Insulin requirements are known to increase during pregnancy, but it has not been reported whether this relates to prandial or basal requirements, or to a change in insulin pharmacokinetics. In nine unselected pregnant patients the pattern of this increase was that of a large increase in the total morning dose and a reduction in the evening dose of intermediate acting insulin, in order to maintain good control while avoiding nocturnal hypoglycaemia. 24 h metabolic profiles were carried out in these patients in the third trimester of pregnancy. Plasma free insulin profiles reflected the dosage patterns and there was no change in insulin metabolic clearance rate in pregnancy. Pregnant diabetic patients had a broad peak of free insulin concentration around lunchtime followed by a steady fall until next morning. Blood lactate and alanine were higher than normal and 3-hydroxybutyrate lower than is usually seen in non-pregnant diabetic patients. The observations suggest that there may be differential changes in insulin sensitivity in diabetic pregnancy between the fed and fasting states, and that the therapeutic response to this causes a measurable metabolic change.

3-Hydroxybutyric Acid↗

PubMedDate not supplied

HIV and pregnancy.

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Female↗

PubMedDate not supplied

Maternal factors in HIV transmission.

In order to identify features associated with an increased risk of transmission of HIV from seropositive women to their offspring, 70 children of 58 HIV seropositive mothers were studied. Fifty-six children were followed prospectively from pregnancy; in 14 identified after the puerperium, obstetric notes were reviewed and stored serum was tested. Twelve infants of 10 mothers were HIV infected. Risk of transmission was increased in the first year after seroconversion; 5/9 infants born at this time were infected compared with 7/61 born subsequently (P < 0.001). Progression to stage IV in transmitters was more likely, occurring in the mothers of 9 infected children at a median of 3 years (range 0.5-6.5) and in mothers of 19 non-infected children at a median of 5 years (range 1-7) (P = 0.032). Maternal CD4+ counts < 400 x 10(6)/l were found in 7/12 transmitting and 7/49 non-transmitting pregnancies (P < 0.01). Differences in HIV antigenaemia did not reach significance. These factors may influence the counselling of mothers regarding their child's and their own prognosis.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

HIV testing and prevalence in pregnancy in Edinburgh.

The objective was to study the changes in pregnancy HIV prevalence with time. Data were collected from multiple sources to provide a comprehensive record of all HIV seropositive pregnant women identified in the Edinburgh area (Scotland) until December 1992. There were 177 pregnancies in 108 HIV seropositive identified women. Risk factors were injection drug use (79% of pregnancies) and a known HIV seropositive injection drug-using partner (16%). Prevalence has decreased for Edinburgh City women from 0.5% of all pregnancies in 1986 to 0.1% in 1992; It was higher for induced abortion (0.6%) than for delivery (0.2%). HIV testing in pregnancy has declined. Comparison with unlinked anonymized testing showed that in 1990-1991, 20/22 seropositive women were known. In 1992, only 3 of 10 seropositive pregnancies were identified. The cohort initially infected by exposure to a 'drug related' risk factor between 1983 and 1985 may have increasingly finished childbearing, deliberately decided against pregnancy because of HIV status, and declined because of death, illness and emigration from the area, There may not have been major early tertiary heterosexual spread; however, data from 1992 suggest that this could now be impacting on pregnancy prevalence. Local testing policies have not adapted to this possible change.

AIDS Serodiagnosis↗

PubMedDate not supplied

Management of pregnancy in women with HIV infection.

HIV infection is a common medical problem in pregnancy in many parts of the world. Management involves supportive multiagency care, easy and effective communication, an awareness and understanding of other issues (which may be more important to the mother than her HIV infection), and specialists with both experience and an up-do-date knowledge base.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Pregnancy management in women with insulin-dependent diabetes.

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Diabetes Mellitus, Type 1↗