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  • Freinkel, Norbert  (4)
  • Phelps, Richard L  (4)
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  • 1
    Online-Ressource
    Online-Ressource
    American Diabetes Association ; 1980
    In:  Diabetes Care Vol. 3, No. 3 ( 1980-05-01), p. 402-409
    In: Diabetes Care, American Diabetes Association, Vol. 3, No. 3 ( 1980-05-01), p. 402-409
    Kurzfassung: To assess the effects of gestational diabetes mellitus (GDM) on intermediary metabolism in late pregnancy, circulating levels of glucose, FFA, triglycerides, cholesterol, and individual amino acids were monitored for 24 h while subjects received a liquid formula diet (containing 2110 cal and 275 g carbohydrate) in three equal feedings at 0800, 1300, and 1800. Attempts were made to distinguish between varying degrees of severity of gestational diabetes by subdividing the population into those with fasting plasma glucose within the normal range for pregnancy, i.e., below 105 mg/dl (GDM & lt; 105), and those with fasting plasma glucose of 105 mg/dl or greater (GDM ≥ 105). Both groups were compared with pregnant women with normal carbohydrate metabolism (NM). The diurnal profiles indicated that premeal, postprandial averages, and integrated 24-h values for plasma glucose were consistently higher in GDM ≥ 105 than in GDM & lt; 105; both GDM groups uniformly exceeded the values in NM. Plasma FFA tended to be higher in all GDM, with maximal increments occurring in the early hours before breakfast and assuming greatest significance in GDM ≥ 105. The elevations in circulating cholesterol that occur in pregnancy were not significantly different at any time point in NM, GDM & lt; 105, and GDM ≥ 105. However, the increases in plasma triglycerides were greater in GDM & lt; 105 and GDM ≥ 105 than in NM and most marked in GDM ≥ 105. Diurnal profiles for a number of individual amino acids (phenylalanine, tyrosine, alanine, serine, proline) were not affected by gestational diabetes. However, certain other amino acids, particularly the branched chain (leucine, isoleucine, valine), tended to be elevated in subjects with GDM and to the most significant extent in GDM ≥ 105. Although the GDM subjects tended to be heavier than the NM, the progressively more pronounced metabolic abnormalities in GDM ≥ 105 than in GDM & lt; 105 would suggest that relative insulinopenia rather than obesity contributed to the differences. Our findings indicate that gestational diabetes is attended by disturbances of varying degrees in all major classes of insulin-dependent foodstuffs and must be viewed as a disorder of multiple fuels.
    Materialart: Online-Ressource
    ISSN: 0149-5992 , 1935-5548
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 1980
    ZDB Id: 1490520-6
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 2
    In: Diabetes, American Diabetes Association, Vol. 34, No. Supplement_2 ( 1985-06-01), p. 1-7
    Kurzfassung: We have examined gravida with gestational diabetes mellitus (GDM), as defined by the National Diabetes Data Group (Diabetes 1979; 28:1039), for phenotypic and genotypic heterogeneity. Fasting plasma glucose (FPG) at diagnosis was used for further stratification of GDM according to putative metabolic severity into class A, (FPG & lt; 105 mg/dl [N = 129]), class A2 (FPG 105–129 mg/dl [N = 47] ), and class B1 (FPG ≥ 130 mg/dl [N = 23]). All GDM classes tended to be older and heavier than consecutive gravida with documented normal glucose tolerance (controls, N = 148). Subdivision into “lean” and “obese” indicated that plasma immunoreactive insulin (IRI) was greater after overnight fast in the obese of all groups except B1. However, absolute increases in IRI above fasting levels in response to glucose during OGTT were significantly enhanced by obesity only in class A2 gravida. Adjustment for the effects of age and weight by covariate analysis indicated that the IRI response to glycemic stimulation is usually attenuated in all forms of GDM. Mean values for increases in IRI above fasting values during the first 15 min and IRI increments relative to the increases in plasma glucose throughout the 180-min OGTT were below control values in all GDM groups and progressively so, i.e.,A1 & lt; A2 & lt; B1. The absolute insulinopenia was not invariable; a small number of gravida from all GDM groups displayed well-preserved IRI responses to oral glucose. Genotypic evaluation of the GDM population disclosed an increased occurrence of “markers” known to be associated with type I diabetes mellitus. HLA antigens DR3 and DR4 were more frequent in all GDM groups, and the incidence of cytoplasmic islet cell antibodies was enhanced significantly in class A2, and even more so in class B1. Thus, GDM appears to be a heterogeneous entity with substantial phenotypic and genotypic diversity in the mothers. Offspring from some class A1 and diet-treated class A2 gravida were examined to assess whether minimal abnormalities in maternal metabolism suffice to impact on intrauterine development independent of maternal diversity. Amniotic fluid insulin at 36 ± 0.1 wk of gestation and cord plasma C-peptide at birth were increased in offspring of mothers with class A1 GDM, thus indicating that even the mildest forms of GDM can cause accelerated maturation of fetal islet function. Birth weight and symmetry index in the newborn from class A1 arid diet-treated class A2 gravida were significantly increased above control values, even after adjustment for maternal age and weight, thus documenting for the first time that GDM per se can influence the anthropometric characteristics of the neonate. The findings underscore that GDM constitutes an independent risk factor with particular implications for islet and somatic development during fetal life. These unequivocal effects of maternal metabolism on cell development in the fetus may provide the most compelling reason for aggressive approaches to GDM, especially if prospective as well as retrospective studies continue to support their postulated association with increased obesity and diabetes in later life (i.e., “fuel-mediated teratogenesis”; Diabetes 1980; 29:1023).
    Materialart: Online-Ressource
    ISSN: 0012-1797 , 1939-327X
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 1985
    ZDB Id: 1501252-9
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 3
    Online-Ressource
    Online-Ressource
    American Diabetes Association ; 1980
    In:  Diabetes Care Vol. 3, No. 3 ( 1980-05-01), p. 425-429
    In: Diabetes Care, American Diabetes Association, Vol. 3, No. 3 ( 1980-05-01), p. 425-429
    Kurzfassung: We have attempted to use perinatal islet performance as an index of the impact of maternal fuels during fetal development. Accordingly, we analyzed cord plasma for C-peptide and amniotic fluid (secured several weeks before delivery) for immunoreactive insulin in infants of mothers with normal metabolism (NM), gestational diabetes (GDM), and tightly regulated White Class B or Class C insulin-dependent diabetes mellitus (IDDM). We tried to subdivide mothers with GDM on the basis of severity by distinguishing between those with fasting plasma glucose within the normal range for pregnancy (i.e., less than 105 mg/dl and those with fasting plasma glucose of 105 mg/dl or greater). Most of the latter were treated with insulin whereas the former received diet alone. We found that cord plasma levels of C-peptide in infants of mothers with GDM & lt; 105, GDM ≥ 105, and IDDM did not differ significantly from one another; all were approximately twofold greater than in infants from mothers with NM. Values for insulin and ratios of insulin/glucose in amniotic fluid were also increased and to a similar degree in all three diabetic groups; all exceeded the findings in the NM group. Our results indicate that islet function is enhanced at birth in the offspring of mothers with even the mildest forms of untreated gestational diabetes (i.e., GDM & lt; 105) to a degree that is not appreciably different than in more severe forms of diabetes receiving tightly regulated insulin therapy. The augmented B-cell secretion cannot be ascribed to intrapartum events, since similar changes were also found in amniotic fluid secured several weeks before delivery. We conclude that neonatal insulin secretion may constitute an exquisitely sensitive index of the effects of ambient fuels during intrauterine life. Neonatal B-cell function thereby may provide a useful yardstick for the retrospective evaluation of maternal glucoregulation during late gestation.
    Materialart: Online-Ressource
    ISSN: 0149-5992 , 1935-5548
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 1980
    ZDB Id: 1490520-6
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 4
    In: Diabetes, American Diabetes Association, Vol. 34, No. Supplement_2 ( 1985-06-01), p. 111-115
    Kurzfassung: We evaluated glucose tolerance during the first year postpartum in 113 women with gestational diabetes mellitus (GDM) diagnosed according to the criteria of the First International Workshop-Conference on GDM and the National Diabetes Data Group. The high incidence of abnormal postpartum glucose tolerance (38% “diabetes mellitus” plus 19% “impaired glucose tolerance”) was correlated with certain of the heterogeneous characteristics of the population at the time of antepartum diagnosis. Virtually all women with antepartum fasting plasma glucose (FPG) & gt;130 mg/dl (GDM class BO remained abnormal postpartum (21/22 [95%]), which suggests that this group may include women with preexisting glucose intolerance unrecognized before pregnancy. In the remainder, those with FPG & gt; 105–129 mg/dl (GDM class A2) were more likely to be abnormal postpartum than those with FPG & lt;105 mg/dl (GDM class A,). Within the A, and A2 groups, increasing maternal age, relative insulinopenia, and hyperglycemia at 2 h during antepartum OGTT were also associated with a greater likelihood of abnormal glucose tolerance postpartum. The presence of HLA-DR3 and/or -DR4 antigens was not predictive of the status of glucose tolerance during the first year postpartum, although the increased frequency of cytoplasmic islet cell antibodies in A2 and B1 subjects was associated with a high incidence of abnormal postpartum glucoregulation. The high incidence of abnormal postpartum glucose tolerance in all GDM classes makes a compelling case for careful, early, and continuing follow-up of all women with a diagnosis of GDM. The risks of abnormal glucose tolerance in the first year postpartum appear to be correlated with some of the heterogeneous characteristics of women with GDM. Differences in such genotypic and phenotypic features as we have analyzed may account for differences in the incidence of postpartum abnormality in different populations. They must be considered in all studies attempting to elucidate the pathophysiology of GDM or to evaluate therapeutic strategies designed to alter the prognosis for glucoregulation under nongravid conditions.
    Materialart: Online-Ressource
    ISSN: 0012-1797 , 1939-327X
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 1985
    ZDB Id: 1501252-9
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
    BibTip Andere fanden auch interessant ...
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