Diabetic retinopathy in pregnancy: A review

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Citations fromthe Literature

for Children, Pyrmont Bridge Rd., Camperdown, NS W 2050, AUS NEW ENGL. J. MED. 1990,322/5 (303-308) The use of the dried-blood immunoreactive-trypsin assay for the detection of cystic fibrosis in newborns has been questioned on the grounds that it may fail to identify patients with enough pancreatic function to have normal fat absorption. To investigate this possibility, we assessed pancreatic function in 78 patients identified in a neonatal screening program as having cystic fibrosis. The diagnosis of cystic fibrosis was confirmed by abnormal results on a sweat chloride test. The results of measurements of fecal fat excretion, pancreatic-stimulation tests, and estimations of the serum level of pancreatic isoamylase indicated that 29 of the 78 children (37 percent) had substantial preservation of pancreatic function. These children (median age, four years) had growth that was close to normal and comparable to growth in children with severe pancreatic insufficiency who received oral enzyme therapy. Pancreatic insufficiency subsequently developed in 6 of the 29 patients, at 3 to 36 months of age. We conclude that the serum immunoreactive-trypsin assay used in neonatal screening programs identifies patients with cystic fibrosis who have sufficient pancreatic function to have normal fat absorption and that a substantial proportion of infants identified as having cystic fibrosis are in this category. Diabetic retinopathy in pregnancy: a review Elman KD; Welch RA; Frank RN; Goyert GL; Sokol RJ Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA OBSTET. GYNECOL. 1990,75/l (119-127) Diabetic retinopathy is the leading cause of blindness between the ages of 24-64 years. The first half of this period corresponds to peak fertility and the childbearing years. The effects of pregnancy on diabetic retinopathy are unclear, but recent studies suggest that pregnancy may be less harmful to the retina of the diabetic subject than was thought previously. Nevertheless, there is reason to believe that at least some women experience a worsening of their retinopathy as a result of pregnancy. Thus, careful ophthalmic evaluation and followup are essential for the pregnant woman with diabetes. This should include a minimum of one complete eye examination every trimester and within 3 months post-partum. Color fundus photography and laser treatment are safe, whereas fluorescein angiography, although commonly used to evaluate retinal vascular disease, can usually be avoided during pregnancy. A quantitative analysis of placental vasculature in the thirdtrimester fetus with autosomal tdsomy Rochelson B; Kaplan C; Guzman E; Arato M; Hansen K; Trunca C Department of Obstetrics and Gynecology, State University of New York at Stony Brook, Stony Brook, NY. USA OBSTET. GYNECOL. 1990,75/l (59-63) Growth disturbance in the trisomic fetus is believed to be primarily fetal in origin. ‘There has been only sparse description of placental pathology in the third trimester in these fetuses, Int J Gynecol Obstet 33

and therefore the placental role in their growth and development remains unexplored. We performed quantitative morphometric analysis on the placentas of 18 fetuses with trisomy and ten normal control fetuses. Doppler umbilical artery analysis was performed on ten abnormal fetuses and all controls. The placentas of trisomic fetuses exhibited a significant reduction in small muscular artery count and small muscular artery/ villus ratio. Abnormal Doppler waveforms correlated closely with reduced small muscular artery counts. Undervasculari&on and increased vascular resistance of the placenta of trisomic fetuses may contribute to diminished fetal growth. The placenta appears to be another fetal organ whose structure and function are affected adversely by abnormal karyotype. Risk of fetal chromosomal anomalies in patients with elevated maternal serum alpha-fetoprotein Warner AA, Pettenati MJ; Burton BK Department of Pediatrics, Bowman Gray School of Medicine of Wake Forest University, 3W South Hawthorne Road, Winston-Salem, NC27103, USA OBSTET. GYNECOL. 1990,75/l (64-66) When elevated maternal serum alpha-fetoprotein (MSAFP) results lead to diagnostic amniocentesis, a decision of whether to karyotype fetal cells must be made. We examined our experience with MSAFP screening in 71,563 unselected pregnancies in which karyotyping was performed when amniocentesis was done because of MSAFP elevations. A total of 727 women (1 .O%) underwent amniocentesis because of elevated MSAFP values and among this group, seven chromosomal anomalies (incidence one in 104) were detected. Of the 727 women, 658 (91Vo) had normal amniotic fluid AFP. In this group, there were six (one in 109) chromosomally abnormal fetuses: three with triploidy, two with 47,xXx, and one with 46,XX,lq - . Among the 69 pregnancies with elevated amniotic fluid AFP, one fetal chromosomal anomaly (trisomy 13) was diagnosed. The incidence of all chromosomal anomalies observed in women undergoing amniocentesis because of elevated MSAFP is comparable to that reported in women 36 years of age undergoing testing because of advanced maternal age. We believe that chromosome analysis should be performed on amniotic fluid samples obtained because of elevated MSAFP unless there are compelling financial circumstances that preclude this. Even in such cases, cell cultures should be established until the amniotic fluid AFP result is available. Chromosome analysis is essential when the amniotic fluid AFP is elevated because of the known association between open fetal defects (spina bitida, omphalocele, and scalp defects) and trisomies 13 and 18. Maternal and cord serum glycosylated protein in neonatal macrosomia and correlation with birth weight Ghosh G; Pildes RS; Richton S; Ajayi 0 DivCion of Neonatology, Department of Pediatrics, Cook County Hospital, University of Illinois College of Medicine, 700 South Wood Street, Chicago, IL 60612, USA OBSTET. GYNECOL. 1990,75/l (79-83) Maternal glycosylated hemoglobin and glycosylated protein