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Biomedical subjects

U Hanson

Publications and source records attributed to U Hanson.

At least 37 records · Page 2Linked to original sources
PubMed1993

Decreased beta-cell function in women with previous small for gestational age infants.

Insulin, proinsulin and C-peptide responses to intravenous glucose (glucose infusion test, GIT) and insulin sensitivity were measured in women who previously and for unexplained reasons gave birth to small-for-gestational-age infants (SGA, n = 10) or appropriate-for-gestational-age infants (AGA, n = 11). Insulin sensitivity was evaluated by two different methods, somatostatin-, insulin- and glucose infusion test (SIGIT) and Bergman's minimal model method applied to the frequently samples intravenous glucose tolerance test. The two groups were comparable with regard to age, parity and body mass index. The SGA group exhibited significantly (p < 0.01) lower early (0-10 min) and late (10-60 min) insulin, C-peptide and proinsulin responses during GIT than were seen in the control AGA group. Insulin sensitivity evaluated by the two techniques was increased in the SGA group, significantly so only with the minimal model method. The insulin sensitivity index (Si) according to Bergman was 10.98 +/- 2.10 in the SGA as compared to 4.36 +/- 1.18 x 10(-4)min-1 x uU-1 in the AGA group (antilogged values +/- 95% confidence intervals). Early insulin response (GIT) and Si values were inversely correlated (r = -0.48, p < 0.05).

Adult↗
PubMed1993

Outcome of pregnancies complicated by type 1 insulin-dependent diabetes in Sweden: acute pregnancy complications, neonatal mortality and morbidity.

This prospective nationwide study conducted during 1982-1985 examined the rates of hypertensive disorders, perinatal mortality and morbidity in 491 insulin-dependent diabetic pregnancies (White's classes: B, 164; C, 129; D, 172; F, 26) and in the total population of 279,000. The rates of pregnancy-induced hypertension (PIH) or pre-eclampsia (20.6%), premature delivery (24.6%), and cesarean section (45.2%) in the diabetic group were more than four times higher than normal. PIH or preeclampsia occurred significantly (p < 0.01) more frequently in patients with diabetic microangiopathy. Mean birthweight was similar in the two populations but gestational age was significantly (p < 0.001) shorter (38 weeks) in the diabetic group. The rate of large for gestational age infants (20%) in the diabetic group was considerably above normal (3.5%). Although perinatal mortality rate in the diabetic group was only 3.1%, it was 4.4 times higher than normal; five of ten fetal deaths were associated with poor glycemic control and thus may not really be unexplained. Neonatal morbidity was significantly more frequent in the diabetic group; still, the incidence of idiopathic respiratory distress syndrome was only 1.6% compared with 0.6% in the general population. Discriminant analysis revealed that gestational age at birth and elevated maternal HbA1c values in early pregnancy independently of each other had a significant impact on the occurrence of neonatal morbidity.

Diabetes Mellitus, Type 1↗
PubMed1993

Insulin dependent diabetes in pregnancy: impact of maternal blood glucose control on the offspring.

Definition of optimal glycaemic control in diabetic pregnancy may still be debated. Measures of glucose control (based on 4-6 daily glucose and frequent HbA1c values) were recorded in two series of diabetic pregnancies; one multicentre study (n = 92, 1979-82), and one study from our own institution (n = 113, 1983-85). The average pregnancy glucose levels were 5.9 mmol/L (third trimester only) and 6.5 mmol/L (all trimesters), respectively. Discriminant analysis (including pregnancy glucose, HbA1c, gestational age, diabetes duration and hypertension) revealed that gestational age only (first series) and gestational age and HbA1c independently of each other (second series) were significantly associated with the occurrence of severe neonatal morbidity present among 30 and 16.8% of the infants, respectively. The overall outcome was favourable. The findings of no perinatal mortality, normal premature delivery rate (8.9%) and a very low rate of severe maternal hypoglycaemia (4.4%) in series two support the feasibility of a strict but individualized management programme.

Animals↗
PubMed1992

Conservative treatment of mild and moderate hypertension in pregnancy.

In a prospective study regarding conservative treatment of mild to moderate hypertension in pregnancy 5244 women were evaluated at delivery. Two hundred and fifty-eight (4.9%) were registered as hypertensive during pregnancy with a blood pressure (BP) greater than or equal to 140/90 mmHg. One hundred and ninety-six of these continued their pregnancy without medication and 96/196 were defined as preeclamptic (PE), 45/196 as chronic hypertensive (CH), and 55/196 as having gestational hypertension (GH). In 62/258 women antihypertensive treatment was initiated in the mean 6.5 (+/- 8.7) days after onset of hypertension, due to a BP greater than or equal to 150/100 mmHg. There was a later onset of hypertension in the untreated group, and BP at delivery differed in the untreated groups (p less than 0.001) with the lowest BP in women with mild GH. There was no difference in cesarean section rate in the mild hypertensive group as compared to the normal population. Birth weight and length of pregnancy were significantly lower in the untreated mild hypertensive group as compared to normal pregnant women (p less than 0.05). But in the subgroup with mild GH pregnancy length and birth weight did not differ from normal pregnancy. The conclusion from our study is that women with mild hypertension in pregnancy might refrain from antihypertensive therapy if they are closely observed during pregnancy and delivery, especially if there has been no hypertension before pregnancy and no proteinuria develops.

Adult↗
PubMed1991

Antenatal nonstress test in complicated and uncomplicated pregnancies in type-1-diabetic women.

111 pregnant women with type-1 diabetes were cared for at the Karolinska Hospital from 1979 to 1986. As routine fetal monitoring, a non-stress test (NST) was performed twice weekly from the 35th or 36th week of gestation to delivery. If pregnancy complications occurred, an NST was still used for fetal monitoring, but more frequently. The median gestational age at delivery was 270 days. The mean maternal blood glucose during the third trimester was 6.0 mmol/l. In 88 of the totally 111 women the only indication for an NST was the patient's diabetes. In this routinely monitored group, 2/88 patients had abnormal NSTs and cesarean sections were performed. The neonatal outcome was good in both cases. Twenty-three had such complications as pre-eclampsia or IUGR, and in these cases the frequency of an NST was individualized. Four of these 23 had abnormal NSTs leading to cesarean sections. There were no signs of asphyxia among these four infants. Thus, in diabetic pregnancies with a well-regulated blood glucose, intervention due to abnormal fetal monitoring is more associated with acute pregnancy complications than the diabetes per se. The results of this study suggest that antenatal NSTs twice a week from week 35-36 is sufficient in well blood-glucose regulated type-1-diabetic women with a well-regulated blood glucose. If pregnancy complications occur, the NST, in an individualized frequency, seems to be a safe way of fetal monitoring.

Blood Glucose↗
PubMed1991

Follow-up of women with previous GDM. Insulin, C-peptide, and proinsulin responses to oral glucose load.

Gestational diabetes mellitus (GDM) is a strong predictor of glucose intolerance later in life. Former GDM (n = 145) and control (n = 41) subjects were studied 3-4 yr after the index pregnancy. They were subjected to a 75-g oral glucose tolerance test (OGTT) with measurements of insulin, C-peptide, and proinsulin in the basal state and every 30 min for 180 min. In the former GDM group, 5 subjects (3.4%) had developed non-insulin-dependent diabetes mellitus (NIDDM), and 32 (22%) had developed impaired glucose tolerance (IGT; by World Health Organization criteria). In the control group, 2 (4%) had IGT. In the GDM group, IGT or NIDDM was significantly associated with obesity (body mass index [BMI] greater than or equal to 25 kg/m2) and earlier diagnosis of GDM during pregnancy (P less than 0.001). Nonobese (BMI less than 25 kg/m2) GDM subjects with normal glucose tolerance at follow-up had significantly higher mean glucose (P less than 0.01), insulin (P less than 0.05), and proinsulin (P less than 0.001) values during the OGTT than control subjects, whereas there was no significant difference in C-peptide values. A comparison between control subjects with normal OGTT and BMI less than 25 kg/m2 (n = 39) and GDM subjects (n = 39) selected to have a comparable area under the glucose curve, BMI, and age demonstrated no group differences in glucose, C-peptide, or insulin levels, whereas the proinsulin levels were significantly higher (P less than 0.001) during the glucose load. The molar ratio between proinsulin and insulin was also significantly higher among the former GDM subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

A simplified model for management of women with gestational diabetes at the primary care level.

A simplified model for management of women with gestational diabetes mellitus (GDM) that could be applied at the level of the primary antenatal care was evaluated. Two groups were compared: group I included 172 consecutive GDM subjects cared for at the hospital-based specialized antenatal clinic 1984-85. Group II included 149 consecutive GDM subjects cared for at the primary antenatal clinics 1985-86. Both groups were instructed in self-monitoring of blood glucose and were given dietary instructions. Insulin treatment was initiated if blood-glucose exceeded 9 mmol/l post-prandially three times a week. While women in group II mainly were cared for by midwives, following the routine antenatal program, women in group I were seen every two weeks by an obstetrician and non-stress tests were performed twice weekly from gestational week 35. There were no significant differences with respect to the number of women who required insulin treatment, rate of pregnancy complications or mode of delivery. There were two intrauterine deaths, one in each group, both were unrelated to GDM. There were no group differences regarding large-for-gestational-age infants, respiratory disturbances, neonatal hypoglycemia, hyperbilirubinemia or polycythemia. We conclude that an effective care of GDM-women can be achieved at the primary care level provided frequent self-monitoring of blood glucose is performed for early detection of insulin requiring diabetes.

Adult↗
PubMed1990

Relationship between haemoglobin A1C in early type 1 (insulin-dependent) diabetic pregnancy and the occurrence of spontaneous abortion and fetal malformation in Sweden.

This prospective nationwide study examined the relationship between diabetic control in early pregnancy as assessed by HbA1C and the incidence of spontaneous abortion and fetal malformation. HbA1C and plasma C-peptide were determined in 532 women with Type 1 (insulin-dependent) diabetes mellitus, corresponding to approximately 80% of all the diabetic pregnancies in the country during the study period 1982-1985, and 222 non-diabetic control women. Median gestational week for sampling was 9.0 in the Type 1 diabetic and 10.0 in the control group. The median value of HbA1C was 7.7% in the diabetic and 5.3% in the control group (p less than 0.001). The rates of spontaneous abortion, 7.7% vs 7.2%, and malformation, 4.3% (major 2.0%) and 2.4% (major 1.0%), were not significantly different between the diabetic and control group, respectively. These rates of malformation were not significantly different from the national figures of 4.55% (major 1.75%). Much elevated HbA1C, i.e., greater than 10.1% equal to 8 SD above the normal mean control value, was significantly associated with the occurrence of spontaneous abortion (p less than 0.001) and malformation (p less than 0.01). Discriminant analysis revealed that after correction had been made for the significant value of HbA1C to predict the occurrence of spontaneous abortion and malformation, no further predictive power was displayed by measurable plasma C-peptide, maternal age or duration of diabetes or presence of diabetic microangiopathy. We conclude that poor metabolic control in early pregnancy contributes to an increased risk of both spontaneous abortion and fetal malformation.

Abortion, Spontaneous↗
PubMed1989

A longitudinal study of circulating progesterone, oestradiol, hCG and hPL during pregnancy in type 1 diabetic mothers.

Serum progesterone, oestradiol, human chorionic gonadotrophin (hCG) and human placental lactogen (hPL) were determined serially throughout 27 pregnancies in insulin-dependent diabetic patients from Newcastle (UK), 15 such patients from Stockholm (Sweden) and in 69 normal women having uncomplicated pregnancies. Mean progesterone, oestradiol and hCG concentrations were somewhat higher in the diabetic women during the third trimester but hPL values were not different from normal. The increased hormone concentrations did not relate to the increased birthweights or placental weights in the diabetic women. It is suggested that the usual physiological endocrine changes during normal pregnancy are relatively undisturbed by insulin-dependent diabetes or the degree of diabetes control achieved.

Adult↗
PubMed1989

Factors influencing neonatal morbidity in gestational diabetic pregnancy.

The influence of obstetric factors and indices of maternal blood glucose control on neonatal morbidity was examined in 261 women with gestational diabetes. A reference group of 218 women, matched for age and day of delivery, within 1 week, was used for comparison. Perinatal morbidity was significantly more frequent in the gestational diabetic pregnancies (23%) than in the reference group (13%), whereas the occurrence of large-for-gestational-age infants was not different between the groups. Infants born to women with gestational diabetes were categorized to a no-morbidity group (n = 200) and a morbidity group (n = 61). The group with morbidity had significantly shorter gestational age at delivery, higher frequency of caesarean section, higher maternal pre-pregnancy weight and higher area under the glucose tolerance curve. There was no significant difference in third-trimester blood glucose between the groups. Discriminant analysis revealed that the most significant influence on neonatal morbidity was gestational age at delivery. After correction for this factor the only factor with added significance for neonatal morbidity was maternal pre-pregnancy weight. The present study clearly illustrates that other factors beside blood glucose control are of importance for neonatal outcome in gestational diabetic pregnancy.

Adult↗
PubMed1989

A comparative evaluation of the 75 G OGTT and the 50 G OGTT during pregnancy.

The aim of the present study was to establish reference values for the diagnosis gestational diabetes (GD) by the 75 g OGTT using the 3 hr 50 g OGTT as a reference. Women with an area of greater than or equal to 42 AU in the 50 g OGTT were regarded as gestational diabetics. Sixty-one women with a 3 hr area of greater than or equal to 39 AU in the 50 g OGTT were subject also to a 3 hr 75 g OGTT within one week. 25/61 had GD according to the result of the 50 g OGTT. The 2 hr concentration in the 75 g OGTT had the highest correlation (r = 0.62, p less than 0.001) to the 3 hr-area in the 50 g OGTT. A 2 hr B-glucose concentration of greater than or equal to 8.0 mmol/l in the 75 g OGTT will give about the same number of GD patients (25/61) as a 3 hr-area of greater than or equal to 42 in the 50 g OGTT and have an acceptable sensitivity without too low specificity.

Adult↗
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↗
PubMed1987

Glucose tolerance, insulin release, and insulin sensitivity in normal-weight women with previous gestational diabetes mellitus.

Out of 57 women with previous histories of gestational diabetes (GD), 23 were of normal weight postpartum and willing to participate in three studies characterizing oral glucose tolerance (OGTT), insulin responsiveness to intravenous glucose (glucose infusion test, GIT), and insulin sensitivity (somatostatin, insulin, and glucose infusion test, SIGIT). The experiments were performed 6-36 mo after cessation of breast-feeding. The control group comprised 10 healthy women with normal OGTT matched for age and weight. Among subjects with previous histories of GD, 9 had normal, 8 borderline, and 6 decreased OGTT. As a group, women with previous histories of GD have significantly decreased insulin response and insulin sensitivity. Furthermore, all 14 with borderline and decreased OGTT demonstrated a low early insulin response during GIT (5-min value below the upper border of the lower quartile of normals), whereas insulin sensitivity was normal in 6 and low in 8 (glucose values attained during SIGIT were lower or higher, respectively, than the lower border of the upper quartile of controls). The women with previous histories of GD and normal OGTT exhibited normal (n = 4) and low (n = 5) insulin responses. Three of the former subjects had low and the remaining 6 had normal insulin sensitivity. In conclusion, as many as 60% of normal-weight women with previous histories of GD had borderline or decreased OGTT 6-36 mo postpartum. This derangement could be due to impaired early insulin response, which in some subjects was combined with low insulin sensitivity. Follow-up of women with previous histories of GD might enlighten the pathogenesis of non-insulin-dependent diabetes mellitus.

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

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↗
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↗
PubMed1984

Oral glucose tolerance test in pregnancy. Evaluation of a simplified procedure.

After initial screening for gestational diabetes, 182 3-hour OGTTs in altogether 168 patients with determination of plasma glucose at 30-minute intervals were performed. Two-hour and 3-hour areas below the curve were calculated. Twenty-two patients had a reduced glucose tolerance test as judged by the 3-hour areas. Twenty of the 22 patients had a reduced glucose tolerance even according to the 2-hour areas. The correlation coefficient between the 3-hour areas and the 2-hour areas was 0.97. In 160 observations plasma glucose and capillary blood glucose were compared. The correlation coefficient between plasma glucose and capillary blood glucose concentrations was 0.99. It is concluded that the discriminatory power of the 2-hour OGTT with capillary blood glucose determinations is comparable to that of the 3-hour OGTT with venous plasma glucose determinations. The simplicity of the suggested method makes it suitable for use in instances with moderate or small laboratory resources.

Blood Glucose↗