Birth weight predicts the risk of gestational diabetes mellitus and pregravid obesity.

OBJECTIVES: It has been suggested that birth weight may determine metabolic abnormalities later in life. The aim of the current study was to assess the association between birth weight and future risk of gestational diabetes mellitus (GDM) and pregravid obesity in a homogenous sample of Caucasian Polish women. METHODS: In this retrospective study, we collected the medical reports of 787 women with GDM and 801 healthy pregnant women. We analyzed the following data: birth weight, age, pregravid weight, prior GDM, prior macrosomia, parity, and family history of diabetes. RESULTS: Birth weight was inversely associated with the risk of GDM; for each decrease in birth weight of 500 g, the risk increased by 11% (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.02-1.21). Birth weight was a strong predictor of GDM independent of other risk factors (OR, 1.19; 95% CI, 1.09-1.31), and it was positively correlated with pregravid weight (R = 0.21; P < 0.00001). An increase in birth weight of 500 g substantially increased the risk of overweight and obesity (OR, 1.17; 95% CI, 1.01-1.34 and OR, 1.35; 95% CI 1.11-1.64, respectively). Each of the traditional risk factors for GDM were also strong predictors of pregravid obesity: age (P < 0.0001), prior GDM (P < 0.01), prior macrosomia (P < 0.0001), multiparity (P < 0.0001), and maternal (but not paternal) history of diabetes (P < 0.0001). CONCLUSIONS: Among Caucasian Polish women, the risk of GDM is associated with low birth weight, and pregravid obesity is associated with high birth weight. Traditional risk factors for GDM, including maternal (but not paternal) history of diabetes, are also risk factors for pregravid obesity.

[Fetal Parvowirus B19 infection with hydrops fetalis, a case report]. / Obrzek uogólniony plodu w przebiegu zakazenia Parvowirusem B19, opis przypadku.

Parvovirus B19 (B19V) infection during pregnancy is a cause of nonimmune hydrops. We report a case of hydrops fetalis with severe fetal anemia in the course of B19V infection in the third trimester of pregnancy. Maternal and fetal parvovirus B19 infection was confirmed using quantitative real time PCR detection of viral DNA. The affected fetus was treated with three intrauterine transfusions. The baby was delivered by caesarean section at 36 weeks. Up until 6 months of age no abnormalities in the development of the child were observed.

[RHD variant in RhD/-/ mother with anti-D makes noninvasive fetal RHD genotyping impossible]. / Obecnosc "niemego" genu RHD u RhD ujemnej kobiety ciezarnej z przeciwcialami anty-RhD uniemozliwia okreslenie genotypu RHD plodu metoda nieinwazyjna.

OBJECTIVES: Noninvasive fetal RHD genotyping from maternal plasma of RhD(/-) pregnant women of Caucasian race may be used for predicting the risk of hemolytic disease because the RHD gene is usually absent in such populations. If detected in plasma of such women, the RHD gene originates from the RhD(+) fetus. The number of fetal copies of the gene in maternal plasma is extremely small. In the presented case of the RhD(/-) pregnant woman with anti-D it was impossible to give a fetal RHD result due to mother's RHD(+) genotype. The fetal RHD was determined from amniocytes. AIM: to present the difficulties related to the interpretation of results of invasive and noninvasive procedures. MATERIAL AND METHODS: whole blood, plasma and amniotic fluid of the RhD(-) woman with anti-D (14 week of pregnancy) as well as whole blood of the newborn. RHD and RHCE*c were genotyped by real-time PCR in DNA isolated from maternal plasma and amniocytes and the RHD and d-genotypes were tested by SSP methods in DNA isolated from whole blood and amniocytes. RESULTS: RHD and RHCE*c were detected in DNA isolated from plasma. The high level of RHD suggested its origin from the mother's DNA therefore it was impossible to determine the fetal RHD. The d-little test identified a RHD(IVS3+ 1G>A) variant in the mother's genome. A weak signal of real-time PCR for the RHD was obtained in amniocytes but the RHD was not detected by SSP. The RHCE*c was detected by both methods. Results were inconclusive; the fetal RHD status remained unknown. The child was RhD(-) with RHD in its DNA undetected by either method. CONCLUSIONS: 1/The RHD(IVS3+ 1G>A) variant in the RhD(-) mother precluded formal noninvasive fetal RHD genotyping. 2/Real-time PCR is too sensitive for amniocyte testing and may lead to false results as it detects trace maternal DNA in amniotic fluid. 3/The frequency of RHD(IVS3+1G>A) occurrence in Poland requires further studies.

[Estimation of diagnostic value of the middle cerebral artery peak systolic velocity in prediction of fetal anemia in pregnancies complicated by alloimmunisation]. / Ocena wartosci diagnostycznej oznaczania wskaznika MoM PSV MCA w przewidywaniu niedokrwistosci u plodu w konflikcie serologicznym.

UNLABELLED: The use of the middle cerebral artery peak systolic velocity (PSV) for the noninvasive diagnosis of fetal anemia in pregnancies complicated by alloimmunisation has the potential to reduce the number of invasive procedures. OBJECTIVES: The study was undertaken to determine the detection of fetal anemia by fetal middle cerebral artery peak systolic velocity (MCA PSV). MATERIAL AND METHODS: 31 fetuses with red cell alloimmunisation were evaluated with Doppler ultrasongraphy. On the basis of ROC (AUC) analysis the cutoff point of MoM=1.215 with the highest sensitivity and specificity was established. We examined the relation between MoM=1.215 and neonatal hemoglobin level and the maternal antibody titre in the indirect antiglobulin test. Sensitivity specificity positive and negative value and statistical significance were calculated. CONCLUSIONS: Data reported to date suggest that a threshold of 1.215 multiples of the median can be used to better diagnostic of fetal anemia.

[Intrapartum amnioinfusion in patients with meconium-stained amniotic fluid]. / Amnioinfuzja sródporodowa u pacjentek 2 obecnoscia smólki w plynie owodniowym.

OBJECTIVES: The aim of the study was to evaluate the effect of intrapartum amnioinfusion in the presence of meconium stained amniotic fluid. MATERIAL AND METHODS: 93 women with meconium-stained amniotic fluid were assigned to receive amnioinfusion or no amnioinfusion (128 women). The trials were evaluated for fetal distress syndrome, route of delivery, fetal acidemia, Apgar score at 1 and 5 min., meconium aspiration syndrome, postpartum endometritis and maternal hospital stays. RESULT: Amnioinfusion in cases of meconium-stained fluid did not improve the number of fetal distress symptoms during fetal heart rate monitoring. Amnioinfusion was associated with a significant decrease of neonatal acidemia although it did not improve Apgar score. In our study amnioinfusion was not associated with reduction in the incidence of neonatal outcome and puerperial complications.

The analysis of the correlation between extracellular fetal DNA concentration in maternal circulation and severity of preeclampsia.

INTRODUCTION: Increased fetal DNA in maternal plasma has been reported in pregnancies complicated by preeclampsia. Fetal DNA may by liberated from fetal or placental cells during apoptosis. The aim of the study is the estimation of the correlation between clinical and biochemical characteristics of preeclampsia and the concentration of fetal DNA in maternal circulation. MATERIAL AND METHODS: Peripherial blood samples were obtained from women suffering from preeclampsia and healthy pregnant women between 20 and 28 weeks of pregnancy. For analysis of DNA isolated from maternal plasma real time PCR were performed. CONCLUSIONS: 1. Significant increase of fetal DNA concentration in preeclamptic women plasma is associated with severe course of preeclampsia and especially with fetal distress symptoms. 2. The evaluation of number of fetal DNA copies in pregnant women plasma is characterized by high sensitivity but low specificity of this test in regards to preeclampsia with complications such as HELLP syndrome and intrauterine growth retardation (IUGR).