MicroAlbuminuria Prevalence Study (MAPS) in hypertensive type 2 diabetic patients in Hong Kong.

OBJECTIVES: To assess the prevalence of macroalbuminuria and microalbuminuria, and the level of blood pressure control in patients with type 2 diabetes and hypertension in Hong Kong. DESIGN: Cross-sectional clinic-based epidemiological study. SETTING: Six medical centres (including two public hospital diabetes centres) in Hong Kong. PATIENTS: Recruited from the medical centres from April to November 2002, after excluding those with bacteriuria and haematuria. MAIN OUTCOME MEASURES: Body mass index; blood pressure; levels of blood glucose, macroalbuminuria, and microalbuminuria; treatments for hypertension and diabetes. RESULTS: The as per-protocol recruited population of 437 hypertensive type 2 diabetic patients had a mean age of 61.7 (standard error, 0.5) years. Overall, the prevalence of diabetic nephropathy in this population was high; 18.3% had macroalbuminuria (95% confidence interval, 16.5-20.2%) and 24.9% had microalbuminuria (95% confidence interval, 22.9-27.0%). Predictive factors were advanced age, male sex, poor blood pressure control, and existing cardiovascular complications. Whilst almost all patients (96.1%) were receiving treatment for hypertension, only 25.6% had systolic/diastolic blood pressures below the 130/85 mm Hg target. CONCLUSIONS: In Hong Kong, the prevalence of microalbuminuria and macroalbuminuria is high in type 2 diabetic patients with hypertension, particularly in males and those with poorly controlled systolic blood pressure. Tight glycaemic control, antihypertensive therapy, and use of renin-angiotensin system inhibitors/blockers are necessary to retard the progression of nephropathy to advanced renal disease.

Nutritional intake and placental size in gestational diabetic pregnancies--a preliminary observation.

A disproportionately large placenta may represent an adaptive response to adverse intrauterine conditions. Both maternal nutritional intake and presence of gestational diabetes (GDM) have been found to affect relative placental growth. As dietary modification is part of the standard management in GDM women, the observed increase in placental size in these women may be partly due to dietary modification. In this study, we set out to examine the relationship between dietary intake and placental size in GDM pregnancies. Food diaries for five consecutive days for 52 women diagnosed with GDM were obtained to assess their nutritional intake in terms of total calories, carbohydrate, protein and fat. Spearman's correlations were calculated for nutritional intake and various factors that may correlate with placental weight. There was a significant inverse relationship (P=0.021) between placental weight and protein intake. No correlations with the other two nutritional components could be demonstrated. Maternal nutritional intake was not correlated with infant birthweight. It is possible that dietary modulations improve GDM pregnancy outcome, not only by improving glycaemic controls but also by affecting placental growth by altering the proportion of protein intake.

Perinatal morbidity and placental size in gestational impaired glucose tolerance.

OBJECTIVE: The clinical significance of large placentas in diabetic pregnancies is not known. A retrospective study was performed to determine whether a disproportionately large placenta, as represented by a high ratio of placental weight to birth weight (placental ratio), in pregnancies complicated by the World Health Organization category of impaired glucose tolerance (IGT), was associated with perinatal morbidity. METHODS: We categorized 1472 consecutive singleton pregnancies with gestational IGT as having a high placental ratio (> 0.2095 or mean plus one standard deviation of the value established for appropriate-for-gestational age infants from nondiabetic pregnancies in a previous study) or a normal ratio. Maternal characteristics and glycemic parameters, infant birth weight and neonatal complications, and placental weight were compared between these two groups. RESULTS: A high placental ratio was found in 400 (27.2%) pregnancies. This group had similar maternal anthropometric and glycemic parameters, except for a slightly higher prepregnancy body mass index and fasting glucose level in the oral glucose tolerance test. The high placental ratio was from increased placental weight rather than the decreased birth weight. The neonates had increased incidence of low 1-minute Apgar score, treatment for neonatal jaundice and infection, and respiratory complications. After adjusting for the effects of preterm birth and vaginal delivery, a high ratio was still associated with low Apgar score, respiratory complications, and treatment for infection. CONCLUSIONS: The placental ratio in pregnancies complicated by IGT was unrelated to maternal characteristics or glycemic status, but a high ratio was associated with increased perinatal morbidity.

Does maternal glucose intolerance affect the length of gestation in singleton pregnancies?

OBJECTIVE: This study determined whether maternal glucose tolerance has a progressive effect on the length of gestation in singleton pregnancies and whether there is an increasing tendency towards spontaneous preterm birth with increasing glucose intolerance. METHODS: A total of 2,168 consecutive Chinese women with singleton pregnancies who underwent the 75-g oral glucose tolerance test (OGTT) over a 24-month period were categorized by their OGTT 2-hour value (mmol/L) into the following six groups: 5.9 or less, 6.0-6.9, 7.0-7.9, 8.0-8.9, 9.0-10.9, and 11.0 or greater mmol/L. Women with a 2-hour glucose value of 8.0 or more mmol/L were considered to have gestational diabetes mellitus (GDM) and received diet treatment. Women who eventually required insulin were excluded from the final analysis. The mean gestational age, birth weight, incidence of preterm birth, large for gestational age (LGA, birth weight > 90th percentile), and macrosomic (birth weight > or = 4.0 kg) infants were compared among the six groups. RESULTS: The incidence of preterm birth correlated significantly with increasing glucose intolerance. On further analysis, incidence of spontaneous birth before 37 weeks in the lowest to the highest 2-hour value groups was as follows: 5.5%, 2.6%, 3.7%, 4.9%, 8.5%, and 10.3% (P =.015) and that before 32 weeks went from 0.4%, 0.3%, 0.8%, 0.4%, 2.2%, to 3.4% (P =.018), respectively. There was no significant difference in the incidence of LGA or macrosomic infants. Regression analysis confirmed that the OGTT 2-hour glucose value was an independent determinant of gestational length. CONCLUSION: Gestational glucose intolerance affects gestation length and incidence of preterm birth, which should be considered a confounding factor in the analysis of the neonatal outcome of GDM pregnancies.

Relationship between preterm delivery and maternal height in teenage pregnancies.

A retrospective study was performed in 613 singleton pregnancies born to mothers aged < or =19 years over a 4-year period to determine the relationship between maternal height and preterm delivery (<37 weeks). The pregnancies were grouped according to maternal height quartiles for comparison of maternal and infant characteristics, obstetric complications and pregnancy outcome. The incidences of preterm delivery and labour decreased from 17.5% and 15.6% respectively in the lowest quartile, to 8.5% and 7.1% respectively in the highest quartile, without any difference in the risk factors or major complications. In the pregnancies without major complications, which included 73.3% of the cases of preterm labour, the rate of preterm labour was significantly and inversely correlated with the height quartiles. In the newborns, gestational age, birthweight and crown-heel length increased with the higher quartiles, but the ratio between infant crown-heel length and maternal height (height ratio) decreased with the higher quartiles. Unlike birthweight and crown-heel length, the height ratio was not correlated with gestational age. Our findings suggested that the inherent risk of preterm delivery in teenagers was related to their immature physical development at the time of pregnancy, as reflected by the maternal height.

The obstetric implications of teenage pregnancy.

A retrospective review was performed on the obstetric outcome of teenage pregnancies delivered in 1 year in a tertiary centre. The results were compared with the rest of the obstetric population in the same hospital in the same year. The teenage mothers (n = 194) had increased incidence of sexually transmitted diseases (5.2 versus 1.0%, P < 0.05), and preterm labour (13.0 versus 7.0%, P < 0.01), but decreased incidence of gestational glucose intolerance (3.1 versus 11.4%, P < 0.001), when compared with the non-teenage mothers (n = 4914). There was no difference in the types of labour, while the incidence of Caesarean section was lower (4.1 versus 12.6%, P < 0.001) in the teenage mothers. Although the incidence of low birthweight was higher in the teenage mothers (13.5 versus 6.5%, P < 0.001), there was no significant difference in the mean birthweight, gestation at delivery, incidence of total preterm delivery, or perinatal mortality or morbidity. The results indicate that the major risk associated with teenage pregnancies is preterm labour, but the perinatal outcome is favourable. The good results accomplished in our centre could be attributed to the free and readily available prenatal care and the quality of support from the family or welfare agencies that are involved with the care of teenage mothers.

PIP: A retrospective review of the records of 194 adolescents and 4914 women 20 and older who delivered at Hong Kong's Tsan Yuk Hospital in a 12-month period indicated that young maternal age was not a significant risk factor in terms of pregnancy outcome. Compared with their older counterparts, teenage mothers had a significantly increased risk of preterm labor (13.0% versus 7.0%), but a significantly decreased incidence of gestational glucose intolerance (3.1% versus 11.4%). In addition, the incidence of cesarean section was lower in teenagers (4.1%) than in older mothers (12.6%). The incidence of low birth weight was significantly higher among teenage mothers (13.5%) than older mothers (6.5%), but there were no significant differences in terms of mean birth weight, gestation at delivery, incidence of total preterm delivery, or perinatal morbidity or mortality. Although the perinatal outcome was generally good in this series of teenage pregnancies, any adverse effects of young maternal age could have been masked by the free prenatal care and social support available to the study group.

Obstetric outcome of teenage pregnancies.

A retrospective cohort study was performed in a tertiary centre to determine if teenage nulliparas (aged alpha19 years, study group) had higher incidences of instrumental and Caesarean deliveries compared with nulliparas aged 20-34 years (control group) selected from the first women in the birth registry who delivered after each study case and satisfying the criteria for controls. The hospital records of the study and control cases were retrieved for review. Comparison was made in the maternal demographics, major antenatal complications, outcome of labour, mode of delivery, and perinatal outcome. In the study group, maternal height was similar but the body mass index was lower. Although the mean birthweight was lower and the incidences of preterm labour and small-for-gestational-age infants higher, there were also increased incidences of large-for-gestational-age and macrosomic infants. While there was no difference in the types of labour, there were fewer Caesarean and instrumental deliveries, a finding that persisted even after excluding the preterm deliveries. Lastly, teenage mothers aged <17 years had similar outcomes to those aged 17-19 years. These results indicated that teenage mothers had better obstetric outcomes, despite the higher incidence of preterm labour, and that young adolescents (<17 years) performed as well as their older peers.

Induced abortion is not a cause of subsequent preterm delivery in teenage pregnancies.

To examine the possible impact of previous induced abortion on the occurrence of preterm delivery in the subsequent pregnancy in teenage women, a retrospective case-control study was performed on mothers aged 13-19 years who delivered in one tertiary hospital over a 4 year period. Those who had a history of induced abortion prior to the index pregnancy were identified from the records and compared with a control group without previous induced abortion and who were matched for maternal age and parity. Of the 118 cases thus identified, 28 (23.7%) had more than one induced abortions and 18 (15.3%) had one or more induced abortions in the second trimester. There were 10 (8.5%) para 1 cases. No significant differences could be demonstrated between the study and control groups in the maternal demographics, major pregnancy complications, or perinatal outcome, except for the incidence of smokers which was significantly higher (39.0 versus 14.4%, P < 0.02) in the study group. The number of previous induced abortions did not appear to be related to the incidence of preterm labour, which was 10.2 and 8.5% in the study and control groups respectively. Our findings indicate that previous induced abortion is not a significant cause of preterm labour and delivery in teenage pregnancies.

PIP: The possible impact of previous induced abortion on the occurrence of preterm delivery in subsequent pregnancy was investigated in a retrospective case-control study of females 13-19 years of age who delivered at a Hong Kong hospital in 1993-1996. The 118 women whose records indicated a history of induced abortion prior to the index pregnancy were selected as cases and matched for age and parity with controls without previous induced abortion. Among the 118 cases, 28 (23.7%) had more than one induced abortion and 18 (15.3%) had one or more induced abortions in the second trimester. There were no significant differences between cases and controls in maternal demographics or major pregnancy complications, although significantly more cases than controls smoked (39.0% vs. 14.4%). Preterm labor occurred in 10.2% of cases and 8.5% of controls--a nonsignificant difference. These findings suggest that previous induced abortion is not a significant cause of preterm labor and delivery in teen pregnancies.

Impaired glucose tolerance and pregnancy outcome in Chinese women with high body mass index.

To determine if impaired glucose tolerance (IGT) impacts on the outcome of singleton pregnancies in Chinese women with a high (>26 kg/m(2)) body mass index (BMI), a retrospective case-control study was performed on 128 women with IGT and 128 controls with normal oral glucose tolerance test results, who were matched for pre-pregnancy BMI (within 0.1 kg/m(2)) and delivered within the same 3 year period. The IGT group was older, with more multiparae, a higher incidence of previous gestational diabetes mellitus, higher booking haemoglobin and fasting glucose concentrations, but no difference in the pre-pregnancy weight, gestational weight gain, or weight or BMI at delivery. There was no difference in the obstetric complications, mode of delivery, or the gestational age or mean infant birthweight. However, the birthweight ratio (relative to mean birthweight for gestation), incidence of large-for-gestational-age (birthweight >90th percentile) and macrosomic (birthweight > or =4000 g) infants, and treatment for neonatal jaundice, were significantly higher in the IGT group. The results suggest that some of the complications attributed to gestational diabetes mellitus are probably related to maternal weight excess/obesity in the affected subjects, but IGT could still affect infant birthweight outcome despite diet treatment which has normalized gestational weight gain.

alpha-Thalassaemia trait and gestational diabetes mellitus in Hong Kong.

AIMS/HYPOTHESIS: The purpose of this study was to examine the association between maternal alpha-thalassaemia trait and the occurrence of gestational diabetes mellitus in at-risk Chinese women in Hong Kong. METHODS: From 3320 pregnant women who had delivered in our hospital and undergone the oral glucose tolerance test for various risk factors over a three-year period, 163 with alpha-thalassaemia trait were identified (study group). The control group consisted of 163 women chosen from the next patient that was matched for maternal age and parity, following each index case. Comparison was made in the incidence of gestational diabetes mellitus defined by the World Health Organisation criteria, obstetric complications, and perinatal outcome. RESULTS: The incidence of gestational diabetes mellitus was higher in the study group (62.0 % vs 14.7 %, p < 0.0001) which had a higher pre-pregnancy body mass index and lower haemoglobin concentrations. Although more patients in the study group had risk factors (41.7 % vs 26.4 %, p = 0.003), there was no difference in the pregnancy outcome or perinatal complications. Among the gestational diabetic women, those with alpha-thalassaemia trait were considerably younger and their infants had lower body mass index but there was no significant difference in the outcome. On multiple logistic regression analysis, the alpha-thalassaemia trait remained an important factor in the diagnosis of gestational diabetes (OR 11.74, 95 % CI 6.37-21.63). CONCLUSION/INTERPRETATION: Among women at risk of gestational diabetes, the presence of the alpha-thalassaemia trait is an additional risk factor for gestational diabetes mellitus.

Gestational diabetes mellitus in teenage pregnancy: a case-control study.

In a retrospective study, teenage Asian pregnancies with gestational diabetes managed over a 4-year period were compared with a group of age and parity matched controls (2 for each study case) to determine the incidence of gestational diabetes and its impact on the pregnancy outcome. The incidence of gestational diabetes in teenage pregnancy was 5.4% (33/611), and accounted for 1.4% of all the cases of gestational diabetes. There was no difference in the maternal anthropometric parameters or antenatal complications, but the study group had a higher incidence of postpartum haemorrhage (p = 0.010), greater amount of estimated blood loss at delivery (p = 0.016), a trend towards a higher incidence of large-for-gestational age infants, a higher incidence of admission to the neonatal unit (p = 0.024), mostly due to meconium-stained liquor for observation (p = 0.014), and a lower first minute Apgar score (p = 0.012). Our findings support the recommendation that in ethnic groups with a high prevalence of diabetes, universal as opposed to age-limited screening for gestational diabetes should be undertaken.

Cryptosporidiosis in domestic birds.

From March to June 1982, three cases of avian cryptosporidiosis were encountered in chickens, ducklings, and canaries. The bursa of Fabricius of chickens and ducklings were the main target organs and the agents were found to attach the microvillus border of the plical epithelium. In canaries, the parasites adhered to the microvillus border of mucosal epithelium of the proventriculus. Diagnoses were based on the microscopic pathology, the morphology of the parasites, and the type of attachment to epithelium. This represents the first authenticated evidence of cryptosporidial infection in Taiwan.