Does extra-amniotic infection cause preterm labor? Gas-liquid chromatography studies of amniotic fluid in amnionitis, preterm labor, and normal controls.

Gas-liquid chromatography (GLC) was used to identify short-chain organic acid byproducts of bacterial metabolism in amniotic fluid from seven normal control patients, six women with overt amnionitis, and six preterm labor patients. Microbiologic culture for aerobic and anaerobic bacteria was also carried out. Positive GLC findings were generally associated with positive cultures, except in five of the preterm labor patients whose GLCs were positive despite negative cultures. The origin of the short-chain organic acids found in these women is unclear; extra-amniotic bacterial growth may explain this finding.

The effect of hyperprolactinemia on the diurnal variation of adrenal androgens.

Morning and evening plasma cortisol, dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S) were measured in ten women with hyperprolactinemia secondary to pituitary adenomas and in seven control subjects with cyclic menses and normal prolactin (PRL) levels. Plasma cortisol and DHEA-S levels were comparable in both groups. A diurnal variation for cortisol and DHEA was identified and comparable in both groups. These findings indicate that PRL may not be an important physiologic regulator of adrenal androgen secretion.

Total parenteral nutrition in pregnancy complicated by Crohn's disease.

Despite the widespread use of total parenteral nutrition (TPN) in nonpregnant patients, the literature reflects limited experience with TPN in pregnancy. However, since maternal nutritional deprivation may cause adverse fetal effects, its use appears warranted. We present a case of a pregnant patient with a poor reproductive history and recently diagnosed Crohn's disease who required TPN. We discuss the use of TPN with fat emulsions in this patient who was unable to tolerate enteral feedings during pregnancy. The patient underwent a 4-week period without oral intake. Total parenteral nutrition enabled continued fetal growth, resulting in a good outcome for the patient and her infant. This report supports the early use of TPN in pregnancy complicated by inadequate caloric intake.

Glycosylated serum protein levels in diabetic and nondiabetic pregnant patients: an indicator of short-term glycemic control in the diabetic patient.

Measurement of the level of nonenzymatic glycosylation of blood proteins with more rapid turnover times than hemoglobin has been suggested as an indicator of time-averaged glucose control in nonpregnant diabetic patients. Using affinity chromatography, we have measured the levels of glycosylated serum proteins during pregnancy in 14 normal volunteers and 15 insulin-dependent diabetic patients. No relationship was noted between the percentage of glycosylated serum proteins in serum from normal patients and the gestational age at the time of sampling in the second and third trimesters of pregnancy. When the relative frequency distribution of glycosylated serum protein levels in normal patients was compared with that in diabetic patients, a significant difference was noted between the two groups, with a higher percentage of glycosylated serum protein levels in diabetic patients being at elevated values compared to those in normal patients. Normal patients had measured glycosylated serum protein levels of 12.5% +/- 2.2% whereas diabetic patients had glycosylated serum protein levels of 14.0% +/- 3.6%. When peak fasting serum glucose and high Chemstrip glucose levels were compared with glycosylated serum proteins in the diabetic population, a significant correlation for each was noted. The best correlation resulted from a comparison of an average Chemstrip glucose level (mean of 49 glucose values during the previous week) and the glycosylated serum protein value obtained at the end of that week. This inexpensive assay can be adapted to any clinical laboratory and should provide an objective means to evaluate short-term glycemic control, complementing the evaluation provided by self-glucose monitoring (immediate control) and intermittent assay of glycosylated hemoglobin (long-term control).