Ragnhild Hjertberg

Insulin lispro therapy in pregnancies complicated by type 1 diabetes mellitus

OBJECTIVE To compare the efficacy and safety of preprandial administration of rapid-acting lispro analogue with regular short-acting insulin to pregnant women with type 1 diabetes. STUDY DESIGN Open randomised multicentre study. Women were treated with multiple insulin injections aiming at normoglycaemia. Blood glucose was determined six times daily, HbA(1c) every 4 weeks. Diurnal profiles of blood glucose were analysed at gestational week 14 and during the study period at weeks 21, 28 and 34. PARTICIPANTS 33 pregnant women with type 1 DM were randomised to treatment with lispro insulin (n=16) or regular insulin (n=17). RESULTS Blood glucose was significantly lower (P<0.01) after breakfast in the lispro group, while there were no significant group differences in glycemic control during the rest of the day. Severe hypoglycaemia occurred in two patients in the regular group but biochemical hypoglycaemia (blood glucose <3.0 mmol/l) was more frequent in the lispro than in the regular group (5.5 vs. 3.9%, respectively). HbA(1c) values at inclusion were 6.5 and 6.6% in the lispro and regular group respectively. HbA(1c) values declined during the study period and were similar in both groups. There was no perinatal mortality. Complications during pregnancy, route of delivery and foetal outcome did not differ between the groups. Retinopathy progressed in both groups, one patient in the regular group developed proliferative retinopathy. CONCLUSION The results suggest that it is possible to achieve at least as adequate glycemic control with lispro as with regular insulin therapy in type 1 diabetic pregnancies.

Well‐being and sense of coherence during pregnancy

Background.  Our knowledge of how a woman as an individual experiences, evaluates and copes with pregnancy is limited. The concept of ‘sense of coherence’ as described by Antonovsky may be an important factor in how people deal with stressful situations in life. The aim of this study is to describe pregnant womens perception of well‐being during pregnancy and after delivery and to explore its relationship to their sense of coherence.

Conservative treatment of mild and moderate hypertension in pregnancy

In a prospective study regarding conservative treatment of mild to moderate hypertension in pregnancy 5244 women were evaluated at delivery. Two hundred and fifty‐eight (4.9%) were registered as hypertensive during pregnancy with a blood pressure (BP) ± 140190 mmHg. One hundred and ninety‐six of these continued their pregnancy without medication and 96/196 were defined as preeclamptic (PE), 45/196 as chronic hypertensive (CH), and 55/196 as having gestational hypertension (GH). In 621258 women anti‐hypertensive treatment was initiated in the mean 6.5 (± 8.7) days after onset of hypertension, due to a BP ± 150/100 mmHg. There was a later onset of hypertension in the untreated group, and BP at delivery differed in the untreated groups (p < 0.001) with the lowest BP in women with mild GH. There was no difference in cesarean section rate in the mild hypertensive group as compared to the normal population. Birth weight and length of pregnancy were significantly lower in the untreated mild hypertensive group as compared to normal pregnant women (p < 0.05). But in the subgroup with mild GH pregnancy length and birth weight did not differ from normal pregnancy. The conclusion from our study is that women with mild hypertension in pregnancy might refrain from antihypertensive therapy if they are closely observed during pregnancy and delivery, especially if there has been no hypertension before pregnancy and no proteinuria develops.

Premature rupture of the membranes (PROM) at term in nulliparous women with a ripe cervix: A randomized trial of 12 or 24 hours of expectant management

Objective. To compare maternal and neonatal outcomes after 12 or 24 hours of expectant management in healthy nulliparous women with a ripe cervix and PROM at term.

Randomized controlled study in pregnancy on treatment of marked hyperglycemia that is short of overt diabetes.

A randomized multicenter study was conducted in the Stockholm‐Örebro areas in Sweden to evaluate how treatment aiming at normoglycemia affects fetal growth, pregnancy and neonatal outcome in pregnant women with severe hyperglycemia.

Thromboembolism and in vitro fertilization – a systematic review

There is no accepted consensus on thromboprophylaxis in relation to in vitro fertilization (IVF). We aimed to study the frequency of thromboembolism and to assess thromboprophylaxis in relation to IVF.

Late Results after Thrombectomy for Ilio-Femoral Venous Thrombosis

Sixty-three of 68 patients who underwent thrombectomy with a temporary arteriovenous fistula for ilio-femoral venous thrombosis were followed-up after a mean time of 66 months (range 15–130). Fifty-four were women with a mean age of 29 years (range 13–66). A primary successful operation was performed in 54 patients (86%); at 16 months 34 (54%) were judged to have a patent ilac vein. At long-term follow-up 23 patients had no symptoms, 17 had leg swelling, venous claudication and/or present or previous ulcer while 23 had leg swelling only. Fourteen (22%) had noticed a decreased capacity to perform their job and 21 (33%) had to compensate daily for the discomfort of the diseased leg. Recurrent thrombotic disease occurred in eight patients and did not seem to be associated with symptoms at follow-up. The results of the operated patients seem to be favourable compared to other reports of conservative treatment, especially for fertile women and with a reduced risk of future venous insufficiency. In young patients with a long life expectancy this is particularly important.

Latex agglutination test for a-fetoprotein in the diagnosis of premature rupture of the amniotic membranes (prom)

A rapid latex agglutination test for a‐fetoprotein (AFP) was compared with a pH‐indicator and patient history in the detection of premature rupture of the amniotic membranes. Of 120 patients examined, 34 had an established rupture of the membranes, and 56 had suspected rupture. Thirthy patients had no evidence of membrane rupture. The vaginal content was examined with a pH‐indicator. Samples of vaginal content were also obtained to perform the latex agglutination test, and 103 of these samples were analysed by a radio‐immunoassay (RIA) technique for AFP. Our results indicate that the latex agglutination test is of doubtful value due to the many inconclusive test results. The sensitivity of the latex test is less than 15%, and the specificity is 80%. Patient history combined with pH‐indicator test is far more informative than the latex agglutination test.

The Renin-Angiotensin-Aldosterone System in Pregnancy Response to terbutaline provocation in preeclampsia

The blood pressure control in preeclampsia (PE) was studied in 13 pregnant women with PE and 13 controls. They received a 25 minute i.v. infusion of a fi-adrenergic receptor agonist, terbutaline. A paradoxical decrease of systolic blood pressure was seen in women who had, or later developed, severe PE. Blood samples were analyzed for angiotensin converting enzyme (ACE), atrial natriuretic peptide (ANP), norepinephrine, dopamine, angiotensin II (All), renin, aldosterone, Cortisol. In the PE group the severity of PE correlated well with aldosterone levels and differed significantly compared to the control group (p<0.01). Plasma renin levels were significantly lower in PE compared to controls (p<0.05) which may explain the low aldosterone levels. Aldosterone levels also correlated well with All levels in the PE group but not in the control group (correlation coefficient 0.665, p<0.05). The ACE activity level was increased in PE. Analyses of ANP, norepinephrine, Cortisol did not reveal any clues to the diseas...

Treatment efficacy for idiopathic recurrent pregnancy loss - a systematic review and meta-analyses

Medical treatment of women with idiopathic recurrent pregnancy loss is controversial. The objective was to assess the effects of different treatments on live birth rates and complications in women with unexplained recurrent pregnancy loss.