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Background and Objective: Preconception care has been shown to decrease the risk of pregnancy-related complications in women with diabetes, but many women do not plan their pregnancies. Our aim was to identify the associated factors and barriers related to involvement of these women in preconception care., Material and Methods: Fifty women with pregestational diabetes (28 with type 1 diabetes) and 50 non-diabetic pregnant women were consecutively enrolled at our hospital. They completed a questionnaire, and their medical histories were reviewed., Results: All 33 patients with diabetes who received preconception care had a similar current age (34.3±5.3 years) and age at diagnosis (20.3±11.3) than those with no preconception care (n=17) (31.8±5.3 and 19.1±10.6 years respectively; P>.1), but were more frequently living with their partners (97% vs. 70.6%; P=.014), employed (69.7% vs. 29.4%; P=.047), and monitored by an endocrinologist (80.6% vs. 50%; P=.034), had more commonly had previous miscarriages (78.6% vs. 10%; P=.001), and knew the impact of diabetes on pregnancy (87.5% vs. 58.8%; P=.029). The frequency of preconceptional folic acid intake was similar in pregnant women with and without diabetes (23.8% vs. 32%; P>.1)., Conclusions: Preconception care of diabetic patients is associated to living with a partner, being employed, knowing the risks of pregnancy-related complications, having previous miscarriages, and being monitored by an endocrinologist. Pregnancy planning is infrequent in both women with and without diabetes., (Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: to assessed the prevalence of diabetes mellitus (DM) and drug abuse in mothers of children with orofacial clefts (OFC)., Methods: 325 women who had children (0-3y) with clefts were interviewed. Data regarding type of diabetes, use of legal/illegal drugs during pregnancy, waist girth and fasting blood sugar at the first prenatal consult were collected., Results: twenty seven percent of the women had DM, out of these, 89% had gestational DM, 5,5% type 1 DM and 5,5% type 2 DM. The prevalence of DM in mothers of children with OFC was 27%, it is significantly higher than the average Brazilian population which is 7.6% (p<0.01) (OR=4.5, 95%CI=3.5-5.8). Regarding drug abuse during pregnancy, 32% of the mothers used drugs and a significant positive correlation was observed between drug abuse and the occurrence of clefts and other craniofacial anomalies (p=0.028) (OR=2.87; 95%CI=1.1-7.4)., Conclusions: DM and drug abuse during pregnancy increases the risk for OFC and related anomalies and early diagnosis of DM and prevention of drug abuse, especially in pregnant women, should be emphasized.

Haemodynamic changes that occur during pregnancy are maximal between 28 and 34 weeks. In the pregnant woman with several associated diseases, such as hypertensive myocardiopathy and pre-gestational diabetes, these changes can lead to a difficult control of pulmonary hypertension and acute pulmonary oedema. We report the case of a pregnant woman with long term type 1 diabetes mellitus who suffered pre-eclampsia in a previous pregnancy, and since then developed hypertensive cardiomyopathy. She was admitted at 30 week gestation for metabolic and blood pressure control, and developed congestive cardiac failure after the administration of betamethasone for foetal lung maturity. A transthoracic echocardiogram showed a non-dilated hypertrophic left ventricle with good systolic function, restrictive diastolic dysfunction and moderate pulmonary arterial hypertension. When her general condition improved, we performed a caesarean section under regional anaesthesia to prevent the complications of pulmonary and systemic hypertension. We present the anaesthetic management and resolution of complications after oxytocin administration., (Copyright © 2011 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España, S.L. All rights reserved.)

The congenital malformations in the off spring of diabetic mothers are the result of a multifactorial process. Susceptibility to the effects of maternal diabetes in the pathogenesis of these anomalies is influenced by the genetic background, indicating that there are polymorphic genes that modify the cellular response to hyperglycemia. The modifier genes for the teratogenic effect of maternal diabetes are yet unknown. An excessive glucose supply to embryonic tissues leads to a state of oxidative stress, which affects the expression of genes encoding scavenging enzymes such as super oxide dismutase (SOD) and catastases and activates development genes such as PAX3, involved in neural tube defects. Cell proliferation and cell death are important mechanisms underlying malformations in infants born to diabetic mothers. There is an increase of apoptotic Bax and caspase-3 proteins and a low expression of Bcl-Z ant apoptotic protein in embryos exposed to a diabetic environment. Hyperglycemia decreases intracellular levels of reduced GSH, prostaglandin EZ (PGEZ) and DNA synthesis in embryo's tissues. Understanding the molecular pathogenesis of diabetic embryopathy will allow the use of effective therapies for the prevention of teratogenic effects in diabetic mothers.

Background: Relation between gestational diabetes mellitus and pregnancy-induced hypertension increases significantly the maternal and perinatal morbidity and mortality risk., Objective: The purpose of this study was to investigate the risk factors for pregnancy-induced hypertension in women with gestational diabetes mellitus., Material and Methods: In this case-control study, were compared a total of 90 women with gestational diabetes mellitus according to absence (controls, n = 60) or presence (cases, n = 30) of pregnancy-induced hypertension in terms of demographic data, previous reproductive history, maternal and neonatal characteristics. Odds ratios and 95 percent confidence intervals were calculated to estimate the effects of individual factors on the risk of pregnancy-induced hypertension., Results: In our study, the body mass index in cases was greater than controls (35.70 +/- 8.7 vs. 31.17 +/- 5.2). In addition, pregnancy-induced hypertension in a previous pregnancy was the only factor associated with an increased risk of recurrent hypertension (OR = 4.52, IC95%: 1.02-20.03)., Conclusions: Women with gestational diabetes mellitus and pregnancy-induced hypertension in a previous pregnancy require more surveillance for to prevent or achieve an early diagnosis and treatment of hypertension, and if the woman is overweight, she should be offered advice on life style adjustment for to avoid maternal and perinatal complications.

Pre-eclampsia is a serious obstetric complication associated with a high rate of maternal and fetal morbidity and mortality. We report the case of a woman with a medical history of insulin-dependent diabetes mellitus and seizures possibly related to hypoglycemia who was admitted for an emergency cesarian due to severe pre-eclampsia and macrosomic fetus. In the first hour after delivery she experienced loss of consciousness and seizure, with vaginal bleeding and hypovolemic shock. Maximum vigilance is required for a patient with several concomitant diseases and a high-risk pregnancy. All prophylactic measures to lower the risk to mother and fetus should be undertaken. We analyze preanesthetic assessment, differential diagnosis, and choice of anesthesia in relation to this case.

Background: Pregnancy-associated diabetes mellitus poses a risk of fetal growth alterations. Fetal abdominal perimeter can be predictive of weight in full-term fetuses with normal growth, along with biparietal diameter, cephalic circumference, abdominal circumference and length of femur., Objective: To estimate fetal weight through set parameters., Patients and Methods: A descriptive correlational research was done, with study of the biometric parameters of fetal weight estimation during the third trimester of gestation of 59 diabetic pregnant patients, who were studied in the University of Carabobo's Diabetes and Pregnancy Unit and Perinatology Unit at the Enrique Tejera Hospital City in Valencia, Venezuela, 2004., Results: Sixty-four percent had gestational diabetes mellitus, 24% diabetes mellitus type 2, and 12% diabetes mellitus type 1. Serial ultrasound scans were performed on 33 women during the three trimesters of pregnancy, and to 16, it was performed another ultrasound scan one week prior to delivery or cesarean section, for fetal weight estimation. Gestation mean time was 37.5 +/- 0.51 weeks. Average estimated fetal weight was 3555.87 +/- 455.41 g. Kolmogorov-Smirnov normalcy tests: 0.200 (estimated fetal weight), 0.116 (birth weight), 0.000 (assessment week). T test: -0.506 Sig: 0.620 p > 0.05. Estimated fetal weight/birth-weight correlation: Pearson: 0.749 Sig. 0.001 < 0.005, r: 0.749, r2:0.561, F: 17.870 Sig: 0.001 < 0.05, thus demonstrating that correlation does exist. Prediction: newborn weight: 95.2 +/- 0.987 (estimated weight)., Conclusion: Estimated fetal weight at the end of the third trimester constitutes a good predictive parameter of fetal weight in newborn of diabetic mothers.

Background: Fetal heart diseases are increasingly frequent. These are part of birth defects and, therefore, appear in early phases of the gestation. Diagnosis or early detection of functional and structural abnormalities of the heart allows to the obstetrician and the pediatric cardiologist to plan, in a timely manner, the treatment and prenatal and postnatal monitoring with the purpose of preventing complications., Objective: To determine the types and frequencies of heart diseases in pregnancies with high-risk factors., Patients and Method: It was analized an observational, descriptive and retrospective series of cases. From January 2003 to June 2006, fetal echocardiograms were made in women with pregnancies longer than 15 weeks and with high-risk factors. At childbirth was made a cardiovascular evaluation. Analysis was carried out through descriptive statistics., Results: maternal age average was of 27.3 +/- 6.8 years; gestational age was of 31 +/- 5 weeks. In total, there were carried out 275 fetal echocardiograms (FE) in 208 patients; in 56 of them, was made one fetal ecocardiogram, two in 37 and three in 15. Risk factors of reference to the specialized medical unit were: abnormalities detected through obstetrical ultrasound (35.1%), tachycardia-bradycardia-arrhythmia (29.8%), probable chromosomic anomalies (13.9%), oligohydramnios or polyhydramnios (4.8%), familiar antecedents of congenital heart diseases (3.8%), others (12.6%). Heart disease was diagnosed by fetal echocardiogram in 55 patient (26.4%): unique ventricle (n = 5), hypoplastic right ventricle (n = 3), hypoplastic left ventricle (n = 4), congenital complete heart block (n = 1), Ebstein and dysplasia of the mitral and tricuspid valves (n = 12), tumor (n = 5), ectopia cordis (n = 2), auriculoventricular channel (= 1), supraventricular tachycardia (n = 4), supraventricular extrasystole (n = 3) and other. Diagnosis was confirmed at childbirth in 99.5% of the cases. The treatment was initiated in uterus for arrhythmia and cardiac insufficiency in 19 patients. The patients with high-risk cardiopathy (at birth) were evaluated at beginning through specialized cardiological treatment and then they were transferred to the service of pediatric cardiology., Conclusions: Frequency of fetal heart diseases in patients with high-risk factors is of 25.4%. In these patients, the fetal echocardiogram (prenatal and postnatal) allows planning the optimal cardiological and obstetric treatment as well as to inform to the relatives.

Neonatal hypoglycemia is a frequent event in the first hours of life of newborns from mothers with diabetes mellitus. We studied a group of diabetic mothers newborns during the first day of life, taking venous blood samples at < 6 h, 6-12 h and 12-24 h of life for glucose analysis (n = 85), defining hypoglycaemia as a glucose level < 35 mg/dL. Calcium serum levels were also determined in the first venous sample in 19 neonates and 7 mEq/L was the criteria for hypocalcemia. The mothers age (mean +/- standard deviation) was 30.5 +/- 5.5 years (range 16-41 years), 43 (50.6%) of them with gestational diabetes, 40 (47.1%) with type 2 diabetes and 2 (2.4%) with type 1 diabetes. Pregnancies ended by caesarean section in 78 (91.8%) and by partum in seven (8.2%) women. There were 20 (23.5%) preterm newborns. In relation to neonates weight, 27 (31.7%) were macrosomic and 7 (8.2%) were premature, two of them with very low weight. A total of 55 (64.77%) newborns had hypoglycaemia, but only one of them had a convulsive episode, the rest were asymptomatic. In relation to the newborns weight, 18 (66.6%) of the macrosomic, 33 (64.7%) of the normal weight and four (57.1%) of the premature groups had hypoglycaemia. The comparisons between the newborns weight groups showed non significant differences, but the prevalence of neonatal hypoglycaemia was significantly higher in the group of gestational diabetes than in the type 2 diabetes group (p < 0.05). Calcium analysis also disclosed asymptomatic hypocalcemia in five (7.25%) newborns. These results show an elevated prevalence of asymptomatic neonatal hypoglycaemia in the offspring of women with diabetes mellitus in their early hours of life, and stress the importance of systematic glucose monitoring and early treatment in the first hours of life of these neonates.

Diabetes is a genetically determined metabolic disease with fasting hyperglycemia due to relative or absolute absence of insulin. With the use of exogenous insulin, successful gestations are now possible. Nevertheless, there are still severe problems associated, such as spontaneous abortion, perinatal mortality and congenital malformations. Caudal regression syndrome, disclosure of the neural tube and cardiovascular alterations are the most common malformations. Gestational diabetes can induce increased fetal corporal fat and macrosomia with hyperinsulinemia, hypoglycemic, hypoxia, metabolic acidosis and perinatal death. During adult life, diabetic mothers' children can develop obesity, glucose intolerance and type 2 diabetes. In order to study fetuses' alterations during diabetic gestations we now have animal models of diabetes. Maternal diabetes in rats alters fetal development in a very similar manner to that of humans. Although we do not accurately know the pathogenic mechanism by which diabetes produces fetuses' abnormal development, hyperglycemia and hyperketonemia had been mentioned to have predominant roles. Hyperglycemia damages DNA and increases oxidative stress and hyperketonemia increases the rate of embryo malformations. The addition of antioxidants such as C and E vitamins can reduce this damage. During adult life, diabetic rats' cubs have alterations in glucose metabolism and in reproductive function. The understanding of mechanisms by which maternal diabetes affects fetuses development, can help us to prevent complications and improve mothers' and children's life quality.

Background: The risk of congenital malformations is two to three times higher among women with diabetes mellitus before pregnancy. Gestational diabetes is emerging as a risk factor for malformations., Aim: To study the rate and type of congenital malformations among offspring of women with pre-gestational or gestational diabetes., Material and Methods: A search in the databases of the Collaborative Latin American Study for Congenital Malformations and of the Neonatology Unity of The University of Chile Clinical Hospital. All births from January 1998 through June 2004 were investigated., Results: In the study period, 13,965 births occurred, of which 0.7% were stillbirths and 8.1% had malformations. A total of 295 women (2.1%) had diabetes (gestational diabetes in 1.8% and pre gestational diabetes in 0.3%). The prevalence of congenital malformations was 14% and 18.3% among offspring of mothers with pre-gestational and gestational diabetes, respectively (p=NS). The prevalence of congenital malformations among offspring of non diabetic women was 7.9% (p <0.001 with respect to diabetic women). Major malformations were found in 83% and 70% of malformed offspring of women with pre-gestational and gestational diabetes, respectively., Conclusions: Pregnant women with pre-existing or gestational diabetes have a higher risk of giving birth a child with malformations.

Hypoglucemia, or decrease in normal blood glucose concentration, is an important sequel of tight control of type 1 diabetic patients. In pregnant diabetic women, hypoclycemia does not appears affect the embryo or fetal development; while in rodent, it is an important cause of teratogenesis and/or embryotoxicity, when it is presented during organogenesis. Despite metabolic, endocrine and temporal differences between human and rodent pregnancy, a possible damage to the product, caused by hypoblycemia during pregnancy in human, must be considered.

Objective: A descriptive study of an infant of a diabetic mother was carried out in order to analyze if macrosomia (weight greater than P90 for gestational age) is a good criteria in order to predict associated complications., Patients and Methods: A total of 382 diabetic mothers were attended between January 1994 and December 1996., Results: Most of the complications were similar to those reported in the literature. In infants of diabetic mothers there is a significant increase in malformations (7.1%), sepsis (10.7%), hypertrophic cardiomyopathy (12.1%), respiratory distress (12.7%), hypoglycemia (50%), polyglobulia (30.4%) and jaundice (7.1%). We did not find any differences for traumatisms (8.25%), acute fetal suffering (19.6%) or hypocalcemia (1.8%). Respiratory distress was related to gestational age., Conclusions: The high weight for gestational age is a good parameter to predict complications in the infants of diabetic mothers.

The Diabetes Mellitus is the pathology that frequently is associated to the pregnancy and it is responsible for perinatal mobility specially by the respiratory distress syndrome since exists delay in the conversion of myoinositol-phosphatidyl inositol-phosphatidyl glycerol. To demonstrate the reliability of the DO tho 650 nm with standard of 20 in the determination of fetal lung maturity of the infant of diabetic mother. There were included 143 patient with pregnancy > or = 37 weeks with amenorrhea reliable and gestational age confirmed by ultrasound, of those 94 corresponded to gestational Diabetes Mellitus, 49 to pregestational (46 non insulin-dependent and 3 insulin-dependent). In all of them amniotic fluid studies was perform at 37 week and the resolution of the pregnancy was when DO to 650 nm showed fetal lung maturity. It was found a correlation among the DO to 650 nm of 20 and absence of RDS in 130 cases (true positive); there were seven cases with immaturity results by DO that they did not express RDS (false negative) and six cases with results that showed immaturity by DO and there were manifestations of RDS (true negative). We did not find results of false positive. The frequency of RDS was of 4.9% with a positive predictive value of the 100% an negative predictive value of 46%, a specificity of 100% and a sensitivity of 94%. An interesting finding was the fact that six cases true negative cases had poor maternal metabolic control of different degrees. For our results can be deduced that DO to 650 nm with standard of .20 it is reliable for the diagnosis of fetal lung maturity in the pregnancies complicated with Diabetes Mellitus, in addition to be an easy elaboration test and low cost.

Based on animals and human studies on the safety of exercise in pregnancy as well as on their results on the disminution of the perinatal morbidity and mortality, the Second International Workshop-Conference on Gestational Diabetes Mellitus (1985) endorsed the concept that pregnant diabetic women with an active lifestyle may continue a program of moderate exercise under medical supervision. The purpose of this review is to establish the principal aspects of the physical exercise prescription for to get their better benefits. Before starting an exercise program all patients should have a complete history and physical examination, with particular attention to identifying the physical health, chronological and gestational ages, type of diabetes mellitus, diabetic control and presence of any long term complications of diabetes, because the all of them depend the type, duration, intensity and frequency of the exercise, as well as, to avoid any risk.

In 1991 the prevalence of diabetes was 7.6% in women in nine Brazilian state capitals. This disease now ranks among the leading causes of death in the country and is becoming an increasingly alarming public health problem. In spite of advances in the treatment of diabetes and improved obstetric care, gestational diabetes puts a pregnant woman at high risk of spontaneous abortion, ketoacidosis, hypoglycemia, hypertension, and other serious disorders. This study used life histories to investigate the relationship between health, sexuality, and work in five working women who were diabetic and pregnant and who received care at the Prenatal Care Outpatient Clinic of the San Pablo Hospital. All these women had non-insulin-dependent diabetes mellitus, were between 26 and 43 years old, and earned from US$ 150 to 375 per month for working 8-hours days, with one day off each week. Two of the women's male partners were unemployed; all of the women performed household chores during their day off. Quotations taken directly from conversations with the five participants reveal: the difficulty of caring for children and working; the sexual harassment that some of them suffered; the conflict and dissatisfaction associated with work; the myth of the natural joy of motherhood; the sexual control exercised by males; the interference of working conditions and work activities with pregnancy; and the perception that they did not have legal protection owing to employers' lack of respect for workers' rights and for the maternity protection provisions of the Federal Constitutional of Brazil. It is concluded that health policies should pay greater attention to improving the quality of life of working women, especially if they suffer from diabetes and are pregnant.

Objective: To determine the difference in the prevalence of dental caries, gingivitis, and periodontal disease among non-diabetic, type-II diabetic and pregnant diabetic women., Material and Methods: In the period from June 1993 to January 1994, a cross-sectional study was carried out at the Instituto Nacional de Perinatología among 160 pregnant women; eighty non-diabetic women were included in the control group, while 40 type-II diabetic and 40 gestational diabetic women conformed the study group. In each patient the following variables were recorded: age, week of pregnancy, the Simplified Oral Hygiene Index, the Decayed, Missing and Filled Teeth Index, the Gingival Index, and the Extent and Severity Index. Statistical analysis was carried out using Analysis of Variance and the Multiple Range Test, with a 95% confidence internal., Results: All of the groups had similar prevalences of dental caries (100%). Type-II diabetic women showed a higher prevalence of gingivitis (42.5%) than non-diabetic (36.25%) and gestational diabetic (10%) women, but the differences were not statistically significant between the non-diabetic and type-II diabetic women. Type-II diabetic women had a statistically significant higher prevalence of periodontal disease (12.5%) than the women in the other groups., Conclusions: It is very important to establish proper metabolic control and a fitting oral hygiene in pregnant diabetic women, since type-II diabetes was shown to be associated with a higher prevalence of periodontal disease. Besides, gestational diabetes is likely to pose a high risk of periodontal disease in the absence of preventive measures.

The incidence of macrosomic newborns and fetal death and its possible relation to maternal diabetes mellitus (DM) was registered during six months at the Hospital de Ginecoobstetricia "Dr. I. Morones", IMSS. Both criteria for macrosomia 4,000 g and 4,500 g, were taken for data collection. We had a total of 15,217 newborns, of these, 872 (5.73%), weighed > 4,000 g, and there were 42 mothers with DM, 4.2% of the group. Taking 4,500 g as criteria for macrosomia, there were 105 newborns (0.69%) of the total and there were 8 mothers with DM, 7.6%. 501 of the pregnancies finished by cesarean section and 337 by delivery. There were 151 fetal deaths, 9.9 for 1,000 newborns, eight fetuses had a weight over 4,000 g, and two mothers had DM. It is concluded that maternal diabetes mellitus occurred in less than 5% of the mothers with macrosomic newborns (> 4,000 g). The incidence of macrosomia is lower than in European populations. Fetal deaths were higher than expected because this hospital concentrates patients with obstetrical complications.

The purpose of this study was to investigate the perinatal morbidity and mortality in all the diabetic pregnancies seen at the HGO-"LCA" from January 1992 to December 1993. In that period 186 women (mean age 31 yr) were diagnosed as having diabetes during pregnancy: 54% of them had DMG, 40% DM-II and 6% DM-I, with serum glucose concentration of 133 +/- 41 mg/dL. Neonatal morbidity was given by macrosomia (17%), prematurity (14%), hyperbilirubinemia (11%), hypoglycemia (8%), congenital malformation (6%) and hypocalcemia (4%). Perinatal mortality was 5.3%. The principal causes of maternal morbidity were preeclampsia (17%), polyhydramnios (16%), pyelonephritis (4%) and ketoacidosis (0.05%). Cesarean section was performed in 62% of all diabetic patients. There was not any maternal death. This results showed a high perinatal morbidity-mortality in pregnancies complicated by diabetes mellitus which reclaim a better metabolic control during gestation period.

Respiratory distress syndrome is a common morbidity in a infants of diabetic mother however there is a controversy in the literature about apparition of lung maturity in this infants. However this reports have not got a control group. Lung maturity tests were prospectively studied, obtained by amniocentesis at 37 weeks of gestation, in 47 patients: twenty diabetics (studied group) and 27 healthy pregnant women (control group). All the pregnancies were solved by cesarean section. The values of lung maturity tests were related to presence of respiratory morbidity in neonates (respiratory distress syndrome: RDS). Five of 49 infants had some kind of respiratory morbidity. The incidence of RDS was 10.2%. Four of 5 infants with RDS belonged to the diabetic group, which gives us an incidence of 20% versus only one of the 29 healthy infants (3.7%). This difference is statistically significant, p < 0.0001. Four infants had false positive lung maturity tests (Od, L/S), three of them (two with severe metabolic meladjustment) occurred in the study group, with alteration of L/S ratio (3/20 = 15%). There was no false positive in PG (specificity 100%) in both group. The 3 lung maturity tests had a specificity of a hundred per cent in the control group). This study shows that the presence of PG in amniotic fluid of diabetic pregnant women confirms maturity with a very low risk to develop RDS. Finally, when the metabolic control of the diabetic is not appropriate, the L/S ratio may give false positive results in 15% of cases, which is quite important.

Pregnancy and diabetes mellitus have been associated to a high incidence of neonatal morbidity and mortality. The purpose of the present study was to determinate the incidence of macrosomia, congenital malformations and their effect in the neonatal period. We review 42 live infants of insulin dependent diabetic mothers (IDDM) in a third level center. The variables analyzed were: severity of maternal diabetes, sex, weight, gestational age, trophism, Apgar score at one minute, mode of delivery, presence of congenital malformations, morbidity and mortality. The population was divided in three groups: 1. Neonates with appropriate for gestational age (AGA), 2. Large for gestational age (LGA), and 3. Small for gestational age (SGA). According to trophism, 27 (64%) were AGA, eleven (26%) were LGA and four (9%) were SGA. About morbidity, hypoglycemia was more frequent in the LGA. The group of SGA had lower Apgar score at one minute compared with the AGA. There were congenital malformations in seven neonates and being more frequent in the SGA group. The proportion of major malformation was of 4.7%. Fetal hyperinsulinemia is responsible for the morbidity of IDDM, being necessary adequate metabolic control of the mothers before pregnancy and the management of diabetes and pregnancy should be done in a center with experience.

We report the pregnancy of a 35 year old diabetic woman with a positive Australia antigen, 3 years after a successful cadaver kidney transplant. Immunosuppressive therapy with prednisone, azathioprine and cyclosporine was maintained. Pregnancy was complicated by an acute rejection episode on week 13, mild hypertension and intrahepatic cholestasis on week 22. Cesarean section and tubal ligation were performed at 32 and a half weeks. A 2020 g female infant was delivered, with Apgar scores of 8 and 9 at 1 and 5 min, respectively. Mild respiratory distress, jaundice and hypocalcemia were noted. The Australia antigen was negative. No fetal anomalies were detected. The high risk of pregnancy in a class T diabetic patient is confirmed in this case.

Some features as well as pathological findings in 63 infants born to diabetic mothers (IDM) under control in a diabetes unit of a general hospital at metropolitan Santiago, Chile, from 1985 through 1988 are presented. Out of 63 newborns, 22 came from mothers with pregestational diabetes mellitus (PGDM) and 41 were born to mothers with gestational diabetes mellitus (GDM). Significant differences were detected among PGDM and GDM groups of newborns in the following features: mean gestational age (GE) premature (54.5% vs. 26.8% 37 weeks GE or less), jaundice (40.9% vs. 17.1%) and congenital malformations (18.2% vs. 0%). No significant differences were found in fetal distress, hypoglycemia, respiratory distress syndrome and birth trauma although as a whole these last were more frequently recorded among infant born to insulin dependent diabetic mothers. It is concluded that in spite of an appropriate control, morbidity remains higher in IDM, particularly in IDM PGDM.

With the purpose of know the behaviour of the thromboplastic acceleration time in amniotic fluid, there were analized 390 amniotic fluids, 241 from normal pregnancies and 149 from abnormal pregnancies, of these, 52 from diabetic women, and 97 from hypertensive women. It was found an important increase in T.A.T. with the progress of pregnancy and their usefulness as fetal lung maturity test. It was concluded, that this method is easy, cheap, and highly specific, so it can be the first election test for determination of fetal lung maturity in low resources Obstetric Centers.

One case of renal venous thrombosis in a male foetus, born of a diabetic mother is reported. The intrauterine origin and the long age of the thrombosis were confirmed by pathologic studies. Some speculation about the etiopathogenic mechanisms of intrauterine renal venous thrombosis are made.

Six cases of renal venous thrombosis in infants of diabetic mothers, out of a series of 61 infants under two months old affected of R.V.T. (9.8%), are reported. The clinical, metabolic and histopathological features of these cases are discussed, as well as the different etiological theories that exist in the literature. An etiopathogenic hypothesis that maintains a similarity with the theory that explains the origin of R.V.T. in classical cases, is suggested. Prophilactic attitudes in order to prevent R.V.T. by a control of diabetes in the pregnant and close control of the newborn in the 10 first days of life, are pointed out.

Infants of diabetic tend to have more adipose tissue than normal infants at birth. This is thought to be caused by maternal hyperglycemia and fetal hyperinsulinism. Authors examined 160 newborn infants of mothers with gestational diabetes, to determine whether there is a relation between maternal blood-glucose concentrations and subcutaneous fat in the newborn. Mothers of newborns "large for age" present a mean fasting blood-glucose in third trimester greater than mothers of newborns "adequate for age" (p 0.05). Babies born to mothers who had a mean fasting blood-glucose above 90 mg/100 ml had more subcutaneous fat tissue than newborn infants of mothers with a mean fasting blood-glucose under 90 mg/ml (p less than 0.01). Maternal fasting blood-glucose and mean blood-glucose in the third trimester correlated significantly with neonatal weight, skin-fold thickness, K index and body mass index.

An statistical analysis is reported on specific problems of the infant of diabetic mother during the period 1980-1985, with a total of 287 newborns. Complications in this sample are exposed, and significant differences demonstrated in gestational age, fetal distress, hypocalcemia, polycythemia, jaundice, respiratory distress syndrome and associated problems according to clinical type of diabetes mellitus. High percentage of congenital malformations is pointed-out with a predominance of cardiac septal defects. Diabetological control was closer in insulin-dependent group, therefore, its effect has been studied separately. A lower rate of hypoglycemia was found in those under control, while infant of insulin-dependent diabetic mother showed a better compliance between weight and gestational age and a lower rate of respiratory distress syndrome.