Positive association between a single abnormal glucose tolerance test value in pregnancy and subsequent abnormal glucose tolerance.

OBJECTIVE: To study the prevalence of abnormal glucose tolerance among women with a single abnormal glucose tolerance test value in previous pregnancy and identify factors predictive of the later development of abnormal glucose tolerance in this group. STUDY DESIGN: In all, 58 women with gestational diabetes, 66 with a single abnormal value in a glucose tolerance test, and 56 control women underwent a 75-g oral glucose tolerance test at a mean of 6.9 years from the index pregnancy. RESULTS: Abnormal glucose tolerance was present in 34.5% of women with previous gestational diabetes and in 28.7% of women with 1 previous abnormal value, significantly different from the controls (9.7%). Independent risk factors that distinguished the subjects who later developed an abnormal glucose tolerance were prepregnancy BMI, parity > 1, and first-degree relatives affected by diabetes mellitus in the group with gestational diabetes, and prepregnancy BMI, maternal age, (> or = 30 y) and parity > 1 in the group with a single abnormal value. Prepregnancy BMI (> or = 26.9) proved to be the most predictive factor of abnormal glucose tolerance later in life. CONCLUSION: Sicilian women with a single abnormal value at the glucose tolerance test in pregnancy have an increased likelihood of developing an abnormal glucose tolerance later in life, similar to gestational diabetes. Prepregnancy BMI was confirmed as the strongest predictive factor in both groups.

Midtrimester amniotic fluid leptin and insulin levels and subsequent gestational diabetes.

AIMS: To evaluate midtrimester amniotic fluid leptin levels in pregnancies subsequently complicated by gestational diabetes. METHODS: We studied 32 pregnant women with gestational diabetes and a control group of 43 normal pregnancies with an adequate gestational age fetus. All underwent a midtrimester amniocentesis: leptin and insulin were measured in the amniotic fluid. Data were compared with the Mann-Whitney U-test. RESULTS: Median leptin concentrations in the amniotic fluid of the gestational diabetes mellitus patients were significantly higher than in the control group (15.1 vs. 7.9 ng/ml) (p = 0.001); amniotic insulin concentrations were also higher in the gestational diabetes mellitus than in the control group (0.67 vs. 0.38 microU/ml) (p = 0.02). Furthermore, amniotic fluid leptin levels were directly correlated with amniotic insulin concentrations; instead, there was no correlation with maternal BMI and birth weight. CONCLUSION: Our data suggest that in pregnancies subsequently complicated by gestational diabetes, amniotic fluid leptin and insulin levels are higher in the early fetal period.

A randomised trial of progesterone prophylaxis after midtrimester amniocentesis.

BACKGROUND: Midtrimester amniocentesis to investigate fetal karyotype carries a small risk of fetal loss. AIM: To test the hypothesis that progesterone prophylaxis may reduce this. STUDY DESIGN: A randomised controlled trial comparing a short prophylactic treatment with progesterone after amniocentesis with untreated controls. RESULTS: There were no differences in frequency of miscarriage, preterm delivery or neonatal outcome. CONCLUSION: Prophylactic progesterone treatment after amniocentesis does not improve obstetric outcome.

A single abnormal value of the glucose tolerance test is related to increased adverse perinatal outcome.

OBJECTIVE: To evaluate which pregnant women with a single abnormal value in the oral glucose tolerance test are at increased risk for adverse perinatal outcome. METHODS: In this retrospective cohort study, we have evaluated the course of pregnancy in 152 consecutive women with only one abnormal value (OAV), and 624 with a 100 g - glucose tolerance test totally within the range values. RESULTS: The prevalence of caesarean delivery, hypertensive disorders and macrosomia was higher in the study group when compared with the control group, whereas no difference was noted concerning gestational age at delivery, Apgar score at 1 and 5 min and neonatal hypoglycemia. Moreover, in the study group hypertensive disorders were more frequent in the subgroup with the elevated value at 1 h after the glucose load (25%), whereas macrosomia is more frequent when it is the fasting value to be elevated (29.7%). CONCLUSIONS: Our results show that the implications of a single elevated glucose tolerance test value vary in relation to the timing of the abnormal value. In fact, OAV fasting or 1-h after load has a higher prevalence for an adverse obstetric outcome, whereas a 2 or 3-h value does not present significant differences when compared with the control group.

Pregnancy in essential thrombocythemia during aspirin treatment.

INTRODUCTION: Essential thrombocythemia is a rare disease of unknown origin characterized by abnormal increase in the platelet count. CASE REPORT: We report a case diagnosed in a woman who had had an early miscarriage in her first pregnancy, a voluntary abortion because a fetal chromosomal aberration in the second pregnancy and at last a third normal pregnancy. Treatment with low-dose aspirin (100 mg/day) and the use of low molecular weight heparin in the last three weeks of gestation appears to improve the obstetric outcome.