Decreased Production of NO and Prostacyclin

Prostacyclin (PGI2) and NO attenuate platelet adhesion to the endothelium as well as platelet aggregation. Upon binding of PGI2 to its G-protein-coupled cell surface receptor, an increment in the intraplatelet concentration of cyclic adenosine monophosphate (cAMP) is seen. Contemporaneously, as NO diffuses across the platelet membrane it activates guanylate cyclase and increases cyclic guanosine monophosphate (cGMP) concentrations. These inhibitory pathways culminate in the phosphorylation of...

Menopausal Status and the Androgen Milieu

The correlation between menopausal status and sexual health among diabetic women has been poorly investigated. Data seem to suggest, however, that the postmenopausal condition does not cause a significantly negative impact on women's sexuality particularly because of the diabetes mellitus itself (9, 23, 37, 38, 40). Similarly, the potential associations among the circulating androgen milieu total and free testosterone, dehydroepiandrosterone (DHEA), DHEA sulphate (DHEAS), and A4-androstenedione...

Weight Loss

Excess body fat accentuates insulin resistance in patients with PCOS, and obese women with PCOS are more likely than lean women to manifest menstrual irregularities (12). Furthermore, increased body mass index (BMI) is associated with impaired response to standard doses of clomi-phene citrate (18,19). Obesity, independent from hyperinsulinemia, is related to lower oocyte retrieval in IVF and increased total FSH requirements for ovarian stimulation (20, 21). Weight loss has been found to enhance...

Medical Aspects

GDM substantially increases the risk of future DM2. Risk estimates of type 2 diabetes after GDM vary from 17 to 63 within 5-16 years after pregnancy, depending upon the ethnic background of the study population and the detection method for GDM and glucose intolerance 78 . Coustan et al. studied former gestational diabetic women and found diabetes or IGT in 6 of those tested at 0-2 years, 13 at 3-4 years, 15 at 5-6 years, and 30 at 7-10 years postpartum 79 . Kim et al. analyzed 28 studies and...

References

Holemans K, Aerts L, Van Assche F Lifetime consequences of abnormal fetal pancreatic development. J Physiol 547 11-20, 2003 2. Plagemann A, harder T, Rake A, Janert U, Melchior K, Rohde W, Dorner G Malformation of hypothalamic nuclei in hyperinsulinaemic offspring of gestational diabetic mother rats. Int J Dev Neurosci 17 37-44, 1999 3. Barker D, Hales C, Fall C, Osmond C, Phipps K, Clark P Type 2 diabetes mellitus, hypertension and hyperlipidaemia syndrome X relation to reduced fetal...

THE pREvALENcE of Diabetes IN WoMen In Third WoRLD couNTRIEs

The prevalence of diabetes, especially type 2 diabetes mellitus DM2 is increasing by leaps and bounds, and presently it is thought to be in the vicinity of 5.9 of the adult population 20-79 age group or approximately 246 million people globally with the vast majority of diabetes affecting subjects living in developing countries Table 1 . T2DM is the most common form of diabetes and accounts for 85-95 of all diabetes in developed countries and an even higher proportion in developing countries 2...

Counseling and Preconception Care Recommendations to Reduce Maternal and Fetal Risks of Preexisting Diabetes What Are

Women with diabetes and their families need a clear understanding of the risks of diabetes in pregnancy, as the women themselves must play the key role in preventing many of these complications. Diabetes education, both general and specific to pregnancy, is essential, as is a clear, straightforward discussion of risks and strategies to prevent complications. Table 2 provides a checklist for some of the specific components of preconception counseling and care. Structuring preconception...

Pregnancy Induced Hypertension

During normal pregnancy, blood pressure usually falls in the late first to early second trimester and rises again to prepregnancy levels in the third trimester 115 . PIH complicates 5-10 of pregnancies in the USA, including 3-5 of pregnancies in previously normotensive women 115 . Gestational hypertension is defined as elevated blood pressure on two occasions that develops after the twentieth week of pregnancy, without systemic symptoms, in previously normotensive women 171 . Preeclampsia is...

Clomiphene Citrate

Clomiphene citrate, an indirect stimulator of FSH secretion, has been the traditional approach to ovulation induction in infertile patients with PCOS. It is typically given at a dose of 50 mg per day for 5 days starting from day 2 to day 5 of spontaneous or induced menses. The dose of clomiphene can be increased in increments of 50 mg per day each cycle if ovulation is not achieved up to a maximum dose of 250 mg, although doses in excess of 150 mg are not typically prescribed 6 . Ovulation...

Gestational Hyperandrogenism of Maternal Origin

The possible role of PCOS itself as a cause for gestational hyperandrogenism was evaluated in a recent study by Sir-Petermann et al. 60 . Pregnant PCOS women were found to have higher concentrations of androgens than normal pregnant women, thus potentially exposing their unborn daughters to elevated androgen levels in utero. The origin of the androgen excess during pregnancy in women with PCOS women is uncertain but it could be due to increase in androgen production by the maternal theca...

Carbohydrate counting

Either basic or advanced carbohydrate counting can be used, depending on the needs of the patient. Basic carbohydrate counting makes use of a carbohydrate allowance for meals and snacks and provides education on portion sizes. Skills are taught that help identify carbohydrate foods, quantify the amount of carbohydrate in a food serving, and determine the actual portion size eaten. Patients are taught how food, insulin, and physical activity affect blood glucoses. A portion size of each serving...

Thiazolidenediones

Thiazolidenediones TZDs have also been examined for their possible role in the treatment of infertility in PCOS. The main mechanism of action is through activation of the nuclear peroxisome proliferator-activated receptor gamma PPAR-g , which decreases peripheral insulin resistance 73, 74 . Troglitazone was the first drug of this class that was shown to improve ovulation rates, hyperandrogenemia and insulin resistance compared with placebo 75 . It has been shown in vitro to impede LH and...

The Clinical And Molecular Phenotype Of Pcos

PCOS is a common endocrine-metabolic disorder affecting 6-8 of women during their reproductive age. The endocrine abnormalities include hyperandrogenism of ovarian and or adrenal origin, with variable clinical expression, and arrested follicular development leading to oligo- or anovulation and manifesting with oligo- or amenorrhea. Often women with PCOS have augmented luteinizing hormone LH secretion that contributes to hyperandrogenemia 11, 12 . The metabolic trait of PCOS is characterized by...

Effects of HRT on Risk of Developing Diabetes

Given the suggestions of beneficial effects of hormone replacement on glucose homeostasis, the question has been asked as to whether HRT can impact the risk for the development of diabetes. Several observational studies have shown a decreased risk for diabetes in women on HRT 58, 59 although this reduction was not seen in all studies 60 . In a post hoc analysis of the Heart and Estrogen Progestin Replacement Study HERS , a large randomized, double-blind placebo-controlled study, the use of CEE...

Thyroid disease in preexisting diabetic pregnancy

During pregnancy, thyroid levels are altered by several mechanisms hCG stimulation of the TSH receptor increases the free T4 during early pregnancy, and increased thyroid-binding globulin related to estrogen stimulation later in pregnancy results in lowering of free T4. Currently, there is not a consensus regarding routine screening of TSH during pregnancy. However, 10-12 of women of reproductive age have thyroid antibodies 123 . Prepregnancy screening of women with DM1 or DM2 seems warranted...

Cortisol

Increased exposure of fat tissue to cortisol may influence its mass and distribution 107 . This is clearly evident in Cushing's syndrome, in which alterations of the hypothalamic-pituitary-adrenal axis leading to cortisol hypersecretion create a phenotype of abdominal obesity, dyslipidemia, insulin resistance, and hypertension 108 . Common abdominal obesity obviously shares the latter features, although more subtle alterations of cortisol activity have been documented. Specifically, plasma...

Mechanisms Underlying Endothelial Dysfunction in Diabetes

Endothelial dysfunction in diabetes stems from three main sources chronic hyperglycemia, oxidative stress, and the increased production of cytokines and growth factors. Hyperglycemia and Its Immediate Biochemical Sequelae High concentrations of glucose have been shown to be associated with endothelial dysfunction both in vivo 75 and in vitro 76 . Underlying mechanisms contributing to this process include decreased activity and or expression of eNOS, decreased activity and or expression of the...

Mechanisms Adipoinsular Axis

The mechanisms behind the metabolic effects of a diabetic intrauterine environment on exposed offspring are not entirely understood. In 1980, Freinkel's Banting Lecture focused on the hypothesis of fuel-mediated teratogenesis 7 , which suggests that permanent changes in fetal development occur as a result of exposure to altered maternal fuels in the mother with diabetes. Fetal growth is deranged in pregnancies complicated by diabetes 57 , and the excess growth appears to be mainly driven by...

Janet K Snell Bergeon and Dana Dabelea

Diabetes in Pregnancy Epidemiological Studies Mechanisms Public Health and Clinical Implications References Diabetes during pregnancy is thought to contribute to metabolic changes in the fetus, which predispose the offspring of diabetic mothers to obesity, insulin resistance, diabetes and cardiovascular disease. Altered maternal fuels, including but not limited to glucose, may affect the development of the endocrine pancreas in the fetus, resulting in increased adiposity and decreased beta cell...

Effects of HRT on Glycemic Control in Women with Diabetes

Women with diabetes were found to use HRT less commonly than women without diabetes 49 . Yet studies have suggested neutral or beneficial effects of HRT on glycemic control among postmenopausal women with diabetes. Large observational studies have shown that glycemic control is improved in postmenopausal women with diabetes who use HRT compared with those who do not use HRT. One large study of women with diabetes aged gt 50 years included in the Northern California Kaiser Permanente Diabetes...

Other Monogenic Forms of Diabetes

A number of other monogenic forms of early onset diabetes have been reported. These diabetes syndromes can be classified into three main types, that is, congenital pancreatic islet cell dysfunction, congenital insulin resistance, and early autoimmune destruction of pancreatic islet see Table 4 . Monogenic Forms of Congenital Diabetes 1. Transient neonatal diabetes mellitus TNDM is a rare type of diabetes incidence of 1 in 1 million neonates that presents soon after birth, resolves by 18 months,...

The Energy Cost of Pregnancy in Gestational Diabetes Mellitus

In common with others, Okereke et al. 11 observed an increase in BMR from the prepregnant state to late pregnancy in obese women with normal glucose tolerance NGT and obese women with gestational diabetes mellitus GDM . There were no significant differences in basal energy expenditure between NGT and GDM obese women 11 . Obese GDM women had total energy expenditure similar to that of obese NGT women 11 . Similar observations were made for lean GDM and NGT women 18 . GDM women had oxygen...

Sexual Disorders Among Women with Type Diabetes Mellitus

The study by Doruk et al. 38 showed a SD prevalence of 42 within the DM2 women. Low sexual desire was reported in 82 of the DM2 women, whereas 68 complained of low arousal, 38 of reduced lubrication, 38 of orgasm difficulties, 46 of coital pain, and 50 of sexual dissatisfaction. Troubles in sexual arousal, lubrication, and orgasmic function were significantly more prevalent among DM2 subjects than among the healthy controls 23, 38 . Erol et al. 40 assessed the SF profile in 72 premenopausal DM2...

Complications Of Preeclampsia

Preeclampsia may cause both acute complications to the mother and neonate, as well as long-term complications for the mother. Usually maternal and perinatal outcomes are more favorable in women with mild preeclampsia that develops after 36 weeks of gestation 116-118 . Women who develop preeclampsia prior to 33 weeks who have preexisting medical conditions or who live in developing countries have increased maternal and neonatal morbidity and mortality. Immediate complications for the mother...

Short and Long Term Consequences of Fetal Complications

Fetal complications associated with the presence of gestational diabetes in the mother include macrosomia, neonatal hypoglycemia, perinatal mortality, congenital malformations in the case of undiagnosed preexisting DM , hyperbilirubinemia, polycythemia, hypocalcemia, and respiratory distress syndrome, and associated complications of labor and delivery are the most frequent and serious types of morbidity. Macrosomia, defined as birth weight gt 4,000 g, occurs in 20-30 of infants whose mothers...

Diabetic Nephropathy and Superimposed Preeclampsia

Women with diabetes and microalbuminuria or nephropathy are at an increased risk for preeclampsia compared to women with diabetes and no renal disease. In a Danish study 110 of 203 women with type 1 diabetes, 85 had normal albumin excretion, 11 had microalbuminuria, and 5 had diabetic nephropathy. Of those with normal albumin excretion 6 developed preeclampsia, and there was pre-term delivery in 35 . In those with microalbuminuria, 42 developed preeclampsia and 62 with preterm delivery, and in...

Management of GDM Based on Maternal Glucose Control Combined with Fetal Growth

The group of Buchanan and Kjos from Los Angeles picked up Weiss' concept of a fetal-based GDM management and investigated if the fetal AC in the third trimester could serve as a noninvasive method to target GDM pregnancies that need intensive treatment. This fetal-growth based strategy uses the diabetes-specific growth pattern of accelerated growth of the abdomen. This is mainly due to increased subcutaneous fat, which determines 63 of the variation of the fetal AC 24 . While the measurement of...

Summary and conclusions

There are many differences between the sexes in the susceptibility and development of chronic metabolic diseases and CvDs. Fundamental differences between males and females primarily involve hormones, which define the secondary sex characteristics at puberty, regulate fertility, metabolism, and behavior, and play an important role in regulating many functions of different nonreproductive tissues. Changes in the androgen balance have been found to be associated with a series of chronic metabolic...

Circulating Angiogenic Factors

Vegf Diabetic Nephropathy

Soluble fms-like Tyrosine Kinase-1 sFlt-1 Fig. 1 The search for circulating factors that mediate the generalized maternal endothelial function has been the focus of much research, and recent studies have demonstrated an increase in placental expression and secretion of soluble fms-like tyrosine kinase 1 sFLT-1 or sVEGFR-1 , which is a naturally occurring circulating vascular endothelial growth factor VEGF antagonist. VEGF has several receptors, including Flt1 VEGFR1 and Flk1 VEGFR2 , and sFlt1...

Optimal Timing and Frequency

For most patients with DM1 SMBG before and after meals and exercise will provide useful information for adjusting insulin and carbohydrate intake. The ADA suggests that there are no data to support that postmeal glucose monitoring has a specific role in preconception diabetes care beyond what is needed to achieve the target for A1C 30 . However, there is increasing evidence that elevated PPG levels exert a more deleterious effect than elevation of fasting plasma glucose 49 . Many studies...

Risk Factors for Maternal Postpartum Diabetes Among Women with GDM

Glucose intolerance during the index GDM pregnancy, reflected by the glucose values on the 50-g glucose challenge screening test as well as the diagnostic prenatal OGTT, is associated with postpartum hyperglycemia and diabetes 88-93 . Because of variation in diagnostic testing procedures for GDM, as well as the continuous relationship between glucose values and future risk, no single glucose value consistently identifies women at risk for future diabetes 88 . As discussed earlier in the...

The ILRA Locus

Vella et al. identified a novel DM1 locus, interleukin-2 receptor alpha IL2RA , by multilocus association test, based on a candidate gene approach 10 . Our study confirmed this DM1 association 96 . An association between Graves' disease and IL2RA was also found 97 . The DM1 association was initially mapped to an LD block encompassing the IL2RA gene 5' side and promoter region 96 . IL2RA encodes the a chain of the IL2 receptor complex IL2Ra, also known as CD25 . Interleukin-2 IL2 is a powerful...

Preconception counseling

All women of reproductive age with diabetes should receive preconception counseling, as reviewed in Chap. 15. Both preconception counseling and prenatal care entail a team approach including an obstetrician, endocrinologist, nurse educator, dietitian, and social worker. Education should focus on the rationale for good blood glucose control, blood glucose goals for preconception and pregnancy, MNT, exercise, insulin, and effects of diabetes on pregnancy and of pregnancy on diabetes with an...

Diabetes And Eating Disorders Epidemiology And Clinical Features

There has been controversy in the literature about the association of eating disorders and DM1 50 . However, the evidence from methodologically rigorous studies and from a meta-analytic review 51 supports the view that there is an increased risk for both subthreshold and full-syndrome eating disorders in girls and women with DM1. In studies using a diagnostic interview, the prevalence of full-syndrome eating disorders in girls and women with DM1 ranged from 0 to 11 , and the prevalence of...

Laparoscopic Ovarian Drilling

Surgical ovarian wedge resection was the first surgical treatment for anovulatory PCOS but fell out of favor due to the risk of postsurgical adhesion formation 95-97 . Alternatively, LOD involves cautery of the ovarian surface using electrocoagulation or laser, which can be done on an outpatient basis, results in fewer postoperative adhesions, and requires no ongoing monitoring 98-100 . It has been used as an alternate therapy in patients who do not conceive with clomiphene or gonadotropin...

Agathocles Tsatsoulis

The Clinical and Molecular Phenotype of PCOS Evidence for the Developmental Origins of PCOS Potential Origin of Prenatal Androgen Excess in Humans Plausible Biological Mechanisms Conclusions and Future Implications References Polycystic ovary syndrome PCOS is a common endocrine metabolic disorder in women, characterized by hyperandrogenism, chronic anovulation, and or polycystic ovaries in association with android fat distribution and insulin resistance hyperinsulinism. The etiology of PCOS...

Early Pregnancy Loss

Early pregnancy loss EPL is defined as miscarriage of a clinically recognized pregnancy during the first trimester 39 . While EPL occurs in 10-15 of normal women 116 , rates in women with PCOS are as high as 30-50 117 . Because of the prevalence of infertility in patients with PCOS, many women require fertility treatments which in themselves increase the prevalence of miscarriage 118 . However, several studies in women undergoing fertility treatment with IVF have demonstrated that women with...

Renato Pasquali and Alessandra Gambineri

The Biology of Sex Difference in Health and Disease Insulin Resistance in The General Female Population The Metabolic Syndrome, Cardiovascular Risk Factors and Cardiovascular Events in Women How the Definition of the Metabolic Syndrome Overlaps that of Insulin Resistance Diabetes and Cardiovascular Risk Factors in Women The Paradigm of PCOS Androgens and Risk for CvD and Diabetes in the Female Population Lessons From the PCOS Paradigm Summary and Conclusions References There are many...

Coc

COCs contain a wide variety of progestin formulations and doses. Most progestins are testosterone derivatives and have varying degrees of androgenic effects, e.g., decreasing sex-binding globulin, increasing insulin resistance, and adverse changes in serum lipids 3 . Newer formulations of oral progestins desogestrel, gestodene or older lower dose potency norethindrone formulations minimize androgenic side effects and, therefore, generally are preferable. Their net effect is estrogen-dominant...

Diagnosis of Preeclampsia

Although preeclampsia is usually diagnosed clinically based on clinical criteria as outlined by ACOG, the diagnosis can be a challenge in some patients in differentiating preeclampsia from progestational diabetes, gestational hypertension, and or chronic hypertension. In this regard, it has been recently reported in a small pilot study 99 that both sFltl and sEng may be useful in differentiating preeclampsia from other hypertensive disorders in pregnancy. This study found that the sensitivity...

Gonadotropin Therapy

A second-line option for infertility treatment is direct gonadotropin therapy with either FSH or human menopausal gonadotropin hMG . Because of the increased number of FSH-responsive follicles in polycystic ovaries, patients with PCOS are more at risk for OHSS and multiple gestations 82-84 . A low-dose, step-up protocol has been developed, which yields an increased pregnancy rate while reducing the incidence of OHSS and multiple gestations 83, 85, 86 . Treatment consists of employing a low...

Clinical Health Care Concerns

The hypothesis of fuel-mediated teratogenesis suggests that excess fetal growth caused by maternal fuel abnormalities results in adult disease in the offspring, and so interventions to reduce the transmission of obesity, cardiovascular disease and type 2 diabetes would logically focus on normalizing maternal metabolism and fuel delivery to the infant. There is evidence that hyperglycemia increases fetal growth and also may induce other metabolic changes that are associated with adult chronic...

Coagulation Abnormalities in Diabetes Mellitus

Eighty percent of the premature deaths in DM2 patients are secondary to thrombotic events, with 75 of these cases occurring in the cardiovascular system 38 . Diabetic patients are prone to enhanced thrombosis and platelet aggregation adhesion, endothelial dysfunction, altered fibrinolysis, and lipid disorders 2 . Hemostasis is the process of blood clot formation at the site of vessel injury. The coagulation system involves a complex cascade of proteins, which, after activation, lead to thrombin...

The paradigm of pcos

PCOS is one of the most common causes of ovulatory infertility, affecting 4-7 of women. After the original description by Stein and Leventhal 76 , this syndrome has been defined in different ways over the last 15 years. In 1990 the National Institutes of Health NIH established very simple new diagnostic criteria, which were based on the presence of hyperandrogenism either clinical, such as hirsutism, etc., or biochemical and chronic oligo-anovulation, with the exclusion of other causes of blood...

Allison L Cohen and S Ananth Karumanchi

Epidemiology of Preeclampsia Pathophysiology of Preeclampsia Prediction and Diagnosis of Preeclampsia Complications of Preeclampsia Summary References Preeclampsia is a syndrome of new-onset hypertension and proteinuria after 20-weeks gestation in a previously normotensive woman. Preeclampsia is a leading cause of maternal, fetal, and neonatal morbidity and mortality throughout the world. There are multiple risk factors for preeclampsia, including pregestational diabetes and obesity. Women with...

Gestational Diabetes

GDM is defined as diabetes or impaired glucose tolerance that develops during pregnancy 39 . It affects 4-7 of pregnant women 151, 152 and carries considerable perinatal risk including mac-rosomia, hypoglycemia, stillbirth, jaundice and respiratory distress syndrome 153 . A randomized controlled trial has shown that rates of serious perinatal complications were reduced, birth weight was lower, and macrosomia was less frequent in patients who were treated intensively for impaired glucose...

Maternal Endothelial Dysfunction

Endothelial Dysfunction Preeclampsia

All of the clinical features of preeclampsia can be explained as a maternal response to generalized endothelial dysfunction 29, 30 , and women with underlying vascular disease may be at higher risk of developing preeclampsia due to preexisting endothelial dysfunction 31 . Increased vascular permeability results in proteinuria and edema disturbed endothelial control of vascular tone leads to hypertension, and abnormal endothelial expression of procoagulants leads to coagulopathy. In the kidney,...

Introduction

Polycystic ovary syndrome PCOS affects 5-10 of women of reproductive age 1, 2 . It is characterized by hyperandrogenism, often presenting as hirsutism, alopecia or acne, and chronic oligo- or anovulation, which typically presents as oligomenorrhea or amenorrhea and infertility 3 . In addition, hyperinsulinemic insulin resistance is intrinsic to the syndrome, increasing the risk of type 2 diabetes mellitus 4 , metabolic syndrome and cardiovascular risk 5 . From Diabetes in Women Pathophysiology...

Screening And Diagnosis Of

No specific guidelines are available for screening of CVD or CAD in women with diabetes. If patients are symptomatic further testing is likely to be undertaken without delay. However, guidelines on screening asymptomatic individuals are not clearly defined. Recently the American Diabetes Association released a new expert panel recommendation regarding screening for CAD in diabetic patients based on recent evidence that did not support their previous recommendation of screening asymptomatic...

Screening for gestational diabetes in third world countries do we need ethnic and national specific criteria

Defining the performance characteristics of screening strategies for GDM is complicated by the lack of a universally accepted gold standard for the diagnosis of GDM. As can be seen from Table 4, studies that have been carried out in developing countries have used differing screening and diagnostic criteria, mirroring the same lack of consensus in the developed world. More work needs to be done to address a cost-effective diagnostic strategy for GDM that takes into account fetal outcomes rather...

Fibrinolytic System in Diabetes Mellitus Plasminogen Activator Inhibitor

PAI-1, one of the inhibitors of the fibrinolytic system, is synthesized by hepatocytes, fibroblasts, adipocytes, and ECs and is stored within the platelet granules. Elevated PAI-1 levels have been noted in patients with CAD and are strongly correlated with components of cardiometabolic syndrome CMS such as BMI, blood pressure, and triglycerides 2, 27 . Festa et al. examined the relationship between new-onset diabetes and dynamic changes of PAI-1 and fibrinogen 39, 40 . In nondiabetic, healthy...

Hormonal Contraception

Hormonal contraception contains either a progestin compound alone or in conjunction with estrogen. They can be administered orally, intramuscularly, transdermally, and transvaginally. Some IUDs also contain progestin. Estrogen does not affect glucose tolerance 5 , but progestins do increase insulin resistance and decrease glucose tolerance in a dose and potency fashion 6-8 . Estrogen slightly increases blood pressure 9 by increasing angiotensin production while progestins have no effect....

Risk Factors for Preeclampsia

There are multiple risk factors for preeclampsia Table 5 12 . First pregnancy is associated with an increase risk in preeclampsia, though it is not clear why this is such an important factor RR 2.91, 95 CI 1.28-6.61 13 . There are some data suggesting that the risk increases in women who have had limited sperm exposure with the same partner prior to conception 14-16 , though this theory has been challenged. A past history of preeclampsia is a very strong risk factor for preeclampsia in a future...

Prenatal Androgenization and PCOS

The developmental origins hypothesis of PCOS emerged following astute clinical observations in women with congenital virilizing disorders and was further substantiated by experimental animal research. Examples of prenatally androgenized humans are women with classical congenital adrenal hyperplasia from 21-hydroxylase deficiency and rare cases of women with congenital adrenal virilizing tumors 25, 26 . These women are exposed to excess adrenal androgens during intrauterine life and, despite the...

The Metabolic Syndrome in PCOS

Due to the high prevalence of insulin resistance in PCOS, some recent studies used the NCEP ATP III criteria to assess the prevalence of the metabolic syndrome in PCOS women. Glueck et al. 95 studied 138 PCOS patients and found a prevalence rate of 46 , whereas, more recently, Apridonidze et al. 82 found a prevalence of 43 by retrospectively reviewing the medical charts of 106 PCOS women attending the Endocrine Clinic of Richmond, Virginia. Both these studies, therefore, described a prevalence...

Obesity and the Abdominal Phenotype in PCOS

This could be due to a depot-specific inhibition of the expression of hormone-sensitive lipase HSL by testosterone and or to a decrease in the amount of b2 adrenergic receptors. This could also be an important pathophysiological factor behind the insulin-resistant phenotype of the upper-body obesity in men and of the hyperandrogenic PCOS 104 . In humans, it is demonstrated that testosterone increases visceral fat in women. Female-to-male transsexuals treated...

Basal Metabolic Rate in Pregnancy

The large differences in calculated energy costs of pregnancy between studies can be attributed to a high level of intrapopulation variability 9 and also to the level of affluence of the country from which the population was selected 6 . Women from affluent, developed countries showed a rapid early increase in BMR in response to pregnancy 1 . In contrast, women from less affluent countries either show a delayed increase in BMR, or in some there is an initial rapid fall in BMR during the first...

Continuous Glucose Monitoring

SMBG is, without question, one of the most important advances in the field of diabetes and pregnancy, since the discovery of insulin in 1921. To achieve glucose control, it is important to know the target blood glucose levels, and frequent glucose measurements allow a more precise understanding of daily glucose fluctuations. A recent study by Kerssen, which included 43 women with DM1, demonstrated that the detection rate of hyperand hypoglycemic episodes was significantly higher in patients...

Efficacy of PRECoNCEPTIoN Care At ReduCing Pregnancy Complications Why Do I Need Preconception Care

Hemoglobin A1c Congenital Malformations

PCC reduces the risk of congenital malformations and perinatal mortality. In 1949, Dr. Priscilla White published a landmark case series on 439 pregnancies in patients with preexisting diabetes, which highlighted the association of congenital malformations, preeclampsia and prematurity with excess perinatal mortality in infants of mothers with diabetes 11 . Since that time, numerous studies have demonstrated an association between glycemic control and the occurrence of congenital malformations...

With Fetal Growth

In women with preexisting diabetes, ultrasound is considered essential for the detection of congenital malformations. In early pregnancy, maternal hyperglycemia is associated with a high frequency of congenital anomalies. This is a major concern in pregnancies with preexisting diabetes, while in GDM maternal hyperglycemia normally occurs after organogenesis is complete. However, in women with fasting glucose values at diagnosis above 120 mg dl there is obviously an increased risk of congenital...

Metformin Clomiphene Citrate or Both for Ovulation Induction in PCOS

Given the demonstrated efficacy of metformin as monotherapy in increasing ovulation, the question arises whether it might constitute first-line therapy in the treatment of the anovulatory infertility of PCOS. The literature on this issue is conflicting and controversial. Palombo et al. performed a prospective, randomized, double-blind trial of metformin compared with clomiphene 150 mg in 100 nonobese PCOS patients 40 . While there was no difference in ovulation rates, the pregnancy rate was...

Dilys J Freeman and Naveed Sattar

Maternal adaptations in energy metabolism are required to respond to the additional energy demands of pregnancy, and these adaptations are influenced by the degree of maternal obesity. Glucose intolerance does not influence the adaptation of maternal energy metabolism to pregnancy. Pregnancy is associated with increased maternal insulin resistance, which is further increased in obese and glucose-intolerant mothers. Endothelial function is improved in pregnancy but to a lesser extent in obese...

The prevalence of gestational diabetes in women in third world countries

Orientals, first-generation Hispanics, women from the Indian subcontinent and the Middle East, those with a history of infertility, and women with low socioeconomic status are at an increased risk for gestational diabetes 5 . Green et al. 11 from the University of California, San Francisco showed that the incidence of gestational diabetes was significantly greater for Chinese 7.3 and Hispanic 4.2 women than for Black 1.7 and non-Hispanic White 1.6 women. In a cross sectional study, Ferrara et...

Aromatase Inhibitors

Aromatase inhibitors, such as letrozole and anastrozole, have been used for ovulation induction in anovulatory infertility or as adjunctive treatment to gonadotropins for induction of multiple follicles for assisted reproduction 90 . Their mechanism of action is through preventing conversion of androgen to estrogen. Aromatase inhibitors have a relatively short half-life approximately 45 h and therefore cause less adverse effects on estrogen target tissues and no downregulation of estrogen...

JoAnne M Rizzotto Judy Giusti and Laurie Higgins

Introduction Preconception Counseling Nutrition Requirements and Meal Planning with Pregnancy and Preexisting Diabetes Calories for Pregnancy Weight Gain Seafood Recommendations During Pregnancy Nutrition and Meal Planning in Gestational Diabetes Follow-up Postpartum Care clinical Implications Celiac Disease Gluten-free Diet Resources for Celiac Disease and the Gluten-free Diet References From Diabetes in Women Pathophysiology and Therapy Edited by A. Tsatsoulis et al. eds. , DOI 10.1007...

Siri L Kjos

Counseling and Selecting A Method Barrier Methods Hormonal Contraception Question Can She Use Intrauterine Contraception Breastfeeding and Postpartum Contraception Stepwise Questions References Today, diabetic women have an increasing variety of safer and effective contraceptive methods. While more contraceptive trials in diabetic women are needed, data from existing studies and extrapolation from clinical trials in healthy women support the use of most contraceptive methods. This chapter will...

Andrea Salonia Roberto Lanzi Emanuele Bosi Patrizio Rigatti and Francesco Montorsi

Female Sexual Dysfunction Definitions, Clinical Classification, and Epidemiology Predictors of Sexual Dysfunction Among Women with Diabetes Treatment of Sexual Disorders in Women with Diabetes Conclusions References Women's sexual dysfunction SD is defined as a disorder of sexual desire, arousal, orgasm, and or sexual pain, which results in significant personal distress and may have a negative effect on a woman's health and quality of life. Although previously published data suggest that sexual...

Adipocyte Size

The mature adipocyte population of a given depot shows important differences in cell size according to the volume of the triglyceride droplet located in each cell. Adipocyte size varies as a function of sex, adiposity level, nutritional status, and anatomical location of the adipose tissue depot Fig. 4 27-31 . In both sexes, omental and subcutaneous adipocytes become larger with obesity, but adipocyte size reaches a plateau in massively obese subjects 28, 31 . In normal weight to obese women,...

Www.diabetic Fpd.

Clausen TD, Mathiesen E, Ekbom P, Hellmuth E, Mandrup-Poulsen T, Damm P. Poor pregnancy outcome in women with type 2 diabetes. Diabetes Care 28 323-328, 2005 2. Towner D, Kjos SL, Leung B, Montoro MM, Xiang A, Mestman JH, Buchanan TA. Congenital malformations in pregnancies complicated by NIDDM. Diabetes Care 18 1446-1451, 1995 3. Gilbert C, Valois M, Koren G. Pregnancy outcome after first trimester exposure to metformin a meta-analysis. Fertil Steril 86 658-663, 2006 4. Piaggio G, Grimes...

Carbohydrates

Carbohydrates are converted into glucose and have the biggest impact on postprandial blood glucose results. Therefore, it is important to control carbohydrate intake throughout the day. Appropriate distribution of carbohydrates over the day helps attain optimal glycemic control and can prevent hypoglycemia and ketonemia in pregnant women. The IOM recommends 130 g of carbohydrate per day for women of childbearing years based on the minimum of carbohydrate utilized by the brain and red blood cell...

Loss of Estrogen Protection in Diabetic Women

The mechanism by which DM2 abrogates the protective effect of estrogens in premenopausal women is incompletely understood. Increased CVD in diabetics has been linked to several factors, including enhanced platelet aggregation, hypercoagulability, decreased fibrinolysis, endothelial dysfunction, lipoprotein abnormalities, increased oxidative stress and inflammation, and enhanced vascular growth factor stimulation. Both hyperglycemia and insulin resistance hyperinsulinemia abrogate estrogen...

Sadikot Diabetes

The Prevalence of Diabetes in Women in Third World Countries The Prevalence of Gestational Diabetes in Women in Third World Countries Screening for Gestational Diabetes in Third World Countries Do We Need Ethnic and National Specific Criteria Challenges to Heath Care Delivery in Third World Countries Medical Impact of GDM in the Third World Postpartum Consequences of Gestational Diabetes on the Prevalence of Subsequent Diabetes Can we Reduce the Future Risk of Diabetes in Women with Gestational...

Dabelea D. Diabetes 2000 49 2208-11

Hussain A, Claussen B, Ramachandran A, Williams R. Prevention of type 2 diabetes a review. Diabetes Res Clin Pract 2007 76 317-26 2. Dabelea D, Pettitt DJ, Jones KL, Arslanian SA. Type 2 diabetes mellitus in minority children and adolescents. An emerging problem. Endocrinol Metab Clin North Am 1999 28 709-29, viii 3. Dabelea D, Snell-Bergeon JK, Hartsfield CL, Bischoff KJ, Hamman RF, McDuffie RS Kaiser Permanente of Colorado GDM Screening Program. Increasing prevalence of gestational...

Diagnostic Criteria

In several countries, the 100-g 3-h oral glucose tolerance test OGTT is used to diagnose GDM. The diagnostic glucose thresholds using the 100-g 3-h OGTT were first published by O'Sullivan and Mahan in 1964 11 and were based on their ability to predict maternal diabetes subsequent to pregnancy. In this study, the medium assayed was whole blood, and the laboratory method used Somogyi-Nelson assayed for all reducing substances including glucose. In 1979, the National Diabetes Data Group NDDG 12...

Question Can She Use Estrogen Containing Contraception

It is the progestin component of hormonal contraceptives that prevents pregnancy. Estrogen is added to decrease intermenstrual bleeding. To prescribe an estrogen-containing contraceptive, the diabetic woman's cardiovascular risks need to be evaluated due to the estrogen-induced changes in her metabolic profile. Estrogen produces a dose-dependent increase in globulin production, increasing coagulation factors and angiotensin II levels, thereby increasing thromboembolic risk and a slight increase...

HuiQi Qu and Constantin Polychronakos

Introduction Type i Diabetes Type 2 Diabetes Monogenic Diabetes Special Issues in Women Related to the Genetics of Diabetes Genetic susceptibility to type 1 diabetes DM1 and type 2 diabetes DM2 is determined by complex genetic factors. Until recently, only a few loci were known, but this is changing rapidly as a result of the development of high-density genotyping arrays that have permitted genome-wide association studies. Several recent reports of such studies have increased our understanding...