Antropometría como predictor de diabetes gestacional: Estudio de cohorte / Anthropometry as predictor of gestational diabetes mellitus

Background: Gestational diabetes mellitus (GDM) is a high incidence disease. Easily measured predictor factors could help to implement preventive policies and early detection tests. Aim: To measure recognizable risk factors for GDM such as skinfolds and analyze the association between these factors and the development of GDM in a cohort of pregnant women. Material and Methods: Evaluation of 76 mothers that developed gestational diabetes, aged 32.2 ± 0.6 years and 324 control mothers that did not develop the disease, aged 30.1 ± 0.3 years. Weight, height, arm circumference, tricipital, bicipital, subscapular, suprailiac, knee, costal and mid-thigh skinfolds were measured in the pre-diseased stage. History of diabetes, fasting glucose and insulin levels were also evaluated. Results: Age, body mass index (BMI), fasting blood glucose, the homeostasis model assessment of insulin resistance (HOMA), bi-cipital, tricipital, costal, subscapular, suprailiac, and knee skinfolds were associated with GDM development. Age, fasting blood glucose and subscapular skinfolds were independent predictors in the logistic regression model. The odds ratio for a subs-capular skinfold over percentile 90 was 1.7 (95 percent confdence intervals: 1.07-3.04). Conclusions: Age and fasting blood glucose are independent risk factors for GDM. Subscapular skinfold is also an independent risk factor and could be used to detect high risk pregnant women and implement preventive policies.

Incidencia de diabetes gestacional y su relación con obesidad en embarazadas chilenas / Incidence of gestational diabetes and relationship to obesity in Chilean pregnant women

Background: Gestational diabetes (GDM) is associated to a worse outcome of pregnancy. This justifies efforts for finding possible causes of GDM that would allow implementing preventive interventions. Aim: To study incidence of GDM and its relation with obesity and other traditional risk factors. Material and methods: A retrospective study was performed in 234 women who had delivered a singleton during the last 12 months, attended in an outpatient clinic in Santiago, Chile. Familiar and personal history, body mass index (BMI), obstetrical-related pathology and data about the labor and the newborn were analyzed. Results: GDM was diagnosed in 11.2 percent of the women. BMI before pregnancy was 26.6 ± 4.4 kg/m2 (mean ± SD) and it was 25 or over in 37.8 percent of women. Women who developed GDM had significantly higher BMI in the pre-pregnancy stage and in the second and third trimester of pregnancy (p <0.001). The average age was greater in the GDM group (31±0.2 yr versus 26±0.41 yr). Incidence of GDM was 14.4 percent among women 25 years old or older and increased to 21.4 percent when they had, in addition, a BMI of 25 or over. Age, BMI, and family history of diabetes were all independently correlated with the development of GDM. Elective caesarean sections were more common in GDM than in non-GDM women (p = <0.01) and complications were present in 3/23 of newborns of women with GDM and 2/199 among women without GDM (p <0.01) Conclusions: GDM and obesity are highly prevalent in Chilean pregnant women. BMI, first degree relative with DM and age are independent risk factors for the development of GDM (Rev Méd Chile 2004; 132: 931-8).

Human IgE responses to Schistosoma mansoni and resistance to reinfection

Schistosoma mansoni infected Kenyan patients were treated and the intensities of their reinfections were followed over the next two years. in addition, their pre- and six month post-treatment serum levels of IgG1-4, IgM, and IgE, specific for schistosoma, egg and adult worm, were measured in ELISA. No reinfection took place before six months post-treatment. Reinfection intensities varied with age; the younger children becoming reinfected at significantly higher intensities than older individuals. When antibody and reinfection levels were compared, only the six month post-treatment IgE response against adult worm correlated negatively with intensities of reinfection and, therefore, was predictive of resistance or immunity to reinfection. IgE and IgG specific Western Blots were carried out. The adult worm antigens recognized by IgE were restricted compared with the IgG responses of the same patients, although no individual antigen was uniquely recognized by the IgE isotype. A dominant 22 kDa antigen was recognized by most but not all high IgE responders. Patients with IgE responses against this antigen suffered significantly lower subsequent levels of reinfection, compared with non-responders. A monospecific rabbit antiserum against the 22KDa adult worm antigen showed that this antigen is specifically located in the tegument of the adult worm and of 'lung' and 'liver' stage schistosomula, but is absent from the early 'skin' schistosomula. It is possible that this antigen is a target for human IgE mediated immune effector mechanisms active against the post skin stage schistosomula and that this is boosted by the death of adult worms

Human antibody responses to Schistosoma mansoni: does antigen directed, isotype restriction result in the production of blocking antibodies?

After treatment young Kenyan schoolchildren are highly susceptible to reinfection with Schistosoma mansoni. Older children and adults are resistant to reinfection. There is no evidence that this age related resistance is due to a slow development of protective immunological mechanisms, rather, it appears that young children are susceptible because of the presence of blocking antibodies which decline with age, thus allowing the expression of protective responses. Correlations between antibody responses to different stages of the parasite life-cycle suggest that, in young children, antigen directed, isotype restriction of the response against cross-reactive polysaccharide egg antigens results in an ineffectual, or even blocking antibody response to the schistosomulum.