Pregestational diabetes

Linking the Perinatal Environment to Neonatal Cardiovascular Outcomes

Cases of high-risk pregnancies continue to rise throughout the United States and globally, increasing rates of maternal and neonatal morbidity. Common pregnancy complications and morbidities include preterm birth, hypertensive disorders, fetal growth restriction, diabetes mellitus, and chorioamnionitis. Exposure to these perinatal conditions contributes to cardiac morbidities in the fetus and neonate, including altered cardiac growth, congenital heart disease, and cardiac dysfunction. Significant research has demonstrated lasting effects of these pregnancy complications, with increased rates of cardiac morbidities seen in children and adults after these perinatal exposures. The link between the perinatal environment and long-term outcomes has not been fully elucidated. The aim of this review is to discuss the current understanding of the implications of a high-risk pregnancy on fetal and neonatal cardiac development.

Prenatal, Obstetric and Perinatal Aspects in Pregnancy Associated with Pregestational Diabetes

ABSTRACT: We report the case of a 37-year old primigesta, primipara (IGIP) patient with a singleton, naturally obtained pregnancy, diagnosed with type I diabetes mellitus from the age of three, carrier of an insulin pump for 11 years. The patient was diagnosed in adolescence with with a tumor of the ischio-rectal fossa with multiple attempts of excision which failed due to the particular situation of the tumor. Ultrasound examination diagnosed in the first trimester of pregnancy a voluminous right ovarian cystic tumor. The patient presented pregnancy-induced hypertension starting with 28 gestational weeks. Maternal-fetal and obstetric management assumed sequential ultrasound examination, ovarian tumor and maternal blood pressure drug control, and also the surgical management of the ischio-rectal tumor. Cesarean section was performed at 38 gestational weeks, outcoming with a live fetus, normal weight, good neonatal progression and favorable postoperative progression of the mother. In this case report, we emphasize the fact that in pregestational diabetes mellitus and pregnancy-induced hypertension, constant glycemic control, performed by the insulin pump, prior and during gestation, and the maternal blood pressure control are essential for maternal-fetal outcome.

Maternal risk factors and perinatal outcomes among pacific islander groups in Hawaii: a retrospective cohort study using statewide hospital data

Background

Studies suggest Pacific Islander women have disparate rates of preterm birth, primary cesarean delivery, preeclampsia, gestational diabetes, and low birthweight infants. However, data is limited. In order to improve the health of Pacific Islanders, it is essential to better understand differences in obstetric outcomes in this diverse population

Methods

This study compared perinatal outcomes between Pacific Islander (9,646) and White (n = 5,510) women who delivered a singleton liveborn in any Hawaii hospital from January 2010 to December 2011 using the Hawaii Health Information Corporation (HHIC) database. Pacific Islanders were disaggregated into the following groups: Native Hawaiian, Samoan, Micronesian, and Other Pacific Islanders. Perinatal outcomes (e.g. hypertensive diseases, birthweight, mode of delivery) were compared using multivariable logistic models controlling for relevant sociodemographic and health risk factors (e.g. age and payer type).

Results

Significant differences in perinatal outcomes between Pacific Islander and White women and newborns were noted. All Pacific Islander groups had an increased risk of hypertension. Outcome differences were also seen between Pacific Islanders groups. Native Hawaiians had the highest risk of low birthweight infants, Samoans had the highest risk of macrosomic infants and Micronesians had the highest risk of cesarean delivery.

Conclusions

Important differences in perinatal outcomes among Pacific Islanders exist. It is important to examine Pacific Islander populations separately in future research, public health interventions, and policy.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-015-0671-4) contains supplementary material, which is available to authorized users.

Maternal health issues and cardio-metabolic outcomes in the offspring: a focus on Indigenous populations

Non-communicable diseases (NCDs) including diabetes, obesity and cardiovascular disease are the leading causes of death worldwide. Indigenous populations are disproportionally affected. In an effort to halt the increasing disease burden, the mechanisms underlying the increasing rate of NCDs are an important area of study. Recent evidence has focused on the perinatal period as an influential period impacting the future cardio-metabolic health of the offspring. This concept has been defined as metabolic foetal programming and supports the importance of the developmental origins of health and disease in research and clinical practice, specifically in prevention efforts to protect future generations from NCDs. An understanding of the underlying mechanisms involved is not clear as of yet. However, an understanding of these mechanisms is imperative in order to plan effective intervention strategies. As much of the discussion below is gleaned from large epidemiological studies and animal studies, further research with prospective cohorts is necessary.

Dietary sugar in healthy female primates perturbs oocyte maturation and in vitro preimplantation embryo development

The consumption of refined sugars continues to pose a significant health risk. However, nearly nothing is known about the effects of sugar intake by healthy women on the oocyte or embryo. Using rhesus monkeys, we show that low-dose sucrose intake over a 6-month period has an impact on the oocyte with subsequent effects on the early embryo. The ability of oocytes to resume meiosis was significantly impaired, although the differentiation of the somatic component of the ovarian follicle into progesterone-producing cells was not altered. Although the small subset of oocytes that did mature were able to be fertilized in vitro and develop into preimplantation blastocysts, there were >1100 changes in blastocyst gene expression. Because sucrose treatment ended before fertilization, the effects of sugar intake by healthy primates are concluded to be epigenetic modifications to the immature oocyte that are manifest in the preimplantation embryo.

Twin pregnancy among women with pregestational type 1 or type 2 diabetes mellitus

OBJECTIVE

To assess the impact of twin versus singleton pregnancy on obstetric and perinatal outcomes among women with pregestational diabetes mellitus (DM).

METHODS

Multicenter retrospective cohort study of women with pregestational DM and twin or singleton pregnancy, conducted in Spain during 2005-2010. Each group included 63 women (type 1 DM, n=39; type 2 DM, n=24).

RESULTS

Of 269 565 deliveries, 68 (0.025%) were twins of mothers with pregestational DM, with 28/63 (44.4%) conceptions achieved with assisted reproduction technology. Among women with type 1 DM, hypertensive complications were more common among those with twins than among controls (13% versus 3%, P=0.02); the rate of preterm birth was higher (69% versus 15%, P<0.001); and the rate of admission to the neonatal intensive care unit was higher (51% versus 21%, P=0.005). Twin pregnancy was an independent risk factor for adverse perinatal outcomes regardless of the type of diabetes.

CONCLUSION

Twin pregnancy in women with either type of DM dramatically increased the risk of perinatal morbidity. In mothers with type 1 DM, twin pregnancy was more often associated with hypertensive complications than singleton pregnancy. Transfer of more than one embryo should be avoided if ART is needed in a woman with DM.

Effect of maternal chronic disease on obstetric complications in twin pregnancies in a United States cohort

OBJECTIVE

To evaluate the effect of maternal chronic disease on obstetric complications among twin pregnancies.

DESIGN

Multicenter, retrospective, observational study.

SETTING

Clinical centers (19 hospitals).

PATIENT(S)

Twin pregnancies (n = 4,821) delivered ≥ 23 weeks of gestation and classified by maternal chronic disease (either none or any of the following: asthma, depression, hypertension, diabetes, and heart, thyroid, gastrointestinal or renal disease).

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Gestational age at delivery, gestational hypertension, pre-eclampsia, gestational diabetes, placental abruption, placenta previa, hemorrhage, chorioamnionitis, maternal postpartum fever, premature rupture of membranes, labor onset (spontaneous vs. nonspontaneous), route of delivery, and maternal admission to intensive care unit.

RESULT(S)

Women with chronic disease delivered earlier (mean gestational length, 34.1 vs. 34.6 weeks) and were less likely to have term birth (risk ratio 0.80; 95% confidence interval 0.70-0.90). Cesarean delivery after spontaneous labor (risk ratio 1.20; 95% confidence interval 1.05-1.37) was also increased with chronic disease. No statistically significant effects were observed for other complications studied. Women who used assisted reproductive technology were more likely to hemorrhage, independent of chronic disease, but other findings were generally similar to the non-assisted reproductive technology sample.

CONCLUSION(S)

Chronic disease was associated with additional risk of earlier delivery and cesarean section after spontaneous labor in a nationwide sample of US twin pregnancies.