In pregnant women with past or current Graves' disease, ultrasonography of the fetal thyroid gland by an experienced ultrasonographer is an excellent diagnostic tool. This tool in conjunction with close teamwork among internists, endocrinologists, obstetricians, echographists, and pediatricians can ensure normal fetal thyroid function.

A national population-based pregnancy cohort, compiled at 231 maternity units in the United Kingdom, enrolled 2359 diabetic women in a 12-month period. Type 1 diabetes was diagnosed in 1707 enrollees and type 2 diabetes in 652. Compared to women with type 1 diabetes, those with type 2 diabetes were more likely to come from a black, Asian, or other ethnic minority group, and also likelier to be from a deprived area. In addition, these women were older at the time diabetes was diagnosed and also at the time of delivery. They were less likely than women with type 1 diabetes to be primigravidas. Just over one-third of the 1606 women studied by 13 weeks' gestation had good glycemic control.Adjusting for maternal age, stillbirths were 4.7 times more frequent in diabetic women than in the general maternity population. Rates of perinatal and neonatal mortality were 3.8-fold and 2.6-fold greater, respectively, in cases of diabetes. Perinatal mortality rates were comparable in cases of type 1 and type 2 diabetes. The prevalence of major congenital anomalies in women with diabetes was more than double that expected. Much of the difference was accounted for by nervous system anomalies -particularly neural tube defects -and congenital heart disorders. Nearly two-thirds of infants with anomalies were diagnosed before birth. Congenital heart disease was diagnosed antenatally in 55% of offspring, and other anomalies in approximately 72%.Compared to the general maternity population, infants of women who have type 1 or type 2 diabetes are at increased risk of dying perinatally and of having congenital anomalies. The number of pregnant women with diabetes is expected to increase. There is evidence that good glycemic control at the time of conception and in early pregnancy can reduce adverse outcomes, but a majority of diabetic women fail to achieve such control. ABSTRACTGestational diabetes mellitus (GDM)-carbohydrate intolerance that begins or is first recognized during pregnancycarries increased risk for the mother, fetus, and newborn infant. Both impaired insulin secretion and increased resistance to insulin have been described in GDM. Short-term exogenous corticosteroids can derange glucose metabolism when given alone or with beta-adrenergic drugs, but little is known about whether long-term steroid treatment adversely affects glucose tolerance during pregnancy. This case-control study compared 25 pregnant women with idiopathic thrombocytopenic purpura (ITP) who received steroids (5-10 mg daily of prednisone) for longer than 4 weeks with 108 pregnant women who had not received steroids. Women having pregestational diabetes were excluded. The two groups were similar with regard to age and body mass index.Steroids had been given to the ITP group for nearly 10 weeks on average, and the duration of treatment correlated positively with the risk of the development of GDM which was diagnosed in 24% of steroid-treated women, and in 3% of control women. Subsequent diabetes also was more prevalent in steroid-treated women. With one excep...

Congenital hyperthyroidism is less frequent than congenital hypothyroidism but its impact on growth and development can be as dramatic. The immune form of hyperthyroidism that is transmitted from a mother with Graves’ disease to her foetus and then neonate is transient, but cases of persistent congenital hyperthyroidism had also been described, that can now be explained by molecular abnormalities of the thyrotropin receptor. The abundance of published data on the neonatal effects of maternal Graves’ disease contrasts with the paucity of information on fetal effects. Recent studies showed that it is of utmost to scrutinize fetal thyroid by expert ultrasonographist and to have a team work with obstetricians and pediatric endocrinologists in pregnant women with Graves’ disease. This allowed to accurately determine the fetal thyroid status and to adapt the treatment in the mothers successfully. Fetal hyperthyroidism does exist and needs an appropriate aggressive treatment. Clearly the fetus has become our patient!

Our data confirm the feasibility and safety of intraamniotic l-thyroxine treatment for nonimmune fetal goitrous hypothyroidism. Although goiter size reduction is usually obtained, thyroid hormone status remains deficient at birth. Amniocentesis seems inadequate for monitoring fetal thyroid function. Further studies are needed to determine the optimal management of this disorder.

Objective The justification for magnetic resonance imaging (MRI) in isolated mild ventriculomegaly remains controversial. This study was undertaken to evaluate the contribution of third-trimester MRI in isolated 10-to 12-mm fetal ventriculomegaly.Design Observational prospective cohort study.Setting Universitary prenatal reference centre.Population From February 2000 to May 2005, we prospectively collected data concerning fetuses referred to us for cerebral MRI following detection of ventriculomegaly by ultrasound scan (n = 310).Methods Among these, we identified and analysed those cases in which ventriculomegaly was isolated and did not exceed 12 mm in ultrasound examinations prior to MRI scan (n = 185).Main outcome measure Cases in which MRI provided additional information that was likely to have an impact on prenatal management were detailed.Results During the study period, 310 MRI were performed because of fetal ventriculomegaly. Hundred and eighty-five were suspected to be isolated 10-to 12-mm ventriculomegalies in ultrasound scan and formed our database. MRI confirmed the 10-to 12-mm isolated fetal ventriculomegaly in 106 cases (57.3%) and found other abnormalities in 5 (4.7%) of these 106 cases. MRI found ventricular measurement to be less than 10 mm in 43 cases (23.3%) and more than 12 mm in 36 cases (19.4%). Among these 36 fetuses with ventricle size more than 12 mm, 6 (16.7%) had other abnormalities, whereas MRI did not find other abnormalities in the 43 cases with ventricle size below 10 mm.Conclusion Before advantages of MRI to ultrasound examination can be demonstrated, it seems reasonable that MRI should remain an investigational tool, restricted to selected clinical situations in which the results are expected to modify case management. Where ultrasound scan suspects isolated ventriculomegaly of 10 to 12 mm, our data suggest that when the finding is confirmed with MRI this could be expected in around 5% of cases. Therefore, the policy of routine MRI in such cases should depend on prenatal centres' priorities.

Objectives

Objective: Following recent data showing that an inflammatory response exists in the amniotic fluid of gastroschisis-affected fetuses, we hypothesized that amniotic fluid exchange or amnioinfusion would improve the prognosis of prenatally diagnosed gastroschisis. Methods: We compared the outcome of prenatally amnioinfused fetuses with gastroschisis to non-amnioinfused fetuses with gastroschisis. 10 patients undergoing this procedure were matched with 10 patients of our previous study. Comparisons were done on data including surgical procedure, follow-up in the NICU and the gastro-pediatric unit. Results: Our results show that gastroschisis-affected fetuses undergoing amnioinfusion had a lower duration of curarization after surgery (2.2 ± 1.9 vs. 6.8 ± 6.9 days, p = 0.019), a shorter delay before full oral feeding (49.7 ± 21.5 vs. 72.3 ± 56.6 days, NS), and a shorter overall length of hospitalization (59.5 ± 19.7 vs. 88.5 ± 73.6 days, NS). We confirmed our previous data showing that amniotic fluid displays a chronic inflammation profile. Conclusion: Our data suggest that amnioinfusion could improve the outcome of gastroschisis affected fetuses. The hypothesis by which this improvement could be due to a reduction of an inflammatory response remains to be proved.

Objective To define the contribution of prenatal investigation and evaluate the prognosis of isolated mild ventriculomegaly (IMV).