Robert C. Kaufmann

Gestational diabetes diagnostic criteria: Long-term maternal follow-up

OBJECTIVE The purpose of this study was to determine if the risk of having diabetes later in life was different in those who were gestational diabetic by Coustan criteria and not by National Diabetes Data Group criteria and those who are gestational diabetic only by National Diabetes Data Group criteria. STUDY DESIGN Between 1988 and 1990, 331 patients from the Springfield area who were diagnosed as gestational diabetic by either criteria since 1975 were examined for the development of diabetes by history or by 2-hour, 75 gm glucose tolerance test. National Diabetes Data Group criteria were used to determine normality or diabetic abnormality. Variables associated with diabetes were obtained. The data were analyzed using three groups: (1) gestational diabetic by National Diabetes Data Group criteria, (2) gestational diabetic by Coustans criteria only, and (3) both groups 1 and 2. RESULTS Group 1 had 190 (57.4%) and group 2 had 141 patients (42.6%), of which 25.3% and 25.5% had diabetic abnormality, respectively. Variables predictive for the development of diabetic abnormality were glucose tolerance test fasting value, number of gestational diabetic pregnancies, time to follow-up, and prepregnancy weight index. There were no differences in these variables between the normal patients or those with diabetic abnormality in groups 1 and 2. CONCLUSION Because Coustan criteria classify an additional 68.9% patients who have the same risk and risk factors for later development of diabetic abnormality and pregnancy complications compared with patients who are gestational diabetic by National Diabetes Data Group criteria, the criteria of Carpenter and Coustan should be adopted as the standard for diagnosing gestational diabetes.

Failure to obtain follow-up testing for gestational diabetic patients in a rural population.

OBJECTIVE To determine physician and patient compliance rates for diabetes testing in patients with previous gestational diabetes. METHODS Questionnaires regarding follow-up testing and personal health history were sent to 66 patients with previous gestational diabetes who did not have diabetes when they participated in a follow-up study conducted 5 years earlier. A 2-hour glucose tolerance test (GTT) was offered to those whose last test was done more than 1 year previously. RESULTS All 66 individuals returned the questionnaire and 20 (30.3%) reported having received a yearly 2-hour GTT. Of the remaining 46, 19 had been tested at least once in the previous 5 years, but 27 had not been tested. Of the patients who had been tested at least once in the 5-year period, their physicians initiated testing 61.5% of the time and the patients initiated the remainder. There were no significant differences between physician specialty and rate or appropriateness of the testing. Of 39 individuals who had been tested at least once in the 5-year period, eight had diabetes and four were glucose intolerant. Of 12 individuals who had not been tested in the past year and agreed to be tested in 1995, four had diabetes and two had glucose intolerance. CONCLUSION Although physicians and their gestational diabetic patients knew the risks of diabetes development, compliance with follow-up testing was poor and the risk of developing diabetes high.

An animal model of gestational diabetes

Glucose tolerance tests (GTTs), hemoglobin A, levels, and pup weights were studied in both normal (C57BL/KsJ-+m/ + m) and heterozygous (C57BL/KsJ-db+/ + m) mice. There was no difference in GTT or hemoglobin A, levels between heterozygotes and normal animals in the nonpregnant state. However, the pregnant heterozygous mouse had significantly elevated GTTs (p less than 0.001) and hemoglobin A, levels (p less than 0.002) when compared to the normal pregnant mouse. The mean weight of pups from heterozygous parents was significantly greater than that of pups from normal parents (p less than 0.0005). Because the heterozygous mouse (C57BL/KsJ-db+/ + m) exhibits these characteristics of gestational diabetes, it may be possible to use it as an animal model of gestational diabetes.

Ultrastructure of Human Placenta: Effects of Maternal Drinking

Previous investigations employing both animal models and human subjects have already documented that maternal alcohol consumption during pregnancy has definite deleterious effects upon the developing fetus. In these earlier studies, however, only gross morphological assessments were used to determine the toxicity of alcohol upon placenta and fetus. To date, there is nothing in the literature regarding the effects of alcohol upon the ultrastructure of the placenta. In our laboratory, using both scanning and transmission electron microscopy, placental specimens from mothers who drank heavily during the gestational period revealed ultrastructural abnormalities which suggest that maternal alcohol consumption may indirectly affect the fetus by altering the fine structure of the placenta.

Nonspecific immunity in pregnancy: monocyte surface Fcγ receptor expression and function

The state of pregnancy is an immunological enigma during which the body must prevent rejection of the antigenically foreign fetus while at the same time maintain sufficient maternal host defense mechanisms to combat infection. Although most studies on the immunology of pregnancy focus on immune suppression, several studies have shown an increase in nonspecific host defense, which is postulated to be a compensatory mechanism for decreased specific immunity during pregnancy. Studies in this laboratory have shown that monocyte surface FcgammaRI (CD64) and FcgammaRII (CD32) expression progressively increase throughout pregnancy, while surface MHC class II expression remains unchanged. Functional studies revealed that the number of phagocytic monocytes which could be isolated from pregnant women was increased. These cells exhibited an increased capacity to ingest IgG-opsonized human erythrocytes. This study shows for the first time that monocyte surface FcgammaR expression and FcgammaR-mediated functions are increased during pregnancy. These results support the hypothesis that nonspecific immunity as represented by FcgammaR expression and function is increased during pregnancy.

Ultrastructural changes in neonatal sciatic nerve tissue: effects of passive maternal smoking.

The dangers of cigarette smoking having already been recognized, this study attempts to delineate findings from a passive smoking study at the ultrastructural level. The project utilized a model of mice subjected to cigarette smoke and encompassed the electron microscopic examination of neonatal tissue for morphological abnormalities. Study of sciatic nerve tissue taken from the offspring of passively smoked females revealed definite toxic effects on the neonatal tissue. This investigation, which concentrated on morphological changes, indicates that passive maternal smoke inhalation may result in abnormal changes to the fine structure of fetal tissue although further investigation in this area is necessary to broaden our knowledge and understanding of the mechanisms involved.

The effect of maternal smoke exposure on the ultrastructure of fetal peripheral blood vessels in the mouse

Ultrastructural changes have been found in umbilical blood vessels, placental blood vessels, and peripheral blood vessels of human fetuses whose mothers smoked during pregnancy. This study was undertaken to determine if similar changes could be found in peripheral blood vessels of mice fetuses whose mothers were exposed to cigarette smoke during pregnancy. Breeding mice of the C57BL/KsJ strain were placed in a smoking box similar to that described by Younoszai and exposed to cigarette smoke intermittently. This produces carbon monoxide levels in the adult mice similar to that found in human adults smoking one pack of cigarettes per day. Similarly caged mice of the same strain were used as controls. The female mice were not removed from their cage from pre-conception time until after delivery. Upon delivery each pup was sacrificed via neck fracture and the entire pup was immersed in a solution of 2.5% glutaraldehyde in 0.1 M cacodylate buffer at pH 7.3. While still under solution, the rear leg muscles were dissected free, sliced, and immersed in the same preservative for four to five hours. They were then placed in fresh 2.5% glutaraldehyde mixture overnight. The tissues were post-fixed in osmium ferrocyanide and en-block stained with uranyl acetate in a graded series of alcohol. The tissues were infiltrated with and embedded in Spurr. Sections were taken via an ultramicrotome and post-stained with uranyl acetate and lead citrate. The sections were examined in a Philips 201 electron microscope at 60 KV. In the peripheral vessels of the fetuses from smoke-exposed mothers, endothelial blebbing (both surface-type and vacuole-type) was seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrastructural changes in preputial neural tissues: effects of maternal drinking

Peripheral nerves in the prepuces of eight newborns were studied in this investigation. The mothers of four of these newborns were alcohol abusers but did not smoke or take coffee. The other four mothers did not drink alcohol or coffee, nor did they smoke. Using a transmission electron microscope, the peripheral nerves in preputial specimens were studied for pathological changes. In samples taken from the prepuces of those newborns with drinking mothers, the neuropathological changes seen were mainly in the unmyelinated axons. These demonstrated increased vesicular and tubular elements of agranular endoplasmic reticulum and dense bodies not found in the specimens taken from the non-drinking group. Other significant findings in the fetal preputial specimens from the alcohol group were aggregations of mitochondria and collagen entrapment.

Ovarian Effects upon Maternal Glucose Tolerance

Ovaries from homozygous diabetic (db/db) female mice were removed and transplanted into the empty left ovarian sacs of normal homozygous (m/m) female mice which had undergone left oophorectomies. To produce controls, the previously removed normal left ovaries were transplanted into the empty left ovarian sacs of other normal (m/m) left oophorectomized females. Glucose tolerance tests were done on the study and control mice before surgery, after surgery, during pregnancy, and after delivery. There were no significant differences in the glucose tolerance test results between study group and controls before or after surgery. However, the study group, when compared to the controls, had a statistically significant glucose intolerance during pregnancy. After delivery, the glucose levels returned to normal. The ovaries from diabetic (db/db) female mice may produce hormones which, by themselves or in concert with the fetal and placental hormones, may produce maternal glucose intolerance during pregnancy.

The Two-Hour Glucose Screen for Gestational Diabetes

Universal screening for gestational diabetes (GD) using a 1-hr 50-g glucose screen yields a high sensitivity but a low positive predictive value (PPV), resulting in glucose tolerance tests (GTTs) performed on patients who do not have GD. Since the literature suggests that the 2-hr value of the antepartum GTT may be the most predictive of a later development of diabetes, a 2-hr glucose screen during pregnancy may be more predictive of the development of GD. Over a 2½-year period, 620 patients inadvertently underwent glucose determination 2 hr after a 50-g load, while 2,506 patients had the usual 1-hr glucose determination. All patients from both groups whose screen values were >130 mg/dl were given a GTT. The GTT data were analyzed using the Amankwah and NDDG criteria: fst: 100, 1-hr: 180, 2-hr: 160, 3-hr: 140; and fst: 105, 1-hr: 190, 2-hr: 165, and 3-hr: 145, respectively. The incidence of gestational diabetes using Amankwahs criteria was 4.4% for the 1-hr screens and 3.2% for the 2-hr screens; using th...