African-American women have higher initial HbA1c levels in diabetic pregnancy.

OBJECTIVE: African-American women with diabetes are at greater risk for poor glycemic control outside of pregnancy. We evaluated the effect of race on glycemic control in a racially mixed population of women with diabetes entering prenatal care. RESEARCH DESIGN AND METHODS: HbA1c levels along with demographic data were collected at the first prenatal visit from a group of 234 women with preexisting diabetes. We applied logistic multivariate analysis to identify factors associated with HbA1c levels above the median for the group. RESULTS: The median HbA1c level for the group was 8%. HbA1c levels were 8.7 +/- 2.0% in African-Americans and 7.7 +/- 1.5% in Caucasians (P < 0.001). African-American racial designation was significantly and independently associated with high HbA1c when controlled for maternal age, parity, White classification, diabetes type, education, marital status, obesity, insurance type, and first trimester entry into care. The effect of race was confined to the nonobese patients, for whom the adjusted odds ratio for African-American race as a predictor of high HbA1c was 8.15 with a 95% CI of 2.41-27.58 (P = 0.001). CONCLUSIONS: We found a clear racial disparity in glycemic control among women entering prenatal care with preexisting diabetes. This study demonstrates that there generally is need for better glycemic control among reproductive-age women with diabetes, but especially among those who are African-American.

Abdominal circumference vs. estimated weight to predict large for gestational age birth weight in diabetic pregnancy.

Early third trimester fetal abdominal circumference and sonographic fetal weight estimates were compared to predict large for gestational age birth weight in diabetic pregnancy. Both parameters have similar sensitivity, specificity, and predictive values. However, the optimal percentile cutoff values differ. Choice of birth weight standard significantly influences test characteristics. Negative prediction of large birth weight is more accurate than positive prediction. At third trimester sonography with maternal diabetes, the abdominal circumference percentile is potentially useful and should be routinely reported.

Screening for depression in pregnancy: characteristics of the Beck Depression Inventory.

OBJECTIVE: To determine the test characteristics of a self-report questionnaire, the Beck Depression Inventory, when used as a screening test for depression in a population of ambulatory pregnant women. METHODS: One hundred five pregnant women completed the Beck Depression Inventory and underwent a structured interview using the National Institute of Mental Health Diagnostic Interview Schedule-version III. Current depression was diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders-III-R. A receiver operating characteristic curve was constructed for the Beck Depression Inventory score as a predictor of current depression. A table of sensitivities, specificities, predictive values, and likelihood ratios was created for various cutoff values. RESULTS: For the 105 women enrolled, the median Beck Depression Inventory score was 8.0. Twelve women (11%) were diagnosed with current depression and had a median Beck Depression Inventory score of 25.5, compared with those without current depression, who had a median score of 8.0 (P = .001). The area under the receiver operating characteristic curve was 0.9940. Using a cutoff range of greater than 16, the sensitivity of the Beck Depression Inventory to detect current depression was 0.83, the specificity was 0.89, the positive predictive value was 0.50, and the negative predictive value was 0.98. CONCLUSIONS: The Beck Depression Inventory can serve as a rapid screening test for depression during pregnancy. A higher cutoff value is required for pregnant women than is customarily used outside of pregnancy.

Renal transplantation one week after conception.

A successful 38-week pregnancy is reported following renal transplantation approximately 1 week after conception. The patient was treated with quadruple sequential induction therapy, maintenance immunosuppression, and routine posttransplantation care, including ganciclovir treatment for a symptomatic cytomegalovirus infection during the pregnancy and 3 months after delivery. No decline in renal function was noted. The mother and child remain healthy at 18 months. This case demonstrates the ability of renal transplant patients to maintain renal function throughout pregnancy and the lack of deleterious effects upon the child during gestation and at up to 18 months after birth, despite significant immunosuppression, including antithymocyte globulin induction therapy, and infectious complications of the mother's renal transplantation.

Spontaneous resolution of fetal cystic hygroma and hydrops in Turner syndrome.

On a routine ultrasound examination, a cystic hygroma and hydrops were noted at 21 weeks' gestation in a fetus with a 45,X karyotype. Serial studies demonstrated a marked reduction in the size of the cystic hygroma and complete resolution of ascites. At birth, the term infant had features characteristic of the Turner syndrome, including a webbed neck. A critical coarctation of the aorta required repair in the neonatal period. Our case provides glimpses of the intrauterine evolution of the Turner phenotype. We suggest that the possibility of survival when such lesions are detected prenatally may be greater than previously thought.

Effect of dexamethasone on lipoprotein lipase activity of fetal rat lung.

Dexamethasone was administered by continuous subcutaneous infusions (16 microgram/kg/h) to pregnant rats from day 16 of gestation. Administration of the hormone markedly affected maternal and fetal weight gain, fetal lung:body weight ratio and lipoprotein lipase activity of the lung. Cumulative maternal weight gain from days 15-21 of gestation was 80 +/- 4.0 g in control and 30 +/- 10 g in dexamethasone-treated rats. Fetal weight at 22 days of gestation and 1 day after birth was 5.5 +/- 0.39 and 8.6 +/- 0.30 in control and 4.65 +/- 0.26 and 5.9 +/- 0.34 in dexamethasone-treated rats. The ratio of lung weight to body weight was lower throughout the last 5 days of gestation in dexamethasone-treated than in control rats. Dexamethasone administration led to a 2- to 3-fold increase in lipoprotein lipase activity levels in fetal rat lung at 19 and 20 days' gestation and prevented the decline in enzyme activity shortly before birth. Stimulation of fetal lung lipoprotein lipase activity suggests that increased uptake of triglyceride-fatty acids by the lung could be a contributory factor to corticosteroid-enhanced surfactant synthesis.