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PubMed1995

Whole-body protein turnover in preterm appropriate for gestational age and small for gestational age infants: comparison of [15N]glycine and [1-(13)C]leucine administered simultaneously.

Measurements of whole-body protein turnover in preterm infants have been made using different stable isotope methods. Large variation in results has been found, which could be due to different clinical conditions and/or the use of different tracers. We studied 14 appropriate for gestational age and nine small for gestational age orally fed preterm infants using [15N]glycine and [1-(13)C]leucine simultaneously, which allowed us to make a comparison of commonly used methods to calculate whole-body protein turnover. Whole-body protein turnover was calculated from 15N enrichment in urinary ammonia and urea after [15N]-glycine administration and from the 13C enrichment in expired CO2 after administration of [1-(13)C]leucine. Enrichment of alpha-ketoisocaproic acid after [1-(13)C]leucine constant infusion was measured as a direct parameter of whole-body protein turnover. Group means for whole-body protein turnover using [15N]glycine or [1-(13)C]leucine ranged from 10 to 14 g.kg-1.d-1, except when using the end product method that assumes a correlation between leucine oxidation and total nitrogen excretion. We found very low 15N enrichment of urinary urea in the majority of small for gestational age infants. These infants also had a lower nitrogen excretion in urine and oxidized less leucine. Nitrogen balance was higher in small for gestational age infants (416 +/- 25 mg.kg-1.d-1) compared with appropriate for gestational age infants (374 +/- 41 mg.kg-1.d-1, p = 0.003). [15N]Glycine does not seem to exchange its label with the body nitrogen pool to a significant degree and is therefore not always suitable as a carrier for 15N in protein turnover studies in premature infants.

Ammonia↗

PubMed1993

Effect of calcium source, dietary calcium concentration, and gestation phase on various bone characteristics in gestating gilts.

Sixty gravid crossbred gilts were allotted to a 2 x 3 x 2 factorial arrangement of treatments: two Ca sources (sun-cured alfalfa meal and CaCO3), three dietary concentrations of Ca (50, 75, and 100% of NRC requirements), and two phases of gestation (55 and 105 d). The objectives were to determine the effect of Ca source, dietary Ca concentration, and gestation phase on bone characteristics (bone breaking strength, bone ash percentage, bone density, and bone ash density in the rib, thoracic, and coccygeal bones), to correlate bone responses to determine relative bone activity, and to determine reliability of the coccygeal bones as indicators of Ca status in the body. At 55 d, rib strength and coccygeal ash content were lower (P < .01) than at 105 d of gestation. A gestation phase x Ca concentration (P < .05) interaction occurred. As Ca concentration increased, thoracic strength and rib ash responded quadratically during each gestation phase, for which at 55 d a minima and at 105 d a maxima was produced at 75% of NRC. A Ca source x Ca concentration (P < .05) interaction occurred. Gilts fed alfalfa had the lowest rib bone and ash density when fed 75% of NRC for Ca, whereas gilts fed CaCO3 were highest at this level of Ca compared with the other concentrations. Generally, all bones were positively correlated with respect to their response to dietary Ca concentration. Few negative correlations were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Feed↗

PubMed1984

Influence of protein intake, energy intake and stage of gestation on growth, reproductive performance, nitrogen balance and carcass composition in gestating gilts.

Thirty-six crossbred gilts were fed three levels of protein (146, 255 and 364 g/d) and two levels of energy (6,200 and 7,440 kcal of digestible energy/d) throughout gestation in a 3 x 2 factorial arrangement of treatments. Five-day N balance studies were conducted in early (0 to 30 d), mid- (30 to 60 d) and late (60 to 90 d) gestation. At slaughter (90 d of gestation), reproductive tracts were weighed and evaluated for reproductive performance and samples of the reproductive tract, liver and semimembranosus muscle (SM) were analyzed for crude protein. The right half of the carcass was subjected to a physical separation of fat, lean and bone. Neither dietary protein nor energy level significantly affected weight gain or reproductive performance. Nitrogen retention increased as dietary protein level increased and stage of gestation progressed (linear effect, P less than .01), but efficiency of N utilization and dry matter digestibility decreased with increasing protein intakes (quadratic effect, P less than .05 and linear effect, P less than .01, respectively). Nitrogen retention (P less than .01), efficiency of N retention (P less than .05) and dry matter digestibility (P less than .01) were higher in gilts fed high (H) energy compared with gilts receiving moderate (M) energy diets. Increasing dietary protein increased total carcass separable lean tissue (quadratic effect, P less than .01), liver weight (linear effect P less than .01) SM weight (quadratic effect, P less than .05) and SM percentage M (linear effect P less than .10). Similarly, total carcass N and carcass lean N increased as protein level increased (quadratic effect, P less than .10, P less than .05, respectively). In contrast to the increase in muscle N, N in uterine tissue and fluids was not affected by dietary protein level. The results of this experiment suggest that 146 g of crude protein/d during gestation is just as effective as higher levels of crude protein for litter size or storage of N in reproductive tissue, but 255 to 364 g of protein/d are required to maximize muscle N.

Animals↗

PubMed1993

Gestational and non-gestational trophoblastic neoplasms: new developments in DNA analysis, metabolic function, diagnosis and treatment.

Recent technological advances have made it possible to further define important molecular biological characteristics of gestational and non-gestational trophoblast neoplasm, as they relate to genetic origin and metabolic, endocrine, and diagnostic functions. Exciting new work with DNA analysis has defined origins of placental site trophoblastic tumors, a variant of choriocarcinoma not previously well understood. Coexistent hydatidiform mole and normal gestation have been diagnostically defined and carried out to viability. Finally, refinement of classification systems and expanded tumor markers offer promise of improved salvage in gestational neoplasms and an enlarging number of non-gestational neoplasms.

DNA, Neoplasm↗

PubMed1988

The premature small-for-gestational-age infant during the first year of life: comparison by birth weight and gestational age.

To determine the effect of intrauterine growth retardation on the outcome of the premature infant, we compared a group of 35 premature, small-for-gestational-age (SGA) infants with two groups of premature, appropriate-for-gestational-age (AGA) infants: one with similar birth weight (AGA-BW group) and the other with similar gestational age (AGA-GA group). Groups were matched by year of birth, race, gender, and socioeconomic status. Infants were free of major congenital anomalies and intrauterine infection. They were evaluated at term, at 20 and 40 weeks, and at 1 year corrected age. The SGA infants had a lower mean developmental quotient than the two groups of AGA infants. The SGA infants had significantly smaller body dimensions at birth, more nursery complications, and a higher incidence of major neurologic problems than their AGA-GA matches but were comparable to the AGA-BW matches. Poor growth constitutes an additional risk factor to prematurity. The results highlight the importance of comparing premature SGA infants with premature AGA infants of similar gestational age rather than similar birth weight.

Birth Weight↗

PubMed1996

Induction of labor at 38 to 39 weeks of gestation reduces the incidence of shoulder dystocia in gestational diabetic patients class A2.

The purpose of this study was to test the hypothesis that the incidence of shoulder dystocia could be reduced in insulin-requiring diabetic women by elective induction of labor at 38 to 39 weeks of gestation. A prospective study protocol in which labor was induced at 38 to 39 weeks of gestation in insulin-requiring diabetic women was executed between January 1, 1990, and July 31, 1994 (n = 96). The outcome was compared to the results of a previous protocol (years 1983 to 1989) in which the pregnancies were allowed to progress to spontaneous labor, unless fetal health became compromised (n = 164). The incidence of shoulder dystocia in patients in whom labor was electively induced at 38 to 39 weeks of gestation was 1.4% as compared to 10.2% in patients who delivered beyond 40 weeks' gestation (p < 0.05). No increase in cesarean section rate was demonstrated. We conclude that elective induction of labor is suggested for insulin-requiring diabetic women in order to reduce the incidence of shoulder dystocia.

Adult↗

PubMed1989

Classification of small-for-gestational age births: weight-by-gestation standards of second birth conditional on the size of the first.

Percentiles of weight-by-gestational age were constructed for first and second births, based on linked sibship-data from the Medical Birth Registry of Norway. Standards were made for weight-by-gestational age of second births conditional on whether the first birth was small-for-gestational age (SGA) or large-for-gestational age (LGA). These standards were compared with the conventional, cross-sectional standard of all second births. The relevance of the conditional standards was assessed on the basis of perinatal mortality, using logistic regression analyses. When applying cross-sectional standards of second births, more than 30% of the births following a SGA first birth were classified as SGA, compared with only 1.7% following an LGA first births. The overall risk for a perinatal loss in second births following a SGA first birth was twice that among second births following a LGA first birth. When second births were themselves categorised as SGA or non-SGA using the cross-sectional standards, the mortality among the SGA second births was such that the risk was 4 to 5 times higher following LGA first births compared with SGA first births. When conditional standards were applied to define SGA among second births, the risk relation between the subgroups (defined by classification of first birth) corresponded to the observed overall risk pattern. An unconditional SGA classification conceals important differences between clinically distinct subgroups.

Birth Weight↗

PubMed1988

The relationship between large-for-gestational-age infants and glycemic control in women with gestational diabetes.

In this prospective study 246 women with gestational diabetes were followed up to determine the characteristics of metabolic control associated with large-for-gestational-age infants. Memory-based reflectance meters were used for self-monitoring blood glucose. Ambulatory glucose profiles were produced to characterize glycemic control levels throughout pregnancy. With these novel approaches to the collection and representation of glucose data, the severity of glucose intolerance (hyperglycemia) was found to be associated with both maternal and neonatal morbidity in terms of infant size and cesarean section rate. By use of hierarchical cluster analysis to identify three groups on the basis of control levels (low less than 87 mg/dl, mid 87 to 105 mg/dl, high greater than 105 mg/dl) we were able to show a positive outcome in the low group with reduced rates of large-for-gestational-age (2%) and macrosomatic (0%) infants. Furthermore, we showed that as mean blood glucose levels and instability in glycemic control increased from group to group, incidence of large-for-gestational-age and macrosomatic infants increased. Whereas obesity increased the relative risk of adverse neonatal outcome, type of treatment (insulin versus diet) did not appear to be significant. Appropriately monitored toward stability within a narrow range to achieve tight metabolic control, ambulatory glycemia in pregnancy is associated with a decreased risk of maternal and fetal complications.

Blood Glucose↗

PubMed1994

Impact of time since last meal on the gestational glucose challenge test. The Toronto Tri-Hospital Gestational Diabetes Project.

OBJECTIVE: The purpose of the study was to evaluate the impact of time since the last meal on the glucose challenge test and to find cut points that are most likely to predict the outcome of the oral glucose tolerance test in patients screened for gestational diabetes. STUDY DESIGN: This prospective analytic cohort study was carried out at the University of Toronto Perinatal Complex. A 50 gm glucose load was given at 26 weeks' gestation and the time since previous meal ingestion was recorded. At 28 weeks' gestation a 100 gm oral glucose tolerance test was administered. A total of 4274 eligible patients were screened. RESULTS: Time since the last meal had a marked effect on mean plasma glucose. Receiver-operator characteristic curve analysis with National Diabetes Data Group criteria to interpret the oral glucose tolerance allowed the selection of the most efficient cut points for the glucose challenge test on the basis of time since the last meal. These cut points were 8.2, 7.9, and 8.3 mmol/L for elapsed postprandial times of < 2, 2 to 3, and > 3 hours, respectively. With this change from the current threshold of 7.8 mmol/L the number of patients with a positive screening test dropped from 18.5% to 13.7%. There was an increase in positive predictive value from 14.4% to 18.7%. The rate of patient misclassification fell from 18.0% to 13.1%. CONCLUSION: We suggest that screening strategies for detection of gestational diabetes be reconsidered, to account for the impact of variable postprandial status on the test results.

Adult↗

PubMed1996

Early gestational mesencephalon grafts, but not later gestational mesencephalon, cerebellum or sham grafts, increase dopamine in caudate nucleus of MPTP-treated monkeys.

The mechanism of the behavioral improvement observed in parkinsonian primates that receive intrastriatal transplants of fetal dopamine neurons has not been firmly established. Dopamine production by grafted neurons may be the basis of the behavioral recovery. Alternatively, stimulation of the host dopamine system by the transplant procedure itself may be central to the outcome. The present study examined whether dopamine concentration was raised in the caudate nucleus of the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated primate following grafting, and if so, whether the elevation was dependent on either (i) the introduction of the implantation cannula (sham), (ii) the brain region that was grafted, or (iii) the gestational age of fetal tissue that was grafted. Transplantation of early gestational age fetal ventral mesencephalon (embryonic days 40-50) was associated with significant elevation of caudate nucleus dopamine concentration to a mean of approximately 20% of control values in the vicinity (within 2 mm) of the graft, compared with more distant sites in the caudate nucleus. With early gestational age fetal ventral mesencephalon, the ratio of homovanillic acid/dopamine concentration near the graft site was normalized compared to the elevated value found in the caudate nucleus distant from the graft site. Grafts of later stage fetal ventral mesencephalon, or fetal cerebellum, or sham implantation did not increase dopamine concentration or lower homovanillic acid/dopamine ratio near the graft site. Biochemical and histochemical evidence suggests that host dopamine neurons terminating in the nucleus accumbens are not the source of the changes. Numerous tyrosine hydroxylase-positive neurons at the graft site were only observed in the MPTP-treated monkeys that received grafts of early gestational age fetal ventral mesencephalon. These data lend strong support to the hypothesis that dopamine derived from grafted dopamine neurons is the major basis for behavioral recovery observed following intrastriatal transplantation in our MPTP-treated monkeys.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗

PubMed2006

Low-molecular-weight heparin improves the performance of uterine artery Doppler velocimetry to predict preeclampsia and small-for-gestational age infant in women with gestational hypertension.

This study investigated whether a short course of subcutaneous low-molecular-weight heparin (LMWH) might modify the performance of uterine artery Doppler to predict preeclampsia and small-for-gestational age (SGA) newborns in a high-risk population. A controlled, open-labeled study included 94 women with gestational hypertension and 30 healthy women enrolled at 24 to 26 weeks gestation. Doppler evaluation of uterine arteries resistance index (RI) was performed before and after a two-week course of LMWH (enoxaparin, 4000 IU/d, n = 56 hypertensive patients) or no treatment (n = 38 hypertensive women and 30 healthy controls). There was a significant decrease of uterine artery RI after LMWH (p < 0.001, paired Student's t-test), whereas the untreated hypertensive patients and the healthy control group showed no change between the two Doppler evaluations. The change induced by LMWH was restricted to women with normal outcome, whose RI decreased from (mean +/- standard error) 0.62 +/- 0.01 to 0.56 +/- 0.01 (p < 0.0001). By consequence, the second RI measurement, performed after LMWH administration, had fewer false positive results and higher positive likelihood ratios (LR+) to predict both preeclampsia (LR + 5.91) and SGA (LR + 4.69) compared with the first Doppler examination (LR + 1.97 and 2.22, respectively). Thus, LMWH improved the performance of uterine artery RI to predict preeclampsia and SGA in women with gestational hypertension.

Adult↗

PubMed1997

Gestational and pre-gestational diabetes: comparison of maternal and fetal characteristics and outcome.

OBJECTIVE: To determine the incidence of antenatal and intrapartum maternal and fetal complications of gestational diabetes mellitus (GDM) and compare them with pre-gestational diabetes mellitus (pre-GDM) and non-diabetic pregnancies in our population. STUDY DESIGN: Nine-hundred and seventy-two women with gestational diabetes mellitus and 71 women with pre-gestational diabetes mellitus, and their offspring (delivered in our hospital between January 1991 and April 1994) were studied. Maternal and fetal prenatal and intrapartum complications were analyzed. RESULTS: The incidence of GDM was 9.8%. The maternal complications included higher incidences of cesarean section and perineal lacerations in GDM and pre-GDM patients than in the non-diabetic pregnancies, and higher rates of macrosomia and hypoglycemic episodes in their offspring. CONCLUSION: The incidence of maternal, fetal and neonatal complications in GDM is similar to pre-GDM patients and their offspring. Both GDM and pre-GDM pregnancies and the offspring should, therefore, be monitored and managed identically.

Adult↗

PubMed1998

Twin gestation: is there a correlation between the location of the gestational sacs at the beginning of pregnancy, and the order of delivery.

OBJECTIVES: To determine whether there is a dynamic in the location of amniotic sacs in a twin gestation, during pregnancy. STUDY DESIGN: The study group comprised 63 twin pairs discordant for sex, who by vaginal sonography performed between 14 and 16 weeks' gestation, were characterized as first twin (opposite the internal os), and second twin. The order of delivery was recorded in the pregnancies that ended with vaginal birth. RESULTS: Thirty seven of 41 (90.2%) twins who were delivered vaginally (between 32 and 41 weeks' gestation), were born in the same order as that predicted by transvaginal sonography early in pregnancy. It was found that in this small series there was a dynamic in the amniotic sac location in twin gestations during pregnancy in only about 10% of the cases. CONCLUSIONS: In roughly 90% of twins, there is no dynamic in the location of the amniotic sacs during pregnancy, and the first twin at the beginning of pregnancy intrinsically remains.

Adult↗

PubMedDate not supplied

Elevated lipoprotein lipids and gestational hormones in women with diet-treated gestational diabetes mellitus compared to healthy pregnant controls.

The objective of this study was to describe plasma and lipoprotein perturbations in gestational diabetes mellitus (GDM) compared to controls, and determine if alterations in lipids are related to gestational hormones and/or glucose control. Maternal HbA1c, free fatty acids (FFA), beta-estradiol, progesterone, prolactin, and plasma, very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), high-density lipoprotein (HDL), HDL2 and HDL3 triglyceride (TG), cholesterol, and dietary intake were determined for women with diet-treated GDM and controls in a longitudinal design. Subjects (N = 25/group) were matched for age, race, and body-mass index (BMI). Women with GDM had significantly higher HbA1c than controls, although both groups were within the normal range (4%-6%). However, body weight gain was less for women with GDM. There was a trend for higher plasma FFAs at 37-38 weeks in GDM versus controls. Plasma and lipoprotein TG among the groups increased over the third trimester, and mean concentrations were greater for women with GDM. In GDM versus controls, VLDL and HDL3 TGs were higher at all times, HDL and HDL2 TGs at 33-34 and 37-38 weeks, and LDL TGs at 37-38 weeks. In VLDL, core lipids (TG + cholesterol) increased over gestation and were greater in GDM. In HDL, the TG/cholesterol ratio was greater in GDM. In GDM versus controls, plasma progesterone and prolactin were higher at all times; beta-estradiol was elevated at 37-38 weeks. HbA1c, progesterone, and prolactin correlated with all lipoprotein TG fractions. Exaggerated hypertriglyceridemia, particularly in the VLDL and HDL fractions, is a feature of GDM. The increase in VLDL TG is likely due to an increase in VLDL synthesis, whereas particle enrichment in TG is a plausible explanation for changes in HDL TG. Slight perturbations in glucose control and gestational hormones in diet-treated GDM may contribute to the observed increase in plasma and lipoprotein TG.

Adult↗

PubMedDate not supplied

A prospective controlled study of neonatal morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-class Al).

OBJECTIVE: Infants of gestational diabetes mellitus (GDM)-A1 women are unlikely to experience the marked excursion in maternal glucose levels that may characterize insulin-requiring GDM (class-A2) or insulin-dependent diabetes (IDDM). However, infants born to GDM-A1 women are traditionally managed like infants born to GDM-A2 or IDDM women. AIMS: To examine monitoring protocols for infants of GDM-A1 women, and to examine the efficacy of early and frequent feedings to prevent and to treat hypoglycemia. METHODS: A total of 92 of 101 infants born to GDM-A1 women (diabetic group) and 68 of 83 infants born to nondiabetic women (control group) at > or=36 weeks of gestation were prospectively monitored for the development of hypoglycemia and other morbidities. Blood glucose screening was performed in the diabetic group every 30-60 minutes three times, starting soon after birth and then at 3-hour intervals for 24 hours. Liberal feedings were started shortly after birth and provided every 3 hours for at least 24 hours. All women with GDM-A1 had an HbA1c measured before delivery. RESULTS: Both the diabetic and control groups had similar demographics, including LGA incidence. Blood glucose readings before feedings were low (<40 mg/dl) in 24 of 92 infants (26.1%) from the diabetic group and in 20 of 68 control infants (29%). After the start of oral feedings, all but four diabetic and three control infants had subsequent glucose readings > or =40 mg/dl. No infant had symptoms of hypoglycemia and none from the diabetic group had birth trauma, hypoxic-ischemic encephalopathy, polycythemia, hypocalcemia, or hypomagnesemia. Hypoglycemic episodes in the infants from the diabetic group could be managed with oral feedings alone. Birth weight, gestational age, sex, Apgar scores, and maternal HbA1c levels could not predict low glucose readings on initial screening in infants from the diabetic group. CONCLUSION: The incidence of hypoglycemia in infants born to GDM-A1 women at > or =36 weeks of gestation is similar to control infants born to nondiabetic women. Low blood glucose levels during the first few hours of life can be prevented or treated with early and frequent oral feeding.

Diabetes, Gestational↗

PubMed2001

Sonographic assessment of amniotic fluid volume between 11 and 24 weeks of gestation: construction of reference intervals related to gestational age.

OBJECTIVE: At present, most of the methods for sonographic assessment of amniotic fluid volume are unreliable in the second trimester of pregnancy, or else they do not present nomograms related to gestational age. DESIGN: The aim of this prospective cross-sectional study was to construct normal reference ranges of four ultrasound parameters for the evaluation of amniotic fluid volume which could be applied in the second trimester. For these parameters we calculated normal curve limits suitable for use in clinical practice. SUBJECTS: From a population of normal pregnant women between the 12th and the 24th weeks of gestation undergoing a routine ultrasound examination during 1997 at our institute, 273 were found to be suitable for the study, after the exclusion of all cases which presented any feto-maternal pathology or complications up to the 24th week. METHODS: The largest 'amniotic pocket' in a vertical direction, free of small fetal parts and umbilical cord, was measured: the maximum vertical and transverse diameters were measured on the same scan; the mean diameter and the product of the two diameters were calculated. The 'mean amniotic fluid diameter', the 'two-diameter pocket', the 'largest vertical pocket' and the 'largest transverse pocket' were the four sonographic parameters considered. RESULTS: The four parameters correlated well with gestational week and with the biparietal diameter; the normal reference intervals and normal curve were then calculated. All these parameters were found to have good intra- and interoperative reproducibility. CONCLUSIONS: We conclude that the use of an ultrasound semiquantitative method based on the measurement of a single amniotic fluid pocket and involving normal reference intervals according to gestational age could improve the early diagnosis of amniotic fluid variations during the second trimester, although this has yet to be confirmed by extensive clinical trials.

Amniotic Fluid↗

PubMed2000

Determination of cytokine mRNA-expression in term human placenta of patients with gestational hypertension, intrauterine growth retardation and gestational diabetes mellitus using polymerase chain reaction.

OBJECTIVE: Our objective was to test the hypothesis, that pregnancy-related diseases are going along with changes in cytokine mRNA-expression at the placental site, either as a part of a pathological process or in connection with regulatory mechanisms induced by disturbances at the feto-maternal interface resulting from previous pathological changes--in the sense of counterregulation. MATERIAL AND METHODS: The cytokines chosen for this investigation are known to 1.) be expressed in the human placental tissue, 2.) to be involved in immunological processes and 3.) the regulation of growth and differentiation processes of different cell types of the placenta or decidua, 4.) to play a role in the angiogenesis at the feto-placental interface and 5.) to be involved in pathological processes in other human diseases. 32 samples derived from term human placentas were examined for messenger RNA levels of interleukin 1 alpha (II-1 alpha), tumor necrosis factor-alpha (TNF-alpha), platelet derived growth factor-A chain (PDGF-A), platelet derived growth factor-B chain (PDGF-B), and platelet derived growth factor receptor (PDGF-R) using a semiquantitative reverse transcriptase (RT) polymerase chain reaction (PCR) protocol. To calibrate samples in our procedure, beta-actin mRNA (messenger ribonucleic acid) known as a "house keeping" gene was proven to be constantly expressed. The sample-groups consisted of normal pregnancies (n = 8), gestational hypertension (GH, n = 7), intrauterine growth retardation (IUGR, n = 6), gestational diabetes mellitus (GDM, n = 5), and gemini (n = 3 x 2). RESULTS: Throughout the 32 samples, a significant correlation between PDGF-A and PDGF-R expression, PDGF-A and TNF-alpha expression was stated (p = 0.007). Compared with the pattern of expression in normal placentas, placentas of growth retarded pregnancies had higher Il-1 alpha mRNA (p = 0.016), PDGF-A (p = 0.029) and PDGF-B (p = 0.001) levels. The samples of the gestational hypertension group and placentas of patients with gestational diabetes displayed a significantly stronger PDGF-R mRNA signal (p = 0.0029 and p = 0.008). CONCLUSIONS: Though these marked differences in cytokine mRNA levels between clinical groups were statistically proven, clear correlation of these differences with clinical data was not found.

Actins↗

PubMed1995

Factors predictive of recurrent gestational diabetes diagnosed before 24 weeks' gestation.

The purpose of this study was to determine which patient and pregnancy characteristics in the first pregnancy complicated by gestational diabetes mellitus (GDM) were associated with the diagnosis of GDM before 24 weeks' gestation in a subsequent pregnancy--early recurrent GDM. The case notes of 180 women who previously had GDM diagnosed and who had glucose tolerance tests performed before 24 weeks' gestation in their next ongoing pregnancy were reviewed. Factors examined included severity of GDM, insulin requirement, racial origin, macrosomia, obesity, age, family history of diabetes, preeclampsia, and parity. Multivariate analysis showed that women with early recurrent GDM were more likely, in their first pregnancy with GDM, to have needed insulin (odds ratio [OR] 11.26; 95% confidence interval [CI] 2.02 to 62.65), to be more often of non-Northern European origin (OR, 5.53; 95% CI, 2.46 to 12.44), to have had a macrosomic infant (OR, 4.01; 95% CI, 1.40 to 11.49) or severe GDM (OR, 3.52; 95% CI, 1.60 to 7.76), and were more often 30 years or more of age (OR, 2.27; 95% CI, 1.05 to 4.90). Obesity, family history, fasting plasma glucose levels, and parity were not significant risk factors. However, even without any of the significant risk factors, logistic regression modeling suggested that a woman who has had GDM in a previous pregnancy has a 5.1% (95% CI, 2.2 to 11.6%) chance of having early recurrent GDM. We therefore continue to recommend that all women who have had GDM diagnosed previously should have glucose tolerance testing performed early (before 24 weeks' gestation) in any future pregnancies.

Adult↗