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Biomedical subjects

M Hod

Publications and source records attributed to M Hod.

At least 73 records · Page 4Linked to original sources
PubMed1996

Fuel metabolism in deviant fetal growth in offspring of diabetic women.

Fetal growth and development from its very first stages of intrauterine life is significantly influenced by the metabolic environment in which the conceptus develops. Maternal disease states such as gestational diabetes and hypertensive pregnancy, representing maternal conditions involved in extremes of impaired fetal growth (macrosomia versus growth restriction), can serve as excellent examples of the various factors that are involved in intrauterine growth.

Diabetes, Gestational↗
PubMed1996

A 'sweet' indication for ovulation induction.

In diabetic patients, euglycaemia at the time of conception is crucial for the success of the pregnancy. In consideration of the difficulty in achieving and maintaining tight glycaemic control for long periods, we administered clomiphene citrate, which is usually indicated in cases of absent or infrequent ovulation, to enhance fecundability in 10 pregestational diabetic patients. All conceived within one to three cycles of the drug, and nine delivered healthy term babies after uneventful pregnancies; one aborted spontaneously in the eighth gestational week. No effect of the drug on the diabetes was noted as based on measurements of glycosylated haemoglobin and fructosamine concentrations and the absence of changes in the patients' insulin requirements. In the light of these successful results, and in view of the importance of euglycaemia at the beginning of diabetic pregnancies, we suggest a new 'sweet' indication for the use of clomiphene citrate.

Adult↗
PubMed1996

Perinatal complications following gestational diabetes mellitus how 'sweet' is ill?

OBJECTIVE: We tested the effect of patient compliance, fasting plasma glucose on oral glucose tolerance test, maternal body constitution, and the method of treatment (diet versus insulin) on the perinatal outcome of patients with gestational diabetes mellitus. STUDY DESIGN: A prospective population-based study compared the perinatal outcome of patients with gestational diabetes mellitus (n = 470) (diabetic with regard to the parameters specified above) and a contemporaneous control group (nondiabetic, n = 250). RESULTS: The diabetic and control groups were matched in demographic characteristics. Patient compliance reduced the rate of macrosomia (14.4%) and neonatal hypoglycemia (3.4%) but not to the levels of the control group (5.2% and 1.2% respectively, p < 0.05). The level of fasting plasma glucose on the oral glucose tolerance test had no effect on perinatal outcome. Intensified (insulin) treatment reduced the rate of macrosomia and large-for-gestational age infants in the subgroups with intermediate and high levels of fasting plasma glucose on the oral glucose tolerance test (9.5%/14.2% and 12.2%/24.2% respectively), again not to levels of the control group (5.2%/10.8%). Obese patients were found to have more perinatal complications than lean patients. Intensified (insulin) treatment has proved to be beneficial in terms of reducing the rate of perinatal complications in the obese patients, but not to the corresponding levels of the control group. Such treatment had no effect on the lean patients. CONCLUSIONS: Strict control of maternal hyperglycemia and high patient compliance are imperative for an effective reduction of perinatal complication in patients with gestational diabetes mellitus. The desired plasma glucose level in the glycemic control of these patients should be further reduced, thus bringing the rate of perinatal complications to that of the normal population.

Adult↗
PubMed1996

Dynamic parameters of maternal amino acid metabolism and fetal growth.

This study presents kinetic parameters of glycine metabolism during pregnancy and the influence of fuel availability on fetal growth. The kinetic studies were done on patients with gestational diabetes mellitus (diet treated) and pre-gestational diabetes mellitus (diet and insulin treated) that was accompanied by increased fetal growth and pregnancy-induced hypertension and, during the third trimester of pregnancy, by intrauterine growth retardation. Gas chromatography-mass spectrometry was used to determine the 15N enrichment of plasma glycine, and to calculate the pool sizes, turnover rate constants, fluxes and metabolic clearance rates. Glycine pool sizes in pre-gestational diabetes were significantly larger than those in normal, hypertensive and gestational diabetes pregnancies. Glycine turnover rate constants and metabolic clearance rates were not significantly different between the normal pregnant women, the hypertensive, and the two diabetic groups of pregnant women. Glycine fluxes were significantly higher in the pre-gestational diabetic pregnant women than in those with gestational diabetes, hypertension, and normal pregnancy. Pre-gestational diabetic pregnant women delivered fetuses with higher birthweights than the other three groups. Fetal birthweight of the hypertensive women was significantly lower than among the normal and diabetic women. Stable isotope methodology using labeled amino acids provides a powerful tool for clinical studies of maternal protein metabolism and its relationship to fetal growth.

Birth Weight↗
PubMed1996

Microalbuminuria as an early marker of severity in hypertensive pregnant women.

The value of microalbuminuria in predicting hypertensive complications in pregnant patients at high risk was tested in a prospective trial. A total of 276 patients were studied (142 in the study group vs 134 controls). Albumin was measured in 8-h overnight urine collection throughout pregnancy using radioimmunoassay technique. The pregnant women, in both the study and control groups demonstrated a statistically significant increase in albumin excretion rate in the second and third trimester compared with the first. Using logistic and linear regression models, the presence of microalbuminuria in the early third trimester was proven to be predictive of severe disease (odds ratio 2.1, confidence interval (CI) 1.26-3.53) and birth weight (R2 = 0.7, P < 0.05) in the study group. Intrauterine growth retardation and neonatal outcome were less predictable. With the introduction of radioimmunoassays, we believe severe disease can be predicted by detecting microalbuminuria in the early third trimester of pregnancy in high risk patients.

Adult↗
PubMed1996

Pregnancy outcome in renal allograft recipients in Israel.

The literature contains reports of 2,309 pregnancies in some 1,600 women who have undergone renal transplantation. Certain pre-pregnancy factors, especially hypertension, renal graft dysfunction and short interval between transplant and pregnancy, appear to increase the neonatal risks. We describe the outcome of 42 pregnancies in 27 allograft recipients at Beilinson Medical Center in Israel during the last 8 years. All were treated with combination immunosuppression regimens. The average interval from time of transplantation to conception was 3.7 +/- 0.4 years (2 months to 9 years). Rejection episodes occurred in 37% prior to pregnancy but in none during or immediately after pregnancy. Of the 42 pregnancies 28% ended in therapeutic or spontaneous abortions, and 29 of the 30 deliveries ended in a life birth. The prematurity rate (65%) was similar to that described in the literature. Renal deterioration was evident in seven women (26%) within 2 years after delivery. Despite this significant success rate, pregnancy in organ transplant patients should still be considered high risk.

Adult↗
PubMed1996

The effects of time interval after venipuncture and of anticoagulation on platelet adhesion and aggregation.

Abnormal platelet function plays an important role in atherosclerosis and thrombotic disorders. Simple in vitro testing of platelet function is preferable to other techniques, and adhesion measurement is especially important because it reflects an immediate platelet response. The time lapse after venipuncture and the anticoagulant may affect platelet function in an as yet unknown way. A method for determining platelet adhesion under controlled whole blood flow conditions and an aggregation study were used. Platelet adhesion and aggregation changed significantly with time elapsed since venipuncture, peaking after 60 min (P < 0.05): a plateau was reached only after more than 120 min. Platelet adhesion was directly suppressed by the use of sodium citrate as an anticoagulant, and surface density decreased from 14.2 to 8.8 (P < 0.001). To prevent the effect of time after venipuncture on platelet function, testing should be performed at the plateau phase.

Adenosine Diphosphate↗
PubMed1996

Advances in the understanding of diabetic embryopathy: signal transduction.

Evidence supports the theory that in diabetic pregnant women, it is the degree of metabolic imbalance present during the crucial time of organogenesis that determines the organogenetic congenital defects. The precise mechanism responsible for abnormal fetal organogenesis is unclear, but fuels such as sugars (glucose, galactose, mannose), ketones, fuel-related principles such as somatomedin inhibitors, insulin, trace elements and, lately, myoinositol, arachidonic acid and free oxygen radicals have all been implicated. The plasma-membrane lipids, in addition to serving as barriers that separate intracellular from extracellular fluid, are the actual sources of signal molecules. In one case, the signal molecule (diphosphoinositol) is derived from a variant of a common membrane lipid. This is similar to the situation in which a hormone, or similar extracellular messenger, binds to its membrane receptor and activates an enzyme that hydrolyzes plasma-membrane phospholipids to liberate arachidonic acid, which is a precursor of signal molecules, including the prostaglandins. Disruption of these delicate processes by various agents (metabolites) could result in deficiencies in phosphoinositol turnover or arachidonic acid metabolism, thus leading to congenital anomalies.

Animals↗
PubMed1996

Prostaglandin metabolism in the yolk sacs of normal and diabetic pregnancies.

The malformations commonly found in fetuses of diabetic mothers occur before the 7th week of pregnancy, when fetal nutritional needs are met largely by the yolk sac. The diabetic milieu has been hypothesized to cause a disruption in the metabolism of arachidonic acid and phosphatidylinositol turnover, leading to a reduction in prostaglandin levels. In this study we evaluated how the diabetic milieu affects yolk-sac prostaglandin levels. We used ultrasound to characterize and guide aspiration of the yolk sacs of eight diabetic and 12 healthy women prior to elective abortion. In addition, we studied the yolk sacs of two healthy women in whom pregnancy termination was carried out by hysterectomy. All fetuses were between 8 and 10 weeks gestational age at the time of pregnancy termination. The yolk-sac prostaglandin E2 levels were measured using radioimmunoassay. We found that the yolk-sac diameters of diabetic women were 1.2 mm larger than those of normal women. Furthermore, the mean prostaglandin E2 level in healthy women was 3605 pg/ml, whereas prostaglandin was undetected in all the yolk sacs of diabetic women (p < 0.001). While this study suggests that defective yolk-sac metabolism of prostaglandins is one of the mechanisms responsible for diabetic embryopathy, further research is necessary to place yolk-sac enlargement and the role of prostaglandins in perspective.

Adult↗
PubMed1996

Microalbuminuria in early pregnancy in normal and high-risk patients.

The albumin excretion rate (AER) is elevated in normal pregnant women in the third trimester of pregnancy, compared to the second and first trimesters, and to the non-pregnant state. The effect of early pregnancy on AER values was tested in normal and high-risk pregnant patients using radioimmunoassay. All pregnant patients demonstrated significantly higher AER values as compared to non-pregnant women, and the results were in correlation with higher urinary creatinine clearance values. The appearance of microalbuminuria in the first trimester can indicate underlying renal damage in patients at high risk of hypertensive complications.

Adult↗
PubMed1995

Are labor abnormalities more common in shoulder dystocia?

OBJECTIVE: Our objective was to determine the association between labor abnormalities and shoulder dystocia. STUDY DESIGN: All consecutive cases of shoulder dystocia from January 1986 to August 1994 were reviewed (n = 276). For purposes of comparison a control group of vaginally delivered patients was randomly selected in a 2:1 ratio (n = 600). Charts were reviewed for demographic information, labor and delivery events, and neonatal outcome. RESULTS: Labor abnormalities were comparable in the shoulder dystocia and control groups, both in the active phase and in the second stage. When patients with diabetes and those with macrosomic infants were analyzed separately, no significant differences in labor abnormalities were identified. The rate of operative vaginal delivery was significantly higher in the shoulder group, and one third of the operative deliveries were midpelvic. In addition, the induction rate was higher in the shoulder group. CONCLUSIONS: Our data suggest that labor abnormalities may not serve as clinical predictors for subsequent development of shoulder dystocia, thus emphasizing the unpredictability of this condition.

Adult↗
PubMed1995

Yolk sac concentration of prostaglandin E2 in diabetic pregnancy: further clues to the etiology of diabetic embryopathy.

Fetal malformation associated with maternal diabetes occurs before the seventh week of pregnancy. Current hypotheses suggest that the diabetic milieu causes a reduction in phosphatidylinositol turnover, leading to a disruption in the arachidonic acid cascade and resulting in a deficiency of prostaglandins, particularly prostaglandin E2. This in turn results in a wide variety of congenital anomalies. This hypothesis has not been tested experimentally in humans. The yolk sac is thought to be the most important source of nutrition in early pregnancy. We sought to compare yolk sac prostaglandin levels in normal and diabetic women. Under ultrasonographic guidance, yolk sacs were aspirated form 8 normal and 12 diabetic women ranging from 8 to 10 weeks gestational age prior to elective abortion. Prostaglandin E2 levels were determined using RIA. The mean prostaglandin E2 level in normal controls was 3605 pg/mL, and was undetected in all of the yolk sacs aspirated from diabetic women (P < 0.001). Yolk sac diameter in diabetic pregnancies was 1.2 mm larger than that of normal pregnancies. The functional and morphological changes demonstrated in this study may increase our understanding of the pathophysiology of diabetic embryopathy.

Blood Glucose↗
PubMed1995

Diabetic nephropathy and pregnancy: the effect of ACE inhibitors prior to pregnancy on fetomaternal outcome.

BACKGROUND: Diabetic nephropathy is associated with an increase in perinatal mortality and morbidity in uncontrolled pregnant patients. Recently angiotensin-converting enzyme inhibitor (ACE-I) was shown to improve the disease status in non-pregnant subjects. The purpose of this study was to examine the effect of prepregnancy treatment of insulin-dependent diabetes mellitus (IDDM) nephrotic women with captopril angiotensin converting enzyme inhibitor (ACE-1), on maternal renal function throughout pregnancy and on the fetomaternal outcome. METHODS: Eight IDDM nephrotic patients planning pregnancy were treated with captopril for a minimum of 6 months prior to conception together with intensive insulin management. Conception was allowed when proteinuria was < 500 mg/day and euglycaemia was achieved. At conception captopril was discontinued. RESULTS: At the beginning of captopril treatment, proteinuria was 1633 +/- 666 mg/day. At conception, proteinuria dropped to 273 +/- 146 mg/day (P = 0.0000) and increased gradually over the three trimesters to 593 +/- 515, 783 +/- 813, and 1000 +/- 1185 mg/day respectively (P = 0.2 between the trimesters); declining to 619 +/- 411 mg/day (P = 0.0002 vs conception) 3 months after delivery. Only in two patients (25%) did proteinuria exceed 1000 mg/day during pregnancy. There was no significant change in any of the other renal function tests: CCT, serum creatinine, uric acid, K+ and blood pressure. However, there were three cases of PET just prior to delivery. Maternal glycaemic control improved significantly prior to conception (P = 0.002) and remained euglycaemic (reflected by daily glucose profile, HbA1C and fructosamine) throughout gestation. Perinatal outcome was excellent. CONCLUSION: Captopril treatment before pregnancy has a prolonged protective effect on maternal renal functions during pregnancy and results in a favourable maternal-fetal outcome.

Adult↗
PubMed1995

Microalbuminuria: prognostic and therapeutic implications in diabetic and hypertensive pregnancy.

Microalbuminuria is defined as urinary excretion of albumin that is persistently above normal, although below the sensitivity of conventional semiquantative test strips. Several studies have reported that Type 1 diabetic patients with microalbuminuria are apparently more likely to develop diabetic nephropathy eventually progressing to renal failure. Microalbuminuria is also a strong predictor of mortality in Type 2 diabetes, and is correlated with increased blood pressure in patients with benign essential hypertension. Radioimmunoassay revealed a significantly higher urinary albumin excretion rate in normal pregnant women in the third trimester of pregnancy, compared to the second and first, and compared to non-pregnant women. Microalbuminuria was found in 30% of women who had a record of gestational diabetes mellitus. Published results are controversial regarding the assumption that microalbuminuria is an early predictor of pregnancy-induced hypertensive complications.

Albuminuria↗
PubMed1995

Microalbuminuria following gestational diabetes.

BACKGROUND: Microalbuminuria (MA) precedes clinical nephropathy in patients with insulin-dependent diabetes mellitus, and is associated with an increased mortality, mostly due to cardiovascular disease in patients with non-insulin-dependent diabetes mellitus. Microalbuminuria is rarely detected in patients with diabetes of less than five years' duration. Our study was designed to determine whether MA and its sequelae also appear 5-8 years after pregnancy complicated by gestational diabetes mellitus (GDM). METHODS: We examined the presence of MA in 72 women who had not conceived since a previous GDM-pregnancy 5-8 years ago and compared them to a control group of 35 women who had no GDM history, and who were matched for age, parity and time since last pregnancy. Microalbuminuria was determined in all subjects using an overnight 8 hours urine collection. Mann-Whitney rank-sum test was used to compare data between the study and the control groups. Student's t test was used to compare data within the study group. RESULTS: Median value of the urinary albumin excretion rate (AER) in the study group was significantly higher than median value of urinary AER of the control group (p < 0.0001), but only 30.5% of the subjects of the study group were found to be microalbuminuria-positive, defined as urinary AER value of more than 21 mg/24 h. No correlation between MA and blood pressure, fasting blood glucose, serum creatinine, blood urea nitrogen and parity was found. CONCLUSIONS: MA was found to be more frequent after GDM and no predisposing factors for its appearance were elucidated. Hence, we suggest that it may well be a sign of early renal disease and that long-term follow-up of all GDM patients for MA and other markers of renal disease is strongly indicated.

Adult↗