A new approach to the treatment of diabetic pregnant women

Roversi, G. D.; Gargiulo, M.; Nicolini, Umberto; Pedretti, E.; Marini, Antonio; Barbarani, V.; Peneff, P

doi:10.1016/s0002-9378(16)32978-7

Cited by 99 publications

(38 citation statements)

References 10 publications

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“…Some authorities advocate very tight control of maternal blood glucose levels in order to secure best outcomes for the baby, 91 This report will endeavour to produce some estimates in a later chapter.…”

mentioning

confidence: 99%

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Screening for gestational diabetes: a systematic review and economic evaluation

Scott

Loveman

McIntyre³

et al. 2002

Health Technol Assess

180

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confidence: 99%

“…85 There is also the problem of who benefits? Some authorities advocate very tight control of maternal blood glucose levels in order to secure best outcomes for the baby, 91 but this may expose the mother to the dangers of hypoglycaemia (reviewed by Fraser 66 ). Maternal hyperinsulinaemia also exposes the baby to the risk of neonatal hypoglycaemia.…”

mentioning

confidence: 99%

Screening for gestational diabetes: a systematic review and economic evaluation

Scott

Loveman

McIntyre³

et al. 2002

Health Technol Assess

180

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“…For example, O'Sullivan showed that by using his current, stricter criteria for abnormal glucose tolerance [12], a prevalence rate considerably lower than that previously reported [6] would have been obtained. (2) All the more recent studies have reported a perinatal mortality amongst gestational diabetic patients which is not significantly different from a non-diabetic population [1,26,27]. This is likely to be due, firstly, to the fact that nearly all the mothers in these studies had some form of treatment to normalise their blood glucose in addition to close antenatal supervision.…”

Section: Perinatal Mortality and Morbiditymentioning

confidence: 93%

Is gestational diabetes a clinical entity?

Beard

Hoet

1982

Diabetologia

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Summary. Gestational diabetes is a clinical entity associated with a significant incidence in diabetes in the later life of the mother and increase in fetal and neonatal morbidity. Lack of agreement on diagnostic criteria and the methodology of glucose tolerance testing has led to inconsistency in the results of published studies. It is recommended that all women should be screened for carbohydrate intolerance in pregnancy.

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“…of insulin are positive. They have already been reported [l, 5,6,7,8,10] and consist of: 1) a reduction in perinatal mortality (P.M.) to values (total P M. 2.9%, corrected P M. 1.9%) of the general P.M. (in 1975 total PM. of the general population in the Clinic 2.5%); 2) near disappearance of foetal macrosomia (3.3% above 4000 g) and normalization of birth weight(newbornweight does not differ from normal newbom weight) [9]; 3) a normal incidence of pathological Symptoms in newborn infants which were not however severe (respiratoiy distress syndrome 0.6%, hypoglycemia 13.4%); 4) reduction of caesarian sections to 24.6%; 5) delivery time did not have to be systematically brought forward, but only in cases where poor conditions of the foetus were apparent (labour induced in 9.6% of cases): 74.7% of the cases gave birth after the 38th week of gestation.…”

Section: Introductionmentioning

confidence: 97%

“…M.T.D. is easily established in a few days by increasing insulin dosage every day with a "small quantity" of fast-acting insulin and then subtracting the last, "small quantity" after the appearance of the first signs of insulin intolerance [4,5,6,7,8,10]. The maternal diabetes results compensated to a degree that can be defined "äs strict äs possible".…”

mentioning

confidence: 99%

Normalization of blood glucose in pregnant diabetics with the maximal tolerated dose (M.T.D.) of insulin

Roversi¹,

Gargiulo²,

Nicolini³

et al. 1980

Journal of Perinatal Medicine

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The perinatal results achfeved through compensating maternal diabetes by administering the M.T.D. of insulin are positive. They have already been reported [l, 5, 6, 7, 8, 10] and consist of: 1) a reduction in perinatal mortality (P.M.) to values (total P M. 2.9%, corrected P M. 1.9%) of the general P.M. (in 1975 total PM. of the general population in the Clinic 2.5%); 2) near disappearance of foetal macrosomia (3.3% above 4000 g) and normalization of birth weight(newbornweight does not differ from normal newbom weight) [9]; 3) a normal incidence of pathological Symptoms in newborn infants which were not however severe (respiratoiy distress syndrome 0.6%, hypoglycemia 13.4%); 4) reduction of caesarian sections to 24.6%; 5) delivery time did not have to be systematically brought forward, but only in cases where poor conditions of the foetus were apparent (labour induced in 9.6% of cases): 74.7% of the cases gave birth after the 38th week of gestation. The M.T.D. of insulin is the highest quantity of insulin that can be administered without bringing about hypoglycemia. M.T.D. is easily established in a few days by increasing insulin dosage every day with a "small quantity" of fast-acting insulin and then subtracting the last, "small quantity" after the appearance of the first signs of insulin intolerance [4,5,6,7,8,10]. The maternal diabetes results compensated to a degree that can be defined "äs strict äs possible". According to this method of treatment, maternal glycemia was not used in our case study äs a guideline to insulin therapy. However, starting in 1971, the 24 hour blood sugar level was routinely checked in order to quantify the above qualitative definition of the degree of compensation. Preliminary data showed that maternal blood glucose levels out into a normal ränge when the insulin M.T.D. has been reached [10]. This paper provides a more detailed study of this aspect. Materials and methodsStarting in 1971 hospitalized pregnant diabetics underwent a 24-hour glycemia check on a fixed day (Wednesday) of every week. It consisted of 6 samples of capillary blood collected every 4 hours, i.e. at 8 a.m., 12 a.m., 4 p.m., 8 p.m., 12 p.m. and 4 a.m. The patients had fasted from midnight until the 8 a.m. meal. Meals, äs usual, were served at 8 a.m., 12 a.m., 4 p.m. and 6.30p. m. The 12 a.m. and 6.30 p.m. meals were the two main meals of the day. In view of the time relationship between meals and blood sampling (Fig. 1), 5 out of the 6 samples represent the lower blood glucose levels over the 24 hours (the three samples at 8 a.m., 12 a.m. and 4 p.m. were taken 4 hours after the last meal and immediately before ** These results were presented at

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A new approach to the treatment of diabetic pregnant women

Cited by 99 publications

References 10 publications

Screening for gestational diabetes: a systematic review and economic evaluation

Screening for gestational diabetes: a systematic review and economic evaluation

Is gestational diabetes a clinical entity?

Normalization of blood glucose in pregnant diabetics with the maximal tolerated dose (M.T.D.) of insulin

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