RESUMO
Pregnant diabetic women represent a unique category of patient in whom diabetic control is most desirable, since even minor degrees of hyperglycemia have adverse effects on the conceptus. In 18 insulin-dependent pregnant diabetic women (White Class B, N = 4; C, N = 5; D, N = 7; and R, N =2), we have utilized a therapeutic program consisting of intensive patient education, a multiple-component insulin regimen (two to four injections daily), careful dietary control, and meticulous balancing of food, activity, and insulin dosage, monitoring such balance with patient-determined blood glucose measurements four to seven times daily using the Dextrostix/Eyetone system. Our goals for blood glucose management have been to attain fasting levels of 60-90 mg/dl, preprandial levels less than 105 mg/dl, and postprandial levels less than 120 mg/dl, in the absence of significant hypoglycemia. We have been able to attain these goals for most of the period of monitoring in the majority of these patients, while in the others we have achieved marked improvement in diabetic control, although we did not consistently attain our goals. Despite this, there was not infrequent neonatal morbidity, including a 33% frequency of macrosomia, an 11% frequency of significant hypoglycemia, and a 22% frequency of congenital malformation. Nevertheless, all infants survived and are generally healthy, whereas only 38% of 21 previous pregnancies in these same women have eventuated in living offspring. Thus, although further refinement is clearly indicated, it appears that our approach has resulted in improved pregnancy outcome. Patient self-monitoring of blood glucose is a procedure that is relatively simple, practical, acceptable to patients, and facilitates the attainment of glycemic control.
Assuntos
Glicemia/análise , Gravidez em Diabéticas/sangue , Adulto , Dieta para Diabéticos , Feminino , Humanos , Insulina/administração & dosagem , Educação de Pacientes como Assunto , Gravidez , Gravidez em Diabéticas/terapia , Fitas ReagentesAssuntos
Líquido Amniótico/análise , Glucose/análise , Hormônio do Crescimento/análise , Insulina/análise , Cordão Umbilical , Peso ao Nascer , Sangue , Glicemia/análise , Feminino , Idade Gestacional , Glucose/metabolismo , Hormônio do Crescimento/sangue , Humanos , Insulina/sangue , Troca Materno-Fetal , Gravidez , Gravidez em Diabéticas/metabolismo , Radioimunoensaio , Artérias Umbilicais , Veias UmbilicaisAssuntos
Trabalho de Parto Induzido , Ocitocina/uso terapêutico , Prostaglandinas/uso terapêutico , Fatores Etários , Peso Corporal , Bradicardia/induzido quimicamente , Cesárea , Ensaios Clínicos como Assunto , Parto Obstétrico , Diarreia/induzido quimicamente , Feminino , Doenças Fetais/induzido quimicamente , Humanos , Recém-Nascido , Tono Muscular/efeitos dos fármacos , Náusea/induzido quimicamente , Ocitocina/administração & dosagem , Ocitocina/efeitos adversos , Paridade , Flebite/induzido quimicamente , Gravidez , Prostaglandinas/administração & dosagem , Prostaglandinas/efeitos adversos , Vômito/induzido quimicamenteRESUMO
Maturity studies are reported on 204 women with high-risk pregnancies. Estimates of fetal maturity were made prenatally by the use of ultrasonic measurements, the lecithin/sphingomyelin (L/S) ratio, and a gestational index based on amniotic fluid creatinine, urea nitrogen, and cytology. These estimates were compared with the neonatal pediatric estimate of maturity. The gestational score agreed with pediatric maturity to within 14 days in 95 per cent of the cases. Estimates of L/S ratio distinguished between mature and immature infants in 86 per cent of the cases. Ultrasound could estimate gestational age only to within 14 days in 75 per cent of the cases, and the disagreements were greatest where either growth retardation or macrosomia was present. However, ultrasound is more useful in estimating fetal size and abnormalities of growth pattern. An estimate of gestational age by gestational score aids management, particularly where growth retardation is present, enabling a decision about delivery to be made even though the infant is very small and has an immature L/S ratio.