Obesity and gestational diabetes among African-American women and Latinas in Detroit: implications for disparities in women's health

OBJECTIVE

to estimate the prevalence of gestational diabetes mellitus (GDM), obesity, and excessive weight gain during pregnancy among Latinas and African-American women in a large Detroit health system and explore risk factors associated with GDM and its implications.

METHODS

Descriptive statistics, chi2 tests, analysis of variance, and logistic regression analyses were used to describe the prevalence of obesity, excessive pregnancy weight gain, and GDM and to assess factors associated with GDM risk in a cohort of 552 African-American women and 653 Latinas in a large Detroit health system.

RESULTS

Women ranged in age from 14 to 47 years. Almost 47% of African-American women and 37% of Latinas were overweight or obese, and 53% of African-American women and 38% of Latinas gained excessive weight during pregnancy. The prevalence of GDM was 5.4% among Latinas and 3.9% among African-American women. After adjusting for other risk factors, Latinas were 2.5 times more likely than African Americans to develop GDM. Other independent risk factors were family history of diabetes, age, body mass index, and gestational weight gain before 28 weeks.

CONCLUSION

Because most women have repeated contact with the health care system during and immediately after pregnancy, care providers have unique opportunities to identify and assist those who are at risk of obesity and diabetes.

Glucose tolerance during pregnancy and birth weight in a Hispanic population

OBJECTIVE

To assess the effect of screening glucose values and gestational diabetes mellitus (GDM) on birth weight in a community-based population of pregnant Hispanic women and infants in Detroit, Michigan.

METHODS

In a prospective cohort study of 372 mother-infant pairs, analysis of variance and multiple linear and logistic regression were used to examine the effects of maternal screening glucose and GDM status on mean birth weight and the risk of large for gestational age (LGA) and small for gestational age (SGA) births.

RESULTS

Screening glucose values of at least 135 mg/dL were found in 26.6% of the mothers and GDM in 5.1%. There was a significant relation between increasing maternal screening glucose level and adjusted mean birth weight (P < .005). As glucose level increased, there was a significant trend toward an increasing percentage of LGA infants and a decreasing percentage of SGA infants (Cochran-Armitage test for trend, P = .001 and P = .009, respectively). Among nondiabetic women, a 10-mg/dL increase in glucose value was associated with an adjusted 30.5-g increase in birth weight (standard error 9.0; P < .001), increased adjusted odds of LGA (adjusted odds ratio [OR] 1.17; 95% confidence interval [CI] 1.02, 1.34), and decreased adjusted odds of SGA (adjusted OR 0.69; 95% CI 0.52, 0.93).

CONCLUSION

Our findings showed a high prevalence of glucose abnormality and an independent effect of maternal glucose level on birth weight in our Hispanic population. Maternal glucose level should be included in studies of factors that affect birth weight, and appropriate prenatal care provided to Hispanic women with abnormal and borderline metabolic status.

Deoxyribonucleic acid, ribonucleic acid, and protein in the placentas of normal and selected complicated pregnancies

Placenta from uncomplicated term pregnancies resulting in the birth of male infants weighing between 2900 and 3800 grams were analyzed for deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and protein content. The mothers of the infants all had pre-pregnancy weights within +/- 15 percent expected body weight for body frame, according to the Metropolitan Life Tables. There were no significant differences, as regards the content of DNA, RNA and protein, between the placental cotyledons. Nine placenta from mothers giving birth to growth retarded infants were analyzed along with the placenta from six mothers with insulin dependent diabetes mellitus. A trend suggesting less DNA in the placenta of the severely growth retarded (symmetric) infants when compared with placenta from the normal pregnancies was not noted in the less severely growth retarded (asymmetric) infants. The placenta from the infants of diabetic pregnancies contained DNA and RNA in amounts similar to that found in normal pregnancy placenta but the protein content was greater.

Intestinal and pelvic endometriosis presenting as a tumor and associated with tamoxifen therapy: report of a case

BACKGROUND

Tamoxifen has been used in the adjuvant treatment of breast cancer because of its antiestrogenic effects. However, recent reports have shown it to have estrogenic effects as well. The purpose of this report is to describe a potential association between tamoxifen therapy and endometriosis.

CASE

A 50-year-old postmenopausal woman who had received 2 years of adjuvant tamoxifen therapy for breast carcinoma developed extensive tumor-like endometriosis necessitating extensive pelvic and intestinal surgery.

CONCLUSION

This case report highlights the need for obstetricians and gynecologists to be familiar with the actions of tamoxifen and its potential complications.

Acquired immunodeficiency syndrome and Pneumocystis carinii infection in a pregnant woman

Human immunodeficiency virus (HIV) infections are being seen with greater regularity by the obstetrician-gynecologist. Acquired immunodeficiency syndrome (AIDS), the extreme of the spectrum of HIV infections, is associated with Pneumocystis carinii infection in more than half of newly diagnosed cases. Four cases of AIDS and P carinii pneumonia complicating pregnancy have been reported in the literature, and all have caused maternal death. We report a case in which the mother survived. Treatment was similar to that used in the other reported cases except that steroids were added. A limited number of patients with AIDS and P carinii infection have been treated with trimethopterim-sulfamethoxazole and steroids, with good results. Steroids should be considered for cases in which other efforts are failing.

Dexamethasone suppresses sex-hormone binding globulin

Dexamethasone suppression (DEX-S) for 14 days has been used to determine the probable source of androgen excess. The exact mechanism(s) of DEX-S is still unclear. The authors postulated that dexamethasone (DEX) inhibits either the synthesis or secretion of sex-hormone binding globulin (SHBG). To examine this hypothesis, 14 women with polycystic ovarian disease (PCOD) and 3 volunteers were given DEX for 14 days. The PCOD group included obese and nonobese women (+/- 15% ideal body weight). Plasma determinations by radioimmunoassay of total testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulfate, luteinizing hormone; follicle-stimulating hormone; cortisol, and SHBG were made. DEX suppressed SHBG levels (P less than 0.01). SHBG levels were significantly lower in the obese than in the nonobese (P less than 0.01). All androgens were suppressed by DEX, with the exception of androstenedione post-DEX levels, which were significantly greater than pre-DEX levels in 6 of 14 subjects (P greater than 0.05). This observation is consistent with DEX suppression of SHBG.

The effect of delta 9-tetrahydrocannabinol in utero exposure on rat offspring fertility and ventral prostate gland morphology

Male rats exposed in utero to delta 9-tetrahydrocannabinol (delta 9-THC) had lower levels of testosterone (T) and luteinizing hormone (LH) prior to puberty (P less than 0.01). At puberty, the levels returned to within the normal range. Ultrastructural examination of the ventral prostate gland at puberty revealed alterations suggestive of degenerative changes. A drastic reduction in secretory granules and acini reflected depressed androgen production and function during the developmental period. The fertility of the F1 and F2 male offspring was decreased by 30 to 40%. It is concluded that THC exposure in utero caused a permanent reduction in fertility and altered ventral prostate gland morphology.

The effect of ultrasonography on midtrimester genetic amniocentesis complications

Midtrimester amniocentesis for antenatal genetic diagnostic purposes is a relatively new procedure. The assumption that placental localization before amniocentesis will reduce the numbers of abortions, bloody taps, and missed taps has resulted in the routine use of diagnostic ultrasound for placental localization. This study consists of two groups undergoing midtrimester amniocentesis. The groups were distinguished by the use and absence of the use of ultrasound data prior to amniocentesis. Comparisons between the groups failed to support the contention that the routine use of ultrasound reduces the complications of midtrimester amniocentesis. Our findings support other published data concluding that the routine use of ultrasound does not help to reduce the number of midtrimester amniocentesis complications.

Menstrual function and renal transplantation

Patients with chronic renal insufficiency usually have menstrual dysfunction. Recent methods of managing chronic renal failure include renal transplantation. In a few instances, previously infertile women have become pregnant. We have studied 23 women who have undergone renal transplantation. Our findings support previous contentions that menstrual irregularity is frequent among women with chronic renal insufficiency. Amenorrhea was the prevailing disturbance and it was not reversed by hemodialysis. Renal transplantation was associated with a return of normal menstrual patterns in 60% of our patient population, and 4 patients experienced pregnancy. These findings support our recommendation of reproductive counseling for all women between the ages of 15 and 50 years who are treated by renal transplantation.