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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.

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.

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.

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.

Unlabelled: The aim of our study was the evaluation of the correlation between carbohydrate metabolism imbalance at the moment of gestational diabetes mellitus (GDM) diagnosis and regulation of glycemia during pregnancy, pregnancy complications, time and mode of delivery and conditions of the newborns., Material: 231 women with GDM delivered in our hospital between 1993-1996 were investigated. This population was divided into 6 groups, according to glycemia levels., Method: The term of diagnosis of the GDM, medical treatment (diet or diet and insulin), the degree of metabolic regulation archived, mode and time of delivery, as well as state of newborns were analysed., Results: In groups I and VI we noticed the greatest percentage of patients treated with insulin (68%, 67%), versus 26% in group II and 17% in group III. In group VI in all cases treated with insulin we begun this therapy shortly after marking GDM. Glycemia in 24 hrs period after GDM diagnosis in group I were 122.7 +/- 28.6 mg/dl, in group VI 112.0 +/- 23.6 mg/dl, while we noticed 90.3 +/- 15.6 mg/dl in group II and 87.7 +/- 15.9 mg/dl in group III. Blood glucose level < 100 mg/dl in first determination of 24 hrs profiles we noticed in 5% in group I, 2% in group VI while 20% in group II and 51% in group III. Average levels of glycemia in last 24 hrs profiles before delivery in group I were 93.0 +/- 15.8 mg/dl, in group VI 96.2 +/- 21.1 mg/dl while 87.8 +/- 13.5 mg/dl in group II and 86.8 +/- 14.1 mg/dl in group III. Blood glucose level < 100 mg/dl of daily profile before the end of pregnancy was discovered in 8% in group I, 47% in group III. The greatest amount of complications (pregnancy induced hypertension and imminent premature delivery) was diagnosed in group VI-75% and in group III-55%. Surgical delivery took place in group I in 50%, in group V in 46%, in group VI in 67% while 17% in group II, 35% in group III and 30% in group IV. Macrosomy of newborns (> 4000 g) was diagnosed in group I in 36% in group V in 23% and in group VI in 42% while 9%, 6% and 15% in groups, II, III and IV respectively. The condition of newborns in the 1st minute of life was determined as good (8-10 points in Apgar scale) in significant percentage, in 87%, 75%, 70% in groups II, III, IV while only 59%, 62%, 58% in groups I, V, VI respectively., Conclusion: Serious intensification of carbohydrates metabolism disorders at the moment of diagnosing GDM, such as fasting glycemia > 140 mg/dl and the result after 2 hours > 200 mg/dl in 75 g OGTT more often requires insulin treating connect with numerous difficulties both in pregnancy monitoring and also has inadventageous influence on obstetrics outcomes-increasing percentage of surgery deliveries and macrosomies, that change the condition of newborns for worse.

The efficiency of glycemia control was compared in two groups of insulin dependent diabetic pregnancies treated with insulin, with and without the aid of the Camit-Diacomp system. The efficiency of glycemia control was analysed in all three trimesters of pregnancy. Mean diurnal fluctuations of glycemia levels in both study groups were compared. The clinical state of newborns, their glycemia and insulin levels in cord blood were analysed as well. No statistically significant differences of glycemia levels between the two compared groups of patients were found, however the observed significant differences of the HbA1C levels between these groups can speak in favour of the efficiency of treatment under the Camit-Diacomp system, which enables a more precise self control of the treatment and dosage of insulin.

A pregnant woman with cerebral tumour of right hemisphere is reported. In the 30th week of pregnancy intracranial pressure was increased and imminent premature delivery were diagnosed. The patient was operated on for cerebral tumour and immediately after this cesarean section was performed. We conclude that in this case neurosurgical operation followed by cesarean section saved the life of the mother and child.

In the present paper we analysed 416 diabetic pregnant women, treated in the Intensive Care Clinic--Poznań, between 1988-93. We found in this period 8 (1.93%) stillbirth, 6 (1.44%) perinatal deaths and 4 (0.96%) deaths in neonatal period. It was together 18 fetal and neonatal deaths, which gives 4.33 per cent of perinatal and neonatal mortality rate. Four newborns died because of RDS, 2 with congenital anomalies (pulmonary hypoplasia), 3 with heart defects and 1 with oesophagus anomaly. Only 3 diabetic pregnant women of the total 18, were under special care from the I trimester, and almost all been difficult to normalize the glycemia. Only in 6 cases this group glycemia profile was below 100 mg/dl, in other 8 cases this value was above 120 mg/dl. Unsuccessful outcomes mostly occurred in women with long--lasting diabetes and with vascular complications. This study prove, that despite substantial reduction of perinatal mortality rate in children of diabetic mothers, diabetes still is a cause of congenital anomalies, as well as fetal anoxia. Special adverse impact of diabetes on the development of the fetus is observed in long--lasting diabetes and uncontrolled metabolism.