Impact of excessive gestational weight gain in non-smoking mothers on body fatness in infancy and early childhood. Prospective prebirth cohort study in Cracow.

Gestational weight gain (GWG) is important for health policy as it may be associated with overweight epidemics in childhood and adolescence. The purpose of the study was to perform the risk assessment of joint effects of the excessive GWG and the pregravid maternal BMI on overweight in infancy and childhood. The observations were collected in the ongoing prospective birth cohort study of 482 non-smoking mothers and their newborns in Cracow inner city area. At 5 years of age the subsample of 312 infants were reexamined in order to assess their nutritional status. Body fatness was assessed by means of the weight/length ratio (WLR) in neonates and weight/height ratio (WHR) in 5-year-olds since they showed the strongest correlation with subcutaneous fat mass of young children. In the statistical analysis the binary regression models were applied to identify predictors of overweight. The excessive GWG (>18 kg) increased more than twofold the adjusted relative risk (RR) of neonatal fatness (R=2.7; 95% CI 2.0-3.7) and was also a significant independent risk factor for postnatal body fatness at 5 years of age (RR=2.0; 95% CI: 1.3-3.3). The results confirmed earlier findings that pregravid overweight increased not only the relative risk of neonatal fatness (RR=2.9; 95% CI: 2.2-3.9) but also overweight in early childhood (RR=2.7; 95% CI: 1.7-4.4). The conclusion is that excessive GWG may be a risk factor for overweight in early childhood and should be a focus of public health policy.

[Pregnancy in patients with end-stage renal failure on maintenance dialysis: case reports]. / Ciaza u pacjentek przewlekle dializowanych z powodu terminalnej niewydolnosci nerek--opisy przypadków.

Pregnancy in women with end-stage renal failure on maintenance dialysis is rare, and the chance of successful delivery is relatively low. In this paper we present two cases of women who conceived just prior to initiation of renal replacement therapy and the pregnancy was terminated successfully already on chronic dialysis treatment. The special attention was paid on the necessity of multi-disciplinary collaboration and the need for changes in regular dialysis schedule as the conditions crucial for successful delivery. In summary, the review of current literature dealing with mentioned problem was done.

[Pregnancy in a woman with a prior myocardial infarction: a case report]. / Ciaza po przebytym zawale serca.

Myocardial infarction during pregnancy is a rare event but is considered to be associated with very high mortality of both mother and fetus. We report uncomplicated cesarean section in the 3rd pregnancy in woman with a prior myocardial infarction that occurred during the first hours after cesarean section delivery of the 2nd pregnancy. Intensive cardiological and obstetrical supervision are required for correct management of the pregnancy.

[Effect of insulin therapy on duration of pregnancy in women with diabetes]. / Wplyw insulinoterapii na czas trwania ciazy u kobiet z cukrzyca.

The paper compares how, in the conditions of long observed rule of relative pregnancy length, the length of pregnancy of women with insulin-dependent diabetes is maintained depending on the ways of treating and controlling diabetes. The observations were taken during two periods. In the years 1980-1986 71 women were treated with insulin in traditional way--without constant monitoring of pregnancy, and from 1987-1992 in 232 women intensive pregnancy monitoring and conventional insulin therapy were used. This treatment allowed to achieve proper stabilizing of diabetes, to prolong pregnancy for 12 days and to improve the newborns condition while keeping the same indications for cesarean-section and other ways of delivery and with the same frequency of spontaneous birth. In addition the number of premature births was decreased four times. From 53.5% in the first period to 12% in the second.

Iodine deficiency in pregnant women in an area of moderate goiter endemia.

Low levels of iodine, observed in endemic goiter areas, decrease the synthesis of T3 and T4. This phenomenon is particularly dangerous during pregnancy when demand for thyroid hormones increases considerably. Iodine deficiency may cause brain tissue damage of varying degree, even cretinism in most severe cases. The aim of the study was to make an initial evaluation of TSH and thyroid hormone levels, thyroid volume, and urine iodine excretion in pregnant women. The group under study consisted of 46 women, inhabitants of Kraków region. Their mean age was 26.8 years, 18 were primiparas and 28 multiparas. All deliveries were physiologica, vaginal, within the biological norm of 281 +/- 22 days from the last menstrual period. The concentrations of T3, T4 and TSH were determined in maternal and umbilical blood. Urine iodine levels were measured in the patients. Mean body weight of the newborns was 3338 g, mean pregnancy duration 39.6 weeks, and mean Apgar score 9.9. The results for maternal blood were (mean, SD in parentheses): T3 1.5 ng/ml (0.4), T4 11.6 micrograms% (2.9), TSH 2.3 microU/ml (1.2), thyroid volume 27.8 ml (15.2), urine iodine level 34.99 micrograms/l (29.12), and for umbilical blood T3 0.59 ng/ml (0.1), T4 10.6 micrograms/dl (2.1), FT3 1.28 pm/l (1.1), FT4 15.6 pm/l (4.8), TSH 3.7 microU/ml (0.9). Urine iodine level in pregnant women was several times lower than normal. 80% of the women under study had enlarged thyroid glands. We conclude that investigations of the problem should be continued.