Could blood ketone monitoring be a tool for managing gestational diabetes mellitus?
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Adult↗
Biomedical subjects
Pierre Fontaine
Publications and source records attributed to Pierre Fontaine.
[Gestational diabetes].
Gestational diabetes represents 6% of all pregnancies and appears even in women without risk factors. This is in favour of a systematic screening between 24th and 28th weeks of gestation. There is as yet still no consensus concerning screening and diagnosis criteria but in France the guidelines are a two step approach: an O'Sullivan test > or = 7.15 mmol/L and a 100 g oral glucose tolerance test (OGTT). Gestational diabetes is defined by 2 or more abnormal values of the OGTT (Carpenter and Coustan criterias). Gestational diabetes has feto-maternal implications: on the one hand gravid hypertension and caesarean section, on the other hand macrosomia, respiratory distress and metabolic complications. The therapeutic management is first diet but insulin therapy is necessary in 40% of cases to obtain glycemic control. During the second part of pregnancy, to obtain a normoglycaemia can decrease and even normalise the rate of feto-maternal complications. Long-term management of women with gestational diabetes and treatment modalities also require better definition, since these patients are at risk for diabetes, mainly type 2. Diabetologists have to set prevention programs up.
Diabetes, Gestational↗
Evidence for adequate thymic function but impaired naive T-cell survival following allogeneic hematopoietic stem cell transplantation in the absence of chronic graft-versus-host disease.
Allogeneic hematopoietic stem cell transplantation (AHSCT) leads to a prolonged state of immunodeficiency characterized by low peripheral naive T-cell counts. To identify the mechanisms leading to this defect we quantitatively and qualitatively analyzed thymic function through quantification of T-cell receptor excision circle (TREC) frequencies (both the signal-joint TREC [sjTREC] and 6 different DbetaJbeta TRECs, by-products of T-cell receptor [TCR] alpha and beta gene rearrangement, respectively), in conjunction with immunophenotype and spectratype analyses in a cohort of patients sampled from 1 to 10 years following AHSCT. In this cohort, reduced thymic function was associated only with ongoing clinical chronic graft-versus-host disease (cGVHD). Nonetheless, the diversity of thymic production remained unchanged irrespective of the patient's cGVHD status. Interestingly, increased homeostatic proliferation was found in the naive T-cell compartment of cGVHD- patients who underwent transplantation. However, reduced expression of both the interleukin-7 receptor alpha (IL-7Ralpha) (CD127) chain and the antiapoptotic protein Bcl-2 was observed. Taken together, these data indicate that the inability to reconstitute the naive T-cell compartment for several years after AHSCT, in the absence of cGVHD, is a consequence of impaired naive T-cell survival rather than thymic dysfunction.
Adult↗
French multicentric survey of outcome of pregnancy in women with pregestational diabetes.
OBJECTIVE: To evaluate perinatal outcome in pregnancies in women with type 1 and type 2 diabetes and the influence of preconception care 10 years after the St. Vincent's declaration. RESEARCH DESIGN AND METHODS: A cross-sectional study was conducted in 12 perinatal centers in France in 2000-2001. The main investigated outcomes were perinatal mortality, major congenital malformations, and preterm delivery. RESULTS: Among 435 single pregnancies, 289 (66.4%) were from women with type 1 and 146 (33.6%) from women with type 2 diabetes. Perinatal mortality rate was 4.4% (0.7% national rate), severe congenital malformations rate was 4.1% (2.2% national rate), and preterm delivery rate was 38.2% (4.7% national rate). Preconception care was provided in 48.5% women with type 1 diabetes and in 24.0% women with type 2 diabetes. Women whose first trimester HbA(1c) was >8% had higher rates of perinatal mortality (9.2 vs. 2.5%; odds ratio 3.9; 95% CI 1.5-9.7; P < 0.005), major congenital malformations (8.3 vs. 2.5%; 3.5; 1.3-8.9; P < 0.01), and preterm delivery (57.6 vs. 24.8%; 1.4; 1.1-1.7; P < 0.005) than those with first trimester HbA(1c) <8%. These results are similar to those reported in France in 1986-1988. CONCLUSIONS: Pregnancies in women with diabetes are still poorly planned and complicated by higher rates of perinatal mortality and major congenital malformations. Despite knowledge of the importance of intensified glycemic control before pregnancy, reaching the St. Vincent's target needs further implementation in France.
Cross-Sectional Studies↗