram, and immunodeficiency workup if clinically indicated. Furthermore, noting that most of these defects occur in structures of neural crest origin, we hypothesize that poorly controlled maternal diabetes interferes with cephalic neural crest cell migration.- - - - - - - - - - ranking = 2keywords = conception (Clic here for more details about this article) |
4/12. Severe diabetic fetopathy despite strict metabolic control.In pregnant women, diabetes mellitus (DM) can cause severe complications for both mother and child during pregnancy and delivery; for example, hypertension, pre-eclampsia, macrosomia or intrauterine fetal death. It is therefore essential to achieve good metabolic control in the mother from before conception to the postpartum period. A 35-year-old primipara with type 2 DM presented herself at our outpatient department at 21 weeks of gestation. Until this time her DM had been treated with oral antidiabetic drugs; these were withdrawn and conventional insulin therapy was initiated. Except for the first two weeks after insulin adjustment, blood glucose values were within the required range. Biometric tests performed until week 30 of gestation showed discreet fetal growth. In the week 31, fetal abdominal girth near the 95% limit was observed for the first time; this was soon followed by an explosion-like enlargement of the abdomen along with glycemic values at the lower limit. A cesarean section was performed in week 35 of gestation because of the excessive macrosomia. The female newborn had a birth weight of 4920 g and, one hour after delivery, a blood glucose of 10 mg/dl requiring an intravenous glucose bolus. In addition, the child needed oxygen and also needed both an enteral and a parenteral supply of glucose until day 7 after delivery. Mother and child were discharged from the clinic 19 days postpartum in good general condition. This case illustrates the complexity of treatment of glucose-tolerance disturbances during pregnancy and underlines the importance of fetal monitoring by ultrasound, given that measurement of maternal blood glucose does not always provide sufficient information on the metabolic situation of the fetus.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
5/12. Spontaneous singleton and twin pregnancy in two patients with polycystic ovary syndrome and type 2 diabetes following treatment with metformin combined with rosiglitazone.Two women, a Saudi Arab and a Caucasian, aged 28 and 41 years, had a long history of polycystic ovary syndrome (PCOS) and primary infertility, which was refractory to various treatment modalities. Both later developed type 2 diabetes, managed initially with metformin; rosiglitazone was added later to improve glycaemic control. Both conceived spontaneously, resulting in singleton and twin pregnancies giving birth to healthy babies. The combination of rosiglitazone with metformin may result in improved fertility with ovulation and spontaneous conception in women with PCOS and type 2 diabetes. Randomized controlled trials are needed to assess the feasibility of this combination to improve fertility in women with PCOS. However, in the absence of any safety data, those women, following counselling, should be warned against the possibility of spontaneous pregnancy and contraceptive measures should be discussed and offered where appropriate.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
6/12. Fetal malformation and serum alpha-fetoprotein concentration of diabetic mothers.Diabetic pregnant patients belong to a high-risk group from a genetic counselling point of view. Therefore serum AFP estimation and ultrasound examination was carried out in 36 diabetic pregnancies, between the 16-20 gestational weeks. Healthy infants were delivered in 28 cases, fetal malformations or diseases were diagnosed in 3 cases (2 exencephaly and 1 polycystic kidney disease), 5 pregnancies ended up with stillbirth and/or severe fetopathy. According to our findings, the feto-maternal AFP balance is altered in poorly controlled diabetic pregnant patients. Therefore the maternal serum AFP concentration does not always reflect the AFP content of amniotic fluid. It is supposed that the low serum AFP concentration in diabetic patients is due to the disturbed AFP balance, which cannot be observed in well controlled pregnant diabetics. In the pregnancy of diabetic mothers both serum AFP and ultrasound examination should be carried out. With further improvement in the preconceptional treatment of diabetic patients not only the number of malformations caused by hyperglycaemia should diminish, but the problems of false negative and false positive serum AFP values caused by the disturbance in carbohydrate metabolism should also become less frequent.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
7/12. The influence of preconceptional glucose values on the outcome of pregnancy.A relationship between maternal diabetes and fetal malformations has been recognized for a long time, but there has been considerable difference of opinion about the size of the risk. Several defects of the pelvis and lower limbs appear to be relatively common in offspring of diabetic mothers. In experimental studies a dose relationship has been shown between some drugs (insulin-trypan blue) and lower limb malformations. Three patients are discribed with congenital malformations with diabetes or prediabetes during pregnancy. Is the caudal regression syndrome a part of a larger syndrome caused by a disturbance of glucose homeostasis?- - - - - - - - - - ranking = 4keywords = conception (Clic here for more details about this article) |
8/12. Rapid development of nephrotic syndrome, hypertension, and hemolytic anemia early in pregnancy in patients with IDDM.In recent years, the prognosis for a successful pregnancy has greatly improved for women with insulin-dependent diabetes mellitus (IDDM) who are under good glycemic control and free of complications such as vascular disease and nephropathy. We report the rapid development of severe nephrotic syndrome, malignant hypertension, and microangiopathic hemolytic anemia during the first trimester of pregnancy in a 29-yr-old woman with IDDM of 18 yr duration. Our patient had no pregestational history of retinopathy or hypertension and only minimal proteinuria. Significant improvement in blood glucose levels had been achieved over the 6 mo before conception. kidney biopsy performed before the termination of pregnancy at 10 wk gestation revealed diabetic nephropathy. No other etiology for her renal disease could be found. An arteriole was noted to have entrapped red blood cell fragments and platelet thrombi, revealing the probable source of her hemolytic process. By 8 wk postpartum, her nephrotic syndrome and hemolysis had completely resolved. At 3 mo postgestation, the patient's hypertension was still present but less severe. Her serum creatinine has continued to decrease toward normal. This is the first report of a woman with IDDM in White's classification C who developed a toxemia-like syndrome during the first trimester of pregnancy, attributable to the underlying diabetic state.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
9/12. pregnancy in a woman with class H diabetes mellitus and previous coronary artery bypass graft: a case report and review of the literature.BACKGROUND: Maternal and fetal mortality have been reported to be high in pregnant women with diabetes mellitus and ischemic heart disease. review of the literature identified only two cases of pregnancy after coronary artery bypass surgery in diabetic patients. Because of limited case experience, there are no clear recommendations for counseling and managing such patients. CASE: We managed a pregnancy complicated by class H diabetes mellitus in which the patient had an earlier need for four-vessel coronary artery bypass surgery. The application of contemporary techniques for diabetic and cardiac management led to successful maternal and perinatal outcomes at 36 weeks' gestation. CONCLUSION: Preconception coronary artery bypass surgery, along with contemporary medical and obstetric management, may lead to improvement in the outcome of pregnancies complicated by class H diabetes.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
10/12. pregnancy in diabetes: reducing the risks.Meticulous glucose control that begins long before conception is fundamental to protecting the fetus and mother. Maternal hypertension, retinopathy, renal disease, and neuropathy may lead to complications, but optimal education, care, and fetal monitoring can reduce the risks.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
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