Biomedical subjects

L M Westgren

Publications and source records attributed to L M Westgren.

6 recordsLinked to original sources

PubMed1998

Placental hormones during induced hypoglycaemia in pregnant women with insulin-dependent diabetes mellitus: evidence of an active role for placenta in hormonal counter-regulation.

OBJECTIVE: To study the effect of induced hypoglycaemia on serum levels of the placental hormones oestriol, human placental lactogen, placental growth hormone and progesterone in the third trimester of pregnancy. DESIGN: A prospective experimental investigation. SETTING: High risk pregnancy unit and diabetes research unit at Karolinska Institutet Danderyd Hospital, a university hospital. PARTICIPANTS: Ten women with insulin-dependent diabetes mellitus in the third trimester of pregnancy. METHODS: Venous blood samples were collected every 15 minutes for analyses of oestriol, progesterone, human placental lactogen and placental growth hormone, during the 150 min of a hyperinsulinaemic hypoglycaemic clamp, which maintained arterial blood-glucose level of about 2.2 mmol/l. MAIN OUTCOME MEASURES: Levels of analysed placental hormones during hypoglycaemia. RESULTS: A statistically significant increase was observed in placental growth hormone during hypoglycaemia (P < 0.0001), whereas the placental hormones progesterone, human placental lactogen and oestriol did not show changes of clinical significance. CONCLUSIONS: The increase in placental growth hormone indicates that the placenta is an endocrine organ which may take an active part in acute metabolic processes, such as here in the hormonal counterregulation of hypoglycaemia.

Adult↗

PubMed1998

Diminished insulin clearance during late pregnancy in patients with type I diabetes mellitus.

1. Intensive insulin treatment of patients with Type I diabetes mellitus during pregnancy is associated with a high frequency of serious hypoglycaemic events. A potential change in insulin metabolism during pregnancy may affect both the frequency and the severity of insulin-induced hypoglycaemia.2. In 10 patients with Type I diabetes, during the third trimester of pregnancy and 5 to 13 months after delivery, hypoglycaemia was induced by the hyperinsulinaemic hypoglycaemic clamp technique. A constant high-dose intravenous insulin infusion was administered for 150 min and arterial blood glucose was clamped at 2.2 mmol/l by counterregulation with intravenous glucose. During the experiment venous samples were collected for later analysis of free plasma insulin, whereby the metabolic clearance rate of insulin could be calculated.3. The desired blood glucose level was approached after approximately 60 min of insulin infusion. After just 30 min the insulin levels were significantly higher during pregnancy compared with after delivery. In addition, the steady-state insulin level from 90 to 150 min was significantly higher during pregnancy.4. From the steady-state insulin levels at 90 to 150 min, the metabolic clearance rate of insulin was calculated, being 24% higher after delivery.5. We conclude that there is a decreased metabolic clearance rate of insulin during pregnancy. This might be due to altered blood-flow distribution, decreased hepatic insulin extraction and relative increase in body fat during pregnancy. A decreased clearance of insulin will contribute to the risk for serious hypoglycaemic events in patients with Type I diabetes during pregnancy.

Adult↗

PubMed1996

Effects of hypoglycaemia on fetal heart activity and umbilical artery Doppler velocity waveforms in pregnant women with insulin-dependent diabetes mellitus.

OBJECTIVE: To study the effect of induced hypoglycaemia on fetal wellbeing as indicated by fetal heart rate and umbilical artery flow velocity waveforms. DESIGN: A prospective experimental investigation. SETTING: High risk pregnancy unit and diabetes research unit at Karolinska Institutet, Danderyd Hospital, a university affiliated hospital. PARTICIPANTS: Ten women with insulin-dependent diabetes mellitus in the third trimester of pregnancy. INTERVENTIONS: The fetal heart rate, the blood flow velocity waveforms in the umbilical artery and the maternal catecholamine levels were investigated during a 150-minute hyperinsulinaemic hypoglycaemic clamp with induction and maintenance of an arterial blood glucose level of about 2.2 mmol/l. MAIN OUTCOME MEASURES: 1. Fetal: changes of fetal heart rate pattern and pulsatility index of the umbilical artery flow velocity waveforms. 2. Maternal: levels of plasma adrenaline and plasma noradrenaline. RESULTS: Maternal hypoglycaemia was associated with an increase in frequency and amplitude of fetal heart rate accelerations, a slight decrease in the pulsatility index of the umbilical artery and a rise in the maternal catecholamine levels. CONCLUSIONS: We speculate that the increased number of fetal heart rate accelerations reflects an increased sympathico-adrenal activity during the hypoglycaemia clamp. No potentially harmful effects on the fetus were observed in the fetal heart rate or in the umbilical artery Doppler waveform analysis during hypoglycaemia.

Adult↗

PubMed1988

Breech delivery and mental handicap.

Recent studies with strict management protocols for selection of cases for trial of vaginal delivery for full-term breech presentations show no significant differences in outcome brought about by the birth route. This is in clear contrast to some of the older studies which indicated considerable risk for the vaginally born breech infant. Prospective follow-up studies and carefully matched controlled studies with sophisticated neurological evaluations indicate that breech infants, regardless of mode of delivery, will score slightly less favourably than infants born in vertex presentation. This difference seems to reflect prenatal factors rather than birth injuries.

Breech Presentation↗

PubMed1986

Intrauterine asphyxia and long-term outcome in preterm fetuses.

The long-term outcome of 108 infants born before the 33rd week of gestation was evaluated and correlated to a fetal heart tracing from the last 24 hours before delivery. Infants with signs of asphyxia (N = 30) were born at the same gestational age as those without (N = 78), but had a significantly lower birth weight (P less than .001). Severe intraventricular hemorrhage occurred more often in infants with asphyxia (30%) than in those without (5%) (P less than .05). Fourteen of 30 asphyxia infants (47%) and 11 of 78 nonasphyxia infants (14%) died within the first two years (P less than .005). At two years of age, four (25%) asphyxia and eight (12%) nonasphyxia infants have developmental or neurologic abnormalities (not significant). Of the eight infants with asphyxia born before the 29th week of gestation in the present study, none was normal at two years of age. The authors conclude that signs of asphyxia, as determined from fetal heart rate pattern, were associated with poor fetal outcome, and especially in infants born before the 29th week of gestation. The clinical implications of these findings are discussed.

Birth Weight↗

PubMed1985

Preterm breech delivery: another retrospective study.

To evaluate the significance of the route of delivery for preterm breech deliveries, a retrospective study was performed on 136 infants in breech presentation, weighing less than 1500 g. Thirty-seven (27%) were delivered vaginally, and the remaining 99 (73%) by cesarean section. Although perinatal mortality was higher in the vaginally delivered infants than in those born by cesarean section (54 versus 37%), statistical significance was not shown. One-fourth of the deaths in the vaginal delivery group occurred intrapartum. Although most previous studies have suggested improved outcome with delivery by cesarean section, the present study fails to demonstrate any statistically significant difference. Whether there is, in fact, no difference in outcome attributable to the route of delivery or a difference exists that is not demonstrable by a retrospective study is an open question. It is concluded that the design of the present retrospective study, as in all published studies on this subject, confounds the results and thereby makes conclusions precarious. The limited value of nonrandomized retrospective studies for the evaluation of a certain obstetric procedure is discussed.

Birth Weight↗