Intensive Medical Nutrition Therapy Alone or with Added Metformin to Prevent Gestational Diabetes Mellitus among High-Risk Mexican Women: A Randomized Clinical Trial.

The aim of this study was to examine the efficacy of intensive medical nutrition therapy (MNT) plus metformin in preventing gestational diabetes mellitus (GDM) among high-risk Mexican women. An open-label randomized clinical trial was conducted. Inclusion criteria were pregnant women with three or more GDM risk factors: Latino ethnic group, maternal age >35 years, body mass index >25 kg/m2, insulin resistance, and a history of previous GDM, prediabetes, a macrosomic neonate, polycystic ovarian syndrome, or a first-degree relative with type 2 diabetes. Women before 15 weeks of gestation were assigned to group 1 (n = 45): intensive MNT-plus metformin (850 mg twice/day) or group 2 (n = 45): intensive MNT without metformin. Intensive MNT included individual dietary counseling, with ≤50% of total energy from high carbohydrates. The primary outcome was the GDM incidence according to the International Association of Diabetes Pregnancy Study Groups criteria. There were no significant differences in baseline characteristics and adverse perinatal outcomes between the groups. The GDM incidence was n = 11 (24.4%) in the MNT plus metformin group versus n = 7 (15.5%) in the MNT without metformin group: p = 0.42 (RR: 1.57 [95% CI: 0.67-3.68]). There is no benefit in adding metformin to intensive MNT to prevent GDM among high-risk Mexican women. Clinical trials registration: NCT01675310.

[Ovarian denervation and polycystic ovary]. / Denervación y poliquistosis ováricas.

BACKGROUND: Ovarian inervation is limited to the superior pedicle and ovarian artery to loose itself within the gonadal smooth muscle. Hence, it is far from clear how is it that the ovary preserves its communication with hypothalamic and pituitary structures for feedback regulation. There is a lack of precision concerning structures and mechanisms involved in the genesis of polycystic disease. OBJECTIVE: To know the role of inervation associated to hormone stimuli in developing polycystic ovaries. MATERIAL AND METHODS: Groups of Sprague Dawley rats were studied: group 1, whom received cornoil (vehicle) served as controls; group 2 had estradiol valerianate (EV) and group 3 was exposed to phenol for denervation and also received estradiol valerianate (EV). After sacrifice, ovaries were exposed and saved in a formol solution until preparation and staining with hematoxilin-eosin and for immunochemical reaction using specific monoclonal antibodies for nerve tissue (PS-100 & GFAP). RESULTS: Biologic response was considered when follicle dilation was seen under microscopy evaluation. The ovaries with higher follicle development belonged to group 2 (EV) while preserving intrinsic follicular nervous activity as shown by a positive immunoreaction to PS-100 & GFAP. Those denervated and exposed to EV (group 3) did not show significant changes in follicular size resembling controls. CONCLUSIONS: The presence of neural activity is vital for development of cysts and the neural mechanisms involved seemed to lie within the ovarian cells.