Stillbirth in the Pregnancy Complicated by Diabetes

Starikov, Roman; Dudley, Donald J.; Reddy, Uma M.

doi:10.1007/s11892-015-0580-y

Cited by 53 publications

(39 citation statements)

References 86 publications

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“…The risk of spontaneous miscarriage, congenital malformations, stillbirth, fetal growth restriction, fetal macrosomia, preeclampsia, early mortality or preterm delivery is increased [15,16]. Pre-gestational diabetes affects also placental weight and function, causing placental circulatory disorders, vasculopathy and placental insufficiency [17]. Gestational diabetes may create conditions likely to induce inflammation and placental hypoxia [18].…”

Section: Discussionmentioning

confidence: 99%

Impact of experimental diabetes and chronic hypoxia on rat fetal body weight

et al. 2018

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Objectives: The aim of the study is to determine the impact of the experimental diabetes and the chronic hypoxia on pregnancy development and rat fetal body weight. Material and methods:The experiment was performed on female Wistar rats. Animals were divided into the experimental groups. I -Controls, II -Untreated diabetes, III -Insulin-treated diabetes, IV -No diabetes with chronic hypoxia, V -Untreated diabetes and chronic hypoxia, VI -Insulin-treated diabetes and chronic hypoxia. Diabetes was induced in groups II, III, V and VI with intraperitoneal injection of streptozocin (STZ) at a dose of 40 mg/kg. Chronic hypoxia was induced by placing dams (groups IV, V and VI) in conditions of 10.5% oxygen and 89.5%. Insulin was administered subcutaneously at the dose of 9 IU/kg. Starting from the 6 th day after STZ injection and chronic hypoxia conditions animals were caged together for 12 hours for 3 consecutive days to ensure fertilization. On day 21 of gestation the animals were decapitated, the fetuses were removed and weighted.Results: Mean fetal body weight in separate groups were: I -5.38 g, II -6.04g, III -5.32g, IV-5.56 g, V -3.45 g, VI -6.23 g. Conclusions:Pre-existing type 1 diabetes does not affect fetal body weight compared to healthy newborn control rats. Prolonged hypoxia does not impact on fetal body weight. Chronic hypoxia during pregnancy complicated with untreated type 1 diabetes mellitus leads to significant reduction of fetal body weight. Insulin treatment reversed the detrimental effect of chronic hypoxia on fetal development.

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Section: Discussionmentioning

confidence: 99%

Impact of experimental diabetes and chronic hypoxia on rat fetal body weight

et al. 2018

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“…The conditions associated with stillbirth rates before the 1930s were not well documented. However, preeclampsia/ eclampsia played an important role, as did diabetes, syphilis, Rhesus (Rh) hemolytic disease, and fetal growth restriction (FGR) (8)(9)(10)(11)(12).…”

Section: Stillbirths In High-income Countriesmentioning

confidence: 99%

“…Screening for syphilis began in the 1920s and antibiotics were introduced in the 1930s and 1940s (9). Screening and improved treatment for diabetes were introduced into prenatal care in the 1950s (12). Screening for maternal Rh disease and treatment of fetal disease were also introduced in the 1950s.…”

Section: Stillbirths In High-income Countriesmentioning

confidence: 99%

“…Preeclampsia/eclampsia/chronic hypertension (8,22,24) Diabetes (12,22) Rhesus incompatibility (10) Maternal trauma (3,22,24) Other medical conditions such as renal disease, systemic lupus erythematosus, sickle cell disease, cholestasis, thrombophilia (11,22,24) Placenta and cord Placental abruption (22,25,26) Placenta previa (22,25,26) Placental malfunction (necrosis and thrombosis) (22,26) Labor complications Prolonged or obstructed labor (22,24,27) Ruptured uterus (25) Cord accident (22,25) Aggressive labor stimulation (51) Maternal infections Malaria (17,24) Syphilis (9,17) Other maternal bacterial and viral infections (17) Fetal conditions Fetal growth restriction (22) De novo fetal distress (22) Congenital anomaly (5,22) Malpresentation (22) Multiple birth (22,24,27) screening and management of diabetes have reduced stillbirths among diabetic women. Screening for Rhnegative status and Rh immune prophylaxis prevent sensitization and the resultant fetal anemia and death (10).…”

Section: Maternal Medical Conditionsmentioning

confidence: 99%

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Reducing stillbirths in low‐income countries

Goldenberg

Saleem

Pasha

et al. 2015

Acta Obstet Gynecol Scand

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Worldwide, 98% of stillbirths occur in low-income countries (LIC), where stillbirth rates are ten-fold higher than in high-income countries (HIC). Although most HIC stillbirths occur prenatally, in LIC most stillbirths occur at term and during labor/delivery. Conditions causing stillbirths include those of maternal origin (obstructed labor, trauma, antepartum hemorrhage, preeclampsia/ eclampsia, infection, diabetes, other maternal diseases), and fetal origin (fetal growth restriction, fetal distress, cord prolapse, multiples, malpresentations, congenital anomalies). In LIC, aside from infectious origins, most stillbirths are caused by fetal asphyxia. Stillbirth prevention requires recognition of maternal conditions, and care in a facility where fetal monitoring and expeditious delivery are possible, usually by cesarean section (CS). Of major causes, only syphilis and malaria can be managed prenatally. Targeting single conditions or interventions is unlikely to substantially reduce stillbirth. To reduce stillbirth rates, LIC must implement effective modern antepartum and intrapartum care, including fetal monitoring and CS.

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“…Stillbirths have been observed most often after the 36th week of pregnancy in patients with vascular disease, poor glycemic control, hydramnios, fetal macrosomia, or preeclampsia [12]. While stillbirth rates for diabetic pregnancies have decreased due to screening, treatment, and antenatal surveillance of these patients in the last decade [31].…”

Section: Implications Of Gestational Diabetesmentioning

confidence: 99%

Gestational Diabetes: Screening, Management, Timing of Delivery

Korkmazer

Solak

Tokgöz

2015

Curr Obstet Gynecol Rep

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Gestational diabetes mellitus (GDM) is a pancreatic function insufficiency to overcome the insulin resistance associated with the pregnant state. The prevalence of GDM is about 2-5 % of normal pregnancies. To prevent the adverse outcome for the mother, the fetus, and neonatal period, detection of GDM is important. Screening methods vary by clinics. Screening can either be selective, based upon risk stratification or universal. Timely testing enables the obstetrician to assess glucose tolerance in the presence of the insulin-resistant state of pregnancy and permits treatment to begin before excessive fetal growth has occurred. After the diagnosis of GDM, close perinatal surveillance is necessary. The goal of treatment in GDM is to reduce fetal and maternal morbidity and mortality. The exact glucose values needed are still unknown. The decision whether and when to induce delivery depends on gestational age, fetal growth, maternal glucose levels, and Bishop score. Screening, follow-up, and treatment of GDM still have controversies.

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Stillbirth in the Pregnancy Complicated by Diabetes

Cited by 53 publications

References 86 publications

Impact of experimental diabetes and chronic hypoxia on rat fetal body weight

Impact of experimental diabetes and chronic hypoxia on rat fetal body weight

Reducing stillbirths in low‐income countries

Gestational Diabetes: Screening, Management, Timing of Delivery

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