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OBJECTIVE: Our purpose was to determine the maternal blood glucose response to food throughout pregnancy. STUDY DESIGN: Forty-five normal, healthy primiparous women with singleton pregnancies were studied longitudinally throughout pregnancy. Blood glucose levels were determined at each stage of pregnancy after a standardized test meal. RESULTS: Fasting plasma glucose decreased throughout gestation and rose again significantly post partum. Glucose values at 30, 60, 90, and 120 minutes after a standardized test meal were similar at all gestational ages studied. CONCLUSIONS: Plasma glucose levels after a physiologic challenge with food do not alter with advancing gestation. This has implications both for the management of insulin-dependent diabetics during pregnancy and for the diagnosis of gestational diabetes.

OBJECTIVE: We characterized insulin secretion and glucose disposal in a large unselected group of women, encompassing the full spectrum of glucose tolerance in pregnancy, and related the findings to maternal obesity. STUDY DESIGN: Intravenous glucose tolerance and first-phase insulin response were measured at about 32 weeks' gestation in 690 unselected pregnancies. The women were designated as "lean," "normal," or "obese" on weight-for-height criteria. RESULTS: The distribution of insulin response was bimodal, but there was no corresponding dichotomy in maternal glucose disposal rate. Insulin response was greatest and glucose disposal rate slowest in obese women. In general, "poor" glucose tolerance was associated with relatively low insulin output. It was not possible to identify any cluster of women, obese or otherwise, in whom poor glucose tolerance was specifically associated with an unusually high insulin response. CONCLUSION: The data indicate that the distribution of glucose tolerance in pregnancy is a continuum. Glucose intolerance represents one end of that spectrum and is attributable to insufficient insulin secretion. This relative insufficency is most frequent with maternal obesity.

The clinical usefulness and limitations of the methods available for monitoring fetal well-being and assessing placental function in diabetic pregnancy are reviewed.

Summary The fasting plasma glucose and fasting plasma insulin levels of eight normal outpatient primigravidae have been studied over six successive days at 37 weeks' gestation. In addition, the fasting plasma glucose in six primigravidae, who were in-patients in a metabolic unit, has been measured on three successive days. It is concluded that while there is in general little day-to-day variation in both fasting plasma glucose and fasting plasma insulin, the plasma glucose was significantly elevated on the first day of the study.

A number of reports of the potential use of magnetic resonance imaging (MRI) for the examination of the human fetus have appeared in the literature over the past four years (Smith et al, 1983; Johnson et al, 1984; Smith et al, 1984; McCarthy et al, 1985; Smith, 1985; Smith et al, 1985; Starket al, 1985).Even though the method is considered to be safe for the examination of pregnancies in the second and third trimester (NRPB, 1983), it has not gained wide acceptance as a method for examining abnormal pregnancy. This may be duein part to a reticence in examining the fetus and in part to the fact that spin-echo pulse sequences do not show sufficient morphological detail in the fetus to be more useful than ultrasound (Weinreb et al, 1986). The use of longtime-torepeat(TR), 2–0 s spin-echo sequences has been advocated but these images are often degraded by fetal motion artefacts (McCarthy et al, 1985). The use of calculated T1 images for the display of fetal fat and fetal morphology has been reported (Smith et...

Pregnancy-associated plasma protein-A was assayed in the blood of 347 women during pregnancy, using a new primary standard of PAPP-A as reference. The protein was assayed by antibody-antigen crossed electrophoresis with the lower limit of confident assay being 9.5 micrograms PAPP-A/ml (13 pmol/ml). PAPP-A was first detected at 14 weeks of gestation; by term it had risen to within the range 20 to 320 micrograms/ml. There was an indication that pregnancies involving a male baby had higher PAPP-A levels in blood than did those involving female babies. In 51 blood samples from 30 patients with gestational diabetes (taken between 28 weeks of pregnancy and term) there was no significant alteration in PAPP-A values compared with controls. In 35 blood samples from 15 patients with insulin-dependent diabetes, levels of PAPP-A were significantly lower than in controls or in gestational diabetes. In 43 blood samples from 35 patients with babies affected with intrauterine growth retardation (between 28 weeks and term), there was no significant difference in PAPP-A levels compared with controls. The effect of insulin on the blood levels of PAPP-A suggests that the concentration of PAPP-A is capable of altering significantly in response to certain physiological changes associated with the control of carbohydrate metabolism.

A retrospective sample of 164 pregnancies in the years 1956 to 1975 of 78 insulin-dependent diabetic women was examined to assess the extent of the risk of clinically recognizable spontaneous abortion relative to the expected risk in a comparable population. This study was done before the implementation of the policy to establish good control of maternal diabetes before conception was attempted. After control of data for pregnancy number, maternal age, and epoch, the risk of spontaneous abortion among the diabetic women was almost double the estimate of the expected risk (p less than 0.001).

The prognosis in diabetic pregnancy has greatly improved as a result of patient education and the availability of home blood glucose monitoring techniques enabling the implementation of good metabolic control pre-pregnancy, antenatal and intrapartum. These in turn have made possible the benefits to the offspring of vaginal delivery at term. Screening for gestational diabetes is important and the prognosis is also good where maternal normoglycaemia is achieved. All diabetic pregnancies should be cared for in specialist units under the supervision of an integrated team comprising an obstetrician, diabetologist and paediatrician, and for optimal results care should start prior to conception.

Summary Serial plasma oestriol values were measured in nine insulin-dependent diabetics during pregnancy. While the plasma oestriol values wete lower than those in uncomplicated non-diabetic pregnancy the curves were of similar shape. It is suggested that serial plasma oestriol determinations in assessing feto-placental function in diabetic pregnancy should be interpreted with caution.

Summary Eleven normal pregnant women selected specifically to avoid the stigmata of potential diabetes, had serial, rapid 25 g. intravenous glucose tolerance tests done at 11 to 13, 25 to 27, and 37 to 39 week's gestation. The results expressed as increment indices and k values showed a significant decrease in glucose tolerance between the second and third trimesters. The difference in the increment indices, between the first and second trimesters was also significant There was no significant difference in the mean fasting venous plasma glucose levels between the three stages of pregnancy studied. It is concluded that intravenous glucose tolerance decreases with advancing gestation.

Summary Maternal serum PP5 concentrations were assayed in pregnancies complicated by intrauterine growth retardation, pre-eclampsia, diabetes mellitus, placental abruption and twins. Elevated PP5 levels were noted in twin pregnancies and to a lesser extent in diabetes and pre-eclampsia. Measurement of PP5 was of no value in the detection of fetal growth retardation. The great majority of PP5 levels above the normal range were associated with a placental abnormality.

One hundred twelve women with impaired glucose tolerance (IGT) diagnosed by intravenous glucose tolerance test (IVGTT) after pregnancy were followed up for a period of up to 22 yr (mean 12.9 yr). About one-third have been treated with chlorpropamide and the others by diet only. At the final assessment, approximately 35% had abnormal intravenous glucose tolerance and less than 7% overt diabetes. Chlorpropamide did not prove significantly more effective than diet only. Factors associated with deterioration in glucose tolerance were age at diagnosis and follow-up and the initial fasting plasma glucose (FPG) level (greater than or equal to 5.8 mM), but obesity was less important, although it was associated with an increased rate of vascular complications. Tests for islet cell antibodies (ICA) were weakly positive in 12.5% of 72 subjects and in only 0.5% of an unselected population; they did not correlate with the final state of glucose tolerance. Only three patients developed insulin-dependent diabetes (IDDM) and did so before the ICA study was started. A comparison is made between the results reported by O'Sullivan in patients diagnosed as having gestational diabetes, only 2% of whom still had abnormal oral glucose tolerance postpartum, and the results of our patients, all of whom had IGT after pregnancy. In spite of differences of technique and in the populations studied, the prevalence of IGT and overt diabetes at follow-up was significantly less in the Aberdeen series, who were initially a higher risk group. It seems probable that this is mainly attributable to dietary treatment in the follow-up period as O'Sullivan's cases were treated only during pregnancy.

Summary No significant difference was found in intravenous glucose tolerance between 95 women who had had proteinuric pre-eclampsia more than 10 years previously and a control group of 58 women with no history of pre-eclampsia. Obesity, defined as above standard weight for height, was more common in the pre-eclamptic group than in the control group but the difference was not significant.

The intravenous glucose tolerance test (I.V.G.T.T.) was used to diagnose chemical diabetes during pregnancy in 180 women, 50 of whom subsequently received chlorpropamide therapy in a daily dosage of 100 mg; the remainder had no drug therapy.Preliminary work showed the I.V.G.T.T. to be reproducible in the second and third trimesters but not in the puerperium in normal pregnancy. Though intravenous glucose tolerance deteriorates between the second and third trimesters in women with no features of diabetes, a significant improvement occurs after a course of chlorpropamide in a daily dosage of 100 mg during pregnancy in chemical diabetes, but this treatment did not enhance the rate of return to normal glucose tolerance post partum.Plasma glucose and insulin studies showed no evidence of hypoglycaemia or hyperinsulinism in the mother at delivery or in the newborn when chlorpropamide had been used compared with a group receiving no such treatment. In the infants of the chlorpropamide-treated mothers there was a suggestion of an increased rate of glucose disposal in response to a glucose challenge, but no increase in birth weight.There were two fetal deaths in the 50 pregnancies of mothers treated with chlorpropamide, one being due to a mistaken premature delivery and the other to a diaphragmatic hernia. Thus chlorpropamide in a dose of 100 mg a day has been shown to reverse chemical diabetes diagnosed and treated in pregnancy without apparent risk to the fetus.

Concerning hypertrichosis pinnae in babies of diabetic mothers, Rafaat1 is by no means the first to observe this phenomenon. We have long used this sign in assessing infants of diabetic mothers.2 It was first described by Akerren3 and later emphasized by Eklund et al.4