Dominic F. H. Li

Prediction of persistent carbohydrate intolerance in patients with gestational diabetes.

A 12-month prospective study was carried out in 120 Chinese patients with gestational diabetes who were found to have persistent carbohydrate intolerance at 6 weeks postpartum. The 75 g OGTT and WHO diagnostic criteria were employed for both antepartum and postpartum assessment. By 12 months, persistent carbohydrate intolerance was found in 13.3% of the patients only, 6 patients were diabetic while 10 had impaired glucose tolerance. Of those whose carbohydrate tolerance reverted to normal, 85% did so within the first 6 months. The clinical variables were analysed by multiple discriminant analysis using the logistic model. Five prognostic variables which were predictive of persistent carbohydrate intolerance at 12 months were identified. In order of decreasing predictive value, these included a high fasting glucose during pregnancy and at the first postnatal visit, a high antepartum 2 h blood glucose, the requirement of insulin during pregnancy, and a high postpartum 2 h blood glucose. Macrosomia, gestational age at diagnosis and a family history of diabetes were not predictive of persistent carbohydrate intolerance. Multiparity, maternal age and body mass index were of marginal significance only. The fitted logistic model provides a mechanism to estimate the probability of persistent carbohydrate intolerance. Such information will be helpful in patient counselling and in the efficient planning of postpartum medical follow-up.

Glucose and Lipid Metabolism with Triphasic Oral Contraceptives in Women with History of Gestational Diabetes

The glucose and lipid metabolism in a group of women with previous history of gestational diabetes were evaluated before and after 6 months treatment with a low-dose triphasic oral contraceptives pill (TP). This group was compared with a control group of women, also with history of gestational diabetes, using intrauterine devices (IUD). In the TP group, 26.7% of the women developed impaired glucose tolerance which reverted to normal in all but one after cessation of the TP. The IUD group showed no change in glucose tolerance. The integrated insulin response to a 75g OGTT in the TP group increased by 48.3% at 6 months compared with an increase of 23.4% for the same period in the IUD group. In the TP group there was a significant decrease in serum total cholesterol without changes in HDL-cholesterol and triglycerides level. We conclude that even low-dose triphasic oral contraceptive pills can cause glucose intolerance in women with previous gestational diabetes mellitus.

Evaluation of the WHO criteria for 75 g oral glucose tolerance test in pregnancy

Summary. A group of pregnant women at high risk of developing diabetes in pregnancy had paired oral glucose tolerance tests (OGTT) using a 100 g load followed by 75 g load. When the World Health Organization (WHO) criteria and the National Diabetes Data Group (NDDG) criteria were compared, the 2‐h plasma glucose value after the 100 g load was the most discriminative in differentiating those with normal glucose tolerance, impaired glucose tolerance and gestational diabetes mellitus. When only the 2‐h plasma glucose values were assessed, the WHO test (75 g: 8 mmol/1) agreed with the NDDG test (100 g load: 9·2 mmol/1) in the diagnosis of glucose intolerance in 60% of subjects only. Using the same criteria at 2‐h (8 mmol/1) the agreement between these tests was 47%. Reducing the glucose load from 100 g to 75 g produced a reduced glucose response in 49% of the subjects, with a significant decrease in the area under the glucose response curve.

Obstetric outcome among Vietnamese refugees in Hong Kong: an age-matched case-controlled study

The obstetric performance of 308 Vietnamese refugees is compared with that of 308 age‐matched Hong Kong Chinese patients. Vietnamese women were of higher parity and had an increased incidence of late booking and unreliable dates. Significant differences were found in the incidence of previous termination of pregnancy, iron‐deficiency anemia, parasitic infestation, tuberculosis (TB) and syphilis. There was no significant difference in the mean birthweight between the two groups. However, there were twice as many low birthweight (< 2500 g) infants amongst the Vietnamese whereas the Chinese patients had a higher incidence of macrosomic (> 4 kg) infants. There were no perinatal deaths and no significant perinatal morbidity.

Assessment of the glucose tolerance test in unselected pregnancy using 75 g glucose load

A 75 g oral glucose tolerance test (OGTT) was performed in 618 unselected pregnant Chinese women between 24 and 28 weeks gestation. The glucose response at fasting, 1, 2 and 3 h were studied. At 2 h the glucose level at 2‐standard deviation and 4‐standard deviation above the mean came very close to the criteria of abnormality suggested by the World Health Organization (WHO): 8.3 mmol/l vs. 8.0 mmol/l for impaired glucose tolerance and 10.8 mmol/l vs. 11.0 mmol/l for gestational diabetes mellitus. The area under the glucose response curve also correlates best with the glucose levels at 2 h during the OGTT (y = 2.1x + 4.6, r = 0.885). The 75‐g OGTT interpreted with the WHO criteria seems appropriate for pregnant Chinese women. The 75‐g test has the added advantages of reducing administration cost and discomfort of the patients.

A Multicentre Study to Investigate the Prevalence of Abnormal Carbohydrate Metabolism in Chinese Pregnant Women

Objectives: To determine the prevalence of abnormal carbohydrate metabolism in Chinese pregnant women. To study the inter‐relationship between maternal body habitus, maternal serum glucose and birth weight of the baby.

Endometrioid carcinoma of the ovary: an unusual cause of postpartum collapse. Case report

This 28-year-old priniigravida booked at 11 weeks gestation and subsequently attended clinic rcgularly. She had certain date5 and the utcriiie sizc was cquivalcnt to the period of gcstation throughout the pregnancy. The antenatal course was uneventful. She was admitted in advanced labour at 37 wccks gestation. and only 15 niin after admission progressed to a spcrntancous vaginal delivery of ii livc female infant weighing 2910 g with Apgar S C Q ~ C S 0 1 10 and 10 at 1 and 5 min. Intramuscular crgometrine, 0.5 nig, was admnnistercd and the third stage was uncomplicated. Whilst the episiotomy was being sutured she vomited once, undigested food only with no haematemesis. On completion of thc episiotomy repair, 20 min after delivery, the patient was found to be unconscious though rouseable. Shc complained only of epigastric pain. On examination she was pale, sweating and had cold extremities. Her pulse was 120 beatsimin and hcr blood prcssure 80140mmHg. Examination of the chest was normal. The abdomen was uniformly distended but no guarding or rebound tenderness could be elicited. There was no fluid thrill o r shifting dullness, and bowel sounds were absent. Vaginal examination showed the vaginal blood loss to be minimal and no tear was prcscnt

Management of Pelvic Endometriosis with a GnRH Analogue

Pelvic endometriosis remains a difficult gynaecological problem to manage and yet the progression of the disease can be very detrimental to the health of the patients. Surgical treatment often involves removal of the reproductive as well as the hormonal functions of the patient. With the discovery of GnRH analogues ability to induce reversible suppression of the hypothalamic-pituitary-ovarian axis, it becomes possible to produce a hypoestrogenic state which allows regression of the disease. This paper reports on a Phase III clinical trial on the use of buserelin (Hoechst China Ltd) in the management of patients with severe pelvic endometriosis.