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Gestational Diabetes
Published in Emmanuel C. Opara, Sam Dagogo-Jack, Nutrition and Diabetes, 2019
There is a direct link between obesity and the risk of developing GDM. In women with pre-GDM, optimal control should occur prior to pregnancy. Observational studies show an increased risk of diabetic embryopathy with poor glycemic control. In patients with pre-GDM, associations between elevated periconceptional HbA1c and embryopathy are convincing; therefore, it is recommended to optimize glycemic control prior to conception with an HbA1c below 6.5% (48 mmol/mol) in order to minimize this risk (47,48).
Postimplantation diabetic embryopathy
Published in Moshe Hod, Lois G. Jovanovic, Gian Carlo Di Renzo, Alberto de Leiva, Oded Langer, Textbook of Diabetes and Pregnancy, 2018
Ulf J. Eriksson, Parri Wentzel
It has been suggested that the absence of a specific malformation pattern for diabetic embryopathy signals the presence of several teratological factors and mechanisms in diabetic pregnancy.37 Likewise, the number of different teratogenic agents identified would indicate that diabetic embryopathy is of complex etiology.38–40 In the following, we will review the various etiological suggestions for diabetic embryopathy, in order to be able to present a reasonable overview of the major teratological pathway(s) and, consequently, to be able to predict the possible future means of (prophylactic) antiteratological treatment of diabetic pregnancy.
The role of FGF-4 and FGFR-2 on preimplantation embryo development in experimental maternal diabetes
Published in Gynecological Endocrinology, 2022
Filiz Yilmaz, Serap Cilaker Micili, Guven Erbil
Diabetes mellitus (DM) is a metabolic disease with high morbidity and mortality, resulting from inadequate insulin secretion or reduced effect, causing multiple organ damage. Diabetes has been associated with impaired fertility, but the underlying mechanisms have not yet been fully defined [1]. Many studies have shown that hyperglycemia negatively affects embryogenesis in vitro conditions, [2,3,4] few studies investigated the effects of maternal hyperglycemia in vivo conditions. It has been proven that maternal hyperglycemia is associated with increased embryonic loss and malformation rates during pregnancy in experimental animals [5,6]. Also, it has been shown that DM during pregnancy causes an increase in pre-implantation and post-implantation embryo losses and intrauterine growth retardation [7]. Although diabetic embryopathy has been described in detail in the literature, the pathology mechanisms are still unknown [8].
Economic burden of congenital athymia in the United States for patients receiving supportive care during the first 3 years of life
Published in Journal of Medical Economics, 2021
Cathleen Collins, Julie J. Kim-Chang, Elena Hsieh, Abigail Silber, Matthew O’Hara, Sarah Kulke, Megan A. Cooper
A total of 10 charts of patients were reviewed in the medical chart audit study; patient demographics and characteristics are listed in Table 1. An equal proportion of patients were male and female. All patients were aged <36 months during the period from which HCRU data were compiled from their medical charts. Most patients (80%) had a condition known to be associated with congenital athymia (40% diabetic embryopathy, 20% DiGeorge syndrome, and 20% CHARGE syndrome). Most patients (70%) had oligoclonal T cell expansion. Seventy percent of patients received a diagnosis of congenital athymia at or within a month of birth. The 30% of patients who were diagnosed with congenital athymia more than 1 month after birth were diagnosed at a median age of 3 months. Among the three deceased patients, the median age at death was 24 months.
Alpha lipoic acid in obstetrics and gynecology
Published in Gynecological Endocrinology, 2018
Chiara Di Tucci, Mara Di Feliciantonio, Flaminia Vena, Carmela Capone, Michele Carlo Schiavi, Daniela Pietrangeli, Ludovico Muzii, Pierluigi Benedetti Panici
Maternal gestational diabetes (GDM) is known to increase the risk of congenital malformation [42,43]. Some studies evaluated the protective effect of lipoic acid (ALA) on fetal outcome of diabetic mothers. Coughlan et al have studied placental tissue from women with GDM and found out that in response to oxidative stress, TNF alpha, 8-isoprostane release and nuclear factor-KB (NF-KB) DNA- binding activity were significantly increased in normal tissues (20-fold, 2-fold, and 35%, respectively, p < .01). Conversely, there was not a significant increase in GDM placental tissues [44]. On the basis of this information, we hypothesize that the antioxidative activity of LA might be effective in preventing diabetic embryopathy. In fact, there have been different reports that suggest the beneficial effect of ALA in preventing diabetic embryopathy in rats [45–47]. In particular Sugimura et al treated daily with either ALA (100 mg/kg body weight) or saline between gestational days 0 and 18 pregnant diabetic or nondiabetic mice. ALA treatment decreased the incidence of cardiovascular malformations (CVMs) from 30 to 3%, of skeletal malformations from 29 to 6%, of external malformations from 39% to 11% and of neural tube defects (NTDs) from 30% to 8% [45]. An in vitro study conducted on human umbilical vein endothelial cells (HUVECs) demonstrates that both Centella asiatica (CA) and ALA, or a combination thereof, are able to reduce the inflammatory response induced congenital malformations, therefore, potentially dangerous on the endothelium of chronic exposure to hyperglycemia in vivo [48].