Pregestational diabetes: Insulin requirements throughout pregnancy

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Citations from the Literature

gm (p < 0.02)), head circumference (1.7 cm (p < 0.025)), and placental weight (136 gm (p < 0.02)) in those patients with a high initial umbilical artery systolic/diastolic ratio. For the 12 women with an extreme initial systolic/diastolic ratio, aspirin therapy did not result in a significantly different pregnancy outcome. Effects of low-dose dopamine therapy in the oliguric patient with preeclampsia Kirshon B; Lee W; Mauer MB; Cotton DB Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030; USA American Journal of Obstetrics and Gynecology; 159/3 (604607)/1988 Central hemodynamic and renal responses to low-dose dopamine (1 to 5 pg/kg/min) infusion were studied in six oliguric (< 0.5 ml/kg/hr) patients with severe preeclampsia. Hemodynamic parameters were measured and renal function tests were done before and during therapy. There was a significant rise in urine output from a mean (* SD) of 21 + 10 to 43 f 23 ml/hr, accompanied by a rise in cardiac output from 6.8 f 1.8 to 8.0 + 2.3 L/min (p < = 0.05). There were no significant changes in blood pressure, central venous pressure, or pulmonary capillary wedge pressure. The fractional excretion of sodium, negative free water clearance, and osmolar clearance tended to rise during dopamine therapy. No adverse maternal or fetal effects occurred. We conclude that low-dose dopamine produces a significant increase in urine production with resolution of oliguria in severe preeclampsia. The effect of chronic steroid therapy on glucose tolerance in pregnancy Landy HJ; Isada NB; McGinnis J; Ratner R; Grossman JH III Department of Obstetrics and Gynecology, The George Washington University Medical Center, Washington, DC 20037; USA American Journal of Obstetrics and Gynecology; 15913 (61261?)/1988/ We analyzed the records of 26 pregnant patients receiving chronic steroids to assess the combined effect of pregnancy and glucocorticoid administration on glucose tolerance. Five patients (19.2%) developed diabetes mellitus, four of whom required insulin. In a pregnant control group of 1325 patients, 53 patients (4.0%) develcped diabetes mellitus, five of whom required insulin. Glucose intolerance was significantly higher in the steroid-treated group (p = 0.003). Comparison with a nonpregnant steroid-treated control group (47 patients, 15% of whom developed diabetes mellitus) showed no significant different (p = 0.23) between the two. All pregnant steroidtreated patients developing diabetes mellitus began steroid therapy after conception, whereas none of the patients receiving steroid therapy before conception developed glucose intolerance (p = 0.012). There does not appear to be an additive effect of steroid treatment and pregnancy on glucose intolerance; however, all patients receiving steroids should undergo periodic glucose screening. In t J Gynecol Obstet 29

Pregestrtlonal diabetes: Insulin requirements throughout pregnancy Langer 0; Anyaegbunam A; Brustman L; Guidetti D; Levy J; Mazze R Department of Obstetrics and Gynecology, Diabetm Research and Training Center, Albert Einstein College of Medicine, Bronx, NY 10461; USA American Journal of Obstetrics and Gynecology; 15913 (616621)/1988/ The management of pregestational diabetes requires tight metabolic control to reduce maternal and perinatal morbidity and mortality. It has been suggested that type 1 diabetes is a disorder characterized by insulin deficiency and type II diabetes is characterized by insulin resistance; however, it may be hypothesized that a difference in insulin requirements should emerge throughout pregnancy to reflect the dissimilarities in these two metabolic disturbances. The current investigation of 103 women with pregestational diabetes used a novel approach (reflectance meters with onboard memories) to uncover the actual insulin dosage required to reach and maintain optimum metabolic control throughout pregnancy. It was found that both type I and type II diabetes appear to have a triphasic insulin pattern, with the patient having type II diabetes requiring significantly higher doses of insulin during each trimester. This seems to suggest that the hormonal changes in pregnancy may have a similar effect on both type I and type II diabetes but to a different degree. Thus this should be considered in the treatment of pregestational diabetes and in the development of an algorithm for diabetes management. Carbohydrate intolena= In patients receiving oral torolytks Angel JL; O’Brien WF: Knuppel RA; Morales WJ; Sims CJ; Baker JH Divbion of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, FL; USA American Journal of Obstetrics and Gynecology; I5913 (762766)/1988/ This prospective study was designed to evaluate the effects on glucose metabolism of terbutaline used as an oral tocolytic agent. Eighty-six patients were studied when admitted for preterm labor from 24 to 35 weeks’ gestation. After intravenous tocolysis, these patients were maintained on 5 mg of terbutaline every 4 or 6 hours. An oral 50 gm, l-hour glucose challenge test was done 48 hours after terbutaline dosing began. All abnormal glucose challenge test results (> = I35 mg/dl) were followed by a standard 100 gm oral glucose tolerance test. Sixtythree percent (54 of 86) of the terbutaline group had an abnormal l-hour screening result, which was significantly different from the 26.7% (23 of 86) observed in the control group (p < 0.001). The mean fasting blood sugar and l-hour postchallenge values were significantly higher in the study than in the control group (p < 0.0001). Ten of 86 in the treated group (11.6%) and 2 of 86 in the control group (2.3%) with abnormal results met the criteria for gestational diabetes. These numbers achieve statistical significance at p < 0.05. This study shows a significant effect of oral terbutaline therapy on glucose tolerance during