Glucose metabolism assessment in pregnancy

Effect of maternal dexamethasone and alpha-ketoglutarate administration on skeletal development during the last three weeks of prenatal life in pigs

BACKGROUND

The effect of dexamethasone (Dex) on postnatal bone formation processes is known to decrease the synthesis of collagen and bone matrix, but the effect of alpha-ketoglutarate (AKG) is to induce positive effects on growth and skeletal development during postnatal life. However, the effects of Dex and AKG treatment on the prenatal processes of skeletal development have not been investigated so far.

OBJECTIVE

The aim of this study was to determine the effect of Dex and AKG administered separately or simultaneously to sows during the last three weeks of pregnancy on the skeletal development in fetuses.

METHODS

Immediately after birth blood samples were collected from non-suckling piglets for alkaline phosphatase and osteocalcin determinations, and the humeri were isolated. Bone mineral density (BMD) and bone mineral content (BMC) of humeri and the geometric and mechanical properties were evaluated.

RESULTS

Dex and AKG administered separately to pregnant sows during the last 24 days of prenatal life decreased BMD, BMC, and geometric and mechanical parameters of humeri in the newborns. Simultaneous administration of Dex and AKG significantly increased the analyzed properties of humeri.

CONCLUSION

The bone mineral density and mechanical and geometric properties of humeri indicate an inverse effect of maternal separate or simultaneous administration of AKG and Dex to sows on bone development during the last 24 days of prenatal life.

Associação glicemia de jejum e fatores de risco como teste para rastreamento do diabete gestacional

OBJETIVOS: comparar dois testes de rastreamento do diabete gestacional. MÉTODOS: estudo prospectivo no qual foram avaliadas 356 gestantes, sem diagnóstico prévio do diabete melito, submetidas, de modo independente, a dois testes de rastreamento: associação glicemia de jejum e fator de risco (GJ+FR) e teste oral simplificado de tolerância à glicose (TTG50g). A comparação entre os métodos foi realizada pelos índices de sensibilidade (S), especificidade (E) e valores preditivos positivo (VPP) e negativo (VPN), resultados falsos, positivos (FP) e negativos (FN) e pela diferença dos resultados observados e esperados, avaliada pelo teste do Qui-quadrado (p<0,05). RESULTADOS: a associação GJ+FR determinou a confirmação diagnóstica em maior número de gestantes (187; 52,5%) que o TTG50g (49; 13,8%). Esta diferença foi significativa (p<0,05). A associação GJ+FR apresentou sensibilidade de 83,7% e valor preditivo negativo (VPN) de 95,3% em relação ao TTG50g. CONCLUSÕES: os índices elevados de sensibilidade e VPN da associação GJ+FR em relação ao TTG50g, sua simplicidade, praticidade, baixo custo e fácil replicação permitem sua indicação no rastreamento do diabete gestacional.

Pregnant women with impaired tolerance to an oral glucose load in the afternoon: evidence suggesting that they behave metabolically as patients with gestational diabetes

OBJECTIVE

In previous studies we observed the existence of a circadian variation of the blood glucose response to oral glucose in pregnant women with higher values at 4 PM. Some women with increased risk of diabetes with normal oral glucose tolerance tests at 8 AM also had values above maximum normal levels at 4 PM. The aim of this trial was to determine the clinical significance of this impaired tolerance in the afternoon.

STUDY DESIGN

Seventy-seven pregnant women with normal risk of diabetes (65 of normal weight and 12 overweight), 75 with increased risk of diabetes (26 overweight), and 12 patients with gestational diabetes were incorporated in the study. All women underwent two oral glucose tolerance tests (1.5 gm/kg) at 31 to 32 weeks' gestation at 8 AM and 4 PM with a 1-week interval. At 33 weeks' gestation a whole-day blood glucose profile was performed with usual food intake; samples were withdrawn before each meal and at 30, 60, and 120 minutes after each meal. The weight of the newborns was recorded.

RESULTS

(1) Results of oral glucose tolerance tests confirmed a circadian variation of the response in all groups; (2) 37 women with increased risk of diabetes had higher values after oral glucose tolerance testing than the normal threshold at 4 PM but not at 8 AM; (3) among women with normal risk of diabetes all values were within the normal range despite the circadian variation; (4) blood glucose levels during whole-day profiles were normal in women with normal risk of diabetes and with increased risk of diabetes with normal oral glucose tolerance testing at 4 PM, whereas all women with increased risk of diabetes and impaired tolerance in the afternoon showed hyperglycemic episodes; (5) the percentage of newborns with high weight (>90th percentile) among women with increased risk of diabetes and abnormal oral glucose tolerance tests at 4 PM was similar to the percentage found in women with gestational diabetes and much higher than the one observed in women with normal oral glucose tolerance tests in the afternoon.

CONCLUSIONS

The impairment of the response to oral glucose tolerance testing seen in some patients with increased risk of diabetes at 4 PM but not at 8 AM seems of clinical significance in view of the abnormal whole-day blood glucose profile these women had and the weights of the newborns.