RESUMO
OBJECTIVE: To assess fetal growth profiles in an unselected group of pregnant women with either type-1 diabetes (DM1), type-2 diabetes (DM2) or gestational diabetes (GDM), with emphasis on intergroup differences and development of disproportionate fetal growth and macrosomia. METHODS: Second- and third-trimester longitudinal ultrasound measurements of fetal growth were made in 77 women with DM1, 68 women with DM2 and in 99 women with GDM. Altogether 897 ultrasound examinations were performed and 145 uncomplicated pregnancies with 843 ultrasound examinations were included as controls. Ultrasound data included head circumference (HC), abdominal circumference (AC), femur length (FL) and HC/AC ratio. RESULTS: The AC, but not HC and FL, evolved differently in diabetic pregnancies, with a smaller AC in early pregnancy and larger AC at term (significant for DM1 and DM2). The most striking differences were found for the HC/AC ratio, especially in DM1 pregnancies. HC/AC growth trajectories of both macrosomic and non-macrosomic fetuses differed from that of the controls, and the HC/AC ratio at term was lower in all diabetic subgroups except in non-macrosomic DM2 cases. CONCLUSION: We found altered (disproportionate) fetal growth in macrosomic and non-macrosomic fetuses of women with DM1, DM2 and GDM. This indicates that the abnormal intrauterine environment affects the majority of these infants. Growth profiles differed among these groups, the most prominent growth deviations being found in the fetuses of women with DM1. The latter was most probably caused by poor glucose control. In monitoring fetal growth in diabetic pregnancies the HC/AC ratio should be used to assess altered fetal growth.
Assuntos
Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Gestacional/fisiopatologia , Desenvolvimento Fetal/fisiologia , Gravidez em Diabéticas/fisiopatologia , Adulto , Estudos de Casos e Controles , Feminino , Macrossomia Fetal/diagnóstico por imagem , Macrossomia Fetal/fisiopatologia , Humanos , Estudos Longitudinais , Masculino , Gravidez , Fatores de Risco , Ultrassonografia Pré-Natal , Adulto JovemRESUMO
The rate of collapse of a proton gradient across the apical membrane of rat kidney proximal tubule increases upon treatment with calcium, mercuric chloride and mellitin, substances which activate phospholipase A2. Treatment with phospholipase A2 or oleic acid also enhances the rate of proton gradient dissipation. Membrane water permeability is not affected. This phenomenon may have implications in pathological states arising from ischemia or toxic exposure.
