The aim of the paper is to determine the prevalence of thyroid peroxidase antibodies (TPOAb) and ... more The aim of the paper is to determine the prevalence of thyroid peroxidase antibodies (TPOAb) and assess its effect on the thyroid-stimulating hormone (TSH) reference range during pregnancy in a primarily Latina population. Serum samples were collected from healthy pregnant women and non-pregnant controls. TSH reference ranges were calculated when TPOAb-positive patients were either included or excluded. A total of 134 pregnant women and 107 non-pregnant controls were recruited. Positive TPOAb titres were found in 23 (17.2%) of the 134 pregnant women, and in 14 (13.1%) of the 107 non-pregnant controls. When the TPOAb-positive women were included in the TSH analysis, the upper reference limit using two different methods was consistently higher: 0-2.2 fold in the non-pregnant women, 2.01-2.78 fold in the first trimester, 3.18-4.7 fold in the second and 1.05-1.42 fold in the third. The lower TSH reference limit was not affected by the inclusion of TPOAb-positive subjects. In conclusion, inclusion of TPOAb-positive patients results in higher upper reference limits during pregnancy.
The Journal of Clinical Endocrinology & Metabolism, 2012
Objective: The aim was to update the guidelines for the management of thyroid dysfunction during ... more Objective: The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Society's Journals Online web site at http://jcem.endojournals.org). Evidence: This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. Consensus Process: The guideline was developed through a series of e-mails, conference calls, and one face-to-face meeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented o...
The Journal of Clinical Endocrinology & Metabolism, 2012
Objective: The aim was to update the guidelines for the management of thyroid dysfunction during ... more Objective: The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Society's Journals Online web site at http://jcem.endojournals.org). Evidence: This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. Consensus Process: The guideline was developed through a series of e-mails, conference calls, and one face-to-face meeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented o...
Autoimmune hypoglycaemia, based on the presence of autoantibodies directed against endogenous ins... more Autoimmune hypoglycaemia, based on the presence of autoantibodies directed against endogenous insulin (insulin autoimmune syndrome or Hirata's disease), is a rare cause of hypoglycaemia. Treatment of the disease is not standardized and various therapeutic options have been proposed. We wondered whether using a continuous glucose-monitoring system could help quantify precisely glucose excursions and allow evaluation of treatment efficacy. A 44-year-old Caucasian patient with insulin autoimmune syndrome was studied for 7 days using a continuous glucose monitoring system under various treatment regimens, i.e. diet modification, high-dose corticosteroids, alpha-glucosidase inhibitors, and plasmapheresis. Continuous glucose monitoring system data confirmed that insulin autoimmune syndrome alternated between periods of prandial hyperglycaemia and interprandial hypoglycaemia. Alpha glucosidase inhibitors and plasmapheresis were more potent in limiting glucose excursions than corticosteroid or diet-only treatments. The continuous glucose monitoring system appears to be a useful tool in the management of insulin autoimmune syndrome.
Biological research in pregnancy and perinatology, 1984
We studied 125I-insulin binding to monocytes and plasma levels of two trophoblastic proteins from... more We studied 125I-insulin binding to monocytes and plasma levels of two trophoblastic proteins from 38 pregnant patients with varying degrees of carbohydrate intolerance, including 10 pregnant controls (PC), 17 Class A diabetics (A), 6 Class B diabetics - prior to insulin therapy (B-noRx) and 5 different Class B diabetics studied 1-6 weeks following initiation of insulin therapy (B-Rx). All studies were performed in the second half of pregnancy. In comparison to six age- and weight-matched nonpregnant controls (NPC), insulin binding to monocytes was somewhat higher in both PC and A. B.noRx patients had significantly lower tracer binding than did PC (0.71 +/- 0.3 vs 2.6 +/- 0.6%/10(7) cells, p less than 0.01). Insulin treatment of Class B patients restored insulin tracer binding levels to above normal. Levels of human placental lactogen (HPL) were significantly elevated in B-noRx patients compared to PC and A and were lowered to levels comparable to normal in insulin-treated B patients...
It is characterized by chemical and sometimes clinical hyperthyroidism, without evidence of thyro... more It is characterized by chemical and sometimes clinical hyperthyroidism, without evidence of thyroid autoimmunity that resolves spontaneously by 16 weeks gestation without significant obstetrical complications.
Diabetes is a principal and growing health concern in Latin America, accounting for significant m... more Diabetes is a principal and growing health concern in Latin America, accounting for significant mortality and morbidities. Large, randomized, prospective trials of various interventional therapies in patients with both type 1 and type 2 diabetes have demonstrated that reductions in hyperglycaemia and management of diabetes-related risk factors can significantly reduce the micro-and macrovascular complications of diabetes. Therefore, patients with type 2 diabetes will benefit from more aggressive treatment regimens to help decrease the occurrence and rate of progression of diabetic complications. Given the many complexities of diabetes management, it is often difficult for general practice physicians to stay abreast of emerging treatment strategies and therapies. Owing to the high prevalence of type 2 diabetes in Latin America, the majority of patients with diabetes are treated by generalists rather than specialists. This article was intended to assist physicians and other healthcare professionals in developing and using effective treatment strategies to stem the growing epidemic of diabetes and its complications in Latin America.
Pregnant women attending the regular prenatal clinic at Los Angeles County (LAC)/Women's Hosp... more Pregnant women attending the regular prenatal clinic at Los Angeles County (LAC)/Women's Hospital received a 3-h oral glucose tolerance test (GTT). Upper limits for the test are a fasting blood glucose of 100 mg/dl (serum glucose 110 mg/dl), 1 h 170 mg/dl (200 mg/dl), 2 h 130 mg/dl (150 mg/dl), and 3 h 120 mg/dl (130 mg/dl). The incidence of overt diabetes (fasting hyperglycemia) was 3.5% and of Class A diabetic women (abnormal test but normal fasting glucose value) it was 8.8%. The incidence of abnormal tests is greater in obese patients, potential diabetic patients (family history of diabetes or abnormal obstetrical history), and with increasing age. However, it was 3.4% in a group of patients below age 20 yr and without an abnormal medical or obstetrical history. The perinatal mortality in uncomplicated Class A diabetic women is as low as in the general population. Patients with Complicated Class A (previous stillbirth or who develop preeclampsia) and those patients who devel...
American Journal of Obstetrics and Gynecology, 1981
Monocyte insulin receptor binding was studied in six nonpregnant control patients and in 40 pregn... more Monocyte insulin receptor binding was studied in six nonpregnant control patients and in 40 pregnant patients with varying degrees of carbohydrate tolerance. Competitive binding assays were performed to determine insulin binding to monocytes. Fasting insulin levels were determined. We obtained the following results: (1) When compared to values not associated with pregnancy, the number of insulin receptor sites per cell increases twofold (31,000 versus 16,300); (2) Class A diabetic patients have higher numbers of receptor sites than normal pregnant patients (80,800 versus 31,000; (3) untreated Class B diabetic patients have markedly reduced receptor sites (4,575) and bind less insulin at physiologic concentrations (p less than 0.01); (4) insulin therapy of previously untreated Class B diabetic patients restored the number of receptor sites to normal pregnant levels (29,700); and (5) Classes C and D diabetic patients had similar numbers of receptor sites (30,140) and showed a greater receptor affinity for insulin than pregnant control subjects (p less than 0.01).
Thyroid diseases are five to seven times more common in women than men. It has been suggested—alt... more Thyroid diseases are five to seven times more common in women than men. It has been suggested—although never proven—that multiparity could be a risk factor for such increased prevalence in thyroid pathology. In a follow-up study of women with mild thyroid abnormalities in pregnancy, thyroidal abnormalities never returned to complete normalcy following pregnancies (1). Chronic autoimmune disease, the most common etiology of thyroid pathology in areas of sufficient iodine supply, occurs frequently; however the incidence varies with the criteria for diagnosis, the decade when the study was performed and the patients studied (2). In autopsy studies, the prevalence of chronic thyroiditis varies form 5–45% in women and 1–20% in men, according to the severity of the pathologic findings (3). When thyroid antibodies are measured, the incidence is 10–13% in women and 3% in men and increases with age (4). The incidence rate of positive thyroid antibodies in asymptomatic pregnant women is between 6–19.6% (5, 6). It is two to three times higher in women with type 1 diabetes mellitus (7). Immunologic changes occurs throughout normal pregnancy, and it explains the frequent alterations in the natural history of thyroid diseases during and up to 1 yr after delivery (8). Pregnancy is associated with significant—and in most cases reversible—changes in thyroid function.Although never demonstrated with certainty that there is an increase in thyroid production from early pregnancy, laboratory parameters suggest very strongly that such an increase occurs in response to physiologic changes in thyroid economy. In most cases, there is a complete adaptation to this challenge; however, in patients with thyroid pathology, changes in thyroid tests are clearly demonstrated (9,10). The reason(s) for this increase in thyroid demands from very early in pregnancy is not clear; however, there is increasing evidence, that maternal thyroid hormones are important for development of the embryo before fetal thyroid gland becomes functional, which occurs after the 10th wk of gestation.
We prospectively evaluated fasting serum total cholesterol (chol), low- and high-density lipoprot... more We prospectively evaluated fasting serum total cholesterol (chol), low- and high-density lipoprotein cholesterol (LDL-chol and HDL-chol), and triglycerides (TGs) in a large cohort of Hispanic women during the first 36 mo after pregnancies complicated by gestational diabetes mellitus (GDM). In 1340 women studied 6–12 wk postpartum (PP-GDM group), chol and LDL-chol were similar to levels in 43 postpartum control subjects without prior GDM. Compared with control subjects (2.01 ± 1.24 mM), TG was elevated in the PP-GDM women with diabetes mellitus (DM) (2.86 ± 2.21 mM, P < 10−5) and impaired glucose tolerance (IGT) (2.64 ± 1.68 mM, P = 0.02) but not in those with normal glucose tolerance (2.00 ± 1.21 mM). HDL-chol was decreased in PP-GDM women with DM compared with those with normal glucose tolerance. A subgroup of 157 women with prior GDM returned for at least one annual follow-up test on nonhormonal contraception (FU-GDM: n = 60 at 3–11 mo after delivery, n = 78 at 12–23 mo, and n ...
Current Opinion in Obstetrics and Gynaecology, 1999
Thyroid diseases in pregnancy are a group of disorders with different clinical manifestations whi... more Thyroid diseases in pregnancy are a group of disorders with different clinical manifestations which require a rational approach in their diagnosis and management. In many cases, this involves a team approach including different specialties. Several topics have received particular attention in recently published reports. The syndrome of transient hyperthyroidism of hyperemesis gravidarum, more frequently recognized and considered to be caused by inappropriate concentrations of human chorionic gonadotropin in plasma, has been reported for the first time to be secondary to a mutation in the thyrotropin-releasing hormone receptor. Mutations in the thyrotropin-releasing hormone receptor have also being found in cases, most of them familiar, of congenital hypothyroidism caused by resistance to thyrotropin-releasing hormone. However, other cases of congenital hypothyroidism with resistance to thyrotropin-releasing hormone were not caused by mutations in the thyrotropin-releasing hormone receptor. This is a fascinating new field in molecular medicine, stimulated by clinical observations in infants born with congenital hypothyroidism that did not fulfill the classical clinical descriptions. New studies in the metabolism and transfer of anti-thyroid drugs from mother to fetus have indicated no differences between propylthiouracil and methimazole. Finally, changes in titers and the biological action of thyrotropin-releasing hormone receptors antibodies appear to explain the clinical observation of improvement in Graves&#39; hyperthyroidism during the second half of pregnancy and its recurrence during the postpartum period.
To evaluate the outcome of pregnancy in diabetic women who had an episode of ketoacidosis during ... more To evaluate the outcome of pregnancy in diabetic women who had an episode of ketoacidosis during gestation, 20 consecutive cases of ketoacidosis in type I diabetic pregnant women were studied. They were divided into two groups for comparison: Group 1, 13 patients (65%), had a live fetus and group 2, seven patients (35%), had a fetal death on admission. Both groups were similar in age, gravidity, parity, abortions, height, weight, serum sodium and potassium, arterial pH, carbon dioxide tension, bicarbonate, base excess, and anion gap. Significantly different between groups 1 and 2 were: gestational age (24 versus 31 weeks; p &lt; 0.05), serum glucose (374 versus 830 mg/dl; p &lt; 0.005), blood urea nitrogen (14 versus 23 mg/dl; p &lt; 0.025), osmolality (295 versus 311 mmol/kg; p &lt; 0.025), insulin requirements (127 versus 202 U; p &lt; 0.05), and length of resolution (28 versus 38 hours; p &lt; 0.05). Two patients had serum glucoses less than 200 mg/dl despite profound ketoacidosis. Precipitating factors included infections, poor compliance, and very importantly, unrecognized new onset of diabetes (6 patients). All stillborns were grossly normal and those autopsied had no discernible cause of death. There were no maternal deaths. A high fetal mortality (35%) was found but there were no fetal losses once therapy was initiated. The unrecognized new onset diabetics accounted for almost a third (30%) of the cases of ketoacidosis and for 57% of the fetal deaths. Attentiveness to the symptoms of uncontrolled diabetes and appropriate screening can be effective preventive measures.
The aim of the paper is to determine the prevalence of thyroid peroxidase antibodies (TPOAb) and ... more The aim of the paper is to determine the prevalence of thyroid peroxidase antibodies (TPOAb) and assess its effect on the thyroid-stimulating hormone (TSH) reference range during pregnancy in a primarily Latina population. Serum samples were collected from healthy pregnant women and non-pregnant controls. TSH reference ranges were calculated when TPOAb-positive patients were either included or excluded. A total of 134 pregnant women and 107 non-pregnant controls were recruited. Positive TPOAb titres were found in 23 (17.2%) of the 134 pregnant women, and in 14 (13.1%) of the 107 non-pregnant controls. When the TPOAb-positive women were included in the TSH analysis, the upper reference limit using two different methods was consistently higher: 0-2.2 fold in the non-pregnant women, 2.01-2.78 fold in the first trimester, 3.18-4.7 fold in the second and 1.05-1.42 fold in the third. The lower TSH reference limit was not affected by the inclusion of TPOAb-positive subjects. In conclusion, inclusion of TPOAb-positive patients results in higher upper reference limits during pregnancy.
The Journal of Clinical Endocrinology & Metabolism, 2012
Objective: The aim was to update the guidelines for the management of thyroid dysfunction during ... more Objective: The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Society's Journals Online web site at http://jcem.endojournals.org). Evidence: This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. Consensus Process: The guideline was developed through a series of e-mails, conference calls, and one face-to-face meeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented o...
The Journal of Clinical Endocrinology & Metabolism, 2012
Objective: The aim was to update the guidelines for the management of thyroid dysfunction during ... more Objective: The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Society's Journals Online web site at http://jcem.endojournals.org). Evidence: This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. Consensus Process: The guideline was developed through a series of e-mails, conference calls, and one face-to-face meeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented o...
Autoimmune hypoglycaemia, based on the presence of autoantibodies directed against endogenous ins... more Autoimmune hypoglycaemia, based on the presence of autoantibodies directed against endogenous insulin (insulin autoimmune syndrome or Hirata&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease), is a rare cause of hypoglycaemia. Treatment of the disease is not standardized and various therapeutic options have been proposed. We wondered whether using a continuous glucose-monitoring system could help quantify precisely glucose excursions and allow evaluation of treatment efficacy. A 44-year-old Caucasian patient with insulin autoimmune syndrome was studied for 7 days using a continuous glucose monitoring system under various treatment regimens, i.e. diet modification, high-dose corticosteroids, alpha-glucosidase inhibitors, and plasmapheresis. Continuous glucose monitoring system data confirmed that insulin autoimmune syndrome alternated between periods of prandial hyperglycaemia and interprandial hypoglycaemia. Alpha glucosidase inhibitors and plasmapheresis were more potent in limiting glucose excursions than corticosteroid or diet-only treatments. The continuous glucose monitoring system appears to be a useful tool in the management of insulin autoimmune syndrome.
Biological research in pregnancy and perinatology, 1984
We studied 125I-insulin binding to monocytes and plasma levels of two trophoblastic proteins from... more We studied 125I-insulin binding to monocytes and plasma levels of two trophoblastic proteins from 38 pregnant patients with varying degrees of carbohydrate intolerance, including 10 pregnant controls (PC), 17 Class A diabetics (A), 6 Class B diabetics - prior to insulin therapy (B-noRx) and 5 different Class B diabetics studied 1-6 weeks following initiation of insulin therapy (B-Rx). All studies were performed in the second half of pregnancy. In comparison to six age- and weight-matched nonpregnant controls (NPC), insulin binding to monocytes was somewhat higher in both PC and A. B.noRx patients had significantly lower tracer binding than did PC (0.71 +/- 0.3 vs 2.6 +/- 0.6%/10(7) cells, p less than 0.01). Insulin treatment of Class B patients restored insulin tracer binding levels to above normal. Levels of human placental lactogen (HPL) were significantly elevated in B-noRx patients compared to PC and A and were lowered to levels comparable to normal in insulin-treated B patients...
It is characterized by chemical and sometimes clinical hyperthyroidism, without evidence of thyro... more It is characterized by chemical and sometimes clinical hyperthyroidism, without evidence of thyroid autoimmunity that resolves spontaneously by 16 weeks gestation without significant obstetrical complications.
Diabetes is a principal and growing health concern in Latin America, accounting for significant m... more Diabetes is a principal and growing health concern in Latin America, accounting for significant mortality and morbidities. Large, randomized, prospective trials of various interventional therapies in patients with both type 1 and type 2 diabetes have demonstrated that reductions in hyperglycaemia and management of diabetes-related risk factors can significantly reduce the micro-and macrovascular complications of diabetes. Therefore, patients with type 2 diabetes will benefit from more aggressive treatment regimens to help decrease the occurrence and rate of progression of diabetic complications. Given the many complexities of diabetes management, it is often difficult for general practice physicians to stay abreast of emerging treatment strategies and therapies. Owing to the high prevalence of type 2 diabetes in Latin America, the majority of patients with diabetes are treated by generalists rather than specialists. This article was intended to assist physicians and other healthcare professionals in developing and using effective treatment strategies to stem the growing epidemic of diabetes and its complications in Latin America.
Pregnant women attending the regular prenatal clinic at Los Angeles County (LAC)/Women's Hosp... more Pregnant women attending the regular prenatal clinic at Los Angeles County (LAC)/Women's Hospital received a 3-h oral glucose tolerance test (GTT). Upper limits for the test are a fasting blood glucose of 100 mg/dl (serum glucose 110 mg/dl), 1 h 170 mg/dl (200 mg/dl), 2 h 130 mg/dl (150 mg/dl), and 3 h 120 mg/dl (130 mg/dl). The incidence of overt diabetes (fasting hyperglycemia) was 3.5% and of Class A diabetic women (abnormal test but normal fasting glucose value) it was 8.8%. The incidence of abnormal tests is greater in obese patients, potential diabetic patients (family history of diabetes or abnormal obstetrical history), and with increasing age. However, it was 3.4% in a group of patients below age 20 yr and without an abnormal medical or obstetrical history. The perinatal mortality in uncomplicated Class A diabetic women is as low as in the general population. Patients with Complicated Class A (previous stillbirth or who develop preeclampsia) and those patients who devel...
American Journal of Obstetrics and Gynecology, 1981
Monocyte insulin receptor binding was studied in six nonpregnant control patients and in 40 pregn... more Monocyte insulin receptor binding was studied in six nonpregnant control patients and in 40 pregnant patients with varying degrees of carbohydrate tolerance. Competitive binding assays were performed to determine insulin binding to monocytes. Fasting insulin levels were determined. We obtained the following results: (1) When compared to values not associated with pregnancy, the number of insulin receptor sites per cell increases twofold (31,000 versus 16,300); (2) Class A diabetic patients have higher numbers of receptor sites than normal pregnant patients (80,800 versus 31,000; (3) untreated Class B diabetic patients have markedly reduced receptor sites (4,575) and bind less insulin at physiologic concentrations (p less than 0.01); (4) insulin therapy of previously untreated Class B diabetic patients restored the number of receptor sites to normal pregnant levels (29,700); and (5) Classes C and D diabetic patients had similar numbers of receptor sites (30,140) and showed a greater receptor affinity for insulin than pregnant control subjects (p less than 0.01).
Thyroid diseases are five to seven times more common in women than men. It has been suggested—alt... more Thyroid diseases are five to seven times more common in women than men. It has been suggested—although never proven—that multiparity could be a risk factor for such increased prevalence in thyroid pathology. In a follow-up study of women with mild thyroid abnormalities in pregnancy, thyroidal abnormalities never returned to complete normalcy following pregnancies (1). Chronic autoimmune disease, the most common etiology of thyroid pathology in areas of sufficient iodine supply, occurs frequently; however the incidence varies with the criteria for diagnosis, the decade when the study was performed and the patients studied (2). In autopsy studies, the prevalence of chronic thyroiditis varies form 5–45% in women and 1–20% in men, according to the severity of the pathologic findings (3). When thyroid antibodies are measured, the incidence is 10–13% in women and 3% in men and increases with age (4). The incidence rate of positive thyroid antibodies in asymptomatic pregnant women is between 6–19.6% (5, 6). It is two to three times higher in women with type 1 diabetes mellitus (7). Immunologic changes occurs throughout normal pregnancy, and it explains the frequent alterations in the natural history of thyroid diseases during and up to 1 yr after delivery (8). Pregnancy is associated with significant—and in most cases reversible—changes in thyroid function.Although never demonstrated with certainty that there is an increase in thyroid production from early pregnancy, laboratory parameters suggest very strongly that such an increase occurs in response to physiologic changes in thyroid economy. In most cases, there is a complete adaptation to this challenge; however, in patients with thyroid pathology, changes in thyroid tests are clearly demonstrated (9,10). The reason(s) for this increase in thyroid demands from very early in pregnancy is not clear; however, there is increasing evidence, that maternal thyroid hormones are important for development of the embryo before fetal thyroid gland becomes functional, which occurs after the 10th wk of gestation.
We prospectively evaluated fasting serum total cholesterol (chol), low- and high-density lipoprot... more We prospectively evaluated fasting serum total cholesterol (chol), low- and high-density lipoprotein cholesterol (LDL-chol and HDL-chol), and triglycerides (TGs) in a large cohort of Hispanic women during the first 36 mo after pregnancies complicated by gestational diabetes mellitus (GDM). In 1340 women studied 6–12 wk postpartum (PP-GDM group), chol and LDL-chol were similar to levels in 43 postpartum control subjects without prior GDM. Compared with control subjects (2.01 ± 1.24 mM), TG was elevated in the PP-GDM women with diabetes mellitus (DM) (2.86 ± 2.21 mM, P < 10−5) and impaired glucose tolerance (IGT) (2.64 ± 1.68 mM, P = 0.02) but not in those with normal glucose tolerance (2.00 ± 1.21 mM). HDL-chol was decreased in PP-GDM women with DM compared with those with normal glucose tolerance. A subgroup of 157 women with prior GDM returned for at least one annual follow-up test on nonhormonal contraception (FU-GDM: n = 60 at 3–11 mo after delivery, n = 78 at 12–23 mo, and n ...
Current Opinion in Obstetrics and Gynaecology, 1999
Thyroid diseases in pregnancy are a group of disorders with different clinical manifestations whi... more Thyroid diseases in pregnancy are a group of disorders with different clinical manifestations which require a rational approach in their diagnosis and management. In many cases, this involves a team approach including different specialties. Several topics have received particular attention in recently published reports. The syndrome of transient hyperthyroidism of hyperemesis gravidarum, more frequently recognized and considered to be caused by inappropriate concentrations of human chorionic gonadotropin in plasma, has been reported for the first time to be secondary to a mutation in the thyrotropin-releasing hormone receptor. Mutations in the thyrotropin-releasing hormone receptor have also being found in cases, most of them familiar, of congenital hypothyroidism caused by resistance to thyrotropin-releasing hormone. However, other cases of congenital hypothyroidism with resistance to thyrotropin-releasing hormone were not caused by mutations in the thyrotropin-releasing hormone receptor. This is a fascinating new field in molecular medicine, stimulated by clinical observations in infants born with congenital hypothyroidism that did not fulfill the classical clinical descriptions. New studies in the metabolism and transfer of anti-thyroid drugs from mother to fetus have indicated no differences between propylthiouracil and methimazole. Finally, changes in titers and the biological action of thyrotropin-releasing hormone receptors antibodies appear to explain the clinical observation of improvement in Graves&#39; hyperthyroidism during the second half of pregnancy and its recurrence during the postpartum period.
To evaluate the outcome of pregnancy in diabetic women who had an episode of ketoacidosis during ... more To evaluate the outcome of pregnancy in diabetic women who had an episode of ketoacidosis during gestation, 20 consecutive cases of ketoacidosis in type I diabetic pregnant women were studied. They were divided into two groups for comparison: Group 1, 13 patients (65%), had a live fetus and group 2, seven patients (35%), had a fetal death on admission. Both groups were similar in age, gravidity, parity, abortions, height, weight, serum sodium and potassium, arterial pH, carbon dioxide tension, bicarbonate, base excess, and anion gap. Significantly different between groups 1 and 2 were: gestational age (24 versus 31 weeks; p &lt; 0.05), serum glucose (374 versus 830 mg/dl; p &lt; 0.005), blood urea nitrogen (14 versus 23 mg/dl; p &lt; 0.025), osmolality (295 versus 311 mmol/kg; p &lt; 0.025), insulin requirements (127 versus 202 U; p &lt; 0.05), and length of resolution (28 versus 38 hours; p &lt; 0.05). Two patients had serum glucoses less than 200 mg/dl despite profound ketoacidosis. Precipitating factors included infections, poor compliance, and very importantly, unrecognized new onset of diabetes (6 patients). All stillborns were grossly normal and those autopsied had no discernible cause of death. There were no maternal deaths. A high fetal mortality (35%) was found but there were no fetal losses once therapy was initiated. The unrecognized new onset diabetics accounted for almost a third (30%) of the cases of ketoacidosis and for 57% of the fetal deaths. Attentiveness to the symptoms of uncontrolled diabetes and appropriate screening can be effective preventive measures.
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Papers by Jorge Mestman