Biomedical subjects

M Stangenberg

Publications and source records attributed to M Stangenberg.

At least 37 records · Page 2Linked to original sources

PubMed1990

Frequency of HLA genes and islet cell antibodies (ICA) and result of postpartum oral glucose tolerance tests (OGTT) in Saudi Arabian women with abnormal OGTT during pregnancy.

A consecutive series of 55 Saudi women with abnormal 75 g oral glucose tolerance test (OGTT) during pregnancy was reinvestigated 2-4 months after delivery. A 75 g OGTT was done and samples were also drawn for analysis of C-peptide concentration, islet cells antibodies (ICA) and HLA antigens. The results of these laboratory investigations and a number of patient characteristics were analyzed to identify risk factors for patients likely to have impaired OGTT after delivery. Twenty-five (45.5%) of the patients had an abnormal OGTT after delivery. The distribution of HLA antigen frequencies did not differ from a reference group of healthy Saudis. ICA were found in only one patient. Logistic regression analysis identified insulin treatment during pregnancy (p = 0.001) as the only factor to predict an abnormal OGTT after delivery.

Adult↗

PubMed1989

Acid-base status in fetal heart blood in erythroblastotic fetuses: a study with special reference to the effect of transfusions with adult blood.

Blood gas levels, pH, and lactate concentration were studied in fetal heart blood on 70 occasions in 26 fetuses with erythroblastosis. A decreasing hemoglobin concentration correlated to a fall in pH (p = 0.006) and bicarbonate (p = 0.015) and to a rise in base deficit (p = 0.002) and lactate concentration (p = 0.05). Twenty of the fetuses underwent 63 intracardiac transfusions. A multivariance analysis for hemoglobin concentration, percentage of fetal to adult blood, and different acid-base parameters revealed a significant correlation between the presence of adult blood and a rise in PO2 (p = 0.047), but failed to demonstrate any correlation to the other studied acid-base variables. Thus the present study suggests that the fetus can compensate for the physiologic properties of adult hemoglobin that are disadvantageous to itself by increasing PO2 and thereby maintaining oxygen supply. The physiologic background and the clinical implication are discussed.

Acid-Base Equilibrium↗

PubMed1989

Albumin transfusion in non-immune fetal hydrops: Doppler ultrasound evaluation of the acute effects on blood circulation in the fetal aorta and the umbilical arteries.

A case of non-immune fetal hydrops, diagnosed as mucopolysaccharidosis VII with hypoalbuminemia, was treated in utero with albumin transfusions via cordocentesis on five occasions. Blood samples were taken for analysis of full blood count and blood gases before and after the transfusions. Pulsed Doppler ultrasound examinations of the arterial waveform were performed in the umbilical arteries and the descending fetal aorta and analyzed for the pulsatility index (PI). The hemoglobin concentration and the hematocrit decreased from 111 +/- 5 g/l and 0.335 +/- 0.008 to 95 +/- 5 g/l and 0.282 +/- 0.023 (mean +/- SD), respectively, after the transfusions. The calculated blood volume increased more than the given volume, indicating an autotransfusion causing additional plasma volume expansion. The blood gases were not significantly changed by transfusion. The PI decreased both in the umbilical arteries (p less than 0.05) and the descending fetal aorta, indicating peripheral vasodilatation. A positive correlation was found between the umbilical artery PI and the hematocrit before and after the albumin transfusion (r = 0.59; p less than 0.05). This relation could be due to covariation with other factors, e.g. peripheral vasodilatation secondary to the increased blood volume and the puncture of the umbilical vein itself. No improvement of the hydrops was seen after the albumin transfusions. The fetus died in utero during spontaneous labor after 30 gestational weeks.

Albumins↗

PubMed1989

Feto-placental blood volume in severely anemic erythroblastotic fetuses.

The feto-placental blood volume was studied using a hemoglobin hemodilution technique in 15 erythroblastotic fetuses at 43 intravascular transfusions. Four severely anemic fetuses (Hb 30 g/l) had significantly larger blood volumes than 11 moderately anemic fetuses (Hb 30-79 g/l), 169 +/- 37 versus 105 +/- 32 ml/kg fetal body weight (p less than 0.001). We speculate that hypovolemia might be an adaptive change to maintain an adequate hemoglobin concentration. An escape of fluid from the intra- to the extra-vascular space will probably compensate for the reduction in total red cell mass and thus slightly increase the hemoglobin concentration. Theoretically, interstitial fluid accumulation will continue until the hydrostatic pressure of the extravascular tissue balances that of the capillary. This compensatory mechanism seems to function until the hemoglobin concentration drops below, 30 g/l, at which point the blood volume will increase, suggesting a change from a hypo- to a hyper-volemic state.

Anemia↗

PubMed1989

Fetal growth and fetal glucose and C-peptide levels in relation to the degree of anemia in fetuses affected by rhesus iso-immunization.

Fetal growth rate was determined by measuring the fetal biparietal diameter at 63 two-week time points during the second trimester in 14 patients with severe Rhesus isoimmunization. Growth rate was found to be related to the fetal hemoglobin concentration which was determined at the end of each 2-week period. Fetuses with a hemoglobin concentration of less than 30% of the normal value had a significantly decreased growth rate (p less than 0.01). These fetuses had also reduced C-peptide (p less than 0.05) and increased glucose levels (p less than 0.1) compared with less anemic fetuses. The physiological background to impaired fetal growth in cases of severe fetal anamia at Rhesus iso-immunization is discussed.

Anemia↗

PubMed1989

Twenty-four hour excretion of urinary C-peptide in gestational diabetic women before and after treatment with diet or diet and insulin.

24-h urinary C-peptide excretion was studied in 119 women with gestational diabetes before and after treatment with diet or diet and insulin. The 24-h urinary C-peptide excretion in normal-weight gestational diabetic women at diagnosis was also compared to that of a healthy reference group. There was a wide variation in urinary C-peptide values which tended to be higher in normal-weight women with gestational diabetes at diagnosis compared to the reference group, but it did not reach statistical significance. Post partum gestational diabetic women had significantly higher urinary C-peptide excretion (p less than 0.002) than the reference group, indicating insulin resistance in women with gestational diabetes at this time. In 29 overweight women with gestational diabetes 24-h urinary C-peptide excretion did not significantly differ from that in normal-weight women with gestational diabetes. In 32 women with a more marked deviation in glucose tolerance (area greater than or equal to 46 mmol/l) 24-h urinary C-peptide values were significantly (p less than 0.05) higher than in 58 women with gestational diabetes with an area between 42 and 45.9 mmol/l. Both treatment alternatives, diet and diet plus insulin, significantly reduced postprandial blood glucose values (p less than 0.05) and urinary C-peptide excretion was significantly decreased (p less than 0.05).

Adult↗

PubMed1988

Fetal intracardiac transfusions in patients with severe rhesus isoimmunisation.

Six patients with pregnancies of 19-31 weeks' duration showing evidence of erythroblastosis fetalis were treated with 25 fetal intracardiac blood transfusions. Complications related to the procedure occurred on five occasions in three patients. In two of the six patients the fetus died, but it was unlikely that death was related to the intracardiac transfusions. Fetal intracardiac blood transfusion may result in potentially severe complications but offers an alternative when transfusion cannot be performed into the umbilical cord.

Blood Transfusion, Intrauterine↗

PubMed1988

Introduction of a programme for intravascular transfusions at severe rhesus isoimmunization.

Thirty-seven fetuses with severe rhesus isoimmunization with a gestational age of less than 30 week underwent 92 intravascular transfusions. Of these, 77 were intracardiac, 13 umbilical vein and two umbilical artery transfusions. Procedure related complications occurred at eight (10%) intracardiac and at two (14%) umbilical cord transfusions. Reversal of hydrops was observed in 10 of 16 fetuses. The perinatal mortality among transfusion treated fetuses was 8/37 (21%). It is concluded that intravascular, intrauterine transfusion leads to improved results among fetuses with early onset of hydrops. Problems concerning indications and technique are discussed.

Blood Transfusion, Intrauterine↗

PubMed1988

Intravascular fetal blood transfusion under ultrasonic guidance in a case of severe Rh isoimmunization.

A severely Rh-affected fetus with an initial hematocrit value of 7% and a hemoglobin value of 2.3 g/dl was transfused three times by the intravascular route into the umbilical cord under ultrasonic guidance. After the second transfusion, fetal movements recurred and the non-stress test became reactive. Neonatal outcome was favorable. The implications of this procedure are discussed.

Adult↗

PubMed1987

Pancreatic B-cell function during normal pregnancy.

24-h urinary C-peptide excretion was studied in 19 healthy normal weight women with normal glucose tolerance, and related to weight gain and skinfold thickness at 12, 20, 30, 36 weeks of gestation and 6-8 weeks post partum. The urinary C-peptide values (total nmoles or nmoles per kg body weight) showed a significant and progressive increase with gestation. The average C-peptide value was already at 12 weeks of gestation 4 times higher than under non-pregnant conditions. The urinary C-peptide excretion was neither related to maternal weight, weight gain or skinfold thickness at any of the observation periods during pregnancy, nor to the plasma C-peptide response to an oral glucose load at 32 weeks of gestation. A significant correlation was found between urinary C-peptide excretion and body weight determined post partum (r = 0.54, p less than 0.05). The increment in urinary C-peptide excretions at 12 weeks of gestation was unrelated to body mass, suggesting that insulin resistance is present already at this early stage of normal gestation.

Blood Glucose↗

PubMed1986

Prediction of size of infants at birth by measurement of symphysis fundus height.

Symphysis fundus heights (SF) were measured approximately 15 times during pregnancy in a consecutive series of 2941 women with regular menstrual cycles and known last menstrual period. A reference SF chart from 17 to 40 weeks of pregnancy was derived from measurements in 1350 of these women who were healthy, and heights and pre-pregnancy weights within the 10th and 90th centiles and were delivered vaginally of healthy infants with a birthweight/length ratio within +/- 2 SD. The reference chart was used to predict fetal growth deviations in the unselected series of pregnancies. The effectiveness of SF measures to detect fetuses with an infant birthweight/length ratio below -2 SD or a birthweight below the 10th centile was low; the sensitivity was only 16.7 and 26.6% and the predictive value of positive screening result was 1.8 and 18.0%, respectively. Corresponding values for fetuses with an infant birthweight/length ratio above + 2 SD or a birthweight above the 90th centile were 31.8 and 37.5% and 3.3 and 24.5%, respectively. Symphysis fundus (SF) measurement has thus been found to be of limited value as a screening method to detect abnormal size at birth.

Birth Weight↗

PubMed1986

Serum levels of somatomedins and somatomedin-binding protein in pregnant women with type I or gestational diabetes and their infants.

The serum levels of the low mol wt form of somatomedin-binding protein (SMBP) were 5-fold higher in both diabetic (n = 44) and nondiabetic pregnant women (n = 14) than in nonpregnant women. No difference was found between women with type 1 diabetes and those with gestational diabetes. There was a negative correlation between maternal levels of SMBP during the last trimester and the birth weight percentile of the infants (r = -0.51). There was a 2- to 3-fold elevation of maternal insulin-like growth factor (IGF-I) levels during pregnancy in both diabetic and nondiabetic women. A positive correlation (r = 0.49) was found between maternal IGF-I levels and the birth weight percentiles of their infants. The correlation between the ratio of IGF-I to SMBP, which may reflect the IGF-I available to the placenta, to birth weight percentile was higher (r = 0.57), and the SE of estimate of weight percentile was 23%. The ratio between IGF-I and SMBP in cord blood was correlated with birth weight, although cord blood IGF-I and SMBP values were not. The IGF-II levels in cord serum were 50% higher in the infants of diabetic than in those of nondiabetic mothers. These findings raise the questions of whether maternal SMBP levels influence the amount of IGF-I available for the fetal-placental unit and whether IGF-II participates in glucose homeostasis in the fetus.

Adult↗

PubMed1986

Factors influencing neonatal morbidity in diabetic pregnancy.

The influence on neonatal morbidity of factors such as maternal duration of diabetes, third trimester blood glucose control, gestational age at delivery, mode of delivery, and hypertension in pregnancy was analyzed in 92 consecutive diabetic pregnancies (White B35, C22, D26, F9). In a subgroup of 52 diabetic pregnancies the analysis was extended to the influence of hemoglobin A1c at the start and end of pregnancy, blood glucose control during delivery, and fetal insulin secretion at birth. The infants were divided into 3 groups according to the degree of neonatal morbidity: either no (n = 37), minor (n = 27), or severe morbidity (n = 28). There were no significant differences between the groups with no and minor morbidity. Compared to the no-morbidity group, the group with severe morbidity had significantly longer duration of maternal diabetes (p less than 0.05), shorter gestational age at delivery (p less than 0.025), higher frequency of cesarean section (p less than 0.05), and higher frequency of toxicosis (p less than 0.01). The 3 groups did not differ significantly with regard to maternal blood glucose control during pregnancy and delivery. Discriminant analysis revealed that the most significant (p less than 0.001) influence on severe morbidity came from gestational age at delivery. After correction for this factor, there were no other factors with a significant influence on severe morbidity. Within the actual range (mean values 3.9-8.5 mmol/l), blood glucose control during the third trimester had no significant influence on morbidity.

Adult↗

PubMed1985

Nerve conduction in diabetic pregnancy. A prospective study.

Repeated neurographic examinations were performed during and after the pregnancies of 32 diabetic women who had no signs of neuropathy before pregnancy or at the initial examination during the first trimester. The motor conduction velocity, the sensory conduction velocity and the peak amplitude of the compound action potential of the investigated peripheral nerves were not affected by pregnancy. It is concluded that pregnancy does not impair nerve conduction or induce neuropathy in most diabetic women.

Action Potentials↗

PubMed1985

Surveillance of the diabetic pregnancy with antepartum fetal nonstress testing and urinary estriol excretion.

The value of daily fetal heart rate (FHR) nonstress test (NST) and 24-hour urinary excretion of estriol (E3) were compared in a consecutive series of 76 diabetic pregnancies. The NST scoring system (0-10 points) employed included monitoring of fetal movements in addition to evaluation of FHR decelerations, accelerations as well as frequency and amplitude of oscillations. Patients were delivered electively after 38 weeks of gestation unless spontaneous labor began earlier or if delivery was indicated for either maternal reasons or presumed fetal distress. Fetal distress was believed to be present if two consecutive NST scores were 6 points or less. Seven patients had a day-to-day E3 fall of 50% or more at least once. Six of these patients had normal NST scores and 5 of the infants showed no signs of asphyxia at delivery. Forty-two patients had E3 drops of 30-50% and 27 patients had E3 drops of less than 30%; in contrast, the NST scores were 6 or less in 15 patients but were normal the next day. These data indicate that measurements of urinary excretion of E3 give many false alarms of fetal jeopardy and that daily NST can replace measurement of urinary excretion of E3 and reduce unwarranted intervention and unnecessary prematurity.

Estriol↗

PubMed1985

Gestational diabetes mellitus (GDM). Comparative evaluation of two treatment regimens, diet versus insulin and diet.

Two-hundred and two pregnant women with impaired glucose tolerance were randomized to treatment with diet or diet and insulin by stratified selection. Self-monitoring of blood glucose was performed six times a day, 3 days/wk. Dietary treatment was considered inappropriate if fasting and postprandial blood glucose values exceeded 7 and 9 mmol/L, respectively, in which case insulin therapy was instituted. Insulin doses were adjusted according to blood glucose values, aiming at fasting and postprandial values below 5 and 6.5 mmol/L, respectively. There were no perinatal deaths. The two treatment regimens disclosed no differences regarding achieved degree of maternal blood glucose control, hemoglobin A1c at delivery, obstetric or neonatal complications, infant's size at birth including skin-fold thickness, or C-peptide concentration in cord serum. Routine treatment of pregnant women with mild carbohydrate intolerance with insulin seems unnecessary. However, 15 patients (14%) in the diet group needed insulin to achieve acceptable blood glucose control, underlining the importance of monitoring blood glucose to detect those who are at risk of developing overt diabetes.

Adolescent↗

PubMed1985

Random capillary blood glucose and conventional selection criteria for glucose tolerance testing during pregnancy.

The normal variation of random capillary blood glucose values and the usefulness of elevated (greater than or equal to 6.5 mmol/l) blood glucose values as a selection criterion for oral glucose tolerance testing (OGTT) during pregnancy were investigated. A consecutive series of 1,500 pregnant women without signs or symptoms of diabetes and 81 pregnant women with conventional selection criteria for OGTT were studied. The mean blood glucose value was 4.66 mmol/l and the 95% tolerance interval of all blood glucose values was 2.93-6.38 mmol/l. Blood glucose levels were not influenced by time of day or trimester of pregnancy. A blood glucose value of 6.5 mmol/l or higher was found in 174 women, 10 of whom had an abnormal OGTT. Four of thirty women with glycosuria or signs of accelerated fetal growth and 7 of 81 women with conventional selection criteria had abnormal OGTT's. The incidence of carbohydrate intolerance during pregnancy was 1.3%. The results of this study suggest that an elevated (greater than or equal to 6.5 mmol/l) random capillary blood glucose value may be a good selection criterion for OGTT in addition to conventional selection criteria when screening for carbohydrate intolerance during pregnancy.

Adult↗

PubMed1984

Self-monitoring of blood glucose by diabetic women during the third trimester of pregnancy.

The clinical value of self-monitoring blood glucose in diabetic pregnancy at home was compared with hospital care in the thirty-second to thirty-sixth week of pregnancy in a prospective randomized study including 100 pregnancies in 97 patients (White's class B, 38; C, 25; D, 28; and F, 9) of which 54 were in the home group and 46 in the hospital group. The duration of pregnancy was not significantly different in two treatment groups, with a median duration of 266.0 days in the home group and 266.5 days in the hospital group. The mean blood glucose values during the study period were 5.9 mmol/L in the home group and 6.0 mmol/L in the hospital group, thus there were no significant group differences. There were no significant group differences in pregnancy complications; however, 10 of 54 (19%) had to interrupt home-monitoring because of pregnancy complications. The perinatal morbidity was not significantly different in the two treatment groups, with the following percentages of complications in the combined series: 4% idiopathic respiratory distress syndrome, 7% transient tachypnea, 2% symptomatic hypoglycemia, 16% hyperbilirubinemia, 22% feeding problems, and 10% erythrocytosis.

Blood Glucose↗