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1.
Ultrasound Obstet Gynecol ; 60(6): 751-758, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36099480

RESUMO

OBJECTIVES: To compare the ability of three fetal growth charts (Fetal Medicine Foundation (FMF), Hadlock and National Institutes of Child Health and Human Development (NICHD) race/ethnicity-specific) to predict large-for-gestational age (LGA) at birth in pregnant individuals with pregestational diabetes, and to determine whether inclusion of hemoglobin A1c (HbA1c) level improves the predictive performance of the growth charts. METHODS: This was a retrospective analysis of individuals with Type-1 or Type-2 diabetes with a singleton pregnancy that resulted in a non-anomalous live birth. Fetal biometry was performed between 28 + 0 and 36 + 6 weeks of gestation. The primary exposure was suspected LGA, defined as estimated fetal weight ≥ 90th percentile using the Hadlock (Formula C), FMF and NICHD growth charts. The primary outcome was LGA at birth, defined as birth weight ≥ 90th percentile, using 2017 USA natality reference data. The performance of the three growth charts to predict LGA at birth, alone and in combination with HbA1c as a continuous measure, was assessed using the area under the receiver-operating-characteristics curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: Of 358 assessed pregnant individuals with pregestational diabetes (34% with Type 1 and 66% with Type 2), 147 (41%) had a LGA infant at birth. Suspected LGA was identified in 123 (34.4%) by the Hadlock, 152 (42.5%) by the FMF and 152 (42.5%) by the NICHD growth chart. The FMF growth chart had the highest sensitivity (77% vs 69% (NICHD) vs 63% (Hadlock)) and the Hadlock growth chart had the highest specificity (86% vs 76% (NICHD) and 82% (FMF)) for predicting LGA at birth. The FMF growth chart had a significantly higher AUC (0.79 (95% CI, 0.74-0.84)) for LGA at birth compared with the NICHD (AUC, 0.72 (95% CI, 0.68-0.77); P < 0.001) and Hadlock (AUC, 0.75 (95% CI, 0.70-0.79); P < 0.01) growth charts. Prediction of LGA improved for all three growth charts with the inclusion of HbA1c measurement in comparison to each growth chart alone (P < 0.001 for all); the FMF growth chart remained more predictive of LGA at birth (AUC, 0.85 (95% CI, 0.81-0.90)) compared with the NICHD (AUC, 0.79 (95% CI, 0.73-0.84)) and Hadlock (AUC, 0.81 (95% CI, 0.76-0.86)) growth charts. CONCLUSIONS: The FMF fetal growth chart had the best predictive performance for LGA at birth in comparison with the Hadlock and NICHD race/ethnicity-specific growth charts in pregnant individuals with pregestational diabetes. Inclusion of HbA1c improved further the prediction of LGA for all three charts. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.


Assuntos
Diabetes Mellitus , Doenças do Recém-Nascido , Gravidez , Recém-Nascido , Feminino , Criança , Humanos , Gráficos de Crescimento , Idade Gestacional , Hemoglobinas Glicadas , Estudos Retrospectivos , Recém-Nascido Pequeno para a Idade Gestacional , Retardo do Crescimento Fetal/diagnóstico , Ultrassonografia Pré-Natal/métodos , Terceiro Trimestre da Gravidez , Peso Fetal , Desenvolvimento Fetal , Peso ao Nascer , Macrossomia Fetal/diagnóstico por imagem
2.
J Neonatal Perinatal Med ; 6(4): 303-10, 2013 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-24441086

RESUMO

BACKGROUND: In the United States, breastfeeding initiation (BFI) is reported for 75% of all live births; however, little information is available regarding mothers affected by gestational diabetes mellitus (GDM). OBJECTIVE: To examine feeding practices and factors associated with BFI in women with GDM and their infants. METHODS: A total of 303 GDM (58 late preterm and 245 term) pregnancies were studied. Infant feeding preference was ascertained on admission to labor and delivery. Variables known to influence BFI including maternal age, smoking, obesity, racial and educational characteristics were assessed. RESULTS: On admission 188 women intended to BF, 60 intended to feed formula and 55 were undecided. None of the women who wished to feed formula and 27% of the originally undecided later initiated BF. Regardless of feeding preference 163 (54%) of all mothers initiated BF. Similar BFI rates were found for 176 Class A1 and 127 class A2 women. Logistic regression analysis showed that intention to BF was the most significant predictor of BFI. Factors associated with BFI failure included African American race, lower education, smoking, obesity and admission to NICU. Following delivery 264 (87%) infants received well baby care while 39 (13%) were admitted to the NICU. Among 188 women who intended to BF, BFI involved 81% of 160 infants receiving well baby care and 61% of the 28 admitted to the NICU. CONCLUSIONS: More than half of women with GDM, who intended to BF, initiated BF. BFI failure remains associated with race, lower education level, smoking, obesity, preference for formula feeding and admission to NICU.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Intenção , Mães/psicologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
3.
J Matern Fetal Neonatal Med ; 11(4): 226-31, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12375675

RESUMO

OBJECTIVE: A planned study is described which will determine whether a benefit exists for the treatment of mild carbohydrate intolerance during pregnancy. METHODS: A randomized clinical trial of women with mild gestational diabetes will compare perinatal outcomes in those receiving diet therapy and insulin as required versus those randomized to no specific treatment. RESULTS: The primary outcome of this study will be a composite of neonatal morbidity in the treatment and control groups. CONCLUSIONS: A randomized treatment trial of mild gestational diabetes mellitus will clarify whether identification and treatment of mild gestational diabetes mellitus reduces perinatal morbidity. This information will aid in selecting appropriate thresholds for the treatment of gestational diabetes mellitus.


Assuntos
Diabetes Gestacional/terapia , Dietoterapia/métodos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Resultado da Gravidez/epidemiologia , Estudos de Coortes , Diabetes Gestacional/complicações , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Doenças Fetais/etiologia , Humanos , Mortalidade Infantil , Recém-Nascido , Programas de Rastreamento , Estudos Multicêntricos como Assunto , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Estados Unidos/epidemiologia
5.
Am J Obstet Gynecol ; 182(6): 1283-91, 2000 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10871440

RESUMO

OBJECTIVE: Glycemic control, perinatal outcome, and health care costs were evaluated among women with type 1 diabetes mellitus who began insulin pump therapy during pregnancy (group 1, n = 24), were treated with multiple insulin injections (group 2, n = 24), or were already using an insulin pump before pregnancy (group 3, n = 12). Patient satisfaction and continuation of pump therapy post partum were assessed. STUDY DESIGN: A retrospective review of maternal and neonatal medical records was performed, and a questionnaire was sent to patients after delivery. Patients in groups 1 and 2 were matched for age, age at onset and duration of diabetes mellitus, White class, and date of delivery. RESULTS: No differences in glycosylated hemoglobin A levels were observed among groups 1, 2 or 3 in the first, second, or third trimester. Patients in group 1 started pump therapy at a mean of 16.8 weeks' gestation, and 17 (70.8%) began therapy as outpatients. No deterioration in glycemic control was noted during the 2- to 4-week period after the start of pump treatment. Among the women in group 1 eight had at least one episode of severe hypoglycemia before starting pump therapy, but only one had such an episode after this treatment was begun. Two episodes of ketoacidosis occurred in group 1, and no episodes occurred in groups 2 and 3. No significant differences in perinatal outcomes or health care costs were observed among groups 1, 2, and 3. After delivery 94. 7% of the women in group 1 continued to use the pump because it provided better glycemic control and a more flexible lifestyle. Postpartum glycosylated hemoglobin A values were 7.2% in group 1 and 9.1% in group 2, a significant difference. CONCLUSIONS: Insulin pump therapy was initiated during pregnancy without a deterioration of glycemic control and was associated with maternal and perinatal outcomes and health care costs comparable to those among women who were already using the pump before pregnancy or who received multiple-dose insulin therapy. Women who began pump therapy in pregnancy were highly likely to continue pump use after delivery and preferred the flexible lifestyle that this treatment allowed.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Custos de Cuidados de Saúde , Insulina/administração & dosagem , Insulina/economia , Satisfação do Paciente , Gravidez em Diabéticas/tratamento farmacológico , Adulto , Glicemia/análise , Análise Custo-Benefício , Diabetes Mellitus Tipo 1/sangue , Feminino , Seguimentos , Hemoglobinas Glicadas/análise , Humanos , Bombas de Infusão , Insulina/uso terapêutico , Período Pós-Parto , Gravidez , Resultado da Gravidez , Gravidez em Diabéticas/sangue , Estudos Retrospectivos , Fatores de Risco
7.
J Matern Fetal Med ; 9(1): 42-5, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10757434

RESUMO

Subcutaneous insulin infusion or insulin pump therapy has been advocated as an alternative to multiple dose insulin injections for nearly two decades. These devices provide insulin administration in a pattern which more closely resembles that of physiologic insulin release, a basal insulin infusion during the day and throughout the night with boluses given prior to meals. Because the number of patients using an insulin pump is increasing, it is likely the perinatologist will encounter women who are being treated with an insulin infusion pump or are considering this therapy. Insulin pump therapy requires that the patient be highly motivated and compliant. One of the most important criteria in selecting patients for this treatment is their willingness to test their capillary glucose levels 6 to 8 times each day. Interruption of the insulin infusion can produce hyperglycemia in any pump user. Should this occur in the pregnant patient, the likelihood of ketoacidosis developing is significantly greater. Ideally, insulin pump therapy should be initiated prior to pregnancy so that glucose control can be normalized, thereby reducing the risk for spontaneous abortion and fetal malformations. Gradually improving glucose control prior to pregnancy can reduce the likelihood of deterioration of retinopathy, which has been observed when poorly controlled pregnant patients rapidly become euglycemic. The published experience with the insulin pump has demonstrated that this therapy can achieve glucose control and perinatal outcomes comparable to that obtained with multiple-dose insulin injection therapy.


Assuntos
Sistemas de Infusão de Insulina , Gravidez em Diabéticas/tratamento farmacológico , Glicemia/análise , Feminino , Humanos , Insulina/administração & dosagem , Sistemas de Infusão de Insulina/economia , Gravidez , Gravidez em Diabéticas/sangue
11.
Am J Obstet Gynecol ; 180(3 Pt 1): 516-8, 1999 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10076120

RESUMO

This essay presents a brief review of the history advocating a restructuring of residency training to increase the flexibility of the experience. The advantages for both the general obstetrician-gynecologist and the subspecialist are reviewed.


Assuntos
Educação de Pós-Graduação em Medicina/organização & administração , Ginecologia/educação , Internato e Residência/organização & administração , Obstetrícia/educação , Humanos , Estados Unidos
12.
Am J Obstet Gynecol ; 180(3 Pt 1): 578-80, 1999 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10076131

RESUMO

OBJECTIVE: The purpose of this study was to determine whether digital examination introduces vaginal organisms into the cervix. STUDY DESIGN: Thirty-five women with reported ruptured membranes at >/=34 weeks' gestation underwent a sterile speculum examination and a standardized semiqualitative, semiquantitative endocervical culture before and immediately after digital cervical examination. RESULTS: Cultures taken before digital examination demonstrated a mean of 2.8 +/- 1.7 different types of organisms, whereas cultures taken after digital examination demonstrated a mean of 4.4 +/- 1.5 different types of organisms (P <.0001). Twenty-eight patients (80%) had heavier growth or a greater number of different organisms in the postexamination culture than in the pre-examination culture. The state of the fetal membranes (ruptured as opposed to intact) did not alter these relationships. CONCLUSION: An immediate effect of digital examination is the introduction of vaginal organisms into the cervical canal.


Assuntos
Colo do Útero/microbiologia , Ruptura Prematura de Membranas Fetais/microbiologia , Obstetrícia , Exame Físico/efeitos adversos , Complicações Infecciosas na Gravidez/microbiologia , Adolescente , Adulto , Feminino , Humanos , Obstetrícia/métodos , Gravidez
13.
Obstet Gynecol ; 92(6): 1033-7, 1998 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9840572

RESUMO

A consensus conference sponsored by the Council of University Chairs of Obstetrics and Gynecology in February 1997 formulated the organization's response to the many external issues affecting academic medicine and obstetrics and gynecology including 1) a new practice model based on "wellness," 2) reimbursement changes that have jeopardized traditional revenue sources, 3) an emphasis on quality assurance based on outcomes research and evidence-based medicine, 4) the concept of lifelong learning dictated by an expanding knowledge base and new technology, 5) insufficient resources for basic and clinical investigation in obstetrics and gynecology, 6) workforce statistics indicating stabilization in the number of subspecialists, 7) the increasing diversity of the United States population. Recommendations were developed that are intended to foster change and contribute to the design of academic programs. These include appropriate training for residents as providers of primary care, with an emphasis on continuity clinics, an interdisciplinary curriculum in women's health for medical students; promotion of gender, racial, and ethnic diversity at all levels of medical education and academic leadership; creation of clinical trials research units; and the development of expanded opportunities for research in obstetrics and gynecology supported by the National Institutes of Health.


Assuntos
Ginecologia/normas , Obstetrícia/normas , Conferências de Consenso como Assunto , Ginecologia/educação , Obstetrícia/educação , Prática Profissional , Pesquisa , Estados Unidos
14.
Diabetes Care ; 21 Suppl 2: B1-2, 1998 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9704218

RESUMO

This study reviews the summary and recommendations of the first three International Workshops Conferences on Gestational Diabetes Mellitus (GDM) and highlights areas of controversy requiring further research and discussion. The International Workshop Conferences on GDM held in 1979, 1984, and 1990 established a definition of GDM, confirmed the value of universal screening with a 50-g oral glucose load, recommended use of the 100-g oral glucose tolerance test with interpretation according to the diagnostic criteria of O'Sullivan and Mahan, and emphasized the importance of classification after pregnancy with a 75-g oral glucose tolerance test with classification according to the criteria of the National Diabetes Data Group or the World Health Organization. Recommendations for management have included nutritional counseling with limitation of the intake of concentrated sweets, monitoring maternal glucose levels to maintain the fasting plasma glucose < 105 mg/dl and the 2-h postprandial plasma glucose < 120 mg/dl, initiating insulin therapy if treatment with diet fails, and prohibiting the use of oral hypoglycemic agents. Antepartum fetal surveillance with emphasis on the evaluation of fetal growth using clinical and ultrasonographic techniques to detect macrosomia were also proposed. Although much has been accomplished in the first three conferences, areas of continued controversy include establishing a definition and method of detection for GDM that can be agreed on worldwide; defining the appropriate glucose levels to initiate dietary and/or insulin therapy; preventing macrosomia, as well as detecting and managing it, to reduce the cesarean delivery rate; and determining the long-term consequences for the mother with GDM and her infant through further studies.


Assuntos
Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Glicemia/análise , Congressos como Assunto , Dieta para Diabéticos , Feminino , Humanos , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Gravidez , Garantia da Qualidade dos Cuidados de Saúde
15.
Arch Pediatr Adolesc Med ; 152(3): 249-54, 1998 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9529462

RESUMO

OBJECTIVE: To describe the clinical outcome of infants born to mothers with gestational diabetes mellitus (GDM) and preexisting insulin-dependent diabetes mellitus (IDDM). SETTING: A tertiary care regional perinatal center with a specialized diabetes-in-pregnancy program. DESIGN: Case series. RESULTS: Five hundred thirty infants were born to 332 women with GDM and 177 women with IDDM. Thirty-six percent of these 530 newborns were large for gestational age, 62% were appropriate for gestational age, and only 2% were small for gestational age. Seventy-six (14%) of all infants were born before 34 weeks' gestation, 115 (22%) between 34 and 37 weeks of gestation, and 339 (64%) at term. Two hundred thirty-three infants (47%) were admitted to the neonatal intensive care unit due to respiratory distress syndrome (RDS), prematurity, hypoglycemia, or congenital malformation. Hypoglycemia (more common among infants of maternal diabetic classes C through D-R) was documented in 137 (27%) of all newborns. One hundred eighty-two infants (34%) had RDS of varying severity. Polycythemia (5% of infants), hyperbilirubinemia (25%), and hypocalcemia (4%) were other morbidities present. Two hundred forty-four infants were admitted for routine care and enteral feedings. Forty-three of these newborns required subsequent transfer to the neonatal intensive care unit for treatment of hypoglycemia (16 cases), RDS (19 cases), or both (8 cases). Routine care failures were more common among infants whose mothers had advanced diabetes, but less frequent among breast-fed infants. CONCLUSIONS: With modern management, fewer morbidities can be expected in infants of diabetic mothers. Those infants born to women with IDDM remain at risk for hypoglycemia, which can be treated in one half of the cases by enteral feedings alone. The majority of cases of RDS are mild and require short admissions to special care nurseries. Optimal care of infants of diabetic mothers is based on prevention, early recognition, and treatment of common conditions. Severe congenital malformations, significant prematurity, RDS, recurrent hypoglycemic episodes, and asymptomatic infants of women with advanced IDDM should be admitted to special care nurseries. Breast-feeding among women with GDM and IDDM should be encouraged.


Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Gestacional , Resultado da Gravidez , Gravidez em Diabéticas , Adulto , Peso ao Nascer , Aleitamento Materno , Feminino , Idade Gestacional , Humanos , Hipoglicemia/etiologia , Recém-Nascido , Terapia Intensiva Neonatal , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia
16.
Am J Obstet Gynecol ; 176(4): 826-32, 1997 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9125607

RESUMO

OBJECTIVE: The purpose of this study was to review the literature relating to the impact of work and workplace hazards on pregnancy, as well as to provide suggestions to practitioners caring for working women. STUDY DESIGN: This study is a review of the literature to date. RESULTS: Studies examining the impact of work during pregnancy on perinatal outcome have failed to yield consistent findings. An increase in preterm births and low-birth-weight infants has been observed in women who work in adverse conditions or in jobs with known hazardous exposures. No adverse outcomes are seen in women with less strenuous jobs or in women who are able to modify their work activity. CONCLUSION: A careful workplace history should be taken by the obstetrician-gynecologist including level of activity, hazardous exposures, and ease of workplace modification. Women whose work requires prolonged standing or walking should be monitored carefully throughout pregnancy for evidence of intrauterine growth restriction or symptoms of preterm labor. The ultimate decision on continuation of employment during pregnancy should be made by the patient after careful counseling by her physician and discussions with her employer.


Assuntos
Resultado da Gravidez , Mulheres Trabalhadoras , Feminino , Substâncias Perigosas/efeitos adversos , Humanos , Exposição Ocupacional/efeitos adversos , Gravidez , Complicações na Gravidez , Estresse Fisiológico/complicações , Estados Unidos
17.
Am J Obstet Gynecol ; 175(5): 1138-41, 1996 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-8942478

RESUMO

OBJECTIVE: Our purpose was an assessment of statistical analysis in studies published in the American Journal of Obstetrics and Gynecology, as well as documentation of appropriate and inappropriate statistical application. STUDY DESIGN: All papers included in the Clinical Articles section and transactions of societies sections of the January through June 1994 issues of the American Journal of Obstetrics and Gynecology (volume 170, numbers 1 to 6) were reviewed for statistical usage. Each paper was given a rating for the thoroughness of the listing of applied statistics and a rating for the appropriateness of statistical usage, when possible. RESULTS: Of the 190 available articles, 53 consisted of studies void of statistics, 8 of which required statistics or claimed significance without the use of statistics. Therefore 145 articles were included in the final analysis. Because of inappropriate or incomplete descriptions of statistics used within the article (52.6%), the ability to assess the appropriateness of usage was severely limited. However, 44 articles (30.3%) could be classified as having appropriate usage of statistics, whereas 46 articles (31.7%) were deemed to have inappropriate usage of statistics. Furthermore, 27 of these 46 articles were noted to have serious flaws. CONCLUSION: The lack of complete and detailed listings of applied statistics made it difficult to assess the appropriateness of more than half the studies examined, suggesting a need for more detailed guidelines as to the listing of statistical procedures used. Despite this fact, nearly one third of the articles contained examples of statistics used inappropriately. These findings suggest that a policy of statistical review be instituted.


Assuntos
Estatística como Assunto , Editoração , Pesquisa
18.
Obstet Gynecol ; 88(3): 479-81, 1996 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8752262

RESUMO

Today, academicians in obstetrics and gynecology are required to assume leadership roles in teaching, patient care, research, and administration. The junior faculty member facing these challenges needs a guide to help him or her adjust to the culture of the academic department. These lessons can be described in an alphabet of academic medicine.


Assuntos
Ginecologia , Obstetrícia , Docentes de Medicina , Humanos
19.
Am J Obstet Gynecol ; 175(1): 56-62, 1996 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8694076

RESUMO

OBJECTIVE: The objective of this study was to evaluate the hypothesis that ketoacids (acetoacetic acid and beta-hydroxybutyrate) diminish glucose transport in trophoblasts cultured from first-trimester chorionic villi. STUDY DESIGN: First-trimester trophoblasts were obtained by transabdominal chorionic villus sampling for subsequent cytogenetic analysis. The cells were established as a continuous line exhibiting trophoblast characteristics. Trophoblasts were cultured in Ham's F12/Dulbecco's modified Eagle's medium (1:1) supplemented with 15% fetal bovine serum. Experiments were initiated by a 24-hour preincubation in serum-free Ham's F12/Dulbecco's modified Eagle's medium followed by incubation with ketoacids (acetoacetic acid and beta-hydroxybutyrate, 0 to 10 mmol/L) in the presence or absence of insulin-like growth factor-I (100 ng/ml). The cells were challenged with 2-deoxy-[1,2-3H]D-glucose (0.1 mmol/L) for 5 minutes and then cell-associated radioactivity was measured. Total ribonucleic acid was extracted from cells incubated with ketoacids in the presence or absence of insulin-like growth factor-I, and Northern blots were probed with a phosphorus 32-labeled complementary deoxyribonucleic acid fragment encoding the rat GLUT 1. RESULTS: Ketoacids caused a dose-dependent inhibition of glucose transport. At 5 mmol/L acetoacetic acid there was a > 50% reduction in the rate of glucose transport in both control and insulin-like growth factor-I-treated cells. The diminution in glucose uptake by trophoblasts was not due to cellular toxicity of the ketoacids because there was no significant difference in trypan blue exclusion or lactate dehydrogenase release between control and ketoacid-treated cells. Northern analysis revealed that the steady-state expression of GLUT1 messenger ribonucleic acid was diminished in ketone-treated cells, but this effect was overcome by coincubation of cultures with insulin or insulin-like growth factor-I. CONCLUSIONS: These results indicate that ketoacids can suppress the uptake of glucose into first-trimester human trophoblasts. Because ketoacidosis in pregnant women with diabetes mellitus is a frequent clinical consequence of poor metabolic control, it is possible that elevated levels of acetoacetic acid and beta-hydroxybutyrate may impair the transport of glucose across the placental trophoblast and into the fetal circulation.


Assuntos
Glucose/metabolismo , Cetoácidos/farmacologia , Trofoblastos/efeitos dos fármacos , Acetoacetatos/farmacologia , Células Cultivadas , Vilosidades Coriônicas , Feminino , Transportador de Glucose Tipo 1 , Humanos , Hidroxibutiratos/farmacologia , Fator de Crescimento Insulin-Like I/farmacologia , Proteínas de Transporte de Monossacarídeos/efeitos dos fármacos , Proteínas de Transporte de Monossacarídeos/metabolismo , Gravidez , Primeiro Trimestre da Gravidez , RNA Mensageiro/efeitos dos fármacos , RNA Mensageiro/metabolismo , Trofoblastos/metabolismo
20.
Obstet Gynecol Surv ; 51(7): 437-44, 1996 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8807644

RESUMO

Coronary heart disease and myocardial infarction are uncommon complications during pregnancy. Women with insulin-dependent diabetes mellitus (IDDM) have a much greater risk of serious coronary heart disease, but few cases of myocardial infarctions occurring during pregnancy have been reported. Significant maternal morbidity has been reported in half of these cases. This is a case of a myocardial infarction occurring at 21 weeks of gestation in a patient with class R/F IDDM and the subsequent pregnancy management as well as a review of the literature concerning Class H IDDM in pregnancy.


Assuntos
Doença das Coronárias/complicações , Diabetes Mellitus Tipo 1/complicações , Infarto do Miocárdio/complicações , Gravidez em Diabéticas/complicações , Adulto , Doença das Coronárias/terapia , Diabetes Mellitus Tipo 1/classificação , Feminino , Hemodinâmica , Humanos , Infarto do Miocárdio/terapia , Gravidez , Resultado da Gravidez , Gravidez em Diabéticas/classificação
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