From April 1977 to April 1981, 420 deliveries of infants of insulin-dependent diabetic women were performed in our department. Of the infants delivered, 23 had congenital malformations (5.5%). The malformation rate was 1.4% for infants of 420 nondiabetic women. Strict metabolic control was begun after 8 wk gestation in 292 of the diabetic women who delivered 22 infants with congenital malformations (7.5%). Intensive treatment was begun before conception in 128 diabetic women planning pregnancy. There was only one malformation in infants of this group (0.8%), a significant reduction from the anomaly rate in the late registrants (X2 = 7.84; P less than 0.01). These observations indicate that reasonable metabolic control started before conception and continued during the first weeks of pregnancy can prevent malformations in infants of diabetic mothers.
The relationship between maternal glucose levels and the concentration of glucose and insulin levels in human milk from diabetic women has not been elucidated. In addition, the rate of appearance of intravenously injected insulin to the change in concentration of insulin in maternal milk has not been studied. To study this relationship of glucose levels in serum to glucose levels in milk, maternal milk and glucose levels were measured in diabetic lactating women (n = 7) and nondiabetic lactating women (n = 10). In addition, the change in milk concentration of insulin was studied after an intravenous injection of insulin. The maternal whole blood glucose in the seven diabetic women was stabilized at a baseline blood glucose of approximately 100 mg/dl and then elevated with an infusion of intravenous glucose to a level of three times baseline (approximately 300 mg/dl for up to 2 hours). The plasma glucose was then lowered back to baseline with intravenous insulin over 20 minutes. The baseline serum insulin and glucose levels were compared to nonlactating women who donated serum to measure insulin levels in normal controls. Maternal milk glucose levels rise following an increase of plasma glucose levels with a lag time to the peak glucose level of 40-90 minutes, and return to baseline following the return of plasma glucose to baseline with a lag time of 120-150 minutes. Baseline milk insulin levels are elevated in hyperinsulinemic women and the levels of insulin in the milk will rise dramatically above baseline values after an intravenous injection of insulin with a lag time to the peak of concentration in milk of 60-80 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)
Fetal hyperinsulinemia is assumed to play a key role in the pathogenesis of diabetic fetopathy. To investigate the role of enhanced fetal B-cell mass as one cause of fetal hyperinsulinemia during diabetic pregnancy, we studied human fetal pancreatic slices from diabetic women (FDW) with poor metabolic control and nondiabetic women (FNDW) between 11 and 26 wk of pregnancy, morphometrically and by in vitro incubation experiments. Abortions had been performed due to different medical indications. We found a good correlation between the calculated B-cell mass and the gestational age in both FDW and FNDW, but the increase in FDW was much more pronounced. Such a correlation was also found in vitro regarding the insulin response to glucose and IBMX. The FDW had significantly higher values than FNDW of the same age range. In contrast to this, we found in two diabetic patients with tight metabolic control during the whole pregnancy results similar to those in FNDW. Therefore, we assume that it could be possible to prevent fetal hyperinsulinemia and perhaps even diabetic fetopathy in diabetic women by tight metabolic control during the whole pregnancy, but further investigations are necessary.
56 out of the 200 pregnant diabetic women admitted to our clinic between July 1981 and June 1983 had followed a pre-pregnancy metabolic intensive treatment programme. Most of these patients achieved near-normoglycemia: 87% or more of all their blood glucose readings before conception and in the early weeks of gestation were normoglycemic. The 56 patients were delivered of 57 babies, one of them suffering from fatal heart malformation. The 144 pregnant diabetics who were admitted to hospital only after eight weeks of pregnancy and had not had any special preconceptional metabolic control gave birth to 145 children, 9 of which presented congenital malformations: 3 of these were fatal another 3 were severe, and 3 were minor. These data are in line with our previously reported results on the years 1977-81. They stress the importance of a reasonably strict metabolic control, started well before conception, to prevent excess rates of congenital malformation.
The treatment of 620 insulin-dependent diabetic pregnant women is reported. The goal of treatment was to achieve a normal blood glucose concentration as soon as possibly during early, or even before pregnancy. When intensified conventional insulin therapy was started before conception, about 88% of the patients achieved normal blood glucose levels during the first weeks of pregnancy. In only about 20% of the pregnant diabetics without intensified preconceptional treatment a normal blood glucose level was obtained during their first hospitalization in pregnancy. The rate of congenital malformations was 1.1% in the former and 7.1% in the latter group.The treatment of the pregnant woman with insu¬ lin-dependent diabetes mellitus (IDDM) has com¬ pletely changed during the last 10 years. It is now generally accepted that the aim is to achieve tight metabolic control from the earliest weeks of preg¬ nancy and if possible even before conception. In this study we examined how many diabetic women who were able to achieve and maintain tight metabolic control during the preconceptional period and in the first trimester of pregnancy. Further, the influence of this optimized control on the rate of congenital malformations was eva¬ luated. Material and MethodsFrom 1977 to 1983 620 pregnant women with IDDM were treated and delivered in our hospital. 184 were under our care already before preg¬ nancy. They had been educated in home blood glucose monitoring, measurement of basal body temperature and about all other aspects of the treatment of diabetes in pregnancy during their first 'pre-pregnancy' hospitalization. After achiev¬ ing normal blood glucose levels they attended a special prepregnancy clinic and were admitted to hospital for a short period every 3 month until conception. In 436 women education and intensi¬ fied treatment was not started until after the eight week of pregnancy, that is after the critical period of embryogenesis.In all patients the aim was to achieve a blood glucose concentration comparable to that found in non-diabetic pregnant women.Our management of pregnant women with IDDM includes weekly attendance at the out¬ patient department and 5 to 7 short admissions to hospital during pregnancy, depending on the degree of metabolic control. Usually patients are seen at their weekly hospital visits by a specialist physician and obstetrician at their home town. On the whole these teams adhere strictly to our re¬ commendations and if necessary patients are referred back to us earlier than scheduled.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.