[Glutamic acid decarboxylase autoantibody concentration and glucose tolerance in late pregnancy]. / Glutamat-Azetat-Dekarboxylase-Autoantikörper-Konzentration und Glukosetoleranz in der Spätschwangerschaft.

Genetic and immunological factors may play a role as possible causes for gestational diabetes. Autoantibodies to glutamic acid decarboxylase (GADA) are frequently found in patients with insulin dependent diabetes, but have only rarely been analyzed with regard to the carbohydrate tolerance in pregnancy. An oral glucose tolerance test (oGTT) with 75 g glucose was performed in 110 pregnant patients during the third trimenon. Glucose (glucose dehydrogenase method) and insulin (RIA) concentrations were measured after 0, 30, 60, 120, and 180 minutes. Patients were divided into five groups of increasing glucose intolerance based on the highest glucose concentration reached during the oGTT. GADA were measured using a quantitative enzyme-immunoassay. Only a single patient showed pathologically elevated GADA, and her oGTT results were within the normal range. GADA in subjects with normal pathological glucose tolerance showed no significant difference (276.6 +/- 151.6 and 263.0 +/- 107.1 mU/ml respectively). There was a tendency of positive correlations between high GADA-levels and higher concentrations of insulin as well as an increased insulin-glucose-index. These findings suggest that pregnant patients with higher GADA-levels may have an increased insulin resistance. In conclusion, the concentration of GADA was not found to be helpful in evaluating the current metabolic situation in gestational diabetes. It remains unclear whether elevated GADA during pregnancy have a prognostic value regarding the manifestation of overt diabetes mellitus later in life.

[Changes in insulin-glucose quotients in a glucose tolerance test in the third trimester]. / Veränderungen der Insulin-Glukose-Quotienten während eines Glukosetoleranztests im III. Trimenon.

OBJECTIVE: In comparison a higher insulin-glucose-index is usually associated with an increased insulin resistance. In the present study changes in insulin-glucose-indices were examined in relation to a defined glucose tolerance in the last trimester of pregnancy. MATERIAL AND METHODS: 249 pregnant women were challenged with a 75 gm oral glucose tolerance test (oGTT). Serum samples for glucose (glucose-dehydrogenase-method) and insulin measurements (RIA) were drawn before and at 30, 60, 120, and 180 minutes after glucose load during oGTT. Patients were assigned to five groups with increasing glucose intolerance according to maximal glucose levels during the test. RESULTS: There were no significant differences in insulin-glucose-indices prior to glucose load. Pregnant women with gestational diabetes were shown to have significantly lower insulin-glucose-indices in the early and intermediate phase of the challenge test while the indices were higher in the final phase of the test. CONCLUSIONS: Women with gestational diabetes demonstrated an initial delay in insulin secretion in combination with a higher insulin-glucose-index, corresponding to an increased insulin resistance, only in the end of the test. These characteristics may possibly be a cause of the observed disorder in glucose metabolism in these patients.

Opiatabhangigkeit in der Schwangerschaft: Einfluss auf Schwangerschaftsverlauf, Perinatalperiode und langerfristige Entwicklung von Mutter und Kind.

OBJECTIVE: The purpose of this study was to evaluate the effects of opioid addiction on pregnancy, perinatal period, and the long-term development of mother and child. MATERIAL AND METHODS: Records of 44 opioid-dependent women and their children were analyzed. Thirty-three patients were enrolled in methadone maintenance treatment (MMT) programs or received codeine. RESULTS: Problems during pregnancy were premature rupture of membranes (n = 8), premature labor (n = 21), premature delivery (n = 9), abruption placentae (n = 2), cesarean section (n = 10), and fetal growth retardation (n = 15). Whereas MMT improved fetal growth, no influence was seen on other problems during pregnancy. Thirty newborns had significant withdrawal symptoms. One child became HIV-positive and two children required treatment for suspected congenital syphilis. One child died of sudden infant death syndrome. CONCLUSIONS: The major goal has to be the avoidance of an unwanted pregnancy. Does it still happen, the patient needs special support. If an opioid-dependent woman presents herself the first time, an anamnesis concerning drugs in addition to a general anamnesis should be arisen.

Outcome of 22 successful pregnancies after liver transplantation.

To evaluate course and outcome of pregnancies in liver transplanted patients and to provide a brief summary on the development of these children, 22 pregnancies and 23 children (1 month-99 months old) of 16 patients who had been liver transplanted at our institution (mean interval from transplantation to pregnancy 43.1 months) were reviewed. Standard immunosuppressive regimen during pregnancy consisted of cyclosporine A (CyA), tacrolimus (FK), azathioprine (Aza) and/or a low-dose steroid therapy. CyA and FK whole blood trough levels were monitored on a routinely basis to keep therapeutic range (CyA 80-150 ng/mL; FK 4-8 ng/mL). No patient had a graft loss and there were no lethal complications. Beside de novo hypertension (n = 3) and preeclampsia (n = 3) problems during pregnancy included one steroid-sensitive rejection at 36 wk gestation, one case of tacrolimus toxicity at 24 wk with complete reconstitution, and one case of de novo choledocholithiasis with recurrent cholangitis. Three cases of infections occurred. In total, 23 children, including one set of twins, were born. Terms of gestation (mean = 38.1 wk, +/- 2.2 SD), deliveries (spontaneous n = 13, cesarean section n = 7, forceps n = 1, vacuum extraction (VE) n = 1) and birth weights (2876 g, +/- 589.3 SD) were typical. Three pregnancies were preterm, one being a twin pregnancy. Neither congenital malformations nor unusual infections were seen in the children. Postnatal follow-up revealed appropriate physical growth to date. Psychological development seems to be adequate. Our data indicate that successful pregnancies after liver transplantation (LTX) under careful management by transplant specialists, obstetricians and perinatalogists have a good outcome. So far, neither pre- nor postnatal child development appear to be influenced by maternal immunosuppressive therapy during pregnancy.

[Wilson disease and pregnancy. Review of the literature and case report]. / Morbus Wilson und Schwangerschaft. Literaturübersicht und kasuistische Mitteilung.

Wilson's disease is an autosomal recessive disorder of copper metabolism. Since the introduction of penicillamine treatment successful pregnancies have been reported. However little is known about the risks of breast feeding in patients on this medication. We describe the case of a patient suffering from Wilson's disease, who had two uncomplicated pregnancies and breast fed both children for a period of three months each. In the 22 year old gravida I para I the diagnosis of Wilson's disease had been previously made by liver biopsy and penicillamine therapy had been begun. At the time of her first presentation at our department she was 8 week pregnant. Her renal and liver function were normal. Neurologic or psychiatric symptoms were not observed. At 18 weeks the dosage of penicillamine was reduced from 900 mg/d to 750 mg/d. The course of the pregnancy remained uneventful. At 38 + 1 weeks a healthy boy of 3100 gm was delivered. 19 months later the patient presented again in the 16th week of her second pregnancy. Concerning Wilson's disease no major changes were observed, especially liver and renal function were not impaired. The dosage of penicillamin was reduced from 900 mg/d to 750 mg/d during the 21st week. The pregnancy again was uncomplicated and at 38 + 2 weeks resulted in the spontaneous deliver of a healthy boy, weighting 3940 gm. Both children were breast fed over a period of three months and with the exception of an icterus prolongatus no adverse effects were noted.

[Prevalence of hepatitis B in pregnancy and selective screening]. / Prävalenz der Hepatitis B in der Schwangerschaft und selektives Screening.

Infants of mothers positive for HBsAg are at risk for peripartal transmission of hepatitis B infection. Active and passive immunisation administered immediately after birth can prevent neonatal hepatitis B. In a prospective study the prevalence of hepatitis B in pregnant women and the efficiency of selective antepartal screening of women with identifiable risk factors for hepatitis B were analysed. From November 1992 to May 1994, 912 women presenting at the department of obstetrics and gynaecology of the Medizinischen Hochschule Hannover were tested for HBsAg, HBeAg, anti HBs, anti Hbc, and HBV-DNA. Venous blood samples were taken during the third trimester of pregnancy or immediately post partum. 13 (1.4%) patients were found to be HBsAg positive. The prevalence of HBsAg in German females and women from countries with low endemia for hepatitis B was 0.38% versus 5.7% for women from endemic areas. HBeAg was detected in two patients. 10 patients with a positive serological result belonged to groups considered to be of increased risk for hepatitis B infection. Nevertheless, 6 of these women had not undergone antepartal screening. These findings support a need for routine screening of all pregnant women for HBsAg, as it has been recently introduced in Germany.

[Estriol and human placental lactogen as risk indicators in pregnancies of diabetic and hypertensive patients]. / Ostriol und Humanes Plazentares Laktogen als Risikoindikatoren in Schwangerschaften von Diabetikerinnen und Hypertonikerinnen.

The correlation between estriol (E3) and human placenta lactogen (HPL) and perinatal morbidity was investigated in 105 diabetic, 96 hypertensive and 96 pregnancies without diabetes and hypertension. The hormones were determined by radioimmunoassay. Only if two determinations were outside the normal range the values were accepted as pathological. In pregnancies with hypertension a decrease of E3- and HPL-concentrations was correlated to significant higher incidence of operative deliveries and pathological APGAR-Scores. In the diabetic group is the low E3-concentration of significant predictive value in respect of the pathological cardiotocography as the indication of the operative delivery, the same applies to low HPL-concentrations in the hypertension group, in the control group no significant differences could be determined relating thereto. Hypotrophic newborns in the hypertension and control group are significant more frequent, if the concentration of E3 is decreased. The same applies to decreased HPL-concentrations in every group, where the hypertension group shows the highest predictive values.

[Atrial natriuretic peptide in normotensive pregnancy: concentrations in physical stress, pre- and postpartal and in the umbilical cord]. / Das atriale natriuretische Peptid in der normotensiven Schwangerschaft: Konzentrationen unter körperlicher Belastung, prä- und postpartal und in der Nabelschnur.

The concentrations of the atrial natriuretic peptide (ANP) during the 3rd trimester of pregnancy (n = 54), the 1st, 2nd, and 3rd day post partum and in 10 non pregnant females were measured and compared. Moreover ANP was determined in the umbilical cord (artery n = 10, vein n = 48) and the influence of exercise on the concentration of ANP in pregnant (n = 10) and non pregnant women (n = 10) was analyzed. There was no significant difference of the ANP-values measured in non pregnant patients and during the third trimester (100 +/- 57 vs. 97 +/- 27 pg/ml). On the 3rd day post partum a significant rise of ANP was noted (1st day post partum 78 +/- 43, 3rd day post partum 102 +/- 46, 5th day post partum 84 +/- 40 pg/ml). During physical exercise the concentration of ANP increases significantly in pregnant (103 +/- 45 vs. 120 +/- 57 pg/ml, p < 0.05) as well as in non pregnant females (97 +/- 27 vs. 111 +/- 39 pg/ml, p < 0.05). In arterial blood samples from the umbilical cord the concentration of ANP was higher than in venous cord blood (62 +/- 34 vs. 51 +/- 28 pg/ml, p > 0.05).