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Unlabelled: Leptin, as well as many other hormones, may play an important role in the pathogenesis of obesity. Several genetic variants of both leptin and its receptor genes may influence human body weight, Aim: To investigate the role of leptin gene polymorphism promotion region (-2548G/A) and leptin gene receptor polymorphism (668 A/G) in regulation of body weight in the group of women with type 1 diabetes (PGDM-1)., Methods: 78 PGDM-1 first trimester pregnant women were qualified for the study group (SG). They were divided into normal and overweight subgroups, based on pre-pregnancy BMI. Control group (CG) consisted of first trimester healthy pregnant women with normal pre-pregnancy body weight Genetic variants of leptin gene and its receptor were analyzed with the help of PCR-RFLP assays. In the SG, the following metabolic parameters were estimated: MBG, HbA1c, insulin dose, LDL, HDL, T-CHOL, triglycerids, creatinine, creatinine clearance and blood pressure., Results: A tendency for the majority of homozygous A and G variants in LEP -2548 G/A and LEPR 668 A/G was found in overweight and obese patients, in comparison to normal-weight subjects. No specific differences in selected first trimester metabolic parameters were found in relation to patients' genotypes in the diabetic group.

Introduction: Leptin is a polypeptide hormone (167 amino acids, molecular weight of about 16kDa), synthesized mainly in white adipose tissue. The hormone plays an important role in regulation of hunger and satiety processes, in metabolism of carbohydrates and fats, development of cardio-vascular diseases and obesity. The occurrence of the increased level of leptin in pregnant women with hypertension, especially in women with preeclampsia, has also been brought to our attention. In recent years it has been suggested that the presence of different variants of leptin and leptin receptor genes may modify the leptin level in serum, and, in this way, influence an increased risk of obstetric complications, such as preeclampsia or eclampsia., Materials and Methods: We have analyzed a group of 103 hypertensive pregnant women--61 women with gestational hypertension (GH) and 42 women with preeclampsia (PE). The control group consisted of 113 healthy pregnant women who have been investigated. Gestational hypertension and preeclampsia were recognized with the help of and assessed according to the ACOG criteria. The (-2548G/A) polymorphism was determined using polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP)., Results: In our study, a higher frequency of mutated AA genotype in GH group and PE groups (21.31% and 21.43% respectively vs. 16.81% in the controls) and the overrepresentation of mutated A allele in both analyzed groups (47.54% and 45.24% respectively vs. 41.59% in the controls) have been observed, without statistically significant differences., Conclusions: The overrepresentation of AA genotypes and higher frequency of mutated A allele of (-2548G/A) polymorphism of leptin gene in GH and PE groups might indicate its possible contribution in gestational hypertension and preeclampsia.

Objectives: The aim of the study was to evaluate the risk of occurrence of metabolic syndrome (MS) in females who suffered from gestational diabetes mellitus (GDM)., Patients and Methods: 495 letters were sent to patients with a history of GDM treated in the Department between 1993-2002. One hundred and fifty-three (30.9%) patients who responded positively formed the study group. Out of them 74 had already been treated for diabetes mellitus, and glucose intolerance was found in 5 subjects. Seventy-four patients had been subjected to a 75 g Oral Glucose Tolerance Test, as well as the control group that consisted of 155 subjects, in whom GDM during pregnancy was excluded. In all patients lipid parameters, blood pressure, height, weight and waist circumference were measured and body mass index (BMI) was calculated. Metabolic syndrome was diagnosed according to the modified NCEP-ATP III criteria from 2005 (3 of 5 had to be fulfilled)., Results: Patients from the study group were older than from the control group (p <0.05), higher was their BMI at the time of the index pregnancy, as well as after the observation time (p <0.0001). Metabolic syndrome was developed in 47 (30.7%) patients of the study group and 8 (5.2%) patients from the control group (p <0.001). The study group presented all components of MS significantly more often than the control group--in both groups, we found respectively: abnormal waist circumference--57% vs. 37.6% (p <0.005), hypertension--18.9% vs. 1.9% (p <0.001), elevated fasting glycemia--79.1% vs. 1.9%, hypertriglyceridemia--21.6% vs. 2.6% (p <0.0001), and decreased concentrations of high-density lipoprotein cholesterol--11.1% vs. 2.6% (p <0.005)., Conclusions: Patients who suffered from GDM are at high risk for carbohydrate disturbances and metabolic syndrome in the following year. Therefore, they should be under continuous medical surveillance that would enable early detection and treatment of the metabolic disturbances.

The article presents information about leptin as the major metabolic hormone. The structure, localization of the hormone and its receptor have been described focusing on maturation and fertility processes. Several polymorphisms of leptin gene and its receptor have been described as potential developmental factors of pregnancy complications such as diabetes mellitus or pregnancy induced hypertension.

Unlabelled: Gestational diabetes (GDM) is regarded as a predilecting factor for a subsequent development of diabetes or other disturbances in carbohydrate metabolism. The aim of the study was to evaluate the risk of occurrence of failures in carbohydrate metabolism in females who sufferred from GDM, as well as to determine the prognostic values of selected markers that were regarded as factors favouring the development of diabetes mellitus (DM)., Material and Methods: Patients who in the past suffered from GDM were subjected to this study. Out of 153 patients who responded positively to the written invitation to participate in this study, 74 had already been treated for DM. In 5 of them, abnormal glucose tolerance was found, and 74 of this group had been subjected to a 75g OGTT. The control group consisted of 153 subjects, who had given birth at least twice and in whom the metabolic diagnostics performed during the first pregnancy excluded GDM. Results of our study have revealed that patients who in the past had sufferred from GDM constituted a group with high risk for developing disturbances in carbohydrate metabolism or symptoms of metabolic syndrome after pregnancy. The main factors pro the development of the disturbances in carbohydrante metabolism were: overweight, increased fasting glycemia at the time of GDM diagnosis and insulin requirement during pregnancy., Conclusion: High percentage of diagnosis of an impaired carbohydrate metabolism and DM, calls for a special attention toward a group of patients with previous GDM, for a properly directed treatment that would enable a considerable delay in the development of an overt diabetes, as well as would apply a rational therapy, that would result in an optimal control of existing diabetes.

The discovery of insulin in 1921 and introducing insulin into a clinical practice gave an unique opportunity to treat people suffering from a type 1 diabetes successfully. Prior to this success, pregnancy in diabetic women was extremely rare and most of cases resulted in stillbirth and fatal outcome for mother. After the introduction of insulin into therapy of pregnant women with diabetes, a permanent improvement in neonatal and maternal outcome has been noted. However, a diabetic pregnancy still constitutes a high risk pregnancy, requiring a targeted, highly specialized control of women and fetus. This review presents problems concerning diagnose, treatment and outcome of diabetic pregnancy throughout the XXth century.

Objective: To evaluate if maternal glucose level and growth of the fetus were related to placental vascular impedance in pregnancy complicated by gestational diabetes mellitus., Material and Methods: A retrospective study of 146 gestational diabetic women of which 117 needed insulin therapy. Glycosylated hemoglobin (HbA1c) was evaluated as well as umbilical and uterine artery Doppler velocimetry. The results were related to adverse outcome of pregnancy including newborn birthweight., Results: Abnormal umbilical artery blood flow velocity was seen in 5% of the cases and abnormal uterine artery flow in 16%. Uterine and umbilical artery vascular impedance was significantly lower in macrosomic newborns. There was a poor correlation between HbA1c, vascular impedance and birthweight. There were 11 cases that developed preeclampsia, all having abnormal uterine artery Doppler and two abnormal umbilical artery Doppler., Conclusion: Uterine and umbilical artery vascular impedance in pregnancies complicated by gestational diabetes is related to birthweight and placental weight, but not to maternal HbA1c levels. Placental Doppler ultrasound does not seem to be of clinical value for fetal surveillance in these pregnancies unless the pregnancy is complicated by preeclampsia and/or intrauterine fetal growth restriction.

Objective: To determine how metabolic monitoring of women with gestational diabetes influences the morbidity of newborns., Design: Retrospective study., Patients: 352 newborns of mothers with gestational diabetes. 295 mothers suffered from diabetes class G1 (G1DM) and 57 from diabetes class G2 (G2DM)., Material and Methods: Glycated haemoglobin levels measured at the moment of the diagnosis of gestational diabetes and shortly before delivery were higher in women with diabetes type G2, but the difference was statistically significant only at the first measurement (G1 6.1+/-1,5% vs. G2 6.7+/- 1.6%, p<0.01). Mean gestational age at the time of delivery in the whole group was 38 +/- 2 hbd and there was not any difference between newborns of mothers with G1DM and G2DM. Mean birth weight in newborns of G1DM mothers was 3390 +/- 620 g and in newborns ofG2DM mothers it was 3330 +/- 720 g (NS)., Results: 31 (8.8%) infants were large for gestational age (LGA) and 20 (5.7%) infants were small for gestational age (SGA). There was not any difference between newborns of mothers with diabetes class G1 and G2 in the incidence of LGA and SGA. Neither there was any difference between these two groups in the incidence of metabolic disorders (hypoglycemia, hypocalcaemia. hypomagnesaemia. hyperbilirubinemia) and other pathologic conditions (respiratory distress syndrome (RDS), polycythemia, hypertrophic cardiomyopathy and perinatal infections). The incidence of congenital malformations was similar in both groups. LGA newborns were statistically more often newborns of mothers with HbA1c level exceeding the normal value (HbA1c>6.3%). This correlation was observed both in the first measurement of HbA l c and the measurement performed shortly before delivery. In LGA newborns we observed hypoglycemia, polycythemia and hypertrophic cardiomyopathy more often. Perinatal infections appeared statistically more often in the SGA newborns. 31.25% infants from the study group were born before the end of the 37th week of gestation. These newborns more often suffered from RDS, hypoglycemia, hyperbilirubinemia and perinatal infections., Conclusion: There was not any significant difference in neonatal outcome in newborns of mothers with gestational diabetes class G1 and G2. This might have resulted from the fact that there was neither any statistically significant difference between these two groups in HbA1c level measured shortly before delivery. The incidence of metabolic disorders in newborns was correlated with LGA, SGA and prematurity, but there was not any difference in the occurrence of metabolic disorders between newborns of mothers with G1DM and G2DM.

Lymphangioma or cystic hygroma is a congenital malformation of the lymphatic system which has been commonly associated with fetal aneuploidy, hydrops, structural malformations and intrauterine death. In this paper we would like to report two cases of lymphangioma diagnosed prenatally in the third trimester in the fetuses with normal karyotype, normal NT in the first trimester and without other structural anomalies and with good perinatal outcome.

Lymphangioma or cystic hygroma (CH) in neonates is a rare congenital malformation (1:12000 live births), its etiology is unknown. It often occurs in head and neck region. Initial diagnosis based on physical examination is next to be confirmed by MR and CT imaging. The authors presented with diagnosis and treatment of two babies with congenital cystic hygromas of face, neck and thorax. Although in cystic hygroma the surgery still remains as the treatment of choice, the OK-432 sclerotherapy seems to be very promising in huge CH lesions.

Metabolic disturbances related to glucose intolerance and hyperglycemia are known to affect the health and life of women planning the pregnancy. They also are capable of impairing the development of fetuses and newborns. Remarkable advances have been made in recent years in clarifying the metabolic processes that occur during pregnancy and their effect on intrauterine fetal development. Clinicians have become aware of the observations, that maternal diabetes and the occurrence of complications are related to the duration of the disease, to the grade of hyperglycemia and to the time of pregnancy when hyperglycemia occurred. Since the last decade, numerous epidemiological studies have confirmed that a good balanced diabetes mellitus in pregnant women leads to the fruitful fetal development and contributes to reducing maternal mortality. The aim of this study was to discuss the update guidelines for managing diabetic patients with vascular complications before and during the course of pregnancy.

Objectives: There are still controversies referring to pregnancy influence on the development of vascular complications in type 1 diabetes., Materials and Methods: 227 diabetic women were taken into the study (109 who gave at least one birth (GB) and 118, who never were pregnant (NB)). All of patients started to be diabetic before the 15 years of age. We compared the development of vascular complications (VC) (hypertension-RR, proteinuria (P), retinopathy (R) and the age of patients, HbA1C, serum creatinine (Cr), creatinine clearance (CrCl) between the GB and NB groups. We also compared the development of VC in relation to risk factors (RF): HbA1c and duration of diabetes., Results: Women who gave birth were significantly older and developed diabetes earlier than childless women. We didn't find any significant difference in duration of diabetes, HbA1c, mean blood pressure (BP), Cr and CrCl between these two groups. In the GB group in comparison to NB we noticed higher frequency of RR (11.1% vs 6.8%, OR 1.7), proliferative retinopathy (9% vs 6.8%, OR 1.4) and laser therapy (5.5% vs 3.4%, OR 1.6). In the next step we analyzed the development of VC in relation to risk factors: duration of diabetes (less or more than 20 years) and HbA1c levels (below and above 8.0%). Patients, who developed diabetes before 20 years of age were significantly older (36.3 vs 31.2 years p < 0.001), duration of diabetes in this group was longer (26 vs 14 years p < 0.001), Cr was higher (0.9 mg/dl vs 0.8 mg/dl p < 0.05)and CrCl was lower (73 mg/ml vs 86 mg/ml p < 0.05). In this group the frequency of proteinuria as well as retinopathy were higher (18.2% vs 7.9%, OR 2.59) (52% vs 9.2%, OR 10.6). We didn't find the difference in HbA1c concentration between the groups with different duration of diabetes. Higher HbA1c presented no relation to the age of patients, but correlated with lower frequency of patients without retinopathy (60.3% vs 66% OR 0.68). In this group laser therapy had to be performed more frequent (6.8% vs 1.8% OR 6.1)., Conclusions: Pregnancy in diabetic patients with good metabolic control doesn't seem to be a risk factor for developing vascular complications. These complications are still strongly correlated with duration of diabetes.

Background: Causes of fetal hypoxia in diabetic pregnancy are still unknown. Investigation of placental vascular network seems of great importance in this research area. Abnormalities in the structure of capillaries in the vasculo-epithelial membranes and role of perivascular space may be an essential factor in explanation for fetal hypoxia in diabetic pregnant women. The aim of the study was to evaluate the relationship between the vascular surface of the terminal villi to its total surface, evaluation of the endothelial structure, perivascular space and basal membrane of the trophoblast as well as analysis of the studied parameters in relation to the classes of diabetes and metabolic control., Material and Methods: The study was performed on 32 placentas from women with PGDM and GDM. There were 8 pregnant women in class G1 and G2, 15 in class B, C, D, 9 in class R/F and 8 in control group. The mean diurnal glycemia in the analysed groups ranged between 90 + 22 mg/dl and 100 + 55 mg/dl (in control group 80 + 12 mg/dl). HbA1c concentrations were between 6.7 + 0.9% and 7.6 + 1.0% (in control group 6.0 + 0.5%). Placentas were examined using light microscopy and electron microscopy Opton-Zeiss EM-900., Results: Decrease in the vascular surface of terminal villi was found in PGDM with fetal hypotrophy. In this cases we observed separation of basal membranes in basal capillaries and distention and proliferation of endothelial cells, disarrangements of perivascular space,. In placentas of women with hyperglycemia and fetal macrosomia there was a significant thickening of basal membranes of the trophoblast, and structural abnormalities in perivascular space with proliferation of collagen in terminal villi. Intensity of these changes was related to the degree of hyperglycemia and affected fetal and neonatal wellbeing. Examination of the placentas in women with PGDM with normal sugar levels before and during pregnancy revealed no or very limited pathological changes on light and electron microscopy. No significant relationships were shown between vascular surface in terminal villi and selected biochemical parameters and neonatal condition in diabetic pregnant women with fetal eutrophy, Conclusions: Pathologic changes in the placentas of diabetic women (significant thickening of basal membranes of trophoblast separation of basal membranes in basal capillaries, distention and proliferation of endothelial cells, disarrangements of perivascular space and decrease of vascular surface of terminal villi are significant factors contributing to fetal anoxia in pregnancy complicated by diabetes mellitus.

Objective: The purpose of the study was to assess the clinical value of sonographically measured abdominal subcutaneous tissue thickness (SCTAd) in prediction of large for gestational age in pregnancy complicated by diabetes mellitus., Material and Methods: We prospectively evaluated 256 pregnant women with gestational and pregestational diabetes mellitus longitudinally from 24th week of gestation until delivery. In all cases sonography was performed, and abdominal subcutaneous tissue thickness was assessed. After delivery the entire examined group was divided into two groups. The first group comprised mothers who delivered newborns with birth weight above 90th percentiles, and the second group comprised mothers who delivered newborns with birth weight between 10th and 90th percentiles., Result: Based on statistical analyses SCTAd was bigger in Group I than Group II (p. < 0.01) at the beginning of the 31st week of gestation. Based on ROC (receiver operating characteristic) curves we estimated that 5 mm thickness of abdominal subcutaneous tissues differentiate AGA (appropriate for gestational age) and LGA groups with 71% sensitivity and 72% specificity., Conclusions: 1/Use of the SCTAd permitted diagnosis of asymmetric fetal overgrowth complicated by diabetes mellitus since 31st week of gestation 2/5 mm of abdominal subcutaneous tissue thickness allowed differentiate AGA and LGA with 71% sensitivity and 72% specificity in term pregnancies complicated by diabetes mellitus.

The paper presents a case of a 29-years old primipara with the cervical incompetence diagnosed in 22nd week of twin gestation. Cervical cerclage was performed with a cervical dilatation about 7 cm. The pregnancy was prolonged for 84 days. Caesarean section was performed in 34th week of gestation. The mother with healthy newborns was discharged from the Department on 5th day after delivery.

Background: Cervix is very important structure that separates the fetus from external environment, it can be visualized very precisely by transvaginal ultrasonography. Cervical length in the pregnancy is one of the predictors of preterm delivery and diagnosis of cervical incompetence., Materials & Methods: We have investigated 119 pregnant women with diagnosis of preterm labor(n-62), with preterm labor complicated by diabetes mellitus(41) and hypertension (16). Transvaginal sonography was used to measure cervical length between 23 and 29 weeks gestation. Ultrasound examination was performed using 2000 with 5.0 MHz transvaginal transducer. The following measurements were obtained: endocervical canal length between the internal and external os, funneling of the cervix, funnel width, funnel length., Results: The mean endocervical length was 16.3 +/- 0.5 mm in pregnancies delivered before term (n = 19) and 30.1 +/- 0.6 mm in pregnancies delivered at term (n = 100). The mean endocervical length measured in pregnant women without pregnancy complications other than preterm labor was 15.2 +/- 0.6 mm, in women with diagnosis of preterm labour complicated by diabetes mellitus was 16.7 mm + 1.0 and complicated by hypertension 15.9 mm + 0.8. No significant relationships were shown between length of the cervix in pregnancy complicated by diabetes mellitus, hypertension and uncomplicated pregnancy. The mean endocervical length in diabetic pregnancy was 34.7 +/- 4.7 mm; pregnancy with hypertension 32.9 +/- 5.8 mm and uncomplicated pregnancy 35.6 +/- 3.8 mm., Conclusion: Cervical length measured by ultrasonography between 23 and 29 week of pregnancy is very important predictor of preterm delivery. We found significant relationships between cervical length in pregnancies delivered before and at term. No significant relationships were shown between the length of the cervix and investigated pregnancy complications.

Congenital diaphragmatic hernia (CDH) is connected with a high risk of neonatal mortality and morbidity, which are caused mostly by lung hypoplasia. Frequency of these congenital malformations is 1: 2000-3000 live birth. CDH can be isolated, but in as many as 23% of cases, it co-exists with other fetal anomalies. Moreover, in 12% of cases it may be connected with genetically determined syndromes. Ultrasonographic diagnostics, especially in isolated CDH cases, is very difficult so that pregnant women must very often be admitted to perinatal 3rd references center. The first symptom to suggest CDH is polyhydramnios appearing between the 2nd and 3rd trimester of pregnancy. Appropriate prenatal diagnosis, delivery at a specialized perinatal center, and well-prepared neonatal, anaesthesiological and surgical teams significantly improve the survival rate and increase the likelihood of the proper development of newborn infants. The aim of this paper is the presentation of the case of a newborn diagnosed with intrauterine CDH who, upon delivery at 34th week of gestation, was admitted to the Department of Child Surgery, and after surgical procedures, was discharged in a healthy condition.

The analysis of urine culture was performed twice in 120 pregnant women with diabetes mellitus: on their first visit and during the 3rd trimester of pregnancy. During the first evaluation 10% of patients had germ-free culture, 46.7% non-significant bacteriuria and 43.3% significant ones. The percentage of results in the studied group indicating significant bacteriuria decreased as far as to 35.8%, but germ-free culture were still 10% during the second analyses, in 3rd trimester. The incorrect urine culture decreasing count during pregnancy stood in relation with better diabetes control based on 24-hours glucose profile. Staphylococcus and Escherichia coli culture occurred more frequently. The control group comprised of 60 pregnant women without diabetes mellitus-significant bacteriuria occurred in 15% and germ-free culture were observed in 43.4% of patients.