Search

Diabetic ketoacidosis (DKA) is one of the most serious and life-threatening complications of diabetes mellitus (DM), especially when it occurs during pregnancy, with a prevalence ranging from 0.5% to 3%. Pregnancy is considered a susceptible environment for the development of this type of metabolic imbalance due to its inherent physiological changes. Unspecific symptoms (vomiting, diarrhea, abdominal pain, etc.), especially in pregnant women, and the fact that ketoacidosis can develop even with normal glucose values (defined as euglycemic ketoacidosis), often lead to a delayed diagnosis. Evidence suggests that timely diagnosis and appropriate management of ketoacidosis are crucial in preventing adverse outcomes for both the mother and the fetus. Fetal outcomes are often dichotomous, resulting in either fetal demise (miscarriage/stillbirth) with a prevalence of 10% to 35%, or the birth of a healthy baby, with possible complications primarily related to diabetes mellitus itself. Additionally, case reports of ketoacidosis developing even in non-diabetic women due to other diseases (such as acute pancreatitis, appendicitis), as well as in those with gestational diabetes mellitus (GDM), further emphasize the importance of considering this condition in everyday clinical practice. The aim of this paper is to further elucidate the causes and course of this complication, as well as the outcomes for both mother and fetus, to contribute to a better overall understanding.

Pregnancies complicated with either pregestational or gestational diabetes mellitus deserve great attention due to their complexity and potential subsequent complications for both mother and the fetus. Based on already proven role of glycemic variability in the development of these, improving glucose monitoring continues to be an important step towards preventing adverse outcomes. Besides already well-established self-monitoring of glycemia, newer devices in the form of continuous glucose monitoring have found their place due to their proven preciseness and non-invasiveness. This paper has the aim to analyze results and conclusions of obtained, newer studies focused on these methods of glucose monitoring and to also give a closer insight of their usability and limitations.

It has been an entire century since the introduction of insulin into clinical practice, which, among other, led to improvements of fertility and pregnancy outcomes of women suffering from gestational diabetes. The prevalence of diabetes worldwide and in Serbia is high and tends to increase as a consequence of modern lifestyle. Nevertheless, modern diagnostic and therapeutic approaches enable people with diabetes to achieve and complete pregnancies without adverse outcomes. Gestational diabetes can be considered as non-communicable disease and efforts should be made to determine its effects on offspring. In the context of COVID-19 pandemic, diabetes mellitus was identified as an important risk factor for severe forms of the disease.

Metabolic changes occur due to the effects of placental hormones such as human chorionic gonadotropin and human placental lactogen in normal pregnancies. These effects enable the development of insulin resistance among all pregnant women, significantly pronounced in the third trimester. In pregnancies complicated by pre-gestational or gestational diabetes mellitus, these changes are more intensive as they affect the fetoplacental unit. In pregnancies complicated by diabetes the increased number of placental macrophages leads to the increased production of different cytokines which include leptin, tumor necrosis factor alpha, and interleukins. This review addresses placental vascular changes that lead to adverse pregnancy outcomes, along with the effects of the maternal hyperglycemia and fetal hyperinsulinemia.

In order to enhance cost-benefit value of the gestational diabetes mellitus screening (GDM) the concept of universal screening i.e., screening of all pregnant women for gestational diabetes, has mostly been abandoned in favor of the concept of selective screening. Selective screening implies that only women with risk factors are being screened for GDM. However, some recent studies have shown that with the application of the selective screening approach, some women with GDM may not receive proper and timely diagnosis. This review addresses the pros and cons of both concepts. It will also discuss screening methods and methods of preparation and performance of oral glucose tolerance test and the interpretation of its results.

Preconception and prenatal monitoring evaluate the condition of the mother's underlying disease and possible complications during pregnancy. Before conception, patients with diabetes should be informed that suboptimal glycoregulation is associated with reduced fertility and pregnancy losses. The task of the perinatologist in pregnancies affected by diabetes mellitus is to prevent complications of the underlying disease, such as hypoglycemic crises. Another important component of prenatal care in diabetic pregnancies is the recognition and prevention of pregnancy complications such as preeclampsia, polyhydramnios, congenital malformations, fetal macrosomia, and infections.

The nutritional needs of diabetic pregnancies are different from normal pregnancies. Differences in nutritional recommendations can also be seen between pregnant women who are using and who are not using insulin therapy. In this literature review, recommendations for different meal proportions of carbohydrates, proteins, and fats in the diets of pregnant women with diabetes mellitus are listed. Different meal plans were also addressed in this group of patients. The role of exercise in the management of diabetes in pregnancy is undeniable and different approaches found in the literature are presented.

Diabetes mellitus is a metabolic disorder that can occur before pregnancy, be detected during pregnancy, or develop during pregnancy. Therapeutic modalities available today significantly facilitate glycoregulation during pregnancy and childbirth. This review presents different insulin regimens, as well as the advantages and disadvantages of oral antidiabetic agents use with a special focus on hypoglycemia. The importance of maintaining optimal glycemic levels and educating patients in blood glucose self-measurement is explained.

Familial hypercholesterolemia, a genetic disorder marked by elevated low-density lipoprotein cholesterol (LDL-C), poses significant risks for premature atherosclerosis and cardiovascular diseases, particularly during pregnancy. One of the safe methods of treating this condition in pregnancy is with the use of LDL apheresis. We present a 38-year-old primigravida with homozygous Familial Hypercholesterolemia (HoFH), ischemic cardiomyopathy, and angina pectoris. Two years before conception, extremely elevated lipid levels prompted statin therapy and lifestyle changes. Stent placements followed acute myocardial infarction. When planning pregnancy, statins were discontinued, but lipid levels elevated. LDL apheresis was initiated, achieving a 60% reduction. Throughout pregnancy, 16 LDL apheresis sessions were performed every 14 days, maintaining optimal lipid profiles. A cesarean section was performed in the 38th week of gestation, delivering a healthy infant. The patient resumed statin therapy after 8 months of breastfeeding. The patient maintained cardiovascular health, demonstrating the feasibility of controlled HoFH pregnancies. This case highlights the successful management of HoFH during pregnancy using LDL apheresis, ensuring maternal and fetal well-being. Future research on novel treatments and their safety during pregnancy is essential for refining therapeutic approaches in similar cases. [ABSTRACT FROM AUTHOR]

Even though thrombophilias are associated with negative pregnancy outcomes (PO), there is not a consensus of when thrombophilias should be screened for, or how they affect placental vascularization during pregnancy. Therefore, the main aim of this study was to discover inherited thrombophilias (IHT) in the first trimester in women with otherwise no indications for thrombophilia screening, based on their vascularization parameters. LMWH treatment in improvement of placental vascularization and PO was also assessed. Finally, the classification of thrombophilias based on observed obstetric risks was proposed. Women were included in study based on their poor gestational sac and later utero-placental juncture vascularization signal and screening for inherited thrombophilias. LMWH were then initiated and Resistance index of Uterine artery (RIAU) was followed alongside PO (preterm birth, preeclampsia, placental abruption, intrauterine growth reduction). Study group consisted of women with combined inherited thrombophilias. Control group consisted of patients with inherited thrombophilias who have received LMWH therapy since pregnancy beginning. Out of 219 women, 93 had IHT, and 43 had combined IHT. All pregnancies both in both groups ended up with live births. Vaginal birth was more present in the control group (p <.001), and all women in study group delivered by CS. Premature birth was present in 8.4% of patients in control group, and in 32.55% of the patients in the study (p <.001). PE wasn't noted, and only 1 case of PA in control group. In the control group, 6.5% patients had IUGR, and 32.55% in the study group (p <.05). Based on RIAU and PO, thrombophilia categories were established: S (severe), MO (moderate), MI (mild) and L (low). Higher risk thrombophilias had higher RIAU later in the pregnancy, earlier pregnancy termination and Intrauterine Growth Reduction (IUGR). Thrombophilias should be considered and screened when poor vascularization is noted early in the pregnancy with Doppler sonography. Intervention with LMWH prevents adverse PO in these patients. [ABSTRACT FROM AUTHOR]

Letter to the Editor, in response to the paper "Reproductive health of Roma women in Slovakia", Cent Eur J Public Health 2020 28(2):143-148. [ABSTRACT FROM AUTHOR]