Management and outcome of pregnancy in diabetes mellitus, Classes B to R

Gabbe, Steven G.; Mestman, Jorge H.; Freeman, Roger K.; Goebelsmann, Uwe; Lowensohn, Richard I.; Nochimson, David J.; Cetrulo, Curtis; Quilligan, Edward J.

doi:10.1016/0002-9378(77)90388-x

Cited by 171 publications

(46 citation statements)

References 14 publications

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“…One instance of necrotising enterocolitis occurred and Gabbe et al [15] reported 2 cases contributing to the neonatal deaths in their series. We have had altogether 2 cases in 246 live born infants of diabetic mothers (1 infant died) and as this is a fairly rare complication it is possible that there is an association with diabetes.…”

Section: Discussionmentioning

confidence: 92%

“…As in other reported series the neonatal morbidity was high (45%). Soler and Malins [14] reported a neonatal morbidity of 50% in insulin-dependent diabetics in Birmingham, England, and Gabbe et al, [15] from Los Angeles, stated that approximately two thirds of the infants of insulin-dependent diabetics experienced some morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Polycythaemia occurred in 9% of the neonates and was frequently associated with jaundice. Gabbe et al [15] included jaundice and polycythaemia in their group with infant morbidity, but did not give the exact numbers. Soler [16] reports a 19% incidence of severe neonatal jaundice in infants of diabetics and states that it was the single most common neonatal problem.…”

Section: Discussionmentioning

confidence: 99%

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Metformin in management of pregnant insulin-independent diabetics

1979

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Summary.Sixty pregnant "maturity-onset" (insulinindependent), established and gestational, diabetics were treated with Metformin in the second and third trimester after dietary treatment had failed. The incidence of Metformin failure was 53.8% in the established diabetics and 28.6% in the "gestational" diabetics. The 27 Metformin failures were transferred to other therapy, leaving for further analysis 33 patients who received Metformin up till delivery. Two neonatal deaths occurred in this group (1 congenital abnormality and 1 preterm infant) giving a perinatal mortality of 61/1000. This compares with a perinatal mortality of 103/1000 in the Metformin failure group and 105/1000 in a group of insulindependent diabetics treated during the same period. Apart from a high incidence of neonatal jaundice requiring phototherapy the infant morbidity in the Metformin group was low. The mothers of 3 infants with congenital abnormalities had received Metformin only during the last trimester of their pregnancy.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Metformin in management of pregnant insulin-independent diabetics

1979

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“…However, RDS may be less prevalent when maternal diabetes mellitus is mild and well controlled (2,3). The IDM experiences hyperinsulinemia both in utero and in the postnatal period (4), particularly when glucose homeostasis is poor (4,5).…”

Section: Introductionmentioning

confidence: 99%

Chronic hyperglycemia with secondary hyperinsulinemia inhibits the maturational response of fetal lamb lungs to cortisol.

Warburton¹

1983

J. Clin. Invest.

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A B S T R A C T I tested the hypothesis that chronic hyperglycemia with secondary hyperinsulinemia inhibits the stimulation of fetal lung maturation by cortisol. Glucose was infused (16±2 mg/kg per min, mean±SE) from 112 through 130 d gestation into five chronically catheterised twin fetal lambs from which tracheal fluid could be collected. In addition, cortisol was infused (420 pg/h) from 128 through 130 d gestation into both the five glucose-treated twins and the five twin controls. Serum glucose (48±2 mg/dl) and insulin levels (45±3 sU/ml) were significantly higher in the glucose-treated fetuses than serum glucose (23±2 mg/dl, P < 0.001) and insulin (15±3 MU/ml, P < 0.001) in the controls. Serum cortisol levels were <2 ug/dl before 128 d gestation and rose to >6 ig/dl, P < 0.001 during cortisol infusion in both the glucosetreated and control fetuses. Cortisol treatment of control fetuses was associated with a 4.8-fold increase in surface active material (SAM) flux into tracheal fluid, and a 7.7-fold increase in total phospholipid content, a 9.5-fold increase in mixed lecithin content, a 10.5-fold increase in disaturated phosphatidylcholine content, and a 5.6-fold increase in phosphatidylglycerol content of the tracheal fluid (all P < 0.001). In the glucose-treated fetuses there were no significant changes in the tracheal fluid SAM flux and phospholipid content following cortisol administration. In lung wash from the control fetuses treated with cortisol there was 8.9-fold more SAM, and on thin-layer chromatography there was 5.6-fold more total phospholipids, 3.9-fold more mixed lecithin, 6.2-fold more disaturated phosphatidylcholine, and 2.5-fold more phosphatidylglycerol when compared with lung wash from the glucose-treated fetuses treated with cortisol Received for publication 4 February 1983 and in revised form 11 April 1983. (all P < 0.001). Lung volumes at maximal inflation pressure during air pressure-volume studies were 1.8-fold greater in the cortisol-treated control fetuses than in the glucose-treated fetuses, P < 0.025. Chronic hyperglycemia with secondary hyperinsulinemia inhibits the maturational response of fetal lamb lungs to cortisol. A similar mechanism may operate in utero to increase the incidence of respiratory distress syndrome in infants of diabetic mothers with poor maternal glucose homeostasis. Moreover, on the basis of these data, prenatal treatment of infants of diabetic mothers with corticosteroids might not be expected to enhance fetal lung maturation. INTRODUCTIONThe incidence of respiratory distress syndrome (RDS)' is reported by Robert et al. (1) to be increased 5.6-fold in infants of diabetic mothers (IDM), even when suitable corrections are made for gestational age. However, RDS may be less prevalent when maternal diabetes mellitus is mild and well controlled (2, 3). The IDM experiences hyperinsulinemia both in utero and in the postnatal period (4), particularly when glucose homeostasis is poor (4, 5).Stubbs and Stubbs (6) Mason et al. (20). The recovery rates for lipid e...

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“…However, RDS may be less prevalent when maternal diabetes is mild and well controlled (2,3). The IDM experiences hyperinsulinemia both in utero and in the postnatal period (4-7), particularly when glucose homeostasis is poor (8).…”

Section: Introductionmentioning

confidence: 99%

Chronic Hyperglycemia Reduces Surface Active Material Flux in Tracheal Fluid of Fetal Lambs

Warburton¹

1983

J. Clin. Invest.

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A B S T R A C T I tested the hypothesis that chronic hyperglycemia alters fetal lung maturation by continuous infusion of glucose (14±2 mg/kg per min, mean±SE) from 112 up to 145 d gestation into six chronically catheterized fetal lambs from which tracheal fluid could be collected. Serum glucose levels (32±2 mg/dl) and serum insulin levels (38±4 ,uU/ml) in these glucose-treated fetuses were significantly higher than serum glucose levels (18±2 mg/dl, P <0.001) and serum insulin levels (12±3 IAU/ml, P < 0.001) in six chronically catheterized control fetuses of the same gestational ages. Glucose infusion to the fetuses did not alter maternal serum glucose (60±3 mg/dl) or serum insulin levels (35±5 MAU/ml). Arterial blood gases (pH 7.34±0.01, Po2 24.3±0.5 mmHg, Pco2 41.5±0.9 mmHg), oxygen saturation (73±2%), hematocrit (31±1%), and tracheal fluid flow (2.4±0.1 ml/g per h) in the glucose-treated fetuses were not significantly different from controls. Among the control fetuses, surface active material (SAM) began to appear in tracheal fluid at 123 d gestation and was present in all six fetuses by 129 d gestation, whereas SAM did not appear at all in tracheal fluid of four of the glucosetreated fetuses, and appeared in two at low levels after 142 d gestation. SAM flux in the glucose-treated fetuses (<1 ug/g per h) was statistically lower than SAM flux in the control fetuses (60±9 pug/kg per h, P < 0.001).Between 130 and 140 d gestation, tracheal fluid phospholipid content rose fourfold, mixed lecithin content rose ninefold, disaturated phosphatidylcholine content rose fourfold in the control fetuses, whereas little or no increase in these measurements occurred in the glucose-treated fetuses (all differences significant). I conclude that chronic hyperglycemia with secondary hyperinsulinemia reduces SAM flux in tracheal fluid

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Management and outcome of pregnancy in diabetes mellitus, Classes B to R

Cited by 171 publications

References 14 publications

Metformin in management of pregnant insulin-independent diabetics

Metformin in management of pregnant insulin-independent diabetics

Chronic hyperglycemia with secondary hyperinsulinemia inhibits the maturational response of fetal lamb lungs to cortisol.

Chronic Hyperglycemia Reduces Surface Active Material Flux in Tracheal Fluid of Fetal Lambs

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