Smolarczyk R

Carbohydrate metabolism in the course of intrahepatic cholestasis in pregnancy.

Glucose metabolism was evaluated in pregnant women with clinically and biochemically demonstrated intrahepatic cholestasis. Laboratory investigations included measurements of serum glucose concentrations on fasting and 2 hours after breakfast, the glucose tolerance test (100 gm oral glucose load), and 24-hour glycemia profile. All patients were admitted to the II Department of Obstetrics and Gynecology, Institute of Obstetrics and Gynecology of the Medical School in Warsaw, Poland. None of the patients exhibited manifest diabetes mellitus or had any clinical history suggestive of previous diabetes. The serum samples collected 2 hours after breakfast demonstrated higher glucose concentrations in women with intrahepatic cholestasis when compared with healthy control subjects. The glucose tolerance tests demonstrated consistently higher concentrations of glucose in blood serum samples after loading in the study group. The 24-hour glycemia profile showed greater glucose concentrations in serum samples collected 2 hours after breakfast and after supper. These results suggest that in the course of cholestasis in pregnancy, visible changes occur in the carbohydrate metabolism of the pregnant woman.

Alpha-hydroxybutyrate dehydrogenase activity in intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is associated with increased perinatal mortality and morbidity. Alpha‐hydroxybutyrate dehydrogenase (α‐HBDH) is an enzyme that originates in the cytoplasm of hepatocytes and can be detected in the serum. The aim of this study was to determine the characteristics of α‐HBDH activity in ICP.

Kallmann syndrome in women: from genes to diagnosis and treatment

Abstract Kallmann syndrome (KS) can be characterized as genetic disorder marked by hypogonadotropic hypogonadism and anosmia. Franz Jozef Kallmann was the first who described this disease in 1944. He suggested, that this disease has hereditary background. At present, six genes are regarded as causal genes of KS. These genes can be listed in chronological order: KAL1, FGFR1, FGF8, CHD7, PROKR2 and PROK2. The sensitivity of molecular testing of KS is only about 30%. Diagnosis based on clinical findings is therefore such important. Cardinal features of patients with KS include hypogonadotropic hypogonadism and anosmia or hyposmia. Some non-reproductive, non-olfactory symptoms can also be present, depending on the genetic form of disease. Some patients with KS present midline cranial anomalies (cleft lip, cleft palate and imperfect fusion). Sometimes patients can also suffer from missing teeth (dental agenesis). Optic problems, such as colour blindness or optic atrophy also can occur in KS patients. Very characteristic symptom in KS patients is mirror movements of the upper limbs (imitation synkinesis for contralateral limbs). The type of treatment in women with KS depends on the goal of therapy. After the diagnosis of syndrome, the main goal of the treatment is to induce and maintain secondary sex characteristic (estrogen-progestin therapy). The further goal in some patients can be related to enable fertility (gonadotropin, gonadotropin-releasing hormone therapy).

Risk factors of abnormal carbohydrate metabolism after pregnancy complicated by gestational diabetes mellitus

Objective: In gestational diabetes mellitus (GDM) abnormal glucose metabolism normalizes soon after delivery. However, the history of GDM predisposes to carbohydrate intolerance in the future. The aim of the study was to explore risk factors and to evaluate risk of glucose intolerance and diabetes mellitus in women with a history of GDM. Methods: 155 patients entered this case-control study. Participants fulfilled the inclusion criteria: a history of GDM, perinatal care in the study center. Medical and family history and laboratory findings were analyzed. Oral glucose tolerance test (OGTT) was performed. Results: 18.1% of patients presented impaired fasting glucose during the study, 20% presented impaired glucose tolerance and 23.2% presented diabetes mellitus. Gestational age at diagnosis of GDM, the results of OGTT during pregnancy, serum HbA1c concentration at 2nd and 3rd trimester, serum fructosamine concentration, symptoms of diabetic fetopathy in the neonate, the need for insulin therapy after delivery, maternal age at diagnosis of GDM and maternal body mass index before pregnancy were the significant risk factors of impaired glucose tolerance or diabetes in the future. Conclusion: GDM increases the risk of diabetes mellitus. Several risk factors of impaired carbohydrate metabolism can be distinguished in patients with a history of GDM.

The biochemical functions of the renal tubules and glomeruli in the course of intrahepatic cholestasis in pregnancy

Biochemical functions of kidney glomeruli and tubules were estimated in pregnancy complicated by cholestasis. The investigated group consisted of 72 women with pregnancy complicated by cholestasis and 30 healthy pregnant patients as a control group. Biochemical assays were performed for the deamination of amino acids, carbonic acid dissociation and creatinine metabolism. Statistical analysis was carried out using the t-test and P<0.05 was considered to be significant. In diurnal urine samples collected from pregnant patients with cholestasis, decreased concentrations of NH4+ (42.0+/-8.9 versus 50.3+/-7.6 mmol/24 h), H+ (19.0+/-7.0 versus 25.0+/-5.0 mmol/24 h), creatinine (1.15+/-0.2 versus 1.43+/-0.3 mmol/24 h) as well as lower levels of creatinine clearance (89.0+/-23.0 versus 135.0+/-30.0 ml/min) and normal levels of potassium and sodium were observed. Serum creatinine and uric acid concentrations were elevated (86.6+/-7.07 versus 66.3+/-4.42 micromol/l and 32.1+/-8.3 versus 19.0+/-3.57 micromol/l). Diurnal urine volume was lower in patients with cholestasis than in the control group (995+/-313 versus 1264+/-426 ml/24 h). Disturbances of biochemical functions of kidney glomeruli and tubules, regarding creatinine metabolism and deamination of amino acids, and dissociation of carbonic acid, were seen in patients with cholestasis during pregnancy.

Second trimester calcium-phosphorus-magnesium homeostasis in women with threatened preterm delivery

Objective: The effect of threatened preterm delivery on calcium, phosphorus, magnesium homeostasis in the second trimester of pregnancy was investigated. Methods: Serum concentrations of total and ionized calcium, inorganic phosphorus, magnesium, total protein, albumin, total estrogens and human placental lactogen were determined in women with threatened preterm delivery at 23–28 weeks of gestation (the studied group) and in women with uncomplicated pregnancy of the same duration (the control group). Additionally activities of total alkaline phosphatase and heat‐stable alkaline phosphatase fraction were measured. Results: Patients of the studied group compared to the control group showed decreased concentration of total calcium (2.15±0.073 vs. 2.25±0.11 mmol/l, P<0.001), inorganic phosphorus (1.21±0.26 vs. 1.34±0.22 mmol/l, P<0.01) and magnesium (0.63±0.053 vs. 0.71±0.12 mmol/l, P<0.001), total protein (64.0±5.4 vs. 68.6±1.0 g/l, P<0.001), albumin (546.3±55.1 vs. 579.6±49.3 μmol/l, P<0.003) and placental lactogen (3664±1806 vs. 4651±1858 ng/ml, P<0.02); they also demonstrated decreased activity of total alkaline phosphatase (42.17±16.99 vs. 50.66±6.56 IU/l, P<0.001) and its heat stable fraction (22.65±7.89 vs. 31.89±9.09 IU/l, P<0.001). Patients of the studied group showed normal values of ionized calcium and total estrogens. Conclusions: Premature uterine contractility in women in the second trimester is accompanied by lowered serum concentrations of total calcium, inorganic phosphorus, magnesium, total protein and albumin. There is also decreased activity of total alkaline phosphatase, its heat‐stable fraction and placental lactogen which may have diagnostic value. Premature uterine contractility in women in the second trimester may be related to the disturbances of calcium‐phosphorus‐magnesium homeostasis and calcium supplementation should be considered.

Calcium‐phosphorus‐magnesium homeostasis in women with threatened preterm delivery

Objective: The effect of threatened preterm delivery on calcium, phosphorus, magnesium homeostasis in the third trimester of pregnancy was investigated. Methods: Serum concentrations of total and ionized calcium, inorganic phosphorus, magnesium, total protein, albumin, total estrogens and human placental lactogen were determined in women with threatened preterm delivery at 29–36 weeks of gestation (the studied group) and in women with uncomplicated pregnancy of the same duration (the control group). Additionally, activities of total alkaline phosphatase and heat‐stable alkaline phosphatase fraction were measured. Results: Patients of the studied group compared to the control group showed decreased concentration of total calcium (2.17 ± 0.09 vs. 2.28 ± 0.13 mmol/l, P < 0.0005), inorganic phosphorus (1.13 ± 0.27 vs. 1.32 ± 0.23 mmol/l, P < 0.001) and magnesium (0.64 ± 0.07 vs. 0.70 ± 0.10 mmol/l, P < 0.003); they also demonstrated decreased activity of total alkaline phosphatase (70.8 ± 23.2 vs. 81.9 ± 14.9 IU/l, P < 0.01) and its heat‐stable fraction (30.2 ± 15.6 vs. 59.6 ± 14.9 IU/l, P < 0.001). In the studied group no difference was found in concentrations of investigated ions and enzymes between women who delivered at term and women who delivered prematurely. Patients with threatened preterm delivery showed serum deficiency of total calcium, phosphorus and magnesium which might be related to premature uterine contractility but does not predict premature labor by week 36 of gestation (66% of patients delivered at term). Conclusion: The deficiency of minerals and lowered activity of total alkaline phosphatase is observed in women with threatened preterm delivery. Laboratory tests of calcium‐phosphorus‐magnesium homeostatsis have limited predictive value in regard to the term of delivery in women with threatened preterm delivery.

Eating disorders in older women

Eating disorders (EDs) are disturbances that seriously endanger the physical health and often the lives of sufferers and affect their psychosocial functioning. EDs are usually thought of as problems afflicting teenagers. However, the incidence in older women has increased in recent decades. These cases may represent either late-onset disease or, more likely, a continuation of a lifelong disorder. The DSM-5 classification differentiates 4 categories of eating disorder: anorexia nervosa, bulimia nervosa, binge-eating disorders and other specified feeding and eating disorders. The weight loss and malnutrition resulting from EDs have widespread negative consequences for physical, mental and social health. The main risk factors for developing long-term consequences are the degree of weight loss and the chronicity of the illness. Most of the cardiac, neurological, pulmonary, gastric, haematological and dermatological complications of EDs are reversible with weight restoration. EDs are serious illnesses and they should never be neglected or treated only as a manifestation of the fashion for dieting or a womans wish to achieve an imposed standard feminine figure. Additionally, EDs are associated with high risk of morbidity and mortality. The literature concerning EDs in older, postmenopausal women is very limited. The main aim of this paper is to ascertain the epidemiology and prognosis of EDs in older women, and to review their diagnosis and management.

Successful perinatal outcome in an early onset intrahepatic cholestasis of pregnancy with extremely high serum hepatic function tests

We report a case of a 21-year-old pregnant woman with an early onset of intrahepatic cholestasis of pregnancy with very high aminotransferases activity and bilirubin concentration. Viral and autoimmune hepatitis, and other possible causes of liver function impairment were excluded. Treatment with ursodeoxycholic acid improved biochemical markers. The patient delivered a healthy female neonate by caesarean section. Neonatal and postoperative courses were uneventful.

Calcium–phosphorus–magnesium homeostasis in pregnant women after renal transplantation

Objective: The aim of the study was the assessment of calcium–phosphorus–magnesium homeostasis in pregnant women after renal transplantation. Methods: The study covered 64 pregnant women in the third trimester of gestation including: 33 women after renal transplantation (the study group) and 31 healthy pregnant women (the control group). Women from both groups were at the similar age: 30.8±4.7 vs. 31.3±5.0 years (NS) and at the same gestational age 34.8±2.4 vs. 35.3±2.6 weeks (NS). The mean body mass index (BMI) in the women from the study group before pregnancy was 21.49±2.81 vs. 22.1±3.02 in the control group (NS), BMI before delivery was 25.43±3.05 vs. 26.0±3.35 (NS), the percentage of the BMI increase during pregnancy was 18.7±7.68 vs. 17.65±7.13 (NS) and BMI increase during gestation was 3.93±1.56 vs. 3.90±1.54, respectively (NS). Arterial blood pressure at the time of blood samples collection for biochemical tests was 151.4±26.8/92.5±16.9 in women from the study group comparing to 115.0±6.0/68.0±7.0 mmHg (P<0.001) in the patients from the control group. The maximal blood pressure during pregnancy was 169.2±20.7/102.7±14.0 vs. 118.0±7.0/70.0±8.0 mmHg (P<0.001), respectively. We estimated serum levels of: total Ca, ionized Ca2+, inorganic phosphorus (Pi), Mg, total protein, albumin and blood morphology. Moreover, urine levels of Ca, Pi, Mg and protein were assessed. Results: The pregnant women after renal transplantation presented increases in serum concentrations of total Ca (2.54±0.20 vs. 2.16±0.10 mmol/l; P<0.001) and ionized Ca2+ (1.322±0.104 vs. 1.12±0.07 mmol/l; P<0.001) and the decrease in Pi level (1.013±0.211 vs. 1.10±0.16 mmol/l; P<0.05), total protein (59.3±7.0 vs. 65±5 g/l; P<0.001) and albumin (461.6±65.65 vs. 493.2±59 μmol/l; P<0.05). Moreover, in the study group drop in red blood cells count to 3.71±0.56 vs. 4.01±0.35×1012/l (P<0.02) in the control group was detected. Despite increased volume of 24‐h urine collection in the kidney recipients we observed significantly decreased urine 24‐h calcium excretion 2.47±0.92 vs. 6.72±3.49 mmol (P<0.001) and simultaneous increase in urine Mg excretion 3.422±1.025 vs. 2.18±0.52 mmol/24 h (P<0.001). There was no difference in urine 24‐h Pi excretion between the study and the control group. The pregnant renal transplant recipients presented proteinuria of 1.19±1.9 g/24 h. Conclusions: Women after kidney grafting present vital aberrations in calcium–phosphorus–magnesium homeostasis during pregnancy. The most significant changes are associated with calcium metabolism (high increase in serum Ca levels and impairment of renal elimination of calcium). The observed changes may be influenced by the doses of immunosuppressive agents and disturbed renal function.