Biomedical subjects

F Mecacci

Publications and source records attributed to F Mecacci.

At least 19 recordsLinked to original sources

PubMed2003

Cross-sectional and longitudinal evaluation of uterine artery Doppler velocimetry for the prediction of pre-eclampsia in normotensive women with specific risk factors.

OBJECTIVE: To evaluate the performance, in the prediction of pre-eclampsia, of (1) an abnormal mean uterine artery resistance index (RI; cross-sectional index) at 24 weeks of gestation, (2) the individual longitudinal flow pattern of results observed at 16, 20 and 24 weeks of gestation and (3) a multiple logistic regression model including the individual longitudinal flow pattern and the mean RI at 24 weeks. METHODS: A total of 144 normotensive pregnant women with risk factors for pre-eclampsia were evaluated with uterine artery color Doppler at 16, 20 and 24 weeks' gestation. The following indices were obtained: (1) cross-sectional index: the mean RI of both uterine arteries at 24 weeks' gestation was calculated for each patient and considered abnormal when >/= 0.58; (2) longitudinal indices: the individual longitudinal flow pattern of mean RI of both the main uterine arteries at 16, 20 and 24 weeks' gestation was derived for each subject and defined as (a) the typical physiological flow pattern, with a trend of decrease in values or (b) the non-physiological flow pattern. The probability of having a pregnancy complicated by pre-eclampsia was also calculated by means of a multivariate logit model. The log-odds was modeled as a function of variables related to maternal characteristics, the individual longitudinal flow pattern indicator, and of the mean RI at 24 weeks' gestation as a continuous variable. RESULTS: Pregnancies had a physiological course in 108 (75%) women, while 36 (25%) women developed pre-eclampsia during the third trimester. For the prediction of pre-eclampsia, the use of an abnormal uterine artery RI index (> or = 0.58) at 24 weeks showed a sensitivity of 77.8%, a specificity of 67.6%, a positive predictive value (PPV) of 44.4% and a negative predictive value (NPV) of 90.1%, with a likelihood ratio (LR) for an abnormal test of 2.4; with the longitudinal flow pattern indicator, sensitivity was 88.9%, specificity 82.4%, PPV 62.7% and NPV 95.7%, with a LR for an abnormal test of 4.9; the use of a logit model yielded a sensitivity of 72.2%, a specificity of 90.7%, a PPV of 72.2% and a NPV of 90.7%, with a LR for an abnormal test of 8.0. CONCLUSIONS: In this study the use of an individual longitudinal flow pattern indicator resulted in improving accuracy in the prediction of pre-eclampsia as compared with the traditional cross-sectional mean RI at 24 weeks. A further increase in specificity and PPV was obtained using a logit model that includes the longitudinal flow pattern indicator and the cross-sectional RI at 24 weeks. Since both the longitudinal flow pattern indicator and the logit model showed a high performance in predicting pre-eclampsia in women with risk factors for impaired placentation, they might be used to identify a high-risk population in which preventive measures and/or therapeutic options might be tested.

Adult↗

PubMed2001

Time course of recovery and complications of HELLP syndrome with two different treatments: heparin or dexamethasone.

HELLP syndrome is a severe complication of pregnancy characterized by microangiopathic hemolytic anemia, hepatic dysfunction and thrombocytopenia. Though delivery is the ultimate therapeutic option, medical treatments, including the use of heparin or corticosteroids, have been employed in the attempt to improve maternal prognosis. The aim of this retrospective study was to compare the time course of recovery and the incidence of complications in women with HELLP syndrome receiving either heparin or dexamethasone. Between January 1990 and December 1998, 32 patients with HELLP syndrome were cared for at the Institute of Obstetrics and Gynecology of the University of Florence: 20 patients were treated with heparin, administered subcutaneously at a dose of 5000 IU every 12 h, whereas 12 women received dexamethasone, administered intravenously at a dose of 10 mg every 12 h. Categorical data were evaluated with chi-square and Fisher's exact test; continuous data were analyzed with Mann-Whitney U test; P < .05 was considered significant. In the subgroup treated with heparin the incidence of disseminated intravascular coagulation (DIC) (P < .02), the number of patients requiring blood transfusion (P < .05) and the length of stay at the Intensive Care Unit (ICU) (P < .04) were significantly increased as compared with the subgroup receiving dexamethasone; in this latter subgroup, significantly higher platelet count and hematocrit values, and significantly lower levels of lactate dehydrogenase (LDH) could be documented starting from day 2 after delivery. The results of our investigation suggest that the use of dexamethasone in patients with HELLP syndrome is associated with faster regression and lower incidence of complications in comparison to heparin.

Adult↗

PubMed2001

Cardiovascular function in pregnancy: effects of posture.

OBJECTIVE: To evaluate the cardiovascular response to active postural changes in pregnancy. DESIGN: Prospective study. SETTING: Outpatient Clinic, Fetal Maternity Unit. PARTICIPANTS: Sixteen healthy women referred prior to pregnancy. METHODS: Heart rate, arterial pressure, echocardiographic end-diastolic and end-systolic left ventricular volumes (Teichholz' s formula) were measured in the three months before pregnancy, at the end of the first and second trimester, at mid third trimester, and six months after delivery in the supine and standing position, in thirteen women (mean age 33, range 25-38 years). RESULTS: Cardiac output (supine position) significantly increased (28%): it reached its maximum at the second trimester, remained steadily elevated in the mid third trimester, and returned to baseline after delivery. Cardiac output increased during pregnancy also in the active orthostatic position, the percentage increase being greater (70%) since the standing pre-conception value was lower. The postural stress induced similar changes in heart rate, arterial pressure and left ventricular ejection fraction before, during and after pregnancy. However, the reduction in cardiac output associated with early standing attenuated significantly at the second trimester and it was absent at mid third trimester (F = 3.13, P = 0.021). This was due to the interplay between the significantly lesser increase in systemic vascular resistance, occurring since the first trimester, and the significantly lesser decrease in left ventricular end-diastolic volume which was observed in the mid third trimester. CONCLUSION: These data indicate that the elevated cardiac output is adequately maintained in pregnancy during the postural challenge, due to optimisation of the responses of preload and afterload.

Adult↗

PubMed2001

Prediction of the development of pregnancy-induced hypertensive disorders in high-risk pregnant women by artificial neural networks.

Pregnancy-induced hypertensive disorders (PIHD) are common complications of pregnancy and are associated with increased maternal and fetal morbidity. In this study, artificial neural networks (aNN) and multivariate logistic regression (MLR) were applied to a set of clinical and laboratory data (urea, creatinine, uric acid, total proteins, hematocrit, iron and ferritin) collected at 16 and 20 weeks of gestation. The efficacy of the two approaches in predicting the development of PIHD in 303 consecutive normotensive pregnant women at high risk of pre-eclampsia and intrauterine fetal growth retardation was then compared. The aNN were trained with a randomly selected set of 187 patient records and evaluated on the remainder (n=116). MLR analysis was done with the same 116 patients. The performance of each model was assessed using receiver operator characteristic (ROC) curves. Pregnancies had a normal physiological course in 227 cases, whereas 76 (25.1%) women developed PIHD during the third trimester. The best aNN at 20 weeks yielded an area under the ROC curve of 0.952, the sensitivity of 86.2%, the specificity of 95.4%, the positive predictive value of 86.2% and the negative predictive value of 95.5% for PIHD. The corresponding values for the MLR at 20 weeks were 0.962, 79.3%, 97.7%, 92% and 93.4%, respectively. The computer-aided integrated use of these conventional tests seems to provide a useful means for and early prediction of PIHD development.

Abortion, Habitual↗

PubMed2001

Third-trimester maternal glucose levels from diurnal profiles in nondiabetic pregnancies: correlation with sonographic parameters of fetal growth.

OBJECTIVE: To assess the 24-h glucose levels in a group of nondiabetic, nonobese pregnant women and to verify the presence of correlations between maternal glucose levels and sonographic parameters of fetal growth. RESEARCH DESIGN AND METHODS: A total of 66 Caucasian nonobese pregnant women with normal glucose challenge tests (GCT) enrolled in the study; from this population, we selected 51 women who delivered term (from 37 to 42 weeks completed) live-born infants without evidence of congenital malformations. The women were requested to have three main meals and to perform daily glucose profiles fortnightly from 28-38 weeks without modifying their lifestyle or following any dietary restriction. All subjects were taught how to monitor their blood glucose by using a reflectance meter. Fetal biometry was evaluated by ultrasound scan according to standard methodology at 22, 28, 32, and 36 weeks of pregnancy. RESULTS: The overall daily mean glucose level during the third trimester was 74.7 +/- 5.2 mg/dl. Daily mean glucose values increased between 28 (71.9 +/- 5.7 mg/dl) and 38 (78.3 +/- 5.4 mg/dl) weeks of pregnancy. We found a significant positive correlation at 28 weeks between 1-h postprandial glucose values and fetal abdominal circumference (AC). At 32 weeks, we documented positive correlations between fetal AC and maternal blood glucose levels 1 h after breakfast, 1 and 2 h after lunch, and 1 and 2 h after dinner. At 36 weeks, there was a positive correlation between fetal AC and 1- and 2-h postprandial blood glucose levels. In addition, there was a negative correlation between head-abdominal circumference ratio and 1-h postprandial blood glucose values. CONCLUSIONS: This longitudinal study first provides a contribution toward the definition of normoglycemia in nondiabetic, nonobese pregnant women; moreover, it reveals significant correlations of postprandial blood glucose levels with the growth of insulin-sensitive fetal tissues and, in particular, between 1-h postprandial blood glucose values and fetal AC.

Adult↗

PubMed2000

Thyroid autoimmunity and its association with non-organ-specific antibodies and subclinical alterations of thyroid function in women with a history of pregnancy loss or preeclampsia.

Following the observation that non-organ-specific antibodies are related with pregnancy loss and preeclampsia, the role of organ-specific antibodies is currently being extensively investigated. The aim of this study was on the one hand to evaluate the incidence of antithyroid antibodies in a study group of 69 women with a history of early pregnancy loss (subgroup 1), foetal death (subgroup 2) or preeclampsia (subgroup 3) and in a control group, on the other hand to assess the possible association of these autoantibodies with non-organ-specific antibodies and subclinical alterations of thyroid function in the study group. Antithyroid antibodies were present in 26/69 (37.7%) women of the study group (37.9% in subgroup 1; 40.9% in subgroup 2; 33.3% in subgroup 3) and in 10/69 (14.5%) of controls, the difference being statistically significant. A significant difference in the distribution of antibodies to thyroglobulin and thyroid peroxidase was found in subgroup 2. In the study group, the incidence of antiphospholipid antibodies was not significantly different in women positive (26.9%) and negative (34.9%) for antithyroid antibodies. Also, the overall incidence of subclinical alterations of thyroid function in the study group was significantly different in women positive (53.8%) and negative (16.2%) for thyroid autoimmunity (P<0.02). The results of this study seem to confirm the association between thyroid autoimmunity and obstetric complications and suggest the usefulness of undertaking prospective studies in order to evaluate the reproductive outcome of women with a history of recurrent abortion, foetal death or preeclampsia and positivity for antithyroid antibodies.

Abortion, Habitual↗

PubMed2000

What degree of maternal metabolic control in women with type 1 diabetes is associated with normal body size and proportions in full-term infants?

OBJECTIVE: To assess what degree of maternal metabolic control in women with type 1 diabetes is associated with normal fetal growth and results in normal neonatal body proportions in a group of full-term infants. RESEARCH DESIGN AND METHODS: We investigated the anthropometric characteristics of 98 full-term singleton infants born to 98 Caucasian women with type 1 diabetes enrolled within 12 weeks of gestation. The type 1 diabetic mother-infant pairs were divided into three groups on the basis of the daily glucose levels reached during the second and third trimesters of pregnancy (group 1: 37 mother-infant pairs with an average daily glucose level during the second and third trimesters of < or =95 mg/dl; group 2: 37 mother-infant pairs with an average daily glucose level during the second trimester of >95 mg/dl and during the third trimester of < or =95 mg/dl; group 3: 24 mother-infant pairs with an average daily glucose level during the second and third trimesters of >95 mg/dl; control group: 1,415 Caucasian mother-infant pairs with full-term singleton pregnancies and normal glucose challenge test screened for gestational diabetes. RESULTS: Infants of diabetic mothers in group 1 were similar to those of the control group in birth weight and in other anthropometric parameters. In contrast, offspring of diabetic mothers of groups 2 and 3 showed an increased incidence of large-for-gestational-age infants, significantly greater means of ponderal index and thoracic circumferences, and significantly smaller cranial/thoracic circumference ratios with respect to the control group. CONCLUSIONS: The results of our study suggest that, in diabetic pregnancies, only overall daily glucose values < or =95 mg/dl throughout the second and third trimesters can avoid alterations in fetal growth.

Adolescent↗

PubMed2000

[Acute pericarditis in pregnancy. Report of a case].

In this study the authors describe a case of acute pericarditis occurring at 26 weeks' gestation in a woman affected by Wolff-Parkinson-White Syndrome and with a history of Hodgkin's Lymphoma and autoimmune hypothyroidism. The patient was first admitted to the 4th Medical Pathology Unit of the University of Florence, where moderate pericardic effusion with no evidence of heart tamponade was documented by ultrasound scan. Subsequently the patient was cared for on outpatient basis at the Centre of Perinatal Medicine of the Department of Obstetrics and Gynaecology of the University of Florence. Since all examinations and tests aimed at defining the etiology of pericardial effusion were negative, an idiopathic acute pericarditis was diagnosed. The patient was given prednisone at a dose of 75 mg per day; owing to episodes of paroxystic atrial fibrillation, propaphenon was also administered intravenously to treat acute episodes and orally as prophylaxis. The patient underwent close control of both heart function (by means of ultrasound scans of the heart and dynamic EKG) and pregnancy (blood tests, ultrasound scans and Doppler velocimetry). At 36.5 weeks' gestation a healthy fetus was spontaneously delivered. Three months after delivery, the patient underwent an ultrasound scan that demonstrated the complete reabsorption of the effusion.

Acute Disease↗

PubMed1999

Usefulness of screening for congenital or acquired hemostatic abnormalities in women with previous complicated pregnancies.

Activated protein C resistance (APCR) is a common cause of familial thrombophilia and venous thrombosis. The aim of the study was to investigate the prevalence of APCR associated with factor V Leiden mutation and its relevance in comparison to other risk factors for thromboembolic disorders in women with a history of previous complicated pregnancies (history of fetal loss in the second and third trimester n = 34, preeclampsia n = 46). The frequency of APCR was significantly higher in women with a history of fetal loss and preeclampsia (23.5 and 26.1%, respectively) compared with a control group (3.8%). The prevalence of antithrombin, protein C and protein S deficiencies and the presence of antiphospholipid antibodies were also investigated: the prevalence of at least one disorder was 41.2% in the group with previous fetal loss, 37.0% in the group with previous preeclampsia and 7.5% in the control group.

Activated Protein C Resistance↗

PubMed1999

Antimicrobial prophylaxis in obstetric and gynecological surgery.

A major problem in obstetric and gynecological surgery, especially following cesarean section in labor, total vaginal or abdominal hysterectomy, or myomectomy, is postoperative wound infection. Consequently, the use of antimicrobial prophylaxis for cesarean section and for gynecological surgery has been advocated and shown to be effective in reducing postoperative morbidity, costs and duration of hospitalization. We reviewed 1021 patients who underwent cesarean section (597 elective, 424 emergency) and 814 gynecological patients undergoing abdominal (373) or vaginal (248) hysterectomy and myomectomy (193) between 1997-98 in the Obstetrics and Gynecology Clinic of the University of Florence. Before surgery 83.6% of obstetric and 75.1% of gynecological patients received 1 or 2 g of a first or second generation cephalosporin i.v. as a single-dose regimen at induction of anesthesia and sometimes a second postoperative dose. 1.5% of obstetric surgical patients had wound infection, as did 2.8% of gynecological surgery patients, with a mean postoperative hospital stay of 8 days. The short-term perioperative antimicrobial prophylaxis with cephalosporins is useful and provides the benefit of minimal toxicity and risk of chemoresistance.

Adult↗

PubMed1999

True incidence of vaginal vault prolapse. Thirteen years of experience.

OBJECTIVE: To assess the true incidence of vaginal vault prolapse after hysterectomy. STUDY DESIGN: The records of 2,670 patients who had undergone hysterectomy between 1983 and 1987 were reviewed. From this population, 448 patients were selected for follow-up study. The mean follow-up phase was 11 years (range, 9-13). Patients were divided into two groups according to the presence or the absence of genital prolapse at hysterectomy. Pelvic examination was performed in order to identify the presence of vault prolapse. Pelvic support was assessed using Baden and Walker's "halfway description." RESULTS: Five of the 2,670 patients who had undergone hysterectomy at our institution returned on their own initiative for surgical correction of vault prolapse. Using the modalities in the literature, the incidence of vault prolapse was 0.4%. Instead, on pelvic examination, the incidence of vault prolapse was 4.4% (20 patients in a group of 448). Fourteen of the 20 with vault prolapse had previously undergone vaginal hysterectomy for genital prolapse: six had had abdominal hysterectomy for benign disease, excluding genital prolapse. Therefore, the incidence of vaginal vault prolapse was 11.6% (14/120 patients) when hysterectomy had been performed for genital prolapse and 1.8% (6/328) when hysterectomy had been performed for other benign diseases. In the latter group (328 patients), all the cases of vault prolapse developed after abdominal hysterectomy: the incidence was 2% (6/308 patients); no case (0/20 patients) of vault prolapse developed after vaginal hysterectomy that had been performed on patients without genital prolapse. The primary risk factor for vaginal vault prolapse in this study, was obesity. Obese subjects were significantly more susceptible to developing the condition when compared to nonobese (P < .001). CONCLUSION: Our data show that there is a low incidence of vaginal vault prolapse when hysterectomy is performed in the absence of defects in pelvic support. A comparison of our method and those described in the literature to determine the incidence of vaginal vault prolapse showed that this event is often underevaluated if long-term follow-up after hysterectomy is not carried out.

Adult↗

PubMed1998

[Kidney transplantation and pregnancy. Report of a case].

The aim of this study was to evaluate the extent to which the presence of a transplanted kidney conditions the physiological renal and maternal cardiocirculatory adaptation to pregnancy. For this purpose, we compared the trend of cardiocirculatory and renal hematochemical parameters in a kidney-transplant patient to a group of 100 physiological pregnant women followed longitudinally. M. G., aged 36, primigravida, who underwent renal transplantation ten years before, was carefully monitored throughout gestation. Pregnancy was free of complications and ended at 38 weeks with an elective caesarian section. The trend of the parameters mirrored the physiological pattern, even if the values for some renal parameters were completely different. This type of comparison enabled us to evaluate the adaptation of the transplanted organ and the body to pregnancy and to formulate a prognostic judgement halfway through pregnancy regarding the outcome.

Adult↗

PubMed1997

D-dimer plasma levels during normal pregnancy measured by specific ELISA.

A progressive increase in D-dimer plasma levels together with an increase in fibrinogen has been previously reported during normal pregnancy. However, significantly different D-dimer levels have been observed in different assays, due to different specificity of the antibodies employed. The aim of this study was to verify the increase in fibrin degradation product levels during normal pregnancy, using a recently introduced specific D-dimer ELISA. We determined D-dimer (ELISA) and fibrinogen (clotting method) plasma levels in 63 normal pregnant women, during three different periods of pregnancy (A, 7-20 weeks; B, 21-30 weeks; C, > 30 weeks). During period A, D-dimer plasma levels (range 2-103 ng/ml) showed an insignificant increase compared with a control group of non-pregnant women (range 2-73 ng/ml). During periods B and C, we observed an increase in D-dimer level (P < 0.0001) compared with period A, with a significant correlation between D-dimer levels and gestational age (P < 0.0001). Period A fibrinogen levels (range 3.24-6.43 g/l) were significantly higher (P < 0.0001) than in controls (range 2.31-4.71 g/l), with a further increase in periods B and C. In conclusion, we confirmed a progressive increase in plasma concentrations of fibrin degradation product during normal pregnancy, but D-dimer levels were significantly lower than those reported in the literature for other ELISAs.

Adult↗

PubMed1997

Anthropometric features in infants of mothers with gestational diabetes: relationship with treatment modalities.

We compared the effects of two treatment strategies (diet alone versus a combination of insulin and diet) on neonatal anthropometric measurements and the outcome of a full-term white infant sample born to mothers with gestational diabetes mellitus (GDM). Study subjects included 217 consecutive nonrandomized women with GDM with term singleton pregnancies. Insulin therapy was administered on the basis of anamnestic and maternal-fetal criteria. One hundred and twenty-one patients (group 1) received a combination of insulin and diet, and 96 (group 2) underwent diet alone. All 1,052 white patients with term singleton pregnancies without GDM, screened at the same time as the study group, formed the control group. The incidence of large-for-gestational-age (LGA) infants was significantly higher in group 2 (18.8%) compared with group 1 (9.9%) and the control group (8.3%). Male and female infants born to diabetic mothers of group 2 had significantly greater mean birth weights, ponderal indices, thoracic circumferences, weight/length ratios and significantly smaller mean cranial/thoracic circumference ratios than male and female infants in group 1 and the control group (p < 0.05, Scheffe test). Treatment of GDM mothers with insulin and diet has been shown to be able not only to normalize the incidence of LGA infants but also to influence the anthropometric characteristics of the infants born to these mothers to such an extent that they showed no significant differences compared to infants born to non-diabetic mothers.

Adult↗

PubMed1997

Anthropometric characteristics of full-term infants: effects of varying degrees of "normal" glucose metabolism.

Aim of this study was to examine the maternal-neonatal outcome and the neonatal anthropometric characteristics of a full-term mother-infant pairs group with a positive oral glucose challenge test (GCT) without gestational diabetes mellitus (GDM). Our study involved 1615 white women with singleton pregnancies who underwent universal screening for GDM in two periods of pregnancy. This population was divided into three groups according to GCT results: 1) 172 patients with abnormal GCT in both periods; 2) 391 patient with normal GCT in the early period and abnormal GCT in the late period; 3) 1052 patients with normal GCT in both periods (control group). The incidence of LGA (large for gestational age) infants was higher in Group (40.7%) and Group 2 (22.0%) respect to control group (8.3%) (p < 0.00001 and p < 0.0001 respectively) and was significantly different in the two groups (p < 0.0008). Comparison among the three groups of LGA infants showed the following results: male and female newborns of Group I were heavier than those of Group 2 and of the control group, while males and females of the control group had significantly greater length and cranial circumference means. A significant decrease in ponderal index, choracic circumference, weight/length ratio means could be seen as well as a significative increase in cranial/thoracic circumference ratio means from Group I to the control group. These data confirm the involvement of fetal development in terms of weight and anthropometric characteristics in the presence of alterations in maternal glucose metabolism which are not currently classified as gestational diabetes.

Adult↗

PubMed1997

Excursion of daily glucose profiles in pregnant women with IDDM: relationship with perinatal outcome.

The relationship between perinatal outcome and daily glucose profile throughout pregnancy was assessed in 31 White Class B through R pregnant diabetic women. The study population was divided into two groups on the basis of perinatal outcome: 20 patients (Group I) without neonatal complications; 11 patients (Group II) with at least one form of neonatal complications. The overall capillary blood glucose average levels of Group I (98.53 +/- 22.33 mg/dl) and of Group II (110.14 +/- 20.77 mg/dl) was significantly different (ANOVA p < 0.0001). From the first trimester of pregnancy Group I showed significantly lower mean glycemic levels for daytime, evening and night (Bonferroni test p < 0.05) than Group II and both presented daily glycemic profiles with very extensive excursions. During the second trimester the groups continued to maintain these differences in mean glycemic levels (Bonferroni test p < 0.05) but a daily glycemic rthythm with relative nocturnal hypoglycemia with closer fluctuations. In contrast, during the third trimester the two groups presented both a daily rhythm of glucose and glycemic values for daytime, evening and night not statistically different (Bonferroni test p < 0.06). The distribution of women according to glucose levels reached during the night showed a mode of distribution in both Group I and II collocated in a range 70-100 mg/dl. These findings suggest that an optimum perinatal outcome can be achieved only if the pre-pregnancy diabetic women can achieve a metabolic equilibrium during the second trimester which matches the daily excursions of glycemia present in a non-diabetic pregnant women avoiding individual episodes of night-time hypoglycemia.

Adult↗

PubMed1997

Risk factors for fetal macrosomia: the importance of a positive oral glucose challenge test.

OBJECTIVE: The aim of this study was to investigate whether minor abnormalities of glucose metabolism without gestational diabetes are a risk factor for fetal overgrowth. DESIGN: A sample of 1883 unselected white mother-infant pairs were screened for gestational diabetes using a 50 g 1-h oral glucose challenge test (GCT) in two periods of pregnancy: early (16-20 weeks) and late (26-30 weeks). METHODS: The effects of risk factors (glucose metabolism, previous history of mothers, obesity, multiparity and age of mothers) were estimated using a multinomial logit model. RESULTS: The level of risk was related to gestational age at the appearance of an abnormal GCT. Patients with an abnormal GCT in the early and late periods of pregnancy (Group 1) had a risk of delivering a large for gestational age (LGA) infant seven times higher than the control group (normal GCT in both periods), and patients with a normal GCT in the early period and an abnormal GCT in the late period (Group 2) showed a risk three times higher than the control group. Among the historical risk factors for LGA infants, such as maternal obesity, multiparity, previous gestational diabetes and previous delivery of an infant weighing 4000 g or more, only the latter was associated with fetal overgrowth with a risk level 4.7 higher than the control group. Group 1 patients had a significantly higher incidence of pregnancy-induced hypertension and preterm birth. There were no differences in the frequency of 5-min Apgar score < 7 and metabolic complications among the infants of all groups. We found a significantly higher rate of shoulder dystocia in Group 1 infants than in infants in the other groups. CONCLUSIONS: Our results suggest that a positive GCT at 26-30 weeks is the most important risk factor for fetal overgrowth. This result was strongly enforced in patients who had also shown a positive early GCT at 16-20 weeks.

Blood Glucose↗

PubMed1997

[Glycemic thresholds in spontaneous abortion during the first trimester in pregnant women with insulin dependent diabetes].

BACKGROUND AND AIM: To evaluate the hypothesis that insulin-dependent diabetic (IDDM) pregnant women have a threshold of glycemic control during the first trimester of pregnancy for an increased risk of spontaneous abortion. MATERIALS AND METHODS: Seventy IDDM pregnant women were enrolled before the 9th week of gestation and monitored throughout pregnancy. Fifteen pregnancies (21.4%) led to spontaneous abortion within the first trimester (study group) and 55 (76%) continued until term (control group). In order to evaluate the differences between the study group and the control group variance analysis and Student's t-test were used for constant variables and chi 2 and Fisher's exact test for discrete variables; p < 0.05 was considered statistically significance. RESULTS: Mean levels of glycosylated hemoglobin (HbA1c) and fructosamine at the initial prenatal visit were significantly higher in the study group (p < 0.03) compared to the control group. The threshold for an increased risk of spontaneous abortion in the first trimester was found to be initial concentrations > 8% for HbA1c and > 300 mmol/l for fructosamine. CONCLUSIONS: Pregnant women suffering from IDDM with initial HbA1c levels higher than 8% and fructosamine > 3 mmol/l have an increased risk of spontaneous abortion in the first trimester of pregnancy. Below this threshold the risk of spontaneous abortion during the first trimester of pregnancy is similar to that for non-diabetic pregnant women.

Abortion, Spontaneous↗