Relationship between neonatal birth weight and maternal plasma amino acid profiles in lean and obese nondiabetic women and in type I diabetic pregnant women.

Profiles of hemoglobin A1c (HbA1c) and concentrations of plasma glucose and 18 plasma amino acids were obtained in ten nonobese, insulin-dependent type I diabetic women, in 9 age- and weight-matched normal women and in ten obese nondiabetic women throughout pregnancy and postpartum. In late gestation, the period of maximum fetal growth, average HbA1c, plasma glucose, and total amino acid concentrations in diabetic mothers were significantly elevated above lean control values. No differences existed between the obese and lean control groups. Lean diabetic mothers also had significantly heavier babies (mean +/- SEM) relative to the 50th percentile for gestational age and sex (119 +/- 9%) than did the lean control group (94 +/- 3%, P less than .05). Relative birth weights among control lean and obese mothers did not differ significantly (94 +/- 3% v 104 +/- 5%). Late pregnancy profiles of HbA1c and average plasma glucose did not correlate with relative weight of neonates whereas average total plasma amino acids and six individual amino acids did correlate with this parameter. These data suggest that maternal plasma amino acid concentrations may influence fetal weight generally and may have an important role in the development of fetal macrosomia in diabetic pregnancies.

Prolactin and growth hormone responses in the amenorrhea-galactorrhea syndrome.

Fifteen patients with hyperprolactinemia, amenorrhea, and galactorrhea were studied; 10 of these patients had apparent tumors. Nine of 12 patients had a suppression of prolactin with oral L-dopa, and all of 4 patients undergoing dopamine infusion had suppression of prolactin. Eleven and 8 patients underwent chlorpromazine stimulation and insulin-induced hypoglycemia, respectively; none responded. Three of the 4 patients did not show a growth hormone response with dopamine infusion, and L-dopa testing failed to achieve a growth hormone response in 7 of 10 patients. The data suggest an intact dopaminergic inhibition of prolactin with exogenous agents. However, inhibition of endogenous dopamine by chlorpromazine failed to elicit a prolactin response. The disordered growth hormone response to dopaminergic agents suggests a central disorder of dopamine generation. The possible implication of these results with respect to the pathogenesis of hyperprolactinemia is discussed.

Chronic-persistent hepatitis and pregnancy.

The course and possible risks of pregnancy in 7 women between the ages of 20 and 30 yr with chronic-persistent hepatitis (CPH) were evaluated. Ten pregnancies occurred in these women during the follow-up period which ranged from 3 to 8 yr. Four of the fetuses were aborted electively for nonmedical reasons. The other six pregnancies resulted in normal spontaneous vaginal deliveries at term. Each of the women experienced uneventful pre- and postnatal courses, and the neonates were all healthy and developmentally normal at birth. There was no biochemical or clinical evidence to suggest worsening liver disease during pregnancy. Normal menstrual patterns when not pregnant and normal biphasic basal body temperature patterns in 4 women suggested that ovulation and fertility were not impaired significantly. Pregnancy in women with CPH appears safe to both mother and fetus alike. This finding contrasts with the morbidity and mortality some authors have found to be associated with cirrhosis and with portal hypertension. We speculate that our findings may be relevant to women with other portal lesions resembling CPH such as resolving acute hepatitis and chronic active hepatitis in sustained remission.

The effect of a perinatal center on perinatal mortality.

The evolution of a perinatal center over the past 12 years was reviewed. Factors in obstetric practices, maternal morbidity, and perinatal mortality were evaluated. The reduction in conditions leading to uteroplacental insufficiency (toxemia, hypertension, high parity) has been the most significant result. This in turn has led to a decrease in deaths from abruption, asphyxia, and respiratory distress syndrome (RDS). The practice of referring high-risk mothers to a perinatal center for delivery can continue to reduce perinatal mortality significantly.

Amniotic fluid lecithin/sphingomyelin ratio changes related to centrifugal force.

Lecithin/sphingomyelin ratio (L/S ratio) in amniotic fluid has gained wide clinical acceptance as an index of fetal lung maturity. We determined L/S ratios of amniotic fluids centrifuged at various "g-forces." Our studies demonstrate that the L/S ratio value is highly dependent on the g-force used to prepare the fluid. We recommend standardization of the g-force, time, and temperature used in preparation of the amniotic fluid for L/S ratio determination.

Pregnancy in cirrhotic and noncirrhotic portal hypertension.

The course of pregnancy in 1 patient with chronic active hepatitis (CAH) and cirrhosis, and another with extrahepatic portal vein obstruction (EHPVO) is described. The management of pregnancy in these diseases associated with portal hypertension is discussed and risks of pregnancy are compared. The patient with CAH presented with anovulatory cycles, and ovulation occurred following immunosuppressive therapy. Both women experienced massive upper gastrointestinal bleeding from esophageal varices. Bleeding was difficult to control and required variceal ligation in 1. Both patients manifested features suggesting cerebral edema indicating the need for caution with fluid and electrolyte therapy. Recovery of the woman with CAH after termination of pregnancy was slow. Review of literature demonstrated that variceal bleeding occurred in 43% of women with EHPVO compared to 23% of those with CAH and cirrhosis. Additional complications including hepatocellular failure (24%) occurred in patients with CAH but not in EHPVO. The management of pregnancy in portal hypertension and advice for contraception or sterilization are discussed.

Clomiphene citrate therapy in a patient with Laennec's cirrhosis.

Clomiphene citrate therapy was initiated in a male with Laennec's cirrhosis complicated by gynecomastia, testicular atrophy, impotence, and loss of libido. The patient had abstained from alcohol and had stable hepatic function tests for 1 year before starting therapy. Luteinizing hormone and endogenous testosterone levels were maximally elevated with low dose therapy (50 mg per day). Follicle-stimulating hormone was maximally elevated with a dose of 100 mg per day and the elevation of total estrogen levels was not affected by increasing the dose. During treatment increase in testicular size was noted with resolution of impotence and improvement of libido which continued for 6 months after cessation of therapy. Gynecomastia remained unchanged despite the increased serum testosterone. Serum prolactin was normal before and after the clomiphene citrate. Semen initially unobtainable was analyzed after completion of therapy. The patient relapsed 8 months after the course of clomiphene citrate therapy.

Venereal transmission of hepatitis B virus. The possible role of vaginal secretions.

The presence of Type B viral (Australia antigen related serum) hepatitis in vaginal specimens was investigated and compared with that in saliva specimens in a group of patients during the acute phase of their illness. Hepatitis B surface antigen was detectable in most vaginal and salivary secretions during the phase of antigenemia and not in hepatitis B surface antigen-negative controls. Despite care in collection, occult blood was detected in the majority of specimens, but the positivity for hepatitis B surface antigen did not depend on the presence of occult blood. Recovery studies were performed in both vaginal fluids and saliva to determine if inhibitors to hepatitis B surface antigen were similar to those observed in stool samples. Significant inhibition was not observed. Although infectivity of the specimens was not established from this study, handling of these specimens as potentially infective material is recommended.