Sumaiya Adam

Association between gestational diabetes and biomarkers: a role in diagnosis

Abstract Background: We investigated the association between markers of insulin resistance, chronic inflammation, and adipokines and GDM. Methods: In our case-cohort study in Johannesburg we included women with GDM and controls. We tested the ability of biomarkers to identify women at high risk of GDM. Results: Of the 262 pregnant women, 83 (31.7%) had GDM. Women with GDM were heavier (p = 0.04) and had more clinical risk factors (p = 0.008). We found a significant difference in fasting insulin (p < 0.001), adiponectin (p = 0.046), HOMA (p < 0.001) and QUICKI (p < 0.001). HOMA (AUROC = 0.82) or QUICKI (AUROC = 0.82) improved the ability of risk factors to identify women at high risk of GDM. Conclusions: Insulin sensitivity markers are promising tools to identify women at high risk of GDM.

Autologous intrauterine transfusion in a case of anti-U

Minor red blood cell antibodies are becoming a more common cause of hemolytic disease of the newborn. Anti‐U are a rare alloantibody found almost exclusively in people of black descent. There is limited experience to guide the management of pregnancies complicated by anti‐U. Furthermore, there is often no suitable cross‐matched blood available for transfusion of a patient with anti‐U.

Selective Screening Strategies for Gestational Diabetes: A Prospective Cohort Observational Study

Aim We aimed to develop a prediction model for the diagnosis of gestational diabetes and to evaluate the performance of published prediction tools on our population. Methods We conducted a cohort study on nondiabetic women < 26 weeks gestation at a level 1 clinic in Johannesburg, South Africa. At recruitment, participants completed a questionnaire and random basal glucose and HbA1c were evaluated. A 75 g 2-hour OGTT was scheduled between 24–28 weeks gestation, as per FIGO guidelines. A score was derived using multivariate logistic regression. Published scoring systems were tested by deriving ROC curves. Results In 554 women, RBG, BMI, and previous baby ≥ 4000 g were significant risk factors included for GDM, which were used to derive a nomogram-based score. The logistic regression model for prediction of GDM had R2 0.143, Somers Dxy rank correlation 0.407, and Harrells c-score 0.703. HbA1c did not improve predictive value of the nomogram at any threshold (e.g,. at probability > 10%, 25.6% of cases were detected without the HbA1c, and 25.8% of cases would have been detected with the HbA1c). The 9 published scoring systems performed poorly. Conclusion We propose a nomogram-based score that can be used at first antenatal visit to identify women at high risk of GDM.

An audit of the initial resuscitation of severely ill patients presenting with septic incomplete miscarriages at a tertiary hospital in South Africa

BackgroundSeptic incomplete miscarriages remain a cause of maternal deaths in South Africa. There was an initial decline in mortality when a strict protocol based approach and the Choice of Termination of Pregnancy Act in South Africa were implemented in this country. However, a recent unpublished audit at the Pretoria Academic Complex (Kalafong and Steve Biko Academic Hospitals) suggested that maternal mortality due to this condition is increasing. The objective of this investigation is to do a retrospective audit with the purpose of identifying the reasons for the deteriorating mortality index attributed to septic incomplete miscarriage at Steve Biko Academic Hospital.MethodsA retrospective audit was performed on all patients who presented to Steve Biko Academic Hospital with a septic incomplete miscarriage from 1st January 2008 to 31st December 2010. Data regarding patient demographics, initial presentation, resuscitation and disease severity was collected from the “maternal near-miss”/SAMM database and the patient’s medical record. The shock index was calculated for each patient retrospectively.ResultsThere were 38 SAMM and 9 maternal deaths during the study period. In the SAMM group 86.8% and in the maternal death group 77.8% had 2 intravenous lines for resuscitation. There was no significant improvement in the mean blood pressure following resuscitation in the SAMM group (p 0.67), nor in the maternal death group (p 0.883). The shock index before resuscitation was similar in the two groups but improved significantly following resuscitation in the SAMM group (p 0.002). Only 31.6% in the SAMM group and 11.1% in the maternal death group had a complete clinical examination, including a speculum examination of the cervix on admission. No antibiotics were administered to 21.1% in the SAMM group and to 33.3% in the maternal death group.ConclusionThe strict protocol management for patients with septic incomplete miscarriage was not adhered to. Physicians should be trained to recognise and react to the seriously ill patient. The use of the shock index in the identification and management of the critically ill pregnant patient needs to be investigated.

Are we missing at-risk babies? Comparison of customised growth charts v. standard population charts in a diabetic population

Background. Diabetes in pregnancy is associated with both accelerated fetal growth and intrauterine growth restriction. Objective. To compare the difference in occurrence of large-for-gestational-age (LGA) and small-for-gestational-age (SGA) fetuses in a pregnant diabetic population using population-based growth charts and customised growth charts. Methods. Retrospective observational study at Steve Biko Academic and Kalafong hospitals, Pretoria, South Africa. Information from an electronic database was used to retrospectively generate customised centiles using a web-based tool (www.gestation.net). The first fetal growth scan of the third trimester, as determined by ultrasound, was plotted for each patient on both the population-based and customised growth charts. We compared the growth category on the population-based growth chart with the that on the customised growth chart. Results. Of the patients, 44 had type 1 diabetes, 66 type 2 diabetes and 173 gestational diabetes. The growth of 79/283 fetuses would have been reclassified had customised growth charts been used. Of cases in which fetal growth was classified as appropriate for gestation on the population-based growth charts, 58 fetuses would have been LGA and 14 SGA had customised growth charts been used. Four of the fetuses that were SGA and three that were LGA on the population-based growth charts would have been classified as appropriately grown on the customised growth charts. This was a statistically significant difference ( p <0.001), with a Cohen’s kappa of 0.45 indicating moderate agreement. Conclusions. Customised growth charts identified more babies with aberrations of growth, who may need vigilant antenatal care and elective delivery and may be at increased health risk in the future.

Molecular Biomarkers for Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is a growing public health problem worldwide. The condition is associated with perinatal complications and an increased risk for future metabolic disease in both mothers and their offspring. In recent years, molecular biomarkers received considerable interest as screening tools for GDM. The purpose of this review is to provide an overview of the current status of single-nucleotide polymorphisms (SNPs), DNA methylation, and microRNAs as biomarkers for GDM. PubMed, Scopus, and Web of Science were searched for articles published between January 1990 and August 2018. The search terms included “gestational diabetes mellitus”, “blood”, “single-nucleotide polymorphism (SNP)”, “DNA methylation”, and “microRNAs”, including corresponding synonyms and associated terms for each word. This review updates current knowledge of the candidacy of these molecular biomarkers for GDM with recommendations for future research avenues.

Discordant monoamniotic twins with Pena–Shokeir phenotype

Pena–Shokeir phenotype is a rare disorder. However, its etiology is incompletely understood. It may be familial or may be due to anoxic–ischemic etiology. Although rare, it can affect one twin in a monoamniotic pregnancy, most likely due to early cord entanglement.