The effect of paternal and maternal history of diabetes mellitus on the development of gestational diabetes mellitus.

BACKGROUND: There is an ongoing debate whether maternal diabetes is a more important risk factor for gestational diabetes (GDM) development than paternal diabetes. AIM: To describe the risk of GDM associated with paternal and maternal diabetes, and to further characterise GDM women with maternal diabetes. SUBJECTS AND METHODS: Case-control study within a population-based GDM screening program in an urban area of Hungary in 2002-2003. All GDM women (no.=133) and an age-matched control group (no.=135) with a mean age of 31 years was evaluated. Blood pressure, anthropometric data, and blood glucose values from a 75 g Oral Glucose Tolerance Test (OGTT) were recorded at 24-28 weeks of gestation. Family history data were by self-report. RESULTS: Known paternal diabetes was not related to GDM risk [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.35-2.00]. Known maternal diabetes (OR 2.90, 95% CI 0.99-8.49) and diabetes in the maternal line (OR 2.83, 95% CI 1.16-6.89) were both related to GDM after adjustment for body mass index (BMI). GDM women with known maternal diabetes had a higher BMI, 31.6 [9.1] kg/m2 median [interquartile range], than GDM women with or without diabetes in the maternal line, 26.1 [4.9] and 26.3 [6.1] kg/m2, respectively, while figures for fasting glucose during OGTT were 5.2 [0.7] vs 4.4 [1.1] vs 4.9 [0.8] mmol/l respectively (all p<0.05). CONCLUSIONS: Maternal history of diabetes and history of diabetes in the maternal line seems to be a stronger predictor of GDM than paternal history.

Moxifloxacin versus ofloxacin plus metronidazole in uncomplicated pelvic inflammatory disease: results of a multicentre, double blind, randomised trial.

OBJECTIVE: This multinational, multicentre, prospective, randomised, double blind, parallel group, non-inferiority study compared the efficacy and safety of moxifloxacin monotherapy with ofloxacin plus metronidazole in women with uncomplicated pelvic inflammatory disease. METHODS: Women from hospitals throughout 13 countries received a 14 day course of either oral moxifloxacin, 400 mg once daily (n = 384), or oral ofloxacin, 400 mg twice daily plus oral metronidazole, 500 mg twice daily (n = 365). RESULTS: Of the 741 patients in the intent to treat (ITT) population, 564 (74.2%) were valid for the per protocol (PP) analyses; 112 (19.9%) of these were included in the microbiologically valid population (MBV). Clinical resolution rates in the PP population at the test of cure visit (TOC, 5-24 days post-therapy, primary efficacy end point) were 90.2% (248/275) for moxifloxacin and 90.7% (262/289) for ofloxacin plus metronidazole (95% CI: -5.7% to 4.0%). At follow up (28-42 days post-therapy), resolution rates in the PP population were 85.8% (236/275) and 87.9% (254/289) for moxifloxacin and comparator, respectively (95% CI: -8.0% to 3.1%). Bacteriological success rates in the MBV population at TOC were 87.5% (49/56) for moxifloxacin and 82.1% (46/56) for comparator (95% CI: -8.3% to 18.8%). Against Chlamydia trachomatis and Neisseria gonorrhoeae, bacteriological success rates with moxifloxacin were 88.5% (23/26) and 100% (13/13) and for comparator 85.7% (18/21) and 81.8% (18/22), respectively. Drug related adverse events occurred less frequently with moxifloxacin (22.5% (85/378)) versus the comparator (30.9% (112/363)) (p = 0.01). CONCLUSION: In uncomplicated PID, once daily moxifloxacin monotherapy was clinically and bacteriologically as efficacious as twice daily ofloxacin plus metronidazole therapy and was associated with fewer drug related adverse events.

Multicenter study in Hungary with a 30 micrograms ethinylestradiol- and 150 micrograms desogestrel-containing monophasic oral contraceptive.

Among the countries in Central and Eastern Europe, Hungary has a high oral contraceptive prevalence rate. Until recently, however, Hungarian women have not had access to combined oral contraceptives with new, third-generation progestogens. Marvelon (30 micrograms ethinylestradiol and 150 micrograms desogestrel) was first introduced in 1981 in Western Europe and has, in a number of different studies, proven an effective and well-tolerated oral contraceptive with no effect on blood pressure and a favorable lipid profile. Marvelon was introduced in Hungary in October 1991. Prior to its introduction, a multicenter study was undertaken in Hungary with Marvelon to confirm the clinical results of studies from other countries. The present study confirmed Marvelon to be an effective, well-tolerated combined oral contraceptive with no relevant effect on blood pressure. Remarkable improvements were noted, especially with regard to side-effects, in switchers from other oral contraceptives. It is concluded that Marvelon is a valuable extension of the range of contraceptive methods available in Hungary.

Effect of superovulation combination therapy containing Clostilbegyt (clomiphene citrate) on follicular development and the endometrium.

The effect of Clostilbegyt + Humegon + Pregnyl ovulation inductive combination therapy was examined in the woman members of 20 sterile couples appearing at the Outpatient Department of Cryospermatology, Department of Obstetrics and Gynaecology Postgraduate Medical School. In 18 of the 20 cases follicle maturation and ovulation could be induced. In the male members of the couples therapy-resistant sterility existed at the same. By using artificial insemination by donors with cryopreserved sperms, gravidity could be obtained in 14 cases. The importance of the optimal timing of AID has been emphasized. In the course of transvaginal ultrasonography folliculometry was completed with the control of the pre-ovulatory changes of the endometrium. The appearance of the pre-ovulatory ring preceded the occurrence of pregnancy in all cases, being a sign of predictive value considering conception.

Release of prostacyclin (PGI2) from trophoblast in tissue culture: the effect of glucose concentration.

It is known that short term cell culture system offers a reliable and reproducible means for measuring placental PGI2 production in vitro, in which factors controlling its production and metabolism can be studied. The aim of the present investigation was to study the effect of glucose on generation of PGI2 by trophoblast obtained from early pregnancy in short term cell culture. Trophoblast was cultured using the method of Jogee et al and the concentration of 6-oxo-PGF1 alpha in culture supernatans was measured by a specific direct radioimmunoassay (New England Nuclear, USA). There was a significant decrease in 6-oxo-PGF1 alpha production by trophoblast cells when incubating with increased glucose concentrations (300 and 600 mg/dl) compared to controls (without glucose). These data show for the first time that high concentrations of glucose inhibit PGI2 production by cultured trophoblast cells obtained from early pregnancy. The implication of these findings for the mechanism of development of congenital anomalies in diabetic pregnant women is discussed.

A comparison between Nova T and Copper T 200 Ag in Hungary.

In a comparative use-effectiveness study, 855 Nova T and 883 TCu 200 Ag devices were inserted in a randomised sequence. By the end of the first year the gross rate of unplanned pregnancy was 1.1 per 100 users of Nova T and 2.1 per 100 users of TCu. After 2 years the pregnancy rates for Nova T and TCu were 3.1 and 4.8 per 100 users, respectively. Although there was no statistically significant difference between the rates for the two devices, they suggest a higher contraceptive efficacy for Nova T.

PIP: Between February 1982 and February 1983, 2 family planning clinics in Hungary enrolled 1738 subjects for a study comparing contraceptive efficacy and clinical performance of 2 types of IUD. In the comparative use-effectiveness study, 855 Nova T and 883 TCu 200 Ag devices were inserted in a randomized sequence. Subjects were advised to return to the clinic for a check-up at 1, 3, 6, 12, and 24 months after insertion. 40% of the women were IUD users before entering the study. By the end of the 1st year the gross rate of unplanned pregnancy was 1.1/100 users of Nova T and 2.1/100 users of TCu. After 2 years the pregnancy rates for Nova T and TCu were 3.1 and 4.8/100 users, respectively. Although there was no statistically significant difference between the rates for the 2 devices, they suggest a higher contraceptive efficacy for Nova T. In different age categories of Nova T users the pregnancy rate varied from 3.5 among those under 25 to 1.7 in those over 35. For Copper T users, these figures were 9.3 (under 25) and 3.3 (over 35). Over the 2 year period 88 women terminated the study due to pain and/or bleeding. Rate of removal of the device was the same for both types of device.

Effect of acetylsalicylic acid on prostacyclin production in trophoblast.

In attempt to elucidate whether acetylsalicylic acid (ASA) has an in vivo effect on prostacyclin (PGI2)-like activity released from trophoblast we have evaluated PGI2-like activity in pregnant women scheduled for pregnancy termination after ASA ingestion. Following subjects were studied: Group I: 7 healthy pregnant women who were treated with 1.5 g ASA for two days; Group II: 18 control pregnant women who received placebo for two days. Trophoblast specimens were obtained by legal abortions; PGI2-like activity in trophoblast was measured by the method of Moncada. In normal pregnant women (8-10 weeks gestation) treated with ASA the mean PGI2-like activity of trophoblast significantly decreased compared to the controls. These data indicate that treatment with ASA of early pregnant women might have a harmful effect on trophoblast and the problem should be further explored before allowing the administration of cyclooxygenase inhibiting drugs during early pregnancy.

Comparative metabolic effects of oral contraceptive preparations containing different progestagens. Effects of desogestrel + ethinylestradiol on the haemostatic balance.

In two open randomized studies carried out in female volunteers the effects of a new low dose oral contraceptive (O.C.) combination desogestrel + ethinylestradiol (150 micrograms/30 micrograms; Marvelon) on blood coagulation were compared with those of either the combination levonorgestrel + ethinylestradiol (150 micrograms/30 micrograms) or a triphasic preparation containing levonorgestrel + ethinylestradiol. A total of 78 women were involved in the studies which covered a period of 4 cycles; a pretreatment cycle followed by 3 treatment cycles, each consisting of 21 days of drug administration, followed by a 7-day tablet-free period. A blood sample was taken before treatment, after 2 weeks, 2 cycles and 3 cycles of treatment. The following parameters were measured: prothrombin; activated partial thromboplastin time; factors VII, VIII, X; fibrinogen; antithrombin III; euglobulin lysis time; platelet count and aggregation ratio; triglycerides and cholesterol and a glucose tolerance test was made. The effects of the different preparations on these parameters were compared statistically using either an analysis of covariance or the Wilcoxon test. No clinically significant differences were observed between the desogestrel containing preparation and the two other preparations. Any changes in treatment versus pretreatment values were slight and in agreement with the literature on other O.C.'s.

Platelet sensitivity to adenosine diphosphate and to prostacyclin in diabetic pregnancies.

Platelet sensitivity to adenosine diphosphate (ADP) and to prostacyclin (PGI2) was studied in normal and diabetic pregnant women. The threshold concentrations of ADP inducing the second phase of aggregation were used to determine the platelet sensitivity to PGI2. The sensitivity of platelets to ADP increased in both groups in the second trimester, thereafter it decreased both in normal and diabetic pregnancies. In contrast, sensitivity to PGI2 increased in the last trimester of pregnancy. No difference could be observed between diabetic and normal groups. The similarity of the results between the two groups could be explained by the normoglycaemic state of well-controlled diabetic pregnant women.