Nd:YAG water mist laser treatment for giant gestational gingival tumor: A case report

BACKGROUND This case of gestational gingival tumor is huge and extremely rare in clinical practice.As the growth location of this gingival tumor is in the upper anterior tooth area,it seriously affects the pregnant woman's speech and food,causing great pain to the patient.The use of Nd:YGA water mist laser to remove the gingival tumor resulted in minimal intraoperative bleeding,minimal adverse reactions,and good postoperative healing,which is worthy of clinical promotion and application.CASE SUMMARY The patient,a pregnant woman,reported a large lump in her mouth on the first day of postpartum treatment.Based on medical history and clinical examination,the diagnosis was diagnosed as gestational gingival tumor.Postoperative pathological biopsy also confirmed this diagnosis.The use of Nd:YAG water mist laser to remove the tumor resulted in minimal intraoperative bleeding,clear surgical field of view,short surgical time,and good postoperative healing.CONCLUSION In comparison to traditional surgery,Nd:YAG water mist laser surgery is minimally invasive,minimizes cell damage,reduces bleeding,ensures a clear field of vision,and virtually eliminates postoperative edema,carbonization,and the risk of cross infection.It has unique advantages in oral soft tissue surgery for pregnant patients.Therefore,the clinical application of Nd:YAG water mist laser for the treatment of gestational gingival tumors is an ideal choice.

Managing Vogt–Koyanagi–Harada disease during pregnancy with steroid pulse therapy:A case report

BACKGROUND High-dose steroid administration is a common initial therapeutic approach for Vogt–Koyanagi–Harada disease(VKH).Nonetheless,administering substantial doses of steroids to pregnant women necessitates meticulous consideration due to the potential impacts on the mother and fetus.We present a case wherein steroid pulse therapy was administered to a patient who developed VKH during the late stages of pregnancy.CASE SUMMARY The patient was a 26-year-old nulliparous woman.At 33 weeks and 1 day of her pregnancy,she experienced a decline in visual acuity and noticed metamorphopsia in her left eye.Examination revealed bilateral serous retinal detachment,leading to VKH diagnosis.A collaborative effort involving the departments of ophthalmology,internal medicine,and neonatology was initiated.Steroid pulse therapy was administered at 34 weeks and 1 day of pregnancy under hospital supervision.Complications,such as threatened preterm labor and gestational diabetes,emerged,necessitating the initiation of oral ritodrine hydrochloride and insulin therapy.Then,serous retinal detachment was resolved,and visual acuity was restored.Labor pains initiated 32 days post-initiation of steroid pulse therapy(at 38 weeks and 4 days of gestation),culminating in a normal delivery.Mother and newborn experienced an uneventful puerperal course and were discharged from the hospital on the 5th day following delivery.CONCLUSION VKH management in pregnancy requires multidisciplinary coordination,emphasizing collaboration with ophthalmologists and specialists in internal medicine and neonatology.

Data Analytics on Unpredictable Pregnancy Data Records Using Ensemble Neuro-Fuzzy Techniques

The immune system goes through a profound transformation during pregnancy,and certain unexpected maternal complications have been correlated to this transition.The ability to correctly examine,diagnoses,and predict pregnancy-hastened diseases via the available big data is a delicate problem since the range of information continuously increases and is scalable.Many approaches for disease diagnosis/classification have been established with the use of data mining concepts.However,such methods do not provide an appropriate classification/diagnosis model.Furthermore,single learning approaches are used to create the bulk of these systems.Classification issues may be made more accurate by combining predictions from many different techniques.As a result,we used the Ensembling of Neuro-Fuzzy(E-NF)method to perform a high-level classification of medical diseases.E-NF is a layered computational model with self-learning and self-adaptive capabilities to deal with specific problems,such as the handling of imprecise and ambiguous data that may lead to uncertainty concerns that specifically emerge during the classification stage.Preprocessing data,Training phase,Ensemble phase,and Testing phase make up the complete procedure for the suggested task.Data preprocessing includes feature extraction and dimensionality reduction.Besides such processes,the training phase includes the fuzzification process of medical data.Moreover,training of input data was done using four types of NF techniques:Fuzzy Adaptive Learning Control Network(FALCON),Adaptive Network-based Fuzzy Inference System(ANFIS),Self Constructing Neural Fuzzy Inference Network(SONFIN)and/Evolving Fuzzy Neural Network(EFuNN).Later,in the ensemble phase,all the NF methods’predicted outcomes are integrated,and finally,the test results are evaluated in the testing phase.The outcomes indicate that the method could predict impaired glucose tolerance,preeclampsia,gestational hypertensive abnormalities,bacteriuria,and iron deficiency anaemia better than the others.In addition,the model exposed the capability to be utilized as an autonomous learning strategy,specifically in the early stages of pregnancy,examinations,and clinical guidelines for disease interventions.

Prediction of Gestational Diabetes Mellitus in Early Pregnancy: Is Abdominal Skin Fold Thickness 20 mm or More an Independent Risk Predictor?

Background: Gestational Diabetes Mellitus (GDM) is associated with several maternal and perinatal complications. Early detection and treatment can improve pregnancy outcomes. Objectives: To determine the prevalence, risk factors and predictors of GDM in early pregnancy at the University of Port Harcourt Teaching Hospital, (UPTH), Port Harcourt Nigeria. Methods: A cohort of 235 mothers who registered for antenatal care between 15 - 18 weeks of gestation at UPTH was prospectively studied. Their socio-demographic data, examination findings, anthropometric measurements, fasting blood sugar at booking and OGTT results at 28 weeks gestation were collated and entered into PC with SPSS for windows version 21.0 which was also used for the analysis. Variables were expressed as absolute numbers, percentages or means with standard deviations and significant differences determined using chi square test or the student “t” test as appropriate. The level of significance was set at P < 0.05. Results: Of the 235 participants, 35 (14.9%) developed GDM. Women who had GDM were significantly older (P = 0.001), had higher weight (t = 2.95, P = 0.01), BMI (t = 2.29, P = 0.02), abdominal skin fold thickness (t = 4.15, P = 0.001), blood pressure (t = 3.38, P = 0.001) compared to women who did not. Previous history of GDM was significantly different between two groups as χ2 = 93.56 and P = 0.001. Abdominal skin fold thickness and prior GDM history were found to be independent predictors of GDM on application of multiple logistic regression analysis. Conclusion: The prevalence of GDM in Port Harcourt is 14.9% and major risk factors are obesity, previous GDM history, advanced age and hypertension. Abdominal skin fold thickness ≥ 20 mm is an independent predictor. The risk of developing GDM can be predicted in early second trimester using algorithm incorporating risk factor screening and anterior abdominal wall skin fold thickness estimation.

Previable Premature Rupture of Membranes in Dichorionic Diamniotic Twin Gestation, Loss of Leading Twin, Emergency Cervical Cerclage and Ceaserean Delivery at Term

Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G6P1+4 with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.

Comparative effects of insulin pump and injection on gestational diabetes mellitus pregnancy outcomes and serum biomarkers

BACKGROUND Insulin injection is the basic daily drug treatment for diabetic patients.AIM To evaluate the comparative impacts of continuous subcutaneous insulin infusion(CSII).METHODS Based on the treatment modality received,the patients were allocated into two cohorts:The CSII group and the multiple daily injections(MDI)group,with each cohort comprising 210 patients.Comparative assessments were made regarding serum levels of serum-secreted frizzled-related protein 5,homocysteine,and C1q/TNF-related protein 9.Furthermore,outcomes such as fasting plasma glucose,2-hour postprandial glucose levels,pain assessment scores,and the incidence of complications were evaluated post-treatment.RESULTS The CSII group displayed notably lower fasting plasma glucose and 2-h postprandial glucose levels in comparison to the MDI group(P<0.05).Subsequent analysis post-treatment unveiled a significantly higher percentage of patients reporting no pain in the CSII group(60.00%)in contrast to the MDI group(36.19%)(P<0.05).Additionally,the CSII group exhibited a markedly reduced occurrence of fetal distress and premature rupture of membranes compared to the MDI group(P<0.05).However,there were no significant variances observed in other pregnancy outcomes between the two groups(P>0.05).A statistical analysis revealed a significant difference in the incidence of complications between the groups(χ^(2)=11.631,P=0.001).CONCLUSION The utilization of CSII via an insulin pump,as opposed to MDI,can significantly enhance the management of insulin administration in patients with GDM by diversifying the sites of insulin delivery.This approach not only promotes optimal glycemic control but also regulates metabolic factors linked to blood sugar,reducing the likelihood of adverse pregnancy outcomes and complications.The clinical relevance and importance of CSII in GDM management highlight its wide-ranging clinical usefulness.

Relationship between Positive Glucose Screening, Obesity and Pregnancy Outcome in the Absence of Gestational Diabetes: A Retrospective Cohort Study

Background: Currently pregnant women with abnormal glucose screening test (GCT), performed at 26?-?28 weeks gestation with a subsequent normal glucose tolerance test (GTT) receive routine care. Could these women be at risk of adverse pregnancy? Objective: Compare rate of caesarean section (CS), induction of labour (IOL), macrosomia, admission to special care nursery and neonatal hypoglycaemia. Designs: Retrospective cohort study. Setting: Ipswich Hospital, Ipswich, Queensland. Participants: Pregnant women having had the test at the hospital laboratory. Methods: Charts review of outcome measures including induction of labour, caesarean section, macrosomia, RDS and short-term neonatal morbidity. Results: We reviewed 882 charts (441 cases and 441 controls). There was a higher IOL rate among cases 21.1% versus 16.6% (OR and 95% CI 1.45;1.03?-?2.06) and a higher CS rate, 30.4 versus 23.6 (OR and 95% CI 1.41;1.05?-?1.91). Compared to women with BMI 18.5 - 24.9, women with BMI of 30 and above had a significantly higher IOL rate (47.1% versus 22.6%), higher CS rate (47.2% versus 25.7%) and higher rate of macrosomic baby (79.2% versus 4.2%). There were more women amongst the cases who were older, smoked, had a BMI 30 and above and had previous history of GDM. After adjusting for maternal age, BMI and smoking status, there was still an increased odds of CS, IOL and macrosomia, but this did not reach statistical significance. Conclusion: Abnormal glucose screening test in the absence of gestational diabetes is associated with adverse pregnancy outcome. This is largely contributed by maternal obesity.

Use of metformin during pregnancy for women with polycystic ovary syndrome

Objective: The purpose of this article is to review the literature assessing foetal and maternal pregnancy outcomes in women with PCOS who used metformin during pregnancy. Study Design: A literature search was conducted using MEDLINE, with analysis of 25 studies that recorded neonatal and maternal outcomes in women who used metformin during pregnancy. The outcomes assessed in this review include congenital deformities, miscarriages, preterm labour, gestational diabetes (GDM) and pregnancy induced hypertension (PIH). Results: We found that the use of metformin throughout pregnancy correlated with decreased rates of preterm labour, GDM and PIH. Conflicting evidence exists over whether metformin use during pregnancy reduced miscarriage rates. The use of metformin during pregnancy did not increase teratogenicity risks. Conclusion: The use of metformin throughout pregnancy is associated with decreased rates of preterm labour, GDM, and PIH. However, more randomised controls involving larger numbers of participants are required for more definitive results.

Moderate anxiety in pregnant women does not compromise gestational immune-endocrine status and outcome, but renders mothers to be susceptible for diseased states development: A preliminary report

High anxiety levels during pregnancy commonly lead to clinical complications that affect the mother/child’s prenatal and perinatal health. Such complications are thought to result from combining deficiencies of the endocrine milieu and decreased immune tolerance that support pregnancy. It is yet unclear whether pregnant women subjected to moderate anxiety develop a similar state of endocrine deficits and compromised immune tolerance. Here, we evaluated this issue by monitoring endocrine and immune parameters during pregnancy in a sample of women suffering of moderate anxiety. The health of mothers and children, as well as the outcome of the pregnancies were also revised and recorded. Moderately anxious pregnant women present increments of state anxiety, serum cortisol and progesterone, but not of estradiol, as pregnancy progressed. No variations of leukocyte anti- and pro-inflammatory cytokine mRNA expression were found along pregnancy. However, these pregnant women did show an increased frequency of gestational and perinatal complications, conditions that had no major consequences for their health and that of their children at birth. Hence, moderate anxiety renders the mother to be susceptible to develop diseased states during or by the end of pregnancy, while keeping the endocrine milieu and immune tolerance reasonably in place.

Indicators of glycemic control in patients with gestational diabetes mellitus and pregnant women with diabetes mellitus

Recently, it has become clear that mild abnormal glucose tolerance increases the incidence of perinatal maternalinfant complications, and so the definition and diagnostic criteria of gestational diabetes mellitus(GDM) have been changed. Therefore, in patients with GDM and pregnant women with diabetes mellitus, even stricter glycemic control than before is required to reduce the incidence of perinatal maternal-infant complications. Strict glycemic control cannot be attained without an indicator of glycemic control; this review proposes a reliable indicator. The gold standard indicator of glycemic control in patients with diabetes mellitus is hemoglobin A1c(Hb A1c); however, we have demonstrated that Hb A1 c does not reflect glycemic control accurately during pregnancy because of iron deficiency. It has also become clear that glycated albumin, another indicator of glycemic control, is not influenced by iron deficiency and therefore might be a better indicator of glycemic control in patients with GDM and pregnant women with diabetes mellitus. However, largepopulation epidemiological studies are necessary in order to confirm our proposal. Here, we outline the most recent findings about the indicators of glycemic control during pregnancy including fructosamine and 1,5-anhydroglucitol.

Study on the correlation and predictive value of serum pregnancyassociated plasma protein A, triglyceride and serum 25-hydroxyvitamin D levels with gestational diabetes mellitus

BACKGROUND Gestational diabetes mellitus(GDM)is a concern due to its rapid increase in incidence in recent years.AIM To investigate the correlation and predictive value of serum pregnancyassociated plasma protein A(PAPP-A),triglyceride(TG),and 25-hydroxyvitamin D[25-(OH)D]with GDM in early pregnancy.METHODS A total of 99 patients in early pregnancy admitted to Peking University International Hospital from November 2015 to September 2017 were included,and underwent a fasting glucose test and oral glucose tolerance test screening at 24-28 wk of pregnancy.Of these cases with GDM,51 were assigned to group A and the remaining 48 cases without GDM were enrolled in group B.Serum PAPP-A,TG and 25-(OH)D in the two groups were compared and their correlation with blood sugar was analyzed.In addition,their diagnostic value in GDM was determined using receiver operating characteristic(ROC)curve analysis.RESULTS Group A had markedly lower serum PAPP-A and 25-(OH)D levels and a significantly higher serum TG level than group B,with statistical significance(P<0.05).Furthermore,Pearson analysis identified that PAPP-A and 25-(OH)D levels were negatively correlated with fasting blood glucose(FBG)levels(r=-0.605,P<0.001),(r=-0.597,P<0.001),while TG and FBG levels were positively correlated(r=0.628,P<0.001).The sensitivity,specificity,area under the curve(AUC)and optimal cut-off value of serum PAPP-A level in the diagnosis of GDM were 72.55%,82.35%,0.861 and 16.340,respectively,while the sensitivity of TG in diagnosing GDM was 86.27%,the specificity was 66.67%,the AUC was 0.813,with an optimal cut-off value of 1.796.The corresponding sensitivity,specificity,AUC and optimal cut-off value of serum 25-(OH)D were 64.71%,70.59%,0.721 and 23.140,respectively.Moreover,multivariate logistic regression analysis revealed that FBG,vascular endothelial growth factor,Flt-1,serum PAPP-A,TG,and 25-(OH)D were related risk factors leading to GDM in patients.CONCLUSION Serum PAPP-A,TG,and 25-(OH)D levels are all correlated with blood glucose changes in GDM,and are independent factors affecting the occurrence of GDM and have certain value in the diagnosis of GDM.

Food Intake Characteristics during Early Pregnancy in Women with Gestational Diabetes Mellitus

To investigate the characteristic food intake during early pregnancy in women with gestational diabetes mellitus (GDM) in a rural city in Aomori Prefecture, Japan, one hundred and twenty-one women were recruited and queried about their habitual dietary intake. Food intake of patients was assessed using the model nutritional balance chart at 12 - 16, 24 - 28, and 34 - 36 weeks of gestation. Of the 121 pregnant women examined, 19 were obese. During early pregnancy, food intake ratios of the obese women were significantly lower than those of the non-obese women for the categories of milk (p < 0.001) and sugar (p < 0.05). GDM group was 7 women among 19 women in obesity group during mid-pregnancy. During early pregnancy, women with GDM had significantly higher sugar intake ratios than women without GDM (p < 0.05). These results suggested that obese pregnant women are able to prevent GDM by limiting their sugar intake during early pregnancy.

Diagnostic efficacy of virtual organ computer-assisted analysis in measuring the volume ratio of subchorionic hematoma with serum progesterone

BACKGROUND Subchorionic hematoma(SCH)is a common complication in early pregnancy characterized by the accumulation of blood between the uterine wall and the chorionic membrane.SCH can lead to adverse pregnancy outcomes such as miscarriage,preterm birth,and other complications.Early detection and accurate assessment of SCH are crucial for appropriate management and improved pregnancy outcomes.AIM To evaluate the diagnostic efficacy of virtual organ computer-assisted analysis(VOCAL)in measuring the volume ratio of SCH to gestational sac(GS)combined with serum progesterone on early pregnancy outcomes in patients with SCH.METHODS A total of 153 patients with SCH in their first-trimester pregnancies between 6 and 11 wk were enrolled.All patients were followed up until a gestational age of 20 wk.The parameters of transvaginal two-dimensional ultrasound,including the circumference of SCH(Cs),surface area of SCH(Ss),circumference of GS(Cg),and surface area of GS(Sg),and the parameters of VOCAL with transvaginal three-dimensional ultrasound,including the three-dimensional volume of SCH(3DVs)and GS(3DVg),were recorded.The size of the SCH and its ratio to the GS size(Cs/Cg,Ss/Sg,3DVs/3DVg)were recorded and compared.RESULTS Compared with those in the normal pregnancy group,the adverse pregnancy group had higher Cs/Cg,Ss/Sg,and 3DVs/3DVg ratios(P<0.05).When 3DVs/3DVg was 0.220,the highest predictive performance predicted adverse pregnancy outcomes,resulting in an AUC of 0.767,and the sensitivity,specificity were 70.2%,75%respectively.VOCAL measuring 3DVs/3DVg combined with serum progesterone gave a diagnostic AUC of 0.824 for early pregnancy outcome in SCH patients,with a high sensitivity of 82.1%and a specificity of 72.1%,which showed a significant difference between AUC.CONCLUSION VOCAL-measured 3DVs/3DVg effectively quantifies the severity of SCH,while combined serum progesterone better predicts adverse pregnancy outcomes.

Analysis of Gestational Diabetes Mellitus (GDM) and Its Impact on Maternal and Fetal Health: A Comprehensive Dataset Study Using Data Analytic Tool Power BI

Gestational Diabetes Mellitus (GDM) is a significant health concern affecting pregnant women worldwide. It is characterized by elevated blood sugar levels during pregnancy and poses risks to both maternal and fetal health. Maternal complications of GDM include an increased risk of developing type 2 diabetes later in life, as well as hypertension and preeclampsia during pregnancy. Fetal complications may include macrosomia (large birth weight), birth injuries, and an increased risk of developing metabolic disorders later in life. Understanding the demographics, risk factors, and biomarkers associated with GDM is crucial for effective management and prevention strategies. This research aims to address these aspects comprehensively through the analysis of a dataset comprising 600 pregnant women. By exploring the demographics of the dataset and employing data modeling techniques, the study seeks to identify key risk factors associated with GDM. Moreover, by analyzing various biomarkers, the research aims to gain insights into the physiological mechanisms underlying GDM and its implications for maternal and fetal health. The significance of this research lies in its potential to inform clinical practice and public health policies related to GDM. By identifying demographic patterns and risk factors, healthcare providers can better tailor screening and intervention strategies for pregnant women at risk of GDM. Additionally, insights into biomarkers associated with GDM may contribute to the development of novel diagnostic tools and therapeutic approaches. Ultimately, by enhancing our understanding of GDM, this research aims to improve maternal and fetal outcomes and reduce the burden of this condition on healthcare systems and society. However, it’s important to acknowledge the limitations of the dataset used in this study. Further research utilizing larger and more diverse datasets, perhaps employing advanced data analysis techniques such as Power BI, is warranted to corroborate and expand upon the findings of this research. This underscores the ongoing need for continued investigation into GDM to refine our understanding and improve clinical management strategies.

Gestational diabetes mellitus and COVID-19:The epidemic during the pandemic

During the global coronavirus disease 2019(COVID-19)pandemic,people worldwide have experienced an unprecedented rise in psychological distress and anxiety.In addition to this challenging situation,the prevalence of diabetes mellitus(DM),a hidden epidemic,has been steadily increasing in recent years.Lower-middle-income countries have faced significant barriers in providing accessible prenatal care and promoting a healthy diet for pregnant women,and the pandemic has made these challenges even more difficult to overcome.Pregnant women are at a higher risk of developing complications such as hypertension,preeclampsia,and gestational diabetes,all of which can have adverse implications for both maternal and fetal health.The occurrence of gestational diabetes has been on the rise,and it is possible that the pandemic has worsened its prevalence.Although data is limited,studies conducted in Italy and Canada suggest that the pandemic has had an impact on gestational diabetes rates,especially among women in their first trimester of pregnancy.The significant disruptions to daily routines caused by the pandemic,such as limited exercise options,indicate a possible link between COVID-19 and an increased likelihood of experiencing higher levels of weight gain during pregnancy.Notably,individuals in the United States with singleton pregnancies are at a significantly higher risk of excessive gestational weight gain,making this association particularly important to consider.Although comprehensive data is currently lacking,it is important for clinical researchers to explore the possibility of establishing correlations between the stress experienced during the pandemic,its consequences such as gestational gain weight,and the increasing incidence of gestational DM.This knowledge would contribute to better preventive measures and support for pregnant individuals during challenging times.

妊娠期糖尿病患者血清microRNA-17、Netrin4的表达及与妊娠结局的关系

目的探讨妊娠期糖尿病(GDM)患者血清microRNA-17(miR-17)、Netrin4的表达及与妊娠结局的关系。方法回顾性分析2022年1月—2023年6月南通大学第二附属医院收治的GDM患者98例。根据妊娠结局将患者分为对照组(正常妊娠结局)和研究组(不良妊娠结局),分别为65和33例。收集患者临床资料包括受试者年龄、孕产次、口服葡萄糖耐量试验(OGTT)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、白蛋白(ALB)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)。采用实时荧光定量聚合酶链反应检测miR-17和Netrin4的表达。分析影响GDM患者发生不良妊娠结局的因素。结果对照组与研究组体质量指数(BMI)、OGTT 2 h、HbA1c、HOMA-IR比较,差异均有统计学意义(P<0.05)。研究组miR-17相对表达量高于对照组(P<0.05),Netrin4相对表达量低于对照组(P<0.05)。多因素一般Logistic回归分析结果显示:高水平OGTT 2h[OR=1.548(95%CI:1.512,2.531)]、高水平HbA1c[OR=3.041(95%CI:1.054,3.412)]、高表达miR-17[OR=2.865(95%CI:0.741,3.905)]及低表达Netrin4[OR=0.743(95%CI:0.378,0.835)]均是不良妊娠结局的危险因素(P<0.05)。结论GDM患者血清miR-17表达升高和Netrin4表达降低是发生不良妊娠结局的影响因素。

Future clinical prospects of C-peptide testing in the early diagnosis of gestational diabetes

Gestational diabetes is typically diagnosed in the late second or third trimester of pregnancy.It is one of the most common metabolic disorders among expectant mothers,with potential serious short-and long-term complications for both maternal and offspring health.C-peptide is secreted from pancreatic beta-cells into circulation in equimolar amounts with insulin.It is a useful biomarker to estimate the beta-cell function because it undergoes negligible hepatic clearance and consequently it has a longer half-life compared to insulin.Pregnancy induces increased insulin resistance due to physiological changes in hormonal and metabolic homeostasis.Inadequate compensation by islet beta-cells results in hyperglycemia.The standard oral glucose tolerance test at 24-28 wk of gestation sets the diagnosis.Accumulated evidence from prospective studies indicates a link between early pregnancy C-peptide levels and the risk of subsequent gestational diabetes.Elevated C-peptide levels and surrogate glycemic indices at the beginning of pregnancy could prompt appropriate strategies for secondary prevention.

Macrosomia in non-gestational diabetes pregnancy:glucose tolerance test characteristics and feto-maternal complications in tropical Asia Pacific Australia

Objective:To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects.Methods:From 2006 to 2009 all non-gestational diabetes mellitus(non-CDM)pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record.Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM.Results:Ninety-one non-CDM mothers with macrosomia were studied and compared with 41normoglycemic subjects without macrosomia.Of the subjects with non-GDM macrosomia,45(49.4%)had normal SO g glucose challenge test(GCT)without further testing,another 8(8.8%)had abnormal GCT but normal 75 g oral glucose tolerance test(OGTT).A total of 4(4.4%)subjects had normal GCT and OGTT.Interestingly.14 out of 16(87.5%)subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies.Only 12 subjects had both GCT and OGTT,the rest of the cohort had either of the two tests.Subjects with non-CDM macrosomia had higher frequency of neonatal hypoglycaemia 34%as compared to 10%in nonmacrosomic babies(P=0.003).Other feto-maternal complications were similar in both groups.Conclussions:No significant pattern of glucose tolerance characteristics was identified in nonGDM mothers with macrosomic babies.In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies.Further prospective studies on a larger population are needed to verify our findings.

Early Life Obesity and Diabetes: Origins in Pregnancy

The gestational period represent a critical time for influencing birth weight, infant adiposity and growth rate, all of which are important factors in the development of obesity and diabetes in adolescence and adulthood. Prior to pregnancy, the nutritional status and weight of a mother also has significant influence on these factors. During gestation, numerous maternal factors can have a negative influence on programming of the long-term health of the offspring. Rate of maternal weight gain, glucose intolerance, gestational diabetes and pre-pregnancy BMI all have significant influence on infant size and adiposity at birth. Additionally, these factors are related to the development obesity and its co-morbidities in adolescence and adulthood. Given the rates of obesity and associated health care costs, it is very timely to understand possible fetal origins of obesity and diabetes to help shape interventions.

Gestational Weight Gain in Obese Patients and Adverse Pregnancy Events

Objectives: To examine pre-pregnancy obesity and gestational weight gain as predictors for adverse pregnancy outcomes in a predominantly non-white obstetric resident clinic population. Methods: Prenatal charts for patients with pre-pregnancy obesity cared for at our resident clinic from January 1, 2008 through December 31, 2010 were reviewed. Adverse maternal outcomes were grouped into a “Composite Morbidity Index” (CMI-M) and included gestational diabetes, gestational hypertension, preeclampsia, superimposed preeclampsia, dystocia, operative delivery, Cesarean section for arrest disorders, wound infection and disruption, and thromboembolic events. Fetal events, similarly categorized into a composite adverse fetal index (CMI-F), included macrosomia, Apgar at 5 minutes (≤3), NICU admission, congenital anomalies and intrauterine fetal demise. Results: 627 women with a singleton pregnancy and a pre-pregnancy body mass index (BMI) of 30 and greater were included in the analysis. As measured by the composite morbidity index, women with Class III obesity at their first prenatal visit were more likely to have at least one or more maternal and fetal complications compared to women with Class II or Class I obesity. For adverse maternal outcomes (CMI-M), 40.2%, 33.8%, and 27.4% of women within each respective obesity class experienced an adverse event (p = 0.027). Applying the CMI-F, fetal complications were observed in 28.2%, 18%, and 13.9% of Class III, II, and I obesity (p = 0.003). Total gestational weight gain per week was significantly greater for patients with one or more maternal complications (p = 0.045). Conclusion: Among an obese, resident clinic population comprised primarily of women of ethnic minorities, pre-pregnancy body mass index was the strongest indicator for adverse maternal and fetal outcomes.