Diabetes mellitus und Schwangerschaft

Weiss, Peter A. M.; Hofmann, H.

doi:10.1007/978-3-7091-3815-1_20

Cited by 14 publications

(3 citation statements)

References 213 publications

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“…Diabetes was classified according to White [23]. An R was appended to the White class in patients with background retinopathy [24]. Most patients were first seen in the Diabetes Unit of our department between gestational weeks 8 and 12, when they were entered into the study.…”

Section: Overtly Diabetic Womenmentioning

confidence: 99%

Insulin binding to trophoblast plasma membranes and placental glycogen content in well-controlled gestational diabetic women treated with diet or insulin, in well-controlled overt diabetic patients and in healthy control subjects

1992

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Insulin binding to trophoblast plasma membranes and the placental glycogen content were measured in twelve healthy women, in eleven well-controlled gestational diabetic women who were treated either with diet alone (n = 4) or with insulin (n = 7) and in 18 women with well-controlled overt diabetes mellitus (six White B; four White C; eight White D). The competitive binding assay was carried out with 22 concentrations of unlabelled insulin. Binding data were analysed by a non-linear direct model fitting procedure assuming one non-cooperative binding site. Maximum specific binding was unchanged in the total collective of gestational diabetic women, but was decreased by 30% in those treated with diet (6.2 +/- 2.2%) and increased by 90% in insulin-treated women (16.4 +/- 10.2%) as compared to the control subjects (8.7 +/- 2.5%). The diet-treated women had only 40% as many and those treated with insulin had more than twice as many receptors compared to control subjects on a per mg protein basis and if expressed per total placenta. In patients with overt diabetes mellitus maximum specific binding (18.5 +/- 10.6%) was higher (p less than 0.05) due to more receptors compared to control subjects but was similar to the insulin-treated gestational diabetic patients. Maximum specific binding and receptor concentrations did not correlate linearly with maternal plasma insulin levels. Receptor affinities were virtually similar in all groups (1.8 x 10(9) l/mol). The placental glycogen content was reduced (p less than 0.05) to about 80% of that of control subjects in the diet-treated collective, whereas it was unchanged compared to control subjects in the insulin-treated gestational diabetic women despite a 40% increase (p less than 0.001) of the maternal-to-cord serum glucose ratio. In overt diabetic patients the maternal-to-cord serum glucose ratio and the placental glycogen content were higher (p less than 0.05) than in the control subjects. We conclude that trophoblast plasma membranes from gestational diabetic women treated with diet alone express less and those from women treated with insulin express more insulin receptors than those from a healthy control group in vitro. These differences could not have been disclosed without consideration of the mode of treatment. Trophoblast plasma membranes from overt diabetic women have more insulin receptors than those from healthy control subjects.

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Section: Overtly Diabetic Womenmentioning

confidence: 99%

Insulin binding to trophoblast plasma membranes and placental glycogen content in well-controlled gestational diabetic women treated with diet or insulin, in well-controlled overt diabetic patients and in healthy control subjects

1992

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“…(7) in etne m Drittel aller Faile beobaehtet wurden. Aufgrund de r voriiberge he nd geste tgert en Insu linwir kung in der l-ruhschwa nge rschaft ist die Hypogt ykamte gefah r in diesem Zeit raum bescn dcrs hoeh (32). Ande re miitte rliehe Komplikationen wi e die vorzeitige w eh entatigkel t. die Spa tgestose und da s lIyd ram nion traten in belden Zettra ume n nahezu gleich hauflg a uf.…”

Section: Disku Ssionunclassified

Schwangerschaftsausgang unter intensivierter Insulintherapie bei manifestem Diabetes*

Crombach

Wolff²,

Klein³

et al. 1990

Geburtsh Frauenheilk

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In 1981, the intensified insulin therapy for achievement of euglycaemia in pregnant diabetics was introduced at the University Department of Obstetrics and Gynaecology in Cologne. This study compares the results of 112 pregnancies in women with overt diabetes monitored before (1971-1980) or after (1981-1988) changing the therapeutic regimen. In the period from 1981 to 1988, the proportion of euglycaemic patients (preconceptionally 19%, before delivery 79%) was clearly higher than from 1971 to 1980 (n = 42; 7% and 9%, respectively). The tight blood glucose control resulted in a doubling of hypoglycaemic episodes during pregnancy. The proportion of preterm deliveries was reduced from 47% to 24%. The rate of caesarean sections was nearly constant (1971-1980: 38%, 1981-1988: 34%). The marked success of therapy was the decrease of perinatal mortality from 20.9% to 2.9%. The perinatal morbidity also diminished, as shown by the decreasing rates (30-90%) of foetopathy, macrosomy, respiratory distress syndrome, birth trauma, hypoglycaemia, hypocalcaemia and polycythaemia. The malformation rate, however, remained high (1971-1980 = 7%, 1981-1988 = 11%). The results demonstrate the necessity of a strict blood glucose control during pregnancy, beginning before the time of conception.

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“…Following the classification of White [6] modified according to Weiss and Hofmann [12], the patients were subdivided into five groups: A (n " 12), Bo (n = 18), B (n = 68), C (n -24), D (n = 46), and > D (n -21). Most of the patients were insulin-dependent (type I) diabetics, 30 had gestational diabetes and in 2 of the patients noninsulin-dependent type II diabetes was known.…”

Section: Methodsmentioning

confidence: 99%

Complications and Fetal Outcome in Diabetic Pregnancy

Burkart

Hanker

Schneider³

1988

Gynecol Obstet Invest

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From 1978 to 1986 a total of 189 pregnant diabetic women gave birth at our hospital. In this randomized prospective study the influence of maternal diabetes treatment in normoglycemic patients, continuous subcutaneous insulin infusion (n = 48) versus intensified conventional treatment (n = 41), is evaluated. These two groups of patients are further compared to patients (n = 28) who underwent conventional diabetes treatment during pregnancy. It can be shown from our data that the rate of complications such as preeclampsia, intrauterine growth retardation, premature labor and premature delivery can be reduced by intensified conventional and insulin pump treatment as compared to conventionally treated patients with late onset of pregnancy care. As expected, in the groups of CSIIand ICT patients no difference in the rate of pregnancy complications nor in fetal outcome could be demonstrated. Among CSII pregnancies 12/48 were complicated, in the ICT population the respective figure was 13/41 (CT: 20/28). The mean gestational age at the time of delivery ranged between 38 and 40 weeks, depending on the severity of maternal diabetes. CT patients were delivered earlier in all White classes. Fetal morbidity was nearly equal in CSII and ICT children, in CT patients it was greatly enhanced. Also the mortality (perinatal and neonatal) was considerably larger in CT patients (6/28), again, in the CSII and ICT population the mortality was nearly identical (2/48 and 3/41). We conclude, from our prospective information, that insulin pump therapy during pregnancy is indicated if intensified conventional treatment does no lead to normoglycemia. This may be the case if maternal diabetes is complicated by dysregulated insulin resorption, prolonged duration of diabetes, or inconsistant working or living conditions. It could be demonstrated that the higher primary costs of ICT as well as CSII therapy are very effective as compared to conventional treatment.

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Diabetes mellitus und Schwangerschaft

Cited by 14 publications

References 213 publications

Insulin binding to trophoblast plasma membranes and placental glycogen content in well-controlled gestational diabetic women treated with diet or insulin, in well-controlled overt diabetic patients and in healthy control subjects

Insulin binding to trophoblast plasma membranes and placental glycogen content in well-controlled gestational diabetic women treated with diet or insulin, in well-controlled overt diabetic patients and in healthy control subjects

Schwangerschaftsausgang unter intensivierter Insulintherapie bei manifestem Diabetes*

Complications and Fetal Outcome in Diabetic Pregnancy

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