Does hyperglycemia in pregnancy change fetal kidney growth? A longitudinal prospective study.

PURPOSE: To measure fetal renal volume in normoglycemic and hyperglycemic pregnancies. METHODS: A longitudinal prospective study was conducted and included 92 hyperglycemic and 339 normoglycemic pregnant women attended at the prenatal service of a hospital from Rio de Janeiro State. Ultrasound examinations were performed to estimate gestational age at baseline and the kidney volume was estimated using the prolate ellipsoid volume equation. RESULTS: Fetal kidney volume growth between normoglycemic and hyperglycemic pregnancies are significantly different. The fetal kidney volume growth in pregnancy is positively correlated with gestational age explained by these predictor equations, by group: normal renal volume = exp (6.186 + 0.09 × gestational week); hyperglycemic renal volume = exp (6.978 + 0.071 × gestational week) and an excessive growth pattern for hyperglycemic pregnancies may be established according to gestational age. CONCLUSION: This is important for early detection of abnormalities in pregnancy, particularly in diabetic mothers.

Does hyperglycemia in pregnancy change fetal kidney growth?: a longitudinal prospective study / A hiperglicemia na gravidez altera o crescimento renal fetal?: um estudo prospectivo longitudinal

PURPOSE: To measure fetal renal volume in normoglycemic and hyperglycemic pregnancies. METHODS: A longitudinal prospective study was conducted and included 92 hyperglycemic and 339 normoglycemic pregnant women attended at the prenatal service of a hospital from Rio de Janeiro State. Ultrasound examinations were performed to estimate gestational age at baseline and the kidney volume was estimated using the prolate ellipsoid volume equation. RESULTS: Fetal kidney volume growth between normoglycemic and hyperglycemic pregnancies are significantly different. The fetal kidney volume growth in pregnancy is positively correlated with gestational age explained by these predictor equations, by group: normal renal volume = exp (6.186+0.09×gestational week); hyperglycemic renal volume = exp (6.978+0.071×gestational week) and an excessive growth pattern for hyperglycemic pregnancies may be established according to gestational age. CONCLUSION: This is important for early detection of abnormalities in pregnancy, particularly in diabetic mothers.

OBJETIVO: O estudo foi desenvolvido para medir o volume renal fetal em gestações normoglicêmicas e hiperglicêmicas. MÉTODOS: Estudo prospectivo longitudinal, incluindo 92 gestantes hiperglicêmicas e 339 normoglicêmicas que procuraram o serviço pré-natal de um hospital no estado do Rio de Janeiro. A ultrassonografia foi realizada para estimar idade gestacional e volume renal foi estimado utilizando a equação de volume elipsoide. RESULTADOS: O crescimento fetal e os volumes renais entre gestações normoglicêmicas e hiperglicêmicas são estatisticamente distintos. O aumento do volume renal fetal na gravidez é correlacionada com a idade gestacional, de acordo com as seguintes equações preditores, por grupo: volume renal normal = exp (6,186+0,09×semana de gestação); e volume renal hiperglicêmico = exp (6,978+0,071×semana de gestação). CONCLUSÃO: Estes dados são importantes para detecção precoce de anormalidades na gravidez, principalmente em mães diabéticas.

Changes in apoptosis and Bcl-2 expression in human hyperglycemic, term placental trophoblast.

Apoptosis and its associated regulatory mechanisms are physiological events crucial to the maintenance of placental homeostasis; imbalance of these processes, however, such as occurs under various pathological conditions, may compromise placenta function and, consequently, pregnancy success. Increased apoptosis occurs in the placentas of pregnant women with several developmental disabilities, while increased Bcl-2 expression is generally associated with pregnancy-associated tumors. Herein, we tested the hypothesis that apoptosis-associated disturbs might be involved in the placental physiopathology subjected to different maternal hyperglycemic conditions. Thus, in the present study we investigated and compared the incidence of apoptosis using TUNEL reaction and Bcl-2 expression, in term-placentas of normoglycemic, diabetic and daily hyperglycemic patients. Tissue samples were collected from 37 placentas, being 15 from healthy mothers with normally delivered healthy babies, and 22 from mothers with glucose disturbances. From these latter 22 patients, 10 showed maternal daily hyperglycemia and 12 were clinically diabetics. Both Bcl-2 expression and apoptotic DNA fragmentation were established and quantified in the trophoblasts of healthy mothers. Compared to these reference values, a higher apoptosis index and lower Bcl-2 expression were disclosed in the placentas of the diabetic women, while in the daily hyperglycemic group, values were intermediate between the diabetic and normoglycemic patients. The TUNEL/Bcl-2 index ratio in the placentas varied from 0.02 to 0.09 for pregnant normoglycemic and diabetic women, respectively, revealing a predominance of apoptosis in the diabetic group. Our findings suggest that hyperglycemia may be a key factor evoking apoptosis in the placental trophoblast, and therefore, is relevant to diabetic placenta function.

Síndrome HELLP recorrente: relato de dois casos / Recuurrent HELLP syndrome: report of 2 cases

A síndrome HELLP é uma complicaçäo grave da pré-eclâmpsia que determina aumento de morbidade e mortalidade maternas e perinatais. Säo descritos dois casos de recorrência dessa síndrome, sendo que em um deles ocorreu morte materna. Este trabalho alerta para o risco aumentado de síndrome HELLP na gestaçäo seguinte.

Aspectos obstétricos da macrossomia fetal / Obstretrics aspects of fetal macrossomia

Foram estudadas 315 gestaçöes com recém-nascidos macrossômicos, dentro de uma populaçäo de 6.085 nascimentos, com incidência de 5,18 por cento. A idade materna foi superior a 25 anos em 191 gestantes (60,6 por cento). Dos 315 recém-nascidos macrossômicos, apenas 203 mäes fizeram o pré-natal no Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Botucatu. Destas, 115 (56,6 por cento) tinham antecedentes de diabete. A glicemia de jejum foi normal em 167 gestantes (82,3 por cento) e, destas, 78 (38,4 por cento näo tinham antecedentes de diabete. A glicemia de jejum estava alterada em 36 gestantes (17,7 por cento) e 10 näo tinham antecedentes de diabete. Dos 84 GTT realizados, 71 (84,5 por cento) foram normais e 13 (15,5 por cento) alterados. Dos 77 perfis glicêmicos, 29 (37,6 por cento) foram normais e 48 (62,4 por cento) alterados. A análise conjunta dos dois testes revelou que 24 gestantes estavam no grupo I-A (GTT e perfil normais); 31 eram do grupo I-B (GTT normal e perfil alterado); uma era do grupo II-A (GTT alterado e perfil normal) e 12 do grupo II-B (GTT e perfil alterados). A curva de altura uterina é maior após a 28ª semana e o parto foi resolvido por via alta em 50,9 por cento, com índice de Apgar superior a 7 em 78 por cento dos casos