Hassan A. Nasrat

Perinatal Effects of Nicotine

Nicotine alkaloid as a base was administered to 3 groups of pregnant Swiss albino mice during each trimester of their pregnancy. Three doses of the drug (900, 1,800 and 2,700 micrograms/kg/day) which respectively correspond to 3 levels of cigarette smoking (10, 20 and 30 cigarettes per day) were used. In order to find out which stage of pregnancy is most vulnerable to the effects of nicotine, each dose of the drug was administered subcutaneously to a group of animals during each trimester of their pregnancy. The perinatal effects, i.e., gestation period, percent of delivering mothers, the male to female ratio of the offspring, and the perinatal mortality, i.e. still-birth and neonatal death, were observed. In general, nicotine has increased the perinatal mortality. When large doses of the drug were given especially in the second and third trimesters of gestation, there was a significant shortening of the gestation period (p less than 0.05; p less than 0.01). Hence, during pregnancy, mothers who smoke should be warned against the harmful effects of smoking especially in the late period of their pregnancy.

Serum Immunoglobulin Concentrations in Diabetic Patients

The relationship between glycated haemoglobin (an index of long‐term diabetic control), fructosamine (an index of intermediate‐term diabetic control), and serum IgA, IgG, and IgM was studied in 110 diabetic patients (41 Type 1 and 69 Type 2) and compared with 111 healthy non‐diabetic subjects. Significant increases in serum IgA (by 82.7%, p < 0.001) and IgG (by 35.2%, p< 0.001) concentrations were observed whereas the concentration of IgM was significantly decreased (by 46.7%, p < 0.001) in diabetic patients compared with non‐diabetic subjects. Using Spearmans rank correlations, IgA correlated with fructosamine (r = 0.77, p < 0.001), HbA1 (r = 0.76, p < 0.001), and albumin (r = −0.58, p < 0.001) for the entire population sample but only fructosamine (r = 0.19, p < 0.05) and HbA1 (r = 0.28, p < 0.001) correlated with IgA in diabetic patients, respectively. It is concluded that abnormal levels of IgA, IgG, and IgM are very common in diabetic patients in whom serum IgA concentrations are influenced by the degree of glycaemic control. Whether changes in IgA and other immunoglobulins are implicated in the pathogenesis of diabetic complications (such as susceptibility to infection) deserve further study.

Determinants of pregnancy outcome in patients with gestational diabetes

Objectives: To describe the experience of management of gestational diabetes ‘GDM’ among a high‐risk population and to determine the relative contribution of maternal risk factors and some indices of glucose intolerance on pregnancy outcome. Methods: A total of 173 antenatal patients with GDM, matched to 337 non‐diabetic controls were evaluated. Incidences of fetal macrosomia, large birth weight (>4000 g), and operative delivery were noted. Patients with GDM were subgrouped into group I and II, according to the fasting blood glucose (FBG) level on the glucose tolerance test ‘GTT’, whether ≥ or < 5.8 mmol/l, respectively. A logistic regression model was then developed with predictive variables, i.e. maternal weight, height, parity, gestational week at diagnosis of GDM, degree of glucose tolerance, treatment and means of fasting and post‐prandial blood glucose measurements as independent variables against each of the outcome measures as dependent variables. Results: Compared with non‐diabetics, patients with GDM were older in age, weight and parity. The mean fetal birth weight, incidences of macrosomia and babies >4 kg were significantly higher among GDM patients. In patients with GDM the degree of glucose intolerance (determined by FBG on the GTT) and maternal weight were the only variables that significantly increased the risk of macrosomia and operative delivery. Within group I patients (FBG ≥ 5.8 mg/dl) only ‘maternal weight’ significantly increased the risk of both having a baby > 4 kg, and operative delivery. Conclusion: Among patients with gestational diabetes, a GTT with a FBG level ≥ 5.8 mmol/l is a strong predictor for perinatal outcome. Maternal weight is an independent risk factor that increases the risk of both macrosomia and operative delivery.

Autoantibodies to GAD and IA-2 in Saudi Arabian diabetic patients

Aims  To determine the prevalence of autoantibodies in sera of Saudi diabetic patients including Type 1 and Type 2 diabetes mellitus (DM) and gestational diabetes mellitus (GDM) living in Jeddah, Saudi Arabia. Apart from data on the prevalence of islet‐cell antibodies in patients in Ryhadh (Al‐Attas et al. Freqency of islet cell antibodies in adult newly diagnosed diabetic patients. Ann Saudi Med 1990; 10: 369–373) immunological markers of autoimmune diabetes have not been explored in Saudi Arabians.

Prenatal diagnosis of recurrent Meckel syndrome.

We report a rare case of Meckel‐Gruber syndrome in a woman who had three affected offsprings in the past with similar condition. Ante‐natal ultrasonographic diagnosis and management are presented.

Fructosamine as a screening-test for gestational diabetes mellitus: a reappraisal

Fructosamine, glycosylated hemoglobin (HbAIc) and serum total proteins were measured in normal nondiabetic pregnant women (n = 170) at three stages of pregnancy (14–18, 24–28, and 32–40 weeks of gestation). No significant correlation was found between fructosamine and either HbAIc or total plasma proteins. Only early in pregnancy (< 20 weeks of gestation) was a correlation found between fructosamine and fasting blood glucose (r = 0.40, P < 0.05). There was also no correlation between either tests (i.e. fructosamine and HbAIc) and fetal birthweight. The value of fructosamine measurement in the detection of diabetes in pregnancy was further tested in a group of high‐risk patients (n = 98) for developing carbohydrate intolerance. It is concluded that fructosamine has limited value as a screening test for gestational diabetes mellitus, particularly for the mild form of the glucose intolerance.

Anthropometric measurements of newborns of gestational diabetic mothers: Does it indicate disproportionate fetal growth?

Anthropometric and skinfold measurements in 51 newborns of mothers with gestational diabetes were compared to reference ranges obtained from measurements of 501 newborns of nondiabetic mothers. In newborns of diabetic mothers, the means of fetal birth weight, biceps, subscapular, suprailiac skinfolds, and total fat index measurements (the sum of all measurements) were significantly greater than those of the nondiabetic group. While the means of fetal crown-heel length and head circumference did not significantly differ between the two groups, these findings suggest a disproportionate pattern of growth in fetuses of diabetic mothers, with increased tendency for deposition of subcutaneous fat. The studied population were then stratified into six categories according to birth weight percentiles. Within each category, the skinfold measurements in newborns of diabetic mothers were greater--though the difference was not statistically significant than that of nondiabetic mothers. It is possible, however, that in severe cases of maternal diabetes, the risks of complications, such as shoulder dystocia, increase with disproportionate deposition of subcutaneous fat. These risks appear greater than in fetuses of nondiabetic mothers at a comparable birthweight.

Fructosamine in Obese Normal Subjects and Type 2 Diabetes

The effect of various grades of obesity on serum fructosamine concentrations was studied in Type 2 diabetic (n = 105) and non‐diabetic (n = 128) subjects. In obese diabetic and non‐diabetic subjects (body mass index ≥ 30 kg m−2), the concentration of fructosamine was markedly lower than that obtained for lean diabetic and non‐diabetic subjects with similar glycaemic control. Stepwise multiple‐regression analysis showed that fructosamine was associated with glycaemic control (as indicated by fasting plasma glucose and glycated haemoglobin), fasting triglycerides, and body mass index in both diabetic and non‐diabetic subjects. In vitro studies showed marked decreases in both the extent of [14C]‐glucose incorporation into plasma proteins and fructosamine production by incubated sera of obese patients whether diabetic or non‐diabetic, with obese subjects with body mass index > 40 kg m−2 exhibiting the greatest decrease. In conclusion, serum fructosamine concentrations are shown to decrease in obese diabetic and non‐diabetic subjects with body mass index ≥ 30 kg m−2 giving rise to the underestimation of glycaemic control as indicated by fructosamine measurement. A change in the glycation reaction itself may be partly responsible for such decrease.

New criteria for interpretation of the 75 g oral glucose tolerance test in pregnancy

A 75 g oral glucose tolerance test (OGTT) was performed on 135 high-risk pregnant patients. When the current World Health Organization (WHO) criteria for the diagnosis of gestational-glucose tolerance were applied, 88 patients were considered normal, 11 had gestational diabetes, and 36 patients had impaired-glucose tolerance, respectively. The plasma glucose, insulin, and C-peptide levels during the OGTT were further studied in the 88 patients (who had normal results). Two metabolically distinct groups were identified; a group (n = 53) with a 2-hour plasma glucose less than or equal to 6.6 mmol/L (118.8 mg/dL), had a normal insulin and C-peptide pattern, and a second group (n = 35) who had 2-hour plasma glucose greater than 6.6 mmol/L displayed a glycemic, insulin, and C-peptide pattern similar to that of patients with gestational diabetes mellitus. The risks of macrosomic babies and operative delivery were significantly greater in the latter group. These results suggest that in our pregnant population, a group of patients with impaired glucose tolerance will be under-diagnosed using the current WHO criteria. Based on our results new criteria for gestational glucose intolerance are suggested for our population.

Outcome of pregnancy in diabetic mothers

OBJECTIVE: To study complications seen among newborns of gestational diabetic mothers versus nondiabetics, and to compare the pattern of distribution of those complications to similar reports form Western populations. METHOD: Prospective case controlled study of 384 newborns, (191 of diabetic and 193 of nondiabetic mothers) delivered at the King Abdulaziz University Hospital, Jeddah. RESULTS: The overall rate of infant morbidity was greater among newborns of diabetic mothers, especially those who required insulin for metabolic control. The major complications were those associated with increased incidence of large birth weight infants. Complications such as congenital malformations, intrauterine growth retardation and other severe forms of morbidity often associated with insulin‐dependent diabetes were rarely seen. CONCLUSION: Fetal and neonatal risks associated with diabetes in pregnancy depend not only on the severity, but also on the type of diabetes. In modern societies fetal complications associat ed with diabetes are mainly those due to hyperglycemia in the second half of gestation. The results also emphasize the fact that perinatal morbidity rather than mortality should be the yardstick for the efficacy of management of diabetes in pregnancy.