Neopterin and hsCRP are not correlated in gestational diabetes mellitus

Objective: To determine serum neopterin and high sensitive C-reactive protein (hsCRP) levels in patients with and without gestational diabetes mellitus (GDM).

Methods: Neopterin and hsCRP levels were quantified in 28 women with GDM and 20 pregnant women with normal glucose tolerance (NGT). Postpartum neopterin and hsCRP levels were measured in a follow-up study.

Results: Neopterin levels were significantly higher in women with GDM than in women with NGT (15.89?±?8.19?nmol/L versus 10.4?±?3.8?nmol/L, p?p?p?=?0.9, respectively). In contrast, hsCRP levels decreased after delivery in patients with GDM (5.74?±?3.91 versus 3.78?±?2.78, p?r?=?0.3, p?=?0.02) and fasting glucose (r?=?0.4, p?=?0.004), postprandial glucose (r?=?0.3, p?=?0.01), HbA1c (r?=?0.3, p?=?0.02), whereas hsCRP levels were correlated with pre-pregnancy (r?=?0.3, p?=?0.04) and pregnancy body mass index (r?=?0.4, p?=?0.008). No correlation between serum neopterin and hsCRP levels was found (p?=?0.9).

Conclusion: Neopterin levels increased in patients with GDM; hence, it may be related to inflammation. However, the lack of correlation between neopterin and hsCRP suggests the role of different attitudes of these two parameters in the course of pregnancy and GDM.     

The effects of probiotic supplementation on biomarkers of inflammation,oxidative stress and pregnancy outcomes in gestational diabetes

Objective: This study was designed to evaluate the effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes among subjects with gestational diabetes (GDM).

Methods: This randomized, double-blind, placebo-controlled clinical trial was done among 60 subjects with GDM who were not on oral hypoglycemic agents. Patients were randomly allocated to intake either probiotic capsule containing Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum (2?×?10⁹ CFU/g each) (n?=?30) or placebo (n?=?30) for six?weeks.

Results: Compared with the placebo, probiotic supplementation resulted in significant decreases in fasting plasma glucose (FPG) (?5.3?±?6.7 vs.?+0.03?±?9.0?mg/dL, p?=?.01), serum high-sensitivity C-reactive protein (hs-CRP) (?2.2?±?2.7 vs.?+0.5?±?2.4?μg/mL, p?p?=?.03) and MDA/TAC ratio (?0.0003?±?0.0008 vs.?+0.0009?±?0.002, p?=?.004), and a significant increase in total antioxidant capacity (TAC) levels (+65.4?±?103.3 vs. ?37.2?±?143.7?mmol/L, p?=?.002). Probiotic supplementation did not affect pregnancy outcomes.

Conclusions: Overall, probiotic supplementation among women with GDM for six?weeks had beneficial effects on FPG, serum hs-CRP, plasma TAC, MDA and oxidative stress index, but did not affect pregnancy outcomes.     

Macrophage infiltration and stress-signaling in omental and subcutaneous adipose tissue in diabetic pregnancies

Abstract

Objective: To examine if, as in obesity, pregnancies complicated by gestational diabetes mellitus (GDM) exhibit increased macrophage infiltration and activated MAP-kinases in omental adipose tissue.

Methods: Paired omental (OM) and abdominal subcutaneous (SC) fat samples were collected from 11 GDM and 20 normal pregnancies during cesarean delivery. Tissues were stained to detect macrophages, and analyzed to assess MAP-kinases.

Results: OM had higher macrophage counts than SC in GDM (6.10?±?2.20 versus 2.53?±?1.45, p?=?0.04), but not in normal pregnancies (p?=?0.346). GDM pregnancies had more macrophages than normal pregnancies in OM (6.10?±?2.20 versus 1.29?±?0.55, p?=?0.01), while only a trend was observed in SC fat (p?=?0.08). Significant correlation (R?=?0.619, p?=?0.005) was observed between OM-macrophage infiltration and insulin resistance. Using multivariate analysis, only obesity independently associated with GDM. Expression of total p38MAP-kinase was higher in OM versus SC in both normal and GDM pregnancies, without significant differences between these groups. However, expression of activated p-p38MAP-kinase, and its upstream kinase MKK4, was comparable between fat depots.

Conclusion: GDM pregnancies demonstrate increased macrophage infiltration to OM fat, correlating with higher insulin resistance. As in non-pregnant-patients obesity and OM macrophage infiltration may be on the same causal pathway, leading to GDM. Yet, this occurs without activation of p38MAP-kinase signaling.     

Three-dimensional ultrasonographic placental volume in gestational diabetes mellitus

Objectives: We aimed to evaluate the placental volume and placental mean gray value in gestational diabetes mellitus (GDM) and healthy placentas using three-dimensional (3D) ultrasound and Virtual Organ Computer-aided AnaLysis (VOCAL).

Methods: This case-control prospective study consisted of 39 singleton pregnancies complicated by GDM and 42 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm³) was analyzed using the VOCAL imaging analysis program and 3D histogram was used to calculate the volumetric mean gray value (%).

Results: Placental volume was significantly larger in GDM (411.59?±?170.82 versus 343.86?±?128.94?cm³; p?=?0.046). There was no significant difference in mean gray value between GDM and healthy placentas (36.65?±?7.02 versus 38.71?±?7.91, respectively; p?=?0.277). Placental volume was significantly correlated with gestational week (r?=?0.219, p?=?0.035) and parity (r?=?0.228, p?=?0.048). There was negative significant relation between placental volume and umbilical artery systolic/diastolic ratio, pulsatility index and resistance index (r?=??0.278, p?=?0.007; r?=??0.315, p?=?0.002; r?=??0.322, p?=?0.001, respectively).

Conclusions: Placental volume increases significantly in GDM, whereas mean gray values do not alter significantly. These data may reflect the placental changes in GDM placentas that may help to understand the pathophysiology better.     

Relationship between advanced glycation end products and gestational diabetes mellitus

Objective: To investigate the levels of and dynamic changes of advanced glycation end products (AGEs) in maternal plasma during pregnancy and explore the association between these levels and gestational diabetes mellitus (GDM).

Methods: This study recruited 90 GDM women and 90 healthy pregnant controls. The women received prenatal care and were hospitalized for delivery in Peking University First Hospital in China between October 2015 and April 2016. The patients were recruited and provided blood samples during gestational weeks 24–29. The levels of AGEs, TNF-α, hs-CRP, plasma glucose, and FINS and lipid profiles were measured, and HOMA-IR was calculated. New blood samples were collected and AGE was measured again in the two groups at 33–41 weeks of gestation to identify its dynamic changes.

Results: The levels of AGEs were significantly higher in the GDM group than in the NGT group at both 24–29 weeks (473.65?±?105.32 versus 324.36?±?57.86?ng/L; p?p?p?p?=?.003), TNF-α (p?=?.005), and hs-CRP (p?p?=?.001). In the NGT group, there was no significant change in the concentration of AGEs between the two gestational periods (p?=?.388).

Conclusions: Plasma levels of AGEs are associated with GDM. During pregnancy, the changes observed in the levels of AGEs were different between GDM and normal pregnancies.     

The use of coenzyme Q10 and DHEA during IUI and IVF cycles in patients with decreased ovarian reserve

Objective: The objective of this study is to compare the combination of dehydroepiandrosterone (DHEA) and coenzyme Q10 (CoQ10) (D?+?C) with DHEA alone (D) in intrauterine insemination (IUI) and in vitro fertilization (IVF) cycles among patients with decreased ovarian reserve.

Methods: We retrospectively extracted data from patients charts treated by DHEA with/without CoQ10 during IUI or IVF between February 2006 and June 2014. Prestimulation parameters included age, BMI, day 3 FSH and antral follicular count (AFC). Ovarian response parameters included total gonadotropins dosage, peak serum estradiol, number of follicles?>?16?mm and fertilization rate. Clinical outcomes included clinical and ongoing pregnancy rates.

Results: Three hundred and thirty IUI cycles involved D?+?C compared with 467 cycles of D; 78 IVF cycles involved D?+?C and 175 D. In both IUI and IVF, AFC was higher with D?+?C compared with D (7.4?±?5.7 versus 5.9?±?4.7, 8.2?±?6.3 versus 5.2?±?5, respectively, p??16?mm during IUI cycles (3.3?±?2.3 versus 2.9?±?2.2, respectively, p?=?0.01), while lower mean total gonadotropin dosage was administered after D?+?C supplementation compared with D (3414?±?1141 IUs versus 3877?±?1143 IUs respectively, p?=?0.032) in IVF cycles. Pregnancy and delivery rates were similar for both IUI and IVF.

Conclusion: D?+?C significantly increases AFC and improves ovarian responsiveness during IUI and IVF without a difference in clinical outcome.     

Prebiotics for the management of hyperbilirubinemia in preterm neonates

Objective: We evaluated if prebiotics have benefits for the management of hyperbilirubinemia in preterm neonates.

Methods: Preterm neonates were entered into the study when enteral feeding volume met 30?mL/kg/day. They randomly received a mixture of short-chain galacto-oligosacarids/long-chain fructo-oligosacarids or distilled water (placebo) for 1 week. Total serum bilirubin level was measured by transcutaneous bilirubinometry. Stool frequency and meeting full enteral feeding during the study period were considered as secondary outcomes.

Results: Twenty-five neonates in each group completed the trial. Bilirubin level was decreased with the prebiotic (?1.3?± 1.8?mg/dL, p?=?0.004), but not placebo (?0.1?±?3.3?mg/dL, p?=?0.416). Peak bilirubin level was lower with the prebiotic than placebo (8.3?±?1.7 versus 10.1?±?2.2?mg/dL, p?=?0.003). Stool frequency was increased with the prebiotic (0.7?±?1.9 defecation/day, p?=?0.014), but not with placebo (0.6?± 1.5 defecation/day, p?=?0.133). Average stool frequency (2.4?± 0.4 versus 1.9?±?0.5 defecation/day, p?=?0.003) and frequently of meeting full enteral feeding (60% versus 16%, p?=?0.002) were higher with the prebiotic than placebo.

Conclusions: Prebiotic oligosaccharides increase stool frequency, improve feeding tolerance and reduce bilirubin level in preterm neonates and therefore can be efficacious for the management of neonatal hyperbilirubinemia.     

Homeostatic indices of insulin resistance among gestational diabetics in anticipating pregnancy complications

Abstract

Objective: This was to determine HOMA-IR score as well as to assess its association in fetal and maternal outcomes among pregnant women with diabetes risks.

Methods: A prospective cohort study of pregnant women with diabetes risks was done. GDM was diagnosed using modified glucose tolerance test. Serum insulin was taken and measured by an electrochemiluminescence immunoassay method. Plasma glucose was measured by enzymatic reference method with hexokinase. HOMA-IR score was calculated for each patient. Maternal and fetal outcomes were analyzed.

Results: From 279 women recruited, 22.6% had GDM with higher HOMA-IR score (4.07?±?2.44 versus 2.08?±?1.12; p?=?0.001) and fasting insulin (16.76?±?8.63?µIU/L versus 10.15?±?5.07?µIU/L; p?=?0.001). Area under ROC curve for HOMA-IR score was 0.79 (95% confidence interval, 0.74–0.84) with optimum cut-off value of 2.92 (sensitivity?=?63.5%; specificity?=?89.8%), higher than recommended by IDF (2.38). This point showed significant association with neonatal hypoglycemia (p?=?0.02) and Cesarean section (p?=?0.04) in GDM mothers.

Conclusions: HOMA-IR score and insulin resistance levels were higher in GDM women in our population. With the cut-off HOMA-IR value of 2.92, neonatal hypoglycemia and Cesarean section were significant complications in GDM mothers. This can be used in anticipation of maternal and fetal morbidities.     

Gestational diabetes and pregnancy outcome – do we have right diagnostic criteria?

Abstract

Objective: To determine thresholds of maternal glycemia at which specific adverse pregnancy outcomes occur in high-risk population.

Methods: A total of 1002 pregnant women with risk factors for gestational diabetes mellitus (GDM) underwent an originally modified glucose tolerance test (OGTT) with 75?g of glucose. Information on OGTT results and pregnancy outcomes were collected from database and medical records.

Results: Large for gestational age (LGA) newborn, infant’s stay in the neonatal intensive care unit (NICU) >24?h, neonatal hyperbilirubinemia and cesarean section due to cephalopelvic disproportion were identified as specific GDM adverse outcomes. In the study group of participants with one or more specific GDM adverse outcomes, mean glycemic values during the modified OGTT (4.2?±?1.0?mmol/L at 0?min, 6.8?±?1.7?mmol/L at 30?min, 7.9?±?2.1?mmol/L at 60?min, 7.7?±?2.3?mmol/L at 90?min and 7.5?±?2.3?mmol/L at 120?min) according to Student’s t-test for independent samples were significantly higher than mean glycemic values in the control group of participants without specific adverse outcomes (p?<?0.001, p?=?0.02, p?<?0.001, p?<?0.001, p?<?0.001).

Conclusion: This study provides additional data that support the acceptance of the newly recommended outcome-based GDM diagnostic criteria.     

Glycemic control in twin pregnancies with gestational diabetes: are we improving or worsening outcomes?

Objective: To estimate the association between glycemic control and adverse outcomes in twin pregnancies with gestational diabetes (GDM).

Study design: A cohort of patients with twin pregnancies and GDM were identified from one maternal–fetal medicine practice from 2005 to 2014. Patients with prepregnancy diabetes were excluded. First, outcomes were compared between patients with GDMA1 and GDMA2 (gestational age at delivery, birthweight, small for gestational age (SGA, birthweight <10th percentile), preeclampsia, and cesarean delivery). Then, finger stick glucose logs were reviewed and correlated with the risk of SGA and preeclampsia. Abnormal finger stick values were defined as: fasting ≥90?mg/dL, 1-h postprandial ≥140?mg/dL, 2-h postprandial ≥120?mg/dL.

Results: Sixty-six patients with twin pregnancies and GDM were identified (incidence 9.1%). Comparing the 43 patients with GDMA1 to the 23 patients with GDMA2, outcomes were similar, aside from patients with GDMA1 having lower birthweight of the smaller twin (2184?±?519?g versus 2438?±?428?g, p?=?0.040). The risk of preeclampsia was not associated with glycemic control. Patients with SGA had lower mean fasting values (83.3?±?5.5 versus 87.2?±?7.7?mg/dL, p?=?0.033), and a lower percentage of abnormal fasting values (24.0% versus 36.9%, p?=?0.040), abnormal post-breakfast values (9.9% versus 27.1%, p?=?0.003), and total abnormal values (20.1% versus 27.7%, p?=?0.055).

Conclusion: In twin pregnancies with GDM, improved glycemic control is not associated with improved outcomes, and is associated with a higher risk of SGA. Prospective trials in twin pregnancies should be performed to establish goals for glycemic control in twin pregnancies.     

Duration of labor by gestational week in nulliparous women

Abstract

Objectives: To assess whether labor length differs by week of gestation.

Methods: In this observational cross-sectional study, we compared duration of labor by gestational age (36?+?0 through 40?+?6 weeks) in primiparous singleton parturients with vertex presentation. Data were acquired for a period of 24 months (2010–2011).

Results: In general, the rate of change in cervical dilatation decreased as gestational week at delivery advanced: 1.8?±?1.0?cm/h, 1.5?±?0.9?cm/h, 1.3?±?0.8?cm/h, 1.6?±?1.5, and 1.3?±?1.0?cm/h at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p?=?0.040). Concurrently, the total labor duration (1st?+?2nd?+?3rd stages) increased as gestational age advanced: 423.6?±?180.9?min, 496.5?±?212.6?min, 545.9?±?247.1?min, 483.8?±?256.3?min, and 568.2?±?273.8?min at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p?=?0.013).

Conclusions: Gestational week of pregnancy may alter the duration of labor, specifically, the length of labor increases as gestational week at delivery advances.     

Role of antioxidants in gestational diabetes mellitus and relation to fetal outcome: a randomized controlled trial

Objective: To examine the effect of antioxidant administration on the oxidative parameters in both blood and placental tissue and its relation to fetal outcome in women with GDM.

Patients and methods: Two-hundred pregnant women with gestational diabetes mellitus (GDM) were randomized into 2 groups, Group1 received 1 gram L-ascorbic acid per day and Group2 received placebo.

Results: The use of antioxidants significantly lower the needed insulin dose for blood sugar control (25.6?±?20.3 versus 40.5?±?23.7, respectively). In placental tissue homogenates, glutathione (GSH) was 49.6?±?5.9 versus 62.34?±?4.99, malondialdahyde (MDA) was 165.7?±?9.2 versus 264.15 ±?12, superoxide dismutase (SOD) was 0.3?±?0.3 versus 0.054?±?0.16 while catalase (CAT) was 14.06?±?2.4 versus 15.52?±?3.97 and glutathione peroxidase (GPx) was 14?±?4.1 versus 26.3?±?4.26 in antioxidant group compared to the control group (p?<?0.001). In maternal blood, GSH was 1.5?±?0.3 versus 0.74?±?0.088, CAT was 380.7?±?11 versus 325.44?±?21.8, GPx was 52.3?±?8.7 versus 75.82?±?6.84 and SOD was 188?±?15.3 versus 98.56?±?11.05 in antioxidant group compared to control group (p <?0.001). In neonatal blood, the level of MDA and SOD showed a statistically significant difference between antioxidants and control groups (4?±?0.7 versus 6.6 7 ±0.66 and1 8 8?±?15.3 versus 98.5?±?11.05, respectively) (p?<?0.001). The neonatal blood sugar after 1 and 2?hours of delivery was more stable in antioxidant group (56.7?±?10.9 versus 39.7?±?11.1 and 58.5?±?10.8 versus 41.7?±?13.1, respectively) (p <0.05). The neonates NICU admission was lower in antioxidant group (5 versus 11) (p <0.05).

Conclusion: The use of antioxidants markedly reverses the oxidative stresses in women with GDM with marked improvement on neonatal outcome.     

Vaginal alpha-lipoic acid shows an anti-inflammatory effect on the cervix,preventing its shortening after primary tocolysis. A pilot,randomized, placebo-controlled study

Introduction: Inflammation might be an important underlying cause of preterm birth. Our aim is to explore whether vaginal administration α-lipoic acid reduces cervical inflammation and shortening after primary tocolysis.

Materials and methods: Singleton pregnancies between 24–30 weeks remaining undelivered after hospitalization for preterm labor were randomly allocated to placebo (20 women, 15 analyzed) or vaginal ALA 400?mg (active ingredient 10?mg) daily (20 women, 17 analyzed) for 30 days. A cervical swab to quantify pro-inflammatory (IL1, IL2, IL6, IL8, TNFα) and anti-inflammatory (IL4, IL10) cytokines as well as transvaginal ultrasound cervical length measurement (CL) were performed before and after treatment.

Results: The % changes of pro-inflammatory cytokines do not differ between treatment groups, while IL4 significantly increases by vaginal ALA in comparison to placebo (118.0?±?364.3% versus 29.9?±?103.5%, p?=?0.012). Combined anti-inflammatory cytokines show same trend (292.5?±?208.5% versus 64.5?±?107.4, p?=?0.03). CL remains similar in vaginal ALA group (from 23.1?±?6.6 to 20.80?±?7.9?mm), while it significantly decreased in placebo group (from 20.4?±?6.5 to 13.8?±?7.5?mm, p?p?=?0.003 versus vaginal ALA).

Conclusion: Vaginal ALA significantly stimulates anti-inflammatory ILs in the cervix of undelivered women after a preterm labor episode. This effect is associated with a stabilization of the CL.     

Obstetric outcome of second trimester antenatal bleeding

Objective: To evaluate the clinical significance of vaginal bleeding in pregnant women between 14th and 22th gestational weeks.

Methods: This retrospective case–control study was conducted between September 2010 and December 2013. Two-hundred nineteen pregnant women with vaginal bleeding between 14th and 22th gestational weeks were compared with 325 pregnant women without vaginal bleeding for their maternal and early neonatal outcomes.

Results: Mean gestational age and birth weight of study group were significantly different from those of the control group respectively (37.9?±?2.8 versus 38.9?±?1.4 and 3071?±?710 versus 3349?±?446 for groups p?<?0.001). Vaginal bleeding between 14th and 22th gestational weeks had increased risk of having preterm birth (PB) and preterm premature rupture of membranes (PPROM) (OR: 10.8, 95% CI: [4.5–26.1]; OR: 12.0, 95% CI: [3.5–40.6], respectively). Gestational diabetes mellitus (GDM) and polyhydramnios ratio in the study group was significantly higher than the control respectively (4.1% versus 1.2%, p?=?0.031; 1.9% versus 0%, p?=?0.025).

Conclusion: Pregnant women with vaginal bleeding was a significantly risk factor for PB, PPROM, GDM, and polyhydramnios. Consequently, these pregnancies should be closely followed up for maternal and fetus complications.     

Expression of progesterone receptors is significantly impaired in the endometrium of infertile women during the implantation window: a prospective observational study

Objective: To compare the expression of progesterone receptors (A?+?B) and type-B progesterone receptors in the epithelial and stromal cells of fertile and infertile women.

Methods: Women were divided into two groups, the group of fertile controls (group 1) and the group of infertile women (group 2) and were set on regular ultrasound imaging in order to detect ovulation. An endometrial biopsy was obtained on the seventh or eighth post-ovulatory day. Immunohistochemistry was performed to measure percentage of positive nuclei, intensity of staining and h-score for progesterone receptors (PgR) (A?+?B) as well as type-B progesterone receptors in epithelial and stromal cells. Secondary outcomes included endometrial tissue dating, the rate of tissues being out-of-phase and endometrial thickness.

Results: Endometrial issue was obtained from 15 fertile and 30 infertile women. Expression of PgR (A?+?B) and PgR type-B was significantly lower in the epithelial cells of infertile women. PgR (A?+?B) h-score was 220.0?±?18.5 for fertile versus 147.3?±?18.0 for infertile women (p?=?0.02). PgR type-B h-score in epithelial cells was 166.8?±?30.7 for fertile versus 90.8?±?20.6 for infertile (p?=?0.04). No significant difference was observed in stromal cells.

Conclusions: Expression levels of PgR (A?+?B) as well as type-B receptors are significantly lower in the epithelial cells of infertile women during implantation window.     

Role of A1c in the postpartum screening of women with gestational diabetes

Abstract

Objective: This study aimed to determine whether A1c detects a different prediabetes prevalence in women with a history of gestational diabetes mellitus (GDM) compared to those diagnosed with oral glucose tolerance test (OGTT) and the influence of haemoglobin concentrations on A1c levels.

Design and patients: We evaluated carbohydrate metabolism status by performing OGTT and A1c tests in 141 postpartum women with prior GDM in the first year post-delivery.

Results: The overall prevalence of prediabetes was 41.8%. Prevalence of isolated A1c 5.7–6.4%, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) was 10.6%, 7.1%, and 9.2%, respectively. Isolated A1c 5.7–6.4% was associated with Caucasian origin (66.7% versus 32.6%, p?=?0.02) and with higher LDL cholesterol concentrations (123?±?28.4?mg/dl versus 101.6?±?19.2?mg/dl, p?=?0.037) compared with patients diagnosed by OGTT (IFG or IGT). Women with postpartum anaemia had similar A1c levels to those with normal haemoglobin concentrations (5.5%?±?0.6% versus 5.4%?±?0.4%, p?=?0.237).

Conclusions: Use of A1c in postpartum screening of women with GDM detected an additional 10.6% of patients with prediabetes and a more adverse lipid profile. Haemoglobin concentrations did not influence A1c values.     

Insulin detemir versus glyburide in women with gestational diabetes mellitus

Aim: To evaluate the safety, efficacy and pregnancy outcomes of insulin detemir (IDet) versus glyburide treatment in women with gestational diabetes mellitus (GDM).

Methods: We conducted a retrospective cohort study of women with GDM who were treated with either glyburide or IDet for GDM in a university-affiliated tertiary hospital.

Results: Ninety-one patients with GDM were enrolled, 62 were administered glyburide and 29 IDet. Maternal age, pregestational body mass index (BMI) and rate of abnormal oral glucose tolerance test (OGTT) blood glucose values were not significantly different between groups. Good glycemic control rates were comparable. Hypoglycemic episodes were reported only in the glyburide group (19.4% versus 0%, p?=?0.01). Maternal weight gain during pregnancy was significantly higher among women in the glyburide group (8.8?±?5.1?kg, p?p?=?0.71).

Conclusions: To the best of our knowledge, this is the first study on IDet treatment in patients with GDM. By our preliminary results, IDet is a viable treatment option in women with GDM. Further large prospective studies are needed to determine the efficacy and safety of IDet in GDM patients.     

Nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure for transient tachypnea of newborn: a randomized,prospective study

Abstract

Objective: To evaluate the efficacy of nasal intermittent mandatory ventilation (NIMV) in reducing the duration of respiratory distress compared with nasal continuous positive airway pressure (NCPAP) in transient tachypnea of the newborn (TTN).

Patient and methods: ?n this randomized-prospective study, 40 infants with a gestational age ≥37 weeks and birth weight ≥2000?g with TTN were randomized to either nonsynchronized NIMV (n?=?20) or NCPAP (n?=?20). The primary end point was the reduction of the duration of respiratory distress. Secondary end points were the duration and level of oxygen supplementation, the incidence of complications such as pneumothorax, pneumonia and respiratory failure requiring entubation.

Results: There were no significant difference in the duration of respiratory support (28.0?±?19.2?h versus 32.2?±?23.3?h, p?=?0.231), O₂ therapy (31.2?±?15.6?h versus 29.0?±?19.3?h, p?=?0.187), duration of TTN (67.6?±?36.5?h versus 63.3?±?39.1?h, p?=?0.480) and hospitalization (6.2?±?2.6?d versus 5.4?±?2.0?d, p?=?0.330) between the groups. The rate of complications were not significantly different between the groups.

Conclusion: Our study indicates that NIMV is well tolerated and as effective as NCPAP in the treatment of TTN.     

Early versus late inguinal hernia repair in extremely low-birthweight infants

Objective: Compare outcomes of extremely low-birthweight (ELBW) infants following early (before discharge) versus late (after discharge) inguinal hernia (IH) repair.

Study design: In a retrospective study of ELBW infants with IH, data were abstracted for clinical characteristics, IH and related outcomes.

Result: Of the 39/252 (15.4%) ELBW infants who developed IH, those with early (59%) versus late (41%) repair were comparable in birth weight (753?±?158 versus 744?±?131?g, p?=?0.84), gestation age (26?±?2 versus 26.2?±?2 weeks, p?=?0.92), with comparable rate of broncopulmonary dysplasia (87% versus 75%, p?=?0.41), but early repair group had prolonged respiratory support (60.6?±?28.6 versus 39?±?30 days, p?=?0.032). Both groups had comparable diagnosis to repair interval (51.2?±?29.2 versus 60.5?±?30.6 days, p?=?0.38) and early repair group has earlier corrected gestation (41.6?±?3.9 versus 45.4?±?4.6 weeks, p?Conclusions: We did not find significant differences in outcomes of IH in early and late repair groups of ELBW infants.     

Elevated mean platelet volume is associated with gestational diabetes mellitus

The mean platelet volume (MPV) is an indicator of the average size and activity of platelets. Elevated MPV values are associated with larger and more active platelets and perceived as a new independent cardiovascular risk factor. The aim of this study was to determine the MPV in women with gestational diabetes mellitus (GDM) and to determine the correlation of MPV with metabolic parameters in GDM. We retrospectively analyzed 30 women with GDM and 38 body mass index-matched women with healthy pregnancies as controls. MPV and platelet counts were recorded in the third trimester and at postpartum 6–12 months for GDM group and in the third trimester for control group. Third-trimester MPV was significantly higher in GDM group compared to control group (8.8?±?1.0 versus 8.1?±?0.7?fl, p?=?0.002). In women with GDM, there was a significant decrease in MPV in the postpartum period (8.8?±?1.0 versus 8.1?±?0.8?fl, p?r?=?0.346, p?=?0.007 and r?=?0.346, p?=?0.02, respectively). Our results indicate that MPV is increased in GDM. Monitoring MPV, which is widely available in clinical practice, may potentially identify women who will develop gestational diabetes during pregnancy.