The oral glucose tolerance test is a poor predictor of hyperglycemia during pregnancy.

1. In order to assess the efficacy of the use of the diurnal plasma glucose profile rather than that of the glucose tolerance test (GTT) to predict hyperglycemia during pregnancy, we compared the results of the two tests. A total of 192 pregnant women seen at the Prenatal Clinic of the Faculty of Medicine of Botucatu were submitted to the glucose tolerance test (GTT) and determination of diurnal plasma glucose profile. 2. On the basis of two blood tests (GTT and diurnal plasma glucose profile), the subjects were divided into four groups: Group I-A, normal GTT and profile (79 patients, 41.2%); Group I-B, normal GTT and altered profile (63 patients, 32.8%); Group II-A, altered GTT and normal profile (18 patients, 9.4%); Group II-B, altered GTT and profile (32 patients, 16.7%). 3. Large babies were delivered by 25.6% of Group I-A, 53.8% of Group I-B, 28.6% of Group II-A and 51.9% of Group II-B patients. Group I-A patients are normoglycemic, Group I-B patients have intolerance to carbohydrates, protein and lipids, Group II-A patients have intolerance to high carbohydrate amounts, especially in the form of glucose, and Group II-B patients are diabetic. 4. We propose that Group I-A patients should receive no treatment, Group II-A patients should be advised to avoid excess carbohydrate intake and Groups I-B and II-B patients should be placed on a low-calorie diet and treated with insulin if necessary to obtain normal blood glucose levels. 5. Routine determination of blood glucose levels under fasting conditions represents a screening method for diabetes and values of greater than or equal to 90 mg/dl identify a population at risk that should be submitted to GTT and determination of plasma glucose profile.

Quantitation of immunoglobulin A in the human chorioamniotic membrane.

Thirty-eight chorioamniotic membranes were obtained from normal patients divided into three groups according to time of rupture. A protein extract was obtained by destruction and differential centrifugation and immunoglobulin A was measured by the method of Mancini. The authors demonstrated that it is possible to quantitate immunoglobulin A. No statistically significant differences were observed between groups.

Demonstration of the presence of IgA in the human chorioamniotic membrane.

The presence of IgA was detected by direct immunofluorescence techniques in the chorion and decidua of eight fragments of chorioamniotic membranes obtained near the rupture edge from eight normal patients. It is suggested that, similar to what occurs in other organic systems, a first barrier against infection of the amniotic chamber exists at this site.

Prospective evaluation of renal artery resistance and pulsatility indices in normal pregnant women.

OBJECTIVES: To establish normal values for renal artery resistance index (RI) and pulsatility index (PI) during gestation and, by comparison with non-pregnant controls, to determine if pregnancy affects these indices. METHODS: This was a prospective longitudinal study involving 36 normal pregnant women who underwent a total of 280 examinations at 4-week intervals from the 6th gestational week to the end of pregnancy. High-resolution ultrasound equipment with 'triplex' Doppler facilities was used. RI and PI were obtained for the main arteries of both kidneys. The same evaluation was performed in 15 non-pregnant women as controls. RESULTS: The mean RI in pregnant and non-pregnant women was the same (0.65 +/- 0.03 for controls and 0.65 +/- 0.02 for the pregnant women). For PI, the values were 1.25 +/- 0.12 for non-pregnant women and 1.18 +/- 0.09 for pregnant women. The only statistical difference (P < 0.05) was found between the PI of the left renal artery in the control group (1.29 +/- 0.20) and that in the pregnant group at the 8-12-week interval of gestational age (1.08 +/- 0.14). CONCLUSIONS: No significant alterations in renal artery RI and PI occur during normal pregnancy, except for in a subgroup of patients between 8 and 12 weeks of gestation.

Prenatal diagnosis of fetal ovarian hyperstimulation.

A case of prenatal diagnosis of fetal ovarian hyperstimulation in a pregnancy of 35 weeks is reported. Two large cystic septate ovaries with no internal vegetations were observed in the fetal abdomen. The fetus was macrosomic and the remaining morphology was normal. Polyhydramnios and placental thickening were present, with no other macro- or microscopic alterations. The only significant maternal change detected was elevation of blood beta-human chorionic gonadotropin (beta-hCG) levels. Evaluation of the newborn confirmed the prenatal diagnosis, with progressive and spontaneous regression of fetal ovarian volume and of maternal serum beta-hCG occurring after delivery.

Doppler study of the uterine arteries and ovarian stroma in patients with polycystic ovary syndrome.

Doppler analysis of the uterine arteries and ovarian stroma was performed by transvaginal ultrasound in 24 patients with polycystic ovary syndrome (PCOS) and 22 ovulatory women. Vascularization of the ovarian stroma was more abundant in patients with PCOS than in control women, but no significant difference in the mean pulsatility index (PI) was observed between groups (1.14 +/- 0.28 for the PCOS group and 1.05 +/- 0.19 for the control group). The mean PI of the uterine arteries was significantly higher in the PCOS group (PI = 3.7 +/- 0.8) than in the control group (PI = 2.9 +/- 0.4). In the patients with PCOS, no correlation was observed between PI and luteinizing hormone, testosterone or androstenedione levels. Obesity had no effect on uterine artery PI, with no significant differences in this index when the 3 groups were subdivided into obese and non-obese groups.

The oral glucose tolerance test is a poor predictor of hyperglycemia during pregnancy

1. In the order to assess the efficacy of the use of the diurnal plasma glucose profile rather than that of the glucose tolerance tes (GTT) to predict hyperglycemia during pregnancy, we compared the results of the two tests. A total of 192 pregnant women seen at the Prenatal Clinic of the Faculty of Medicine of Botucatu were submitted to the glucose tolerance test (GTT) and determination of diurnal plasma glucose profile. 2. On the basis of two blood tests (GTT) and diurnal plasma glucose profile). the subjects were divided into four groups: Group I-A, normal GTT and profile (79 patients, 41.2%); Group I-B, normal GTT and altered profile (63 patients, 32.8%); Group II-A, altered GTT and normal profile (18 patients, 9.4%) Group II-B, altered Gtt and profile (32 patients, 16,7%). 3. Large babies were delivered by 25.6% of Group I-A, 53.8% of GroupI-B28.6% of Group II-A and 51.9% of Group II-B patients. Group I-A patients are normoglycemic, Group I-B patients have intolerance to carbohydrates, protein and lipides, Group II-A patients have intolerance to high carbohydrate amounts, especially in the form of glucose, and Group II-B patients are diabetic. 4. We propose that Group I-A patients should receive no treatment, Group II-A patients should be adivised to avoid excess carbohydrate intake and Groups I-B and II-B patients should be places on a low-calorie diet and treated with insulin if necessary to obtain normal blood glucose levels. 5. Routine determination of blod glucose levels under fasting conditions represents a screening method for diabetes and values of > ou = 90 mg/dl identify a population at risk that should be submitted to GTT and determination of plasma glucose profile