The aim of this study was to examine the importance of glycemic regulation on the risk of preterm delivery in women with normoal buminuria and no preeclampsia later in pregnancy. Study design and methods: A prospectiv...The aim of this study was to examine the importance of glycemic regulation on the risk of preterm delivery in women with normoal buminuria and no preeclampsia later in pregnancy. Study design and methods: A prospective study of 71 women with type 1 diabetes mellitus where complete data were collected on HbA1c, insulin dose, and albumin excretion rate from week 12 and every second week hereafter. Fundus photography was performed and diurnal blood pressure measured three times during pregnancy. Results: The preterm rate was 23% and women delivering preterm showed higher HbA1c throughout pregnancy. At regression analysis HbA1c was the strongest predictor for preterm delivery from week 6 to 32, also when including insulin dose, BMI, age, duration of diabetes, and diurnal blood pressure. The risk of delivering preterm was more than 40% when HbA1c was above 7.7% in week 8. Diurnal blood pressure was not found associated with preterm delivery. Conclusion: The quality of glycemic regulation in the early and mid pregnancy is a major, independent risk factor for preterm delivery in normoalbuminuric diabetic women without preeclampsia.展开更多
Objectives We sought to determine if the rate of preeclampsia is related to the severity of gestational diabetes mellitus (GDM), and if it can be decreased by optimizing glycemic control. Study design A retrospective ...Objectives We sought to determine if the rate of preeclampsia is related to the severity of gestational diabetes mellitus (GDM), and if it can be decreased by optimizing glycemic control. Study design A retrospective analysis of prospectively collective data of 1813 patients with GDM was performed to determine the rate of preeclampsia. Patients were stratified after treatment was begun by level of glycemic control (well controlled was defined as mean blood glucose < 95 mg/dL). The extent of hyperglycemia was analyzed by the level of the abnormality in the oral GTT and by the degree of abnormality of daily glucose control after treatment has begun. Severity of GDM was categorized using fasting plasma glucose (FPG) on a 3-hour oral GTT by 10 mg/dL increments. Results Overall, preeclampsia was diagnosed in 9.6%(174/1813) of diabetic patients. The GDM subjects who developed preeclampsia were significantly younger, had a higher nulliparity rate, were more obese, and gained significantly more weight during pregnancy. However, no difference was found in glycemic profile characteristics between the 2 groups. A comparison between patients with FPG <105 and FPG >105 revealed that the rate of preeclampsia increased significantly, 7.8%vs 13.8%, (O.R 1.81, 95%CI 1.3-2.51). For GDM patients with only mild hyperglycemia (FPG <105 mg/dL), no significant difference was found in the rate of preeclampsia. Preeclampsia rate was further evaluated in relation to level of glycemic control; for the wellcontrolled patients (mean blood glucose [MBG] <95 mg/dL, n=994), similar rates of preeclampsia were found between each category of FPG severity. In contrast, in poorly controlled patients (MBG >95 mg/dL, n=819), a comparison between severity threshold of FPG <115 and FPG >115 revealed that the preeclampsia rate was 9.8%vs 18%(O.R 2.56, 95%C.I. 1.5-4.3). In a logistic regression model, only prepregnancy BMI (O.R 2.3, 95%CI 1.16-2.30) and severity of GDM (O.R 1.7, 95%CI 1.21-2.38) were independently and significantly associated with an increased risk of preeclampsia. Conclusion The rate of preeclampsia is influenced by the severity of GDM and prepregnancy BMI. Optimizing glucose control during pregnancy may decrease the rate of preeclampsia, even in those with a greater severity of GDM.展开更多
Objective This study was undertaken to determine maternal and perinat al outcom es after expectant management of severe preeclampsia between 24 and 33 weeksge station. Study design A prospective observational study ...Objective This study was undertaken to determine maternal and perinat al outcom es after expectant management of severe preeclampsia between 24 and 33 weeksge station. Study design A prospective observational study of 239 women with severe preeclamptic and undelivered after antenatal steroid prophylaxis was performed. Pregnancy prolongation and maternal and perinatal morbidities were analyzed acc ording to the gestational age at time of expectant management: 24 to 28, 29 to 3 1, and 32 to 33 weeks. Statistical analysis was performed by Student t test and χ2 test. Results The days of pregnancy prolongation were significantly higher a mong those managed at less than 29 weeks (6) compared with the other groups (4). There were 13 perinatal deaths: 12 in those managed at less than 29 weeks and 1 in those managed at 29 to 31 weeks. Neonatal morbidities were significantly hig her among those managed at less than 29 weeks compared with the other groups. Th ere were no instances of maternal death or eclampsia. Maternal morbidities were similar among the groups. Conclusion Expectant management of severe preeclampsia at 24 to 33 weeks in a tertiary care center is associated with good perinatal o utcome with a minimal risk for the mother.展开更多
Rates of pre eclampsia in women with type 1 diabetes are two to four times higher than in normal pregnancies. Diabetes is associated with antioxidant depletion and increased free radical production, and an increasing ...Rates of pre eclampsia in women with type 1 diabetes are two to four times higher than in normal pregnancies. Diabetes is associated with antioxidant depletion and increased free radical production, and an increasing body of evidence suggests that oxidative stress and endothelial cell activation may be relevant to disease pathogenesis in pre eclampsia. The Diabetes and Pre eclampsia Intervention Trial (DAPIT) aims to establish if pregnant women with type 1 diabetes supplemented with vitamins C and E have lower rates of pre eclampsia and endothelial activation compared with placebo treatment. Methods: DAPIT is a randomised multicentre double blind placebo controlled trial that will recruit 756 pregnant women with type 1 diabetes from 20 metabolic antenatal clinics in the UK over 4 years. Women are randomised to daily vitamin C (1000 mg) and vitamin E (400 IU) or placebo at 8- 2 weeks of gestation until delivery. Maternal venous blood is obtained at randomisation, 26 and 34 weeks, for markers of endothelial activation and oxidative stress and to assess glycaemic control. The primary outcome of DAPIT is pre eclampsia. Secondary outcomes include endothelial activation (PAI- 1/PAI- 2) and birthweight centile.展开更多
文摘The aim of this study was to examine the importance of glycemic regulation on the risk of preterm delivery in women with normoal buminuria and no preeclampsia later in pregnancy. Study design and methods: A prospective study of 71 women with type 1 diabetes mellitus where complete data were collected on HbA1c, insulin dose, and albumin excretion rate from week 12 and every second week hereafter. Fundus photography was performed and diurnal blood pressure measured three times during pregnancy. Results: The preterm rate was 23% and women delivering preterm showed higher HbA1c throughout pregnancy. At regression analysis HbA1c was the strongest predictor for preterm delivery from week 6 to 32, also when including insulin dose, BMI, age, duration of diabetes, and diurnal blood pressure. The risk of delivering preterm was more than 40% when HbA1c was above 7.7% in week 8. Diurnal blood pressure was not found associated with preterm delivery. Conclusion: The quality of glycemic regulation in the early and mid pregnancy is a major, independent risk factor for preterm delivery in normoalbuminuric diabetic women without preeclampsia.
文摘Objectives We sought to determine if the rate of preeclampsia is related to the severity of gestational diabetes mellitus (GDM), and if it can be decreased by optimizing glycemic control. Study design A retrospective analysis of prospectively collective data of 1813 patients with GDM was performed to determine the rate of preeclampsia. Patients were stratified after treatment was begun by level of glycemic control (well controlled was defined as mean blood glucose < 95 mg/dL). The extent of hyperglycemia was analyzed by the level of the abnormality in the oral GTT and by the degree of abnormality of daily glucose control after treatment has begun. Severity of GDM was categorized using fasting plasma glucose (FPG) on a 3-hour oral GTT by 10 mg/dL increments. Results Overall, preeclampsia was diagnosed in 9.6%(174/1813) of diabetic patients. The GDM subjects who developed preeclampsia were significantly younger, had a higher nulliparity rate, were more obese, and gained significantly more weight during pregnancy. However, no difference was found in glycemic profile characteristics between the 2 groups. A comparison between patients with FPG <105 and FPG >105 revealed that the rate of preeclampsia increased significantly, 7.8%vs 13.8%, (O.R 1.81, 95%CI 1.3-2.51). For GDM patients with only mild hyperglycemia (FPG <105 mg/dL), no significant difference was found in the rate of preeclampsia. Preeclampsia rate was further evaluated in relation to level of glycemic control; for the wellcontrolled patients (mean blood glucose [MBG] <95 mg/dL, n=994), similar rates of preeclampsia were found between each category of FPG severity. In contrast, in poorly controlled patients (MBG >95 mg/dL, n=819), a comparison between severity threshold of FPG <115 and FPG >115 revealed that the preeclampsia rate was 9.8%vs 18%(O.R 2.56, 95%C.I. 1.5-4.3). In a logistic regression model, only prepregnancy BMI (O.R 2.3, 95%CI 1.16-2.30) and severity of GDM (O.R 1.7, 95%CI 1.21-2.38) were independently and significantly associated with an increased risk of preeclampsia. Conclusion The rate of preeclampsia is influenced by the severity of GDM and prepregnancy BMI. Optimizing glucose control during pregnancy may decrease the rate of preeclampsia, even in those with a greater severity of GDM.
文摘Objective This study was undertaken to determine maternal and perinat al outcom es after expectant management of severe preeclampsia between 24 and 33 weeksge station. Study design A prospective observational study of 239 women with severe preeclamptic and undelivered after antenatal steroid prophylaxis was performed. Pregnancy prolongation and maternal and perinatal morbidities were analyzed acc ording to the gestational age at time of expectant management: 24 to 28, 29 to 3 1, and 32 to 33 weeks. Statistical analysis was performed by Student t test and χ2 test. Results The days of pregnancy prolongation were significantly higher a mong those managed at less than 29 weeks (6) compared with the other groups (4). There were 13 perinatal deaths: 12 in those managed at less than 29 weeks and 1 in those managed at 29 to 31 weeks. Neonatal morbidities were significantly hig her among those managed at less than 29 weeks compared with the other groups. Th ere were no instances of maternal death or eclampsia. Maternal morbidities were similar among the groups. Conclusion Expectant management of severe preeclampsia at 24 to 33 weeks in a tertiary care center is associated with good perinatal o utcome with a minimal risk for the mother.
文摘Rates of pre eclampsia in women with type 1 diabetes are two to four times higher than in normal pregnancies. Diabetes is associated with antioxidant depletion and increased free radical production, and an increasing body of evidence suggests that oxidative stress and endothelial cell activation may be relevant to disease pathogenesis in pre eclampsia. The Diabetes and Pre eclampsia Intervention Trial (DAPIT) aims to establish if pregnant women with type 1 diabetes supplemented with vitamins C and E have lower rates of pre eclampsia and endothelial activation compared with placebo treatment. Methods: DAPIT is a randomised multicentre double blind placebo controlled trial that will recruit 756 pregnant women with type 1 diabetes from 20 metabolic antenatal clinics in the UK over 4 years. Women are randomised to daily vitamin C (1000 mg) and vitamin E (400 IU) or placebo at 8- 2 weeks of gestation until delivery. Maternal venous blood is obtained at randomisation, 26 and 34 weeks, for markers of endothelial activation and oxidative stress and to assess glycaemic control. The primary outcome of DAPIT is pre eclampsia. Secondary outcomes include endothelial activation (PAI- 1/PAI- 2) and birthweight centile.
