S. Grima

Outcomes of hypertensive obstetric patients in the Maltese Islands

a Chinese population with the highest rate of MTHFR C677T mutation. The number of cases is rather low in the NTD group, as in the control group, and larger population studies are needed to confirm this association. These results suggest that the presence of MTHFR C677T in mothers with normal folate levels may be a risk factor for NTD development in our population and that consideration should perhaps be given to folate supplementation.

Genetic factors in risk assessment for the development of type 2 diabetes mellitus in a small case series

OBJECTIVE This study aimed to investigate the role of genetic biomarkers in assessing risk for the eventual development of type 2 diabetes mellitus (T2DM). METHODS Three Maltese women with a history of previous severe GDM and with apparent similar clinical risk factors underwent anthropomorphic and metabolic reassessment 4-7 years post-partum. They were further genotyped for four specific genetic single nucleotide polymorphisms (SNPs) using the qPCR technique for the alleles of SLC2A2 (rs5393A/C), FTO (rs9939609A/T), PCK (rs2071023C/G) and CDKAL1 (rs10946398A/C). RESULTS While the previous obstetric history of all the cases was similar, the biological status was characterized by an increasing degree of obesity correlating to increasing severity of current carbohydrate intolerance. Genotyping showed that all the tested SNPs were homozygous mutant in the T2DM woman and heterozygous in the impaired glucose tolerance woman. The woman with normal glucose tolerance was shown to be wild type for SLC2A2 (rs5393A/C). CONCLUSIONS There appeared to be an interrelationship between eventual severity of carbohydrate metabolism abnormalities and the genetic allele status. It would appear that the specific allele-scoring can be used to identify further the potential risk of developing T2DM.

Metabolic carcinogenesis in the Maltese population.

Endometrial adenocarcinoma has been associated with prolonged oestrogen exposure causing endometrial hyperplasia and adenocarcinoma. Metabolic disorders and nutritional factors may contribute towards obesity and the increased adipose production of oestrogen. The study confirms the association between endometrial carcinoma risk and diabetes mellitus and increased total fat intake. It further relates the malignancy to a prolonged natural oestrogen exposure period and confirms the protective role of past pregnancies.

Conjoint twinning in the Maltese islands

Summary Conjoined twinning is a relatively rare event in any community, with a rate of 1.58 per 100,000 maternities reported in the EUROCAT database. The present study reviews the historical records for conjoined twins born in a closed Central Mediterranean archipelago population with particular reference to the last three decades. While the natural monozygotic twinning rates in the Maltese Islands corresponds to that reported from other communities, the incidence of conjoined twinning in the Maltese Islands has been shown by the present study to be significantly 2.5-times higher than that reported by the remaining EUROCAT contributors. The rate reported from the Maltese Islands by this review is 3.98 per 100,000 maternities.

Hypertensive disorders during pregnancy in gestational diabetic women.

Gestational diabetes is often compounded by hypertensive disease of pregnancy. Women diagnosed as suffering from gestational diabetes were subdivided into two groups: those found to be suffering from some form of hypertension during their pregnancy [n = 78]; and those who did not develop hypertension [n = 345]. The maternal characteristics and perinatal outcome of the two groups were statistically correlated. The results show that obesity was the only statistically significant correlate, and that obstetric outcome more often required planned delivery by induction of labour or caesarean section. The infant was more likely to be delivered prematurely. While the perinatal morbidity did not show any significant differences, this was only because of the more active intervention policy in these women.

Anthropomorphic characteristics as obstetric risk determinants

An essential element in achieving a successful birth process is the size of the infant and its relationship to the birth canal. The maternal anthropomorphic characteristics of height and weight are determinant in establishing birth canal adequacy and infant size. The present study assesses the risk element of these two factors on obstetric performance in a Mediterranean population characterised by a relatively short stature and a high prevalence of the Metabolic Syndrome. Obese women have been shown to have pregnancies which are more likely to be complicated by hypertension and diabetes when compared to their leaner counterparts. They were more likely to be delivered by Caesarean section and vaginal delivery was more likely to be complicated by shoulder dystocia. The infants born to these mothers were heavier and were more likely to suffer from respiratory distress in the neonatal period. The short stature woman similarly had a greater likelihood of requiring Caesarean delivery in spite of having a tendency to infants with smaller birth weights than their taller counterparts. The study confirms that the maternal body habitus remains an obstetric risk consideration that needs to be addressed when deciding on management of delivery.