Biomedical subjects

B Rosenn

Publications and source records attributed to B Rosenn.

At least 19 recordsLinked to original sources

PubMed1996

Hyperreactio luteinalis complicating a normal singleton pregnancy.

Hyperreactio luteinalis is a rare, usually self-limited syndrome with bilaterally enlarged ovaries containing multiple theca lutein cysts. It is usually associated with gestational trophoblastic disease and/or pregnancies that have elevated maternal serum hCG levels. Hyperreactio luteinalis with maternal anasarca was diagnosed at 19 weeks in a spontaneously conceived gestation, in a 16-year-old primigravida. A second trimester termination for maternal respiratory decompensation secondary to pleural effusions and ascites was required. There was no evidence of trophoblastic disease on pathological examination of the products of conception. Hyperreactio luteinalis may be diagnosed prenatally by ultrasound, and intervention may be necessary for maternal indications. Following termination of pregnancy, spontaneous resolution and regression of ovarian size may be expected.

Abortion, Induced↗

PubMed1996

Common clinical manifestations of maternal diabetes in newborn infants: implications for the practicing pediatrician.

Even though perinatal mortality of infants of diabetic mothers has decreased remarkably in recent years and now approaches that of the general population, these infants still face a multitude of potential complications and the propensity for increased morbidity, both in utero and postnatally. Many of these complications are clearly related to the metabolic status of the diabetic mother. Increasing awareness among insulin-dependent diabetic patients and health providers of the need for glycemic control and the ever-growing understanding of the peculiarities of diabetic pregnancies eventually should combine to provide the best possible outcome for these infants.

Abnormalities, Multiple↗

PubMed1995

Interaction of angiotensin II and brain natriuretic peptide in the placentas of normal and diabetic women.

OBJECTIVE: To evaluate the effects of angiotensin II and brain natriuretic peptide on the placental vasculature of diabetic women. METHODS: Term placentas from five diabetic women and five nondiabetic controls were collected. Isolated placental cotyledons were perfused dually with fetal perfusion pressure as an index of vascular response. The effect of angiotensin II (10(-10)-10(-5) mol/L bolus injection) was established in the fetal-placental vasculature of all placentas in the absence or presence of brain natriuretic peptide (10(-8) mol/L final concentration). Data were analyzed using repeated measures analysis of variance and paired t test where appropriate. RESULTS: A significant vasoconstrictor response to angiotensin II was achieved in placentas of both diabetic and nondiabetic women (P < .001); however, the angiotensin II-induced increase in perfusion pressure was significantly greater in the diabetic group (P < .01). Significant attenuation of vasoconstrictor response to angiotensin occurred in the presence of brain natriuretic peptide in placentas of both nondiabetic (P < .0025) and diabetic (P < .025) women, but the effect was more prominent in the diabetic group. CONCLUSION: The in vitro placental vasculature of diabetic women is more sensitive to angiotensin II than is the in vitro placental vasculature of nondiabetic women. The attenuation exerted by brain natriuretic peptide on angiotensin II-induced vasoconstriction is more prominent in placentas from diabetic women compared to those from nondiabetic women.

Adult↗

PubMed1995

Normalization of blood glucose in insulin-dependent diabetic pregnancies and the risks of hypoglycemia: a therapeutic dilemma.

Intensive insulin therapy delays the onset and progression of microvascular complications in insulin-dependent diabetes mellitus (IDDM). Such therapy, however, is associated with an increased risk of potentially life-threatening hypoglycemia due to the loss of normal counterregulatory hormonal responses to hypoglycemia and to the syndrome of hypoglycemia unawareness. Current standards for glycemic control during pregnancy in IDDM women require intensive insulin therapy to optimize pregnancy outcome. Therefore, obstetricians and gynecologists providing prenatal care for women with IDDM should be aware that intensive insulin therapy predisposes these patients to the significant risks of severe hypoglycemia. It often becomes necessary to individualize the optimal balance between glycemic control during pregnancy and the risks of hypoglycemia.

Blood Glucose↗

PubMed1994

Nitric oxide metabolites and preterm pregnancy complications.

OBJECTIVE: Intraamniotic infection may play a significant role in preterm labor and premature rupture of membranes. Synthesis of nitric oxide and its metabolites nitrite and nitrate purportedly are increased in infection. This project was designed to evaluate whether plasma or urine nitrate concentrations are increased in patients with either preterm labor or premature rupture of membranes in comparison with pregnant controls. STUDY DESIGN: A total of 42 patients between 24 and 35 weeks' gestation (20 with preterm labor; 14 with premature rupture of membranes, and 8 with premature rupture of membranes and contractions) and 35 additional patients without preterm labor or premature rupture of membranes (controls) had blood and urine collected for nitrate determination. Nitrate was reduced to nitrite and quantitated with the Griess reagent. RESULTS: The urine nitrate concentrations were significantly higher only in the preterm labor group compared with the control group (1.23 +/- 0.22 vs 0.67 +/- 0.05 mumol/mg creatinine, p < 0.05). The plasma nitrate level, however, was significantly higher in both the preterm labor and the premature rupture of membranes groups compared with the control group (52.47 +/- 10.11 and 40.05 +/- 5.38 mumol/L vs 16.29 +/- 2.89 mumol/L, p < 0.05). However, the concentrations of nitrate in the urine or plasma did not correlate with time from admission to delivery (p > 0.2). Finally, the presence of positive cervical or urine cultures, a clinical examination consistent with chorioamnionitis, or a maternal temperature > 100.4 degrees F was not associated with higher levels of nitrates in this small series of patients. CONCLUSION: Patients with preterm labor or premature rupture of membranes do have increased nitrate concentrations; however, this increased concentration is not predictive of impending delivery but may indicate that a subclinical infectious process is occurring.

Analysis of Variance↗

PubMed1994

Glycemic thresholds for spontaneous abortion and congenital malformations in insulin-dependent diabetes mellitus.

OBJECTIVE: To test the hypothesis that women with insulin-dependent (type I) diabetes have a threshold of glycemic control in early pregnancy for increased risks of spontaneous abortion and congenital malformations. METHODS: Receiver-operating characteristic (ROC) curves were formed for the occurrence of abortion and malformations as a function of the median first-trimester preprandial blood glucose concentration and the first measured glycohemoglobin concentration in pregnant women with type I diabetes. RESULTS: Fifty-two of the 215 women (24%) who enrolled before 9 weeks' gestation had spontaneous abortions. Six percent of the women enrolled before 14 weeks had infants with major congenital malformations. Thresholds for an increased risk of abortion and malformations were a median first-trimester blood glucose concentration of 120-130 mg/dL or an initial glycohemoglobin concentration of 12-13% (6.2-7.5 standard deviations above the normal mean). CONCLUSIONS: Type I diabetic women with initial glycohemoglobin concentrations in pregnancy above 12% or median first-trimester preprandial glucose concentrations above 120 mg/dL have an increased risk of abortion and malformations. Below these glycemic thresholds, the risks are comparable to those in nondiabetic women.

Abortion, Spontaneous↗

PubMed1994

Maternal floor infarction of the placenta: prenatal diagnosis and clinical significance.

OBJECTIVE: To determine whether maternal floor infarction can be diagnosed prenatally. METHODS: We reviewed the charts of 13 patients with maternal floor infarction confirmed histopathologically to determine the frequency of increased placental echogenicity, fetal growth restriction (FGR), and oligohydramnios. Subsequently, we applied these criteria prospectively to diagnose maternal floor infarction in three cases. RESULTS: Twelve of the 13 pregnancies reviewed retrospectively resulted in small for gestational age infants, of which eight were stillbirths. Fetal growth restriction and oligohydramnios were evident on ultrasound in five pregnancies and a placental abnormality was noted in four; two patients exhibited this complete triad of sonographic abnormalities. Three patients were identified prospectively with maternal floor infarction based on sonographic findings and electively delivered live preterm infants. CONCLUSIONS: Maternal floor infarction is a placental condition with profound risk for FGR and stillbirth. Antenatal diagnosis may improve the perinatal outcome with this condition.

Adult↗

PubMed1993

Poor glycemic control and antepartum obstetric complications in women with insulin-dependent diabetes.

OBJECTIVE: The purpose of this study was to test the hypothesis that the rate of complications of pregnancy in women with insulin-dependent diabetes is higher than in nondiabetic women and is associated with poor glycemic control and microvascular disease. METHOD: Women who enrolled in a multidisciplinary program of diabetes in pregnancy prior to 20 weeks' gestation were included in the study and matched 1:2 by age, race and parity to a control group of nondiabetic women. Complications of pregnancy were retrospectively analyzed and compared between groups. The association of complications with glycemic control and microvascular disease was analyzed within the diabetic group. RESULT: Women with diabetes had significantly higher rates of pregnancy-induced hypertension (PIH), polyhydramnios, pyelonephritis, preterm delivery and meconium-stained amniotic fluid. Poor glycemic control, particularly during the first and second trimesters of pregnancy, was associated with all complications, except pyelonephritis. Microvascular disease was associated with PIH and preterm delivery prior to 34 weeks. CONCLUSION: Women with insulin-dependent diabetes are at high risk for complications of pregnancy. Glycemic control during the first and second trimesters may affect events later in pregnancy.

Blood Glucose↗

PubMed1993

Diabetic fetal macrosomia: significance of disproportionate growth.

Fetal hyperinsulinism in infants of diabetic mothers (IDMs) produces increased fetal growth leading to macrosomia, which may or may not be proportionate. Disproportionate macrosomia refers to excessive weight characterized by a high weight/length ratio. We tested the hypotheses that (1) macrosomia in IDMs would be characterized by a high ponderal index (defined as weight/length ratio) and (2) infants with macrosomia who have a high ponderal index would have increased neonatal morbidity--specifically, hyperbilirubinemia, hypoglycemia, polycythemia, and acidosis. We studied 170 IDMs and 510 non-IDMs matched 1:3 for gestational age, race, and year of delivery. Forty-five percent of IDMs had macrosomia compared with 8% of control infants (p = 0.001), and 19% of IDMs had disproportionate macrosomia compared with 1% of control infants (p = 0.001). The rates of hyperbilirubinemia (p = 0.02), hypoglycemia (p = 0.01), and acidosis (p = 0.01) were greatest in infants with disproportionate macrosomia and least in nonmacrosomic infants. The incidence of polycythemia was not significantly different between the groups. We suggest that disproportionate macrosomia in the IDM is associated with an increased likelihood of neonatal complications.

Acidosis↗

PubMed1993

A longitudinal study describing confidence limits of normal fetal cardiac, thoracic, and pulmonary dimensions from 20 to 40 weeks' gestation.

The current prospective, longitudinal study was designed to define the confidence limits and characteristics of growth for fetal cardiac, thoracic, and pulmonary dimensions from 20 to 40 weeks' gestation. We tested the hypotheses that (1) CC/TC, (2) CC/AC, (3) TC/HC, and (4) TC/AC ratios remain constant throughout this period of gestation. The four-chamber view of the fetal heart in diastole, in the absence of fetal breathing, was used as a standard reference for sonographic measurement of cardiac, thoracic, and left and right pulmonary dimensions in a longitudinal study of 45 uncomplicated pregnancies. Cardiac growth is best fit by a quadratic function: -8.147 + 0.900 (GA) - 0.0078 (GA)2. Similarly, thoracic growth is best fit by a quadratic function: -14.072 + 1.757 (GA) - 0.018 (GA)2. The characteristics of growth of the left and right lungs are best described by linear growth equations: -1.71 + 0.426 (GA) and -1.62 + 0.539 (GA), respectively. Each of the CC/TC, CC/AC, TC/HC, and TC/AC ratios changed significantly over time.

Adult↗

PubMed1993

Sonographic estimation of fetal weight based on a model of fetal volume.

OBJECTIVES: To derive a formula for sonographic estimated fetal weight (EFW) based on a two-compartment model of fetal volume and to test it against two widely used formulas, especially at the extremes of fetal weight for which existing formulas are generally inaccurate. METHODS: We analyzed 865 consecutive sonograms that met the following inclusion criteria: singleton pregnancy, normal anatomy, delivery within 3 days of sonography, and measurements of biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). The weight of the fetal head was modeled to be proportional to HC3, and the weight of the trunk proportional to AC2 x FL. The proportionality constants were found by multiple linear regression on 380 sonograms performed in 1990 (the "derivation set"). The new formula was tested for accuracy of prediction of actual birth weight against the formulas of Hadlock et al and Shepard et al using 485 sonograms from 1991-1992 (the "validation set"). RESULTS: In the derivation set, the formula EFW = (0.23718 x AC2 x FL) + (0.03312 x HC3) was fit; the correlation with actual birth weight had an r value of 0.996. In the validation set, the new formula produced smaller systematic errors and smaller absolute errors than either the Hadlock or Shepard formula both overall and in fetal weight strata from less than 1000 g to over 4000 g. CONCLUSION: The new formula makes geometric sense and provides accurate estimates of fetal weight across a broad range of weights.

Birth Weight↗

PubMed1993

Early-pregnancy proteinuria in diabetes related to preeclampsia.

OBJECTIVE: To test the hypothesis that the risk of preeclampsia in diabetic mothers is increased with incipient diabetic nephropathy as well as with overt nephropathy. METHODS: Pregnancy outcome was studied in 311 women with class B-RF diabetes from two institutions. Using 104 women without chronic hypertension followed at the University of California, San Francisco, we constructed a receiver-operating characteristic curve relating 24-hour urinary total protein before 20 weeks' gestation to the subsequent development of preeclampsia. From the curve, a predictive cutoff level of proteinuria was selected and tested in two validation groups not used to construct the curve: 158 women without chronic hypertension followed at the University of Cincinnati and 49 women with chronic hypertension from both institutions. RESULTS: The receiver-operating characteristic curve showed an increased risk of preeclampsia with early-pregnancy proteinuria of 190 mg/day or more. In the Cincinnati validation group, the rate of preeclampsia was 7% in women with early-pregnancy proteinuria of less than 190 mg/day, 31% with proteinuria of 190-499 mg/day, and 38% with proteinuria of 500 mg/day or more. In the chronic-hypertension validation group, the rates were 0, 50, and 58%, respectively. By multiple logistic regression, the increased risk of preeclampsia with proteinuria above 190 mg/day persisted after controlling for the effects of parity, chronic hypertension, retinopathy, and glycemic control. CONCLUSIONS: Diabetic gravidas with early-pregnancy proteinuria of 190-499 mg/day are at increased risk for preeclampsia. The risk is comparable to that in women with overt diabetic nephropathy and is independent of chronic hypertension. We speculate that diabetic women with proteinuria in this range have incipient or subclinical diabetic nephropathy.

Adult↗

PubMed1992

Progression of diabetic retinopathy in pregnancy: association with hypertension in pregnancy.

OBJECTIVE: To test the hypothesis that women with insulin-dependent diabetes and chronic or pregnancy-induced hypertensive disorders are at increased risk for developing retinopathic complications during pregnancy. STUDY DESIGN: One hundred fifty-four women with insulin-dependent diabetes were prospectively followed in an intensive program of diabetes in pregnancy. Ophthalmologic evaluations were obtained through pregnancy and at 6 to 12 weeks post partum, and findings were graded by a standard scale. Association of retinopathic progression with risk factors was tested with chi 2 and multiple logistic regression analysis. RESULTS: Fifty-one women had progression of retinopathy during pregnancy; postpartum regression was observed in 13 women. Changes in glycemic control early in pregnancy, chronic hypertension, and pregnancy-induced hypertension were significantly associated with progression of retinopathy. CONCLUSION: Women with insulin-dependent diabetes who have hypertensive disorders in pregnancy are at increased risk for progression of retinopathy.

Diabetes Mellitus, Type 1↗

PubMed1992

Birth trauma in insulin-dependent diabetic pregnancies.

Infants of insulin-dependent diabetic mothers are considered to be at high risk for birth trauma, presumably due to macrosomia. With current management of diabetes in pregnancy, including strict glycemic control, the rate and the severity of macrosomia should be decreased. The frequent use of ultrasound to assess fetal growth and weight and the use of cesarean delivery in case of fetal macrosomia should further decrease the risk for birth trauma in these infants. We therefore undertook this study to test the null hypothesis that with current management, insulin-dependent diabetic mothers have a rate of birth trauma similar to that of infants of nondiabetic mothers (normal glucose challenge test at 28 weeks' gestation) matched for gestational age at birth, presence or absence of labor, delivery method (vaginal versus cesarean), and race. We studied 118 insulin-dependent diabetic mothers (White classes B-RT) and 354 control subjects (three matches for each insulin-dependent diabetic mother). The rate of birth trauma was 3.4% in insulin-dependent diabetic mothers, not significantly different from controls (2.5%). Logistic regression analysis in which birth trauma was the dependent variable and diabetes, race, presence or absence of labor, mode of delivery (vaginal versus cesarean), infant weight, and infant head circumference were independent variables revealed that only vaginal delivery was a significant risk factor for birth trauma in infants in both groups (p = 0.01). Most frequently observed birth traumas were brachial plexus injury, facial nerve injury, and cephalohematoma. Of the three infants with brachial plexus injury (insulin-dependent diabetic mothers, two; controls, one), two were delivered with use of midforceps.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Human versus animal insulin in the management of insulin-dependent diabetes: lack of effect on fetal growth.

It is generally accepted that the human placenta is impermeable to free insulin and that insulin present in the fetus is entirely of fetal origin. A recent study suggested that antibody-bound animal insulin crosses the placental barrier and may exert direct effects on fetal growth. We hypothesized that mothers with insulin-dependent diabetes treated with animal insulin would have infants with higher birth weights and ponderal indices compared with mothers treated with human insulin. We studied 209 mothers with insulin-dependent diabetes who were enrolled in our program and who delivered after 28 weeks' gestation: 170 were treated with animal insulin and 39 with human insulin. There were no differences between the groups in the mean birth weight (adjusted by gestational age at delivery) or ponderal index of the infants. The rate of macrosomia (birth weight greater than the 90th percentile for gestational age or ponderal index above 2.85) was similar in both groups. The sample size was adequate to yield a power of 80% to detect a difference between groups of 179 g or more in birth weight and 0.1 g/cm3 in ponderal index. We suggest that the type of insulin (animal versus human) used by the pregnant insulin-dependent diabetic mother has no bearing on fetal weight gain.

Adult↗

PubMed1991

Patient experience in a diabetic program project improves subsequent pregnancy outcome.

There has been a notable improvement in the outcome of the pregnancies of insulin-dependent diabetics. This improvement has resulted from intensive health care programs and increased awareness among patients and health providers of the need for specialized prenatal care. We hypothesized that participation in a specialized program providing early glycemic control would benefit the patient's subsequent pregnancy, despite progression of the diabetic disease process. We prospectively studied 55 insulin-dependent diabetic patients enrolled before 9 weeks' gestation through two consecutive pregnancies: sequence 1 and sequence 2. A control group of 55 insulin-dependent diabetic patients, entering the program for the first time, were matched with the sequence 2 pregnancies of the study group by maternal age and year of pregnancy. Specific outcomes related to glycemic control in early gestation were significantly improved from sequence 1 to sequence 2 pregnancies: earlier week of entry (P = .0001), lower glycohemoglobin at 9 weeks (P = .005) and at 14 weeks (P = .02), and improved fetal outcome (decreased rate of spontaneous abortions or major malformations; P less than .01). Week of entry and glycohemoglobin at 9 and 14 weeks were also significantly improved compared with the control group. Seventy-three percent of the patients entered the program earlier in their sequence 2 pregnancies (P = .001) and had lower glycohemoglobin concentrations at 9 weeks (P = .005) compared with their sequence 1 pregnancies. Sixty-five percent of the patients in sequence 2 had advanced diabetic disease (White class D-RF), compared with 46% in sequence 1 (P less than .05) and 44% of the controls (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗

PubMed1991

Hypertension during pregnancy in insulin-dependent diabetic women.

Insulin-dependent diabetic patients are at increased risk for hypertensive disorders of pregnancy. This study was designed to study prospectively the rate of pregnancy-induced hypertension (PIH) in 175 insulin-dependent diabetic pregnancies (88 White classes B-C, 87 classes D-RT). Pregnancy-induced hypertension was defined as two or more occurrences after 20 weeks' gestation of a mean arterial pressure (MAP) of 105 mmHg or greater or an increase of 20 mmHg or greater from the baseline MAP. The rate of PIH in the diabetic population was 15.4% and was significantly associated with nulliparity, poor glycemic control in the first and second trimesters, and advanced White class. Neonatal outcome was not significantly altered in the presence of PIH. We speculate that improved glycemic control throughout pregnancy might reduce the rate of this complication in diabetic patients.

Adult↗

PubMed1991

Pre-conception management of insulin-dependent diabetes: improvement of pregnancy outcome.

Poor glycemic control in early pregnancy in insulin-dependent diabetes is associated with an increased risk for spontaneous abortions and congenital malformations. Strict glycemic control from the initial stages of embryogenesis is one of the major goals of management in these pregnancies. We hypothesized that insulin-dependent diabetic patients attending a pre-conception program would have improved glycemic control compared with insulin-dependent diabetic patients who enrolled after conception and would have better pregnancy outcome, with fewer spontaneous abortions and fewer major malformations. Ninety-nine pregnant insulin-dependent diabetic patients were recruited before reaching 9 weeks' gestation and were followed prospectively throughout pregnancy. Twenty-eight had attended a pre-conception clinic to optimize glycemic control (study group) and 71 had enrolled after conception (control group). Early glycemic control was significantly better in the study group: Glycohemoglobin values at the first prenatal visit and at 9 and 14 weeks' gestation were significantly lower than in the control group. The rate of spontaneous abortion was significantly lower in the study group (7%) than in the controls (24%). There was one major malformation in the control group and none in the study group. We conclude that patients with insulin-dependent diabetes attending a pre-conception program have a decreased rate of early pregnancy loss compared with those receiving prenatal care early in pregnancy.

Abortion, Spontaneous↗