RESUMO
OBJECTIVE: To determine the time of growth acceleration in fetuses of insulin-dependent diabetic women who are large for gestational age (LGA) at birth and the relationship between growth acceleration and diabetic control throughout pregnancy. METHODS: We studied a consecutive sample of 76 women with insulin-dependent diabetes divided by those who delivered LGA or normally grown infants. Fetal abdominal circumference (AC) was measured ultrasonically at regular intervals between 20 and 34 weeks' gestation. Diabetic control was assessed by regular measurement of glycosylated hemoglobin and capillary blood glucose levels. RESULTS: A significant difference in fetal AC between groups developed between 20 and 24 weeks' gestation, and the LGA group continued to have accelerated fetal growth. Between 18 and 24 weeks glycosylated hemoglobin and capillary blood glucose concentrations were significantly higher in women who delivered LGA infants. After 28 weeks, blood glucose concentrations and glycosylated hemoglobin did not differ significantly between groups. There was a nonsignificant trend toward more vaginal deliveries in the normal group (45% versus 32%). CONCLUSION: In insulin-dependent diabetic pregnancy, although actual growth acceleration occurred from about 20 weeks' gestation, growth potential of fetuses appeared to be determined by prevailing maternal glucose concentrations before then. Excessive growth continued despite subsequent satisfactory glucose control. If strict blood glucose control is maintained during first and second trimesters, it might reduce the incidence of LGA infants.
Assuntos
Diabetes Mellitus Tipo 1/sangue , Desenvolvimento Embrionário e Fetal , Macrossomia Fetal/sangue , Gravidez em Diabéticas/sangue , Abdome/diagnóstico por imagem , Abdome/embriologia , Adulto , Glicemia/análise , Diabetes Mellitus Tipo 1/embriologia , Diabetes Mellitus Tipo 1/prevenção & controle , Feminino , Macrossomia Fetal/diagnóstico por imagem , Macrossomia Fetal/embriologia , Hemoglobinas Glicadas/análise , Humanos , Gravidez , Resultado da Gravidez , Gravidez em Diabéticas/embriologia , Gravidez em Diabéticas/prevenção & controle , Ultrassonografia Pré-NatalRESUMO
The finding of a mutation in the alpha-synuclein gene in a rare autosomal dominant form of idiopathic Parkinson's disease (IPD), has prompted increased interest in identifying genes that account for the more common sporadic form. A number of association studies have suggested that functional polymorphisms in genes that play a role in dopamine, drug and toxin metabolism may increase the relative risk of IPD. Unfortunately, patient numbers are often small, and the results have not been consistently reproduced. This article reviews the evidence from epidemiological, imaging and genetic studies to determine the role of genetic susceptibility in IPD and parkinsonian syndromes.
Assuntos
Doença de Parkinson Secundária/genética , Doença de Parkinson/genética , Inglaterra/epidemiologia , Saúde da Família , Predisposição Genética para Doença , Humanos , Doença de Parkinson/epidemiologia , Doença de Parkinson Secundária/epidemiologia , Polimorfismo Genético , Prevalência , Estudos em Gêmeos como AssuntoRESUMO
Rupture of splenic artery aneurysm should be considered in the differential diagnosis of collapse occurring during pregnancy or in the puerperium. It is a relatively rare condition with a high mortality in which lives could be saved by prompt diagnosis and treatment. Anaesthetists and obstetricians should be aware of this because 20-50% of all ruptures occur during pregnancy. We describe two cases and discuss the epidemiology, aetiology and management of this condition.
