ABSTRACT
PURPOSE: This was a prospective observational cohort study that aimed to determine whether fetal sex influences the maternal and fetal outcomes of gestational diabetes mellitus (GDM). METHODS: In this study, 327 European primiparous women were consecutively recruited after diagnosis of GDM. AUC on the oral glucose tolerance test (OGTT), need for insulin therapy, maternal and obstetrical outcomes, and fetal fat mass (by measuring the thickness of the anterior abdominal subcutaneous tissue) were recorded and compared between the two subgroups of female and male fetuses. FINDINGS: Despite the absence of differences in multiple comparisons of the OGTT, the AUC-OGTT was significantly higher in women carrying a male fetus (22.6 [3.2] mmol/L vs 19.7 [2.8] mmol/L). The abdominal fat thickness appeared to increase with gestational age, with higher growth in male fetuses than in female fetuses. The overall risk of need for insulin therapy was significantly higher in women carrying a male fetus (odds ratio = 1.837). At delivery, birthweight was higher in males than in females only if adjusted for gestational age, similarly for placental weight, otherwise there were no significant differences between the groups in total length of gestation, rates of cesarean delivery, and Apgar scores. IMPLICATIONS: Overall, our data propose an association between fetal sex and GDM outcomes, suggesting the hypothesis that in maternal-fetal interactions, the fetus can affect maternal glucose metabolism.
Subject(s)
Diabetes, Gestational/drug therapy , Insulin/administration & dosage , Pregnancy Outcome , Birth Weight , Cohort Studies , Female , Gestational Age , Glucose Tolerance Test , Humans , Infant, Newborn , Male , Pregnancy , Prospective StudiesABSTRACT
IMPORTANCE: Fetal umbilical vein aneurysm is an uncommon anomaly that accounts for approximately 4% of umbilical cord abnormalities. The rate of intrauterine fetal death is reported to be approximately 4% to 5%, higher than the background rate of 0.7% that is generally reported during pregnancy. OBJECTIVE: The aim of this study was to review the pathophysiology, diagnosis, and clinical management of fetal umbilical vein aneurysm. EVIDENCE ACQUISITION: Advances in high-resolution ultrasound combined with color Doppler and 3-dimensional rendering have contributed to an increased understanding of the fetal venous circulation in recent years. RESULTS: When the diagnosis of umbilical vein aneurysm is made, the patient should undergo a detailed ultrasound evaluation of the fetal anatomy, including fetal echocardiography, to exclude associated anomalies. Amniocentesis should be offered when other anomalies are found. Patients should be informed about the potential for an unfavorable outcome of pregnancy and should undergo close ultrasound surveillance to assess the size of the aneurysm, as well as any evidence of thrombosis or signs of hydrops. CONCLUSIONS: The main prognostic feature associated with a poor outcome of umbilical vein aneurysm seems to be the presence of other anomalies. Early diagnosis is associated with a somewhat worse prognosis, and most fetal deaths have been observed between 27 and 30 weeks of gestation. In the third trimester, it is reasonable to perform serial ultrasound examinations to assess fetal growth, the size of the aneurysm, and the blood flow pattern within the aneurysm.
Subject(s)
Aneurysm/diagnostic imaging , Fetal Development , Ultrasonography, Prenatal , Umbilical Veins/abnormalities , Umbilical Veins/diagnostic imaging , Amniocentesis , Aneurysm/complications , Aneurysm/therapy , Cardiomegaly/etiology , Echocardiography, Doppler, Color , Female , Fetal Death/etiology , Fetal Growth Retardation/etiology , Humans , Hydrops Fetalis/etiology , Imaging, Three-Dimensional , Pregnancy , Pregnancy Trimester, Third , Risk Factors , Umbilical Veins/blood supply , Umbilical Veins/pathologyABSTRACT
BACKGROUND: Gaucher disease is a lysosomal storage disorder due to deficiency of glucocerebrosidase enzyme. In this study, a case of enzyme-treated woman during her pregnancy was reported. CASE PRESENTATION: A 27-year old woman with type I Gaucher disease was managed for pregnancy until delivery. She underwent elective splenectomy at age 26 years and was treated with 19-38 units/kg of imiglucerase. A conservative approach with close monitoring of both mother and baby was planned. RESULTS: In the 39th week of pregnancy, a healthy male baby of 3180 g was delivered via cesarean section. CONCLUSION: Apart from mild hematological complications, the pregnancy, the delivery and the puerperium were uneventful. In this case report, the issue of therapy and risk assessment in pregnancy in patients with type I Gaucher disease was discussed.
