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Aim The aim of the study is to compare the effects of metformin and insulin treatment for gestational diabetes mellitus ( GDM) on vitamin B12 and homocysteine (Hcy) status. Methods Women with GDM, who met criteria for insulin treatment, were randomly assigned to metformin (n = 89) or insulin (n = 91) in the Adelaide cohort of the metformin in gestational diabetes ( MiG) trial. Fasting serum total vitamin B12 ( TB12), holotranscobalamin ( HoloTC), a marker of functional B12 status and plasma Hcy concentrations were measured at 20-34 weeks (at randomization) and 36 weeks gestation, then at 6-8 weeks postpartum. Results Circulating TB12, HoloTC and Hcy were similar in both treatment groups at each time point. Women who were taking dietary folate supplements at randomization had higher serum TB12 and HoloTC at randomization than those not taking folate. Overall, serum TB12 fell more between randomization and 36 weeks gestation in the metformin group than in the insulin group (metformin: −19.7 ± 4.7 pmol/l, insulin: −6.4 ± 3.6 pmol/l, p = 0.004). The decrease in serum TB12 during treatment was greater with increasing treatment duration in metformin-treated (p < 0.001), but not in insulin-treated women. Conclusions Total, but not bioavailable, vitamin B12 stores were depleted during pregnancy to a greater extent in metformin-treated than in insulin-treated women with GDM, but neither analyte differed between groups at any stage. This adds further evidence supporting metformin as a safe alternative treatment to insulin in GDM. Further investigation is needed to evaluate whether women treated with metformin for longer periods in pregnancy require additional B12 or other supplementation. [ABSTRACT FROM AUTHOR]

Presents letters related to medicine. Importance of medical staff awareness about major incident planning; Comments about drug treatment of hypertension; Difficulties faced in the identification of malnourished children by the World Health Organization.

Polycystic ovaries (PCO) are detected using ultrasonography in a proportion of women who do not have clinical symptoms of the polycystic ovary syndrome (PCOS). The aim of this study was to compare the metabolic and endocrine differences between women with such ultrasound-detected PCO and women with PCOS, and to relate these changes to clinical presentation with particular reference to cycle irregularity. A group of 118 women showing PCO on vaginal ultrasound scan was divided into those who had no hyperandrogenaemia (n = 21) and those who had increased androgens and a clinical presentation normally associated with PCOS (n = 97). These were compared with a reference group of 26 normal subjects. Glucose tolerance, lipid concentrations and endocrine profiles were compared between groups. Apart from higher concentrations of androgens in the PCOS group, there were no significant differences between the PCO and PCOS groups in either fasting and stimulated insulin and glucose or in concentrations of sex hormone-binding globulin, gonadotrophins and blood lipids or in ovarian volume. Both PCO and PCOS subjects with cycle irregularity had significantly higher concentrations of serum fasting and stimulated insulin independent of androgens and body mass index than those with normal cycles. It was concluded that: (i) PCO and PCOS patients have equivalent disturbances in relation to insulin and glucose metabolism as well as lipid and lipoprotein disturbances compared to reference subjects; (ii) higher serum insulin values are associated with menstrual irregularity in both groups; (iii) ultrasound evidence for PCO predicts similar metabolic sequelae to PCOS and can therefore be used for studies of the genetics and long term risks for this condition. [ABSTRACT FROM AUTHOR]

Six further cases of acute fatty liver of pregnancy are presented and discussed in relation to the world literature on this rare disease of pregnancy, the aetiology of which is still unknown. The importance of vomiting in late pregnancy is emphasized. A common feature seems to be a metabolic stress, possibly related to infection, which tips a susceptible liver into metabolic failure. [ABSTRACT FROM AUTHOR]

DNA was analysed from 33 patients with congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency. In each case Southern blots were prepared from a number of restriction enzyme digests and hybridised with probes for both the 21-hydroxylase and the adjacent fourth component of complement (C4). Evidence for deletion of the active 21-hydroxylase gene (CYP21B) was found in 13 cases and in 10 of these the deletion included the adjacent C4B gene, leading to a hybrid CYP21A/CYP21B gene. Deletion of CYP21B alone was found in one patient, the remaining two cases appearing to have the active gene replaced by the inactive pseudogene. Duplications of the CYP21A-C4B region and deletion of the pseudogene are also described. In a further 12 cases no gross abnormality could be found. [ABSTRACT FROM PUBLISHER]

Background -- Folate deficiency causes genome and developmental defects in the fetus. However, the extent to which individuals vary in their sensitivity to the genome damaging effects of folate deficiency remains unknown. The cytokinesis-block micronucleus (CBMN) assay, one of the best validated and sensitive cytogenetic techniques for measuring chromosome breakage and chromosome malsegregation, appears to be sensitive enough to detect the genotoxic effects of moderate folate deficiency. Objective - To the test the capacity of the CBMN assay to detect inter-individual variation in base-line genome damage rates and sensitivity to the genome damaging effects of folate deficiency in the physiological range. Design - Base-line and folate-deficiency induced micronuclei (MNi) in lymphocytes were measured in one individual on six different occasions and in six different individuals on single occasions. Other biomarkers within the CBMN assay such as nucleoplasmic bridges (NPB, a marker of chromosome rearrangement), nuclear buds (NBUD, a marker of gene amplification), necrosis and apoptosis were also measured. The effect of folate deficiency was investigated in long-term lymphocyte cultures in medium containing either 12nM or 120 nM folic acid. Outcomes - MNi, NPB, NBUD and apoptosis were all significantly increased in 12nM folic acid cultures compared to 120nM folic acid cultures (all P<0.0001). Inter-individual variation was significantly greater than intra-individual variation for MNi (P = 0.0049) and apoptosis (P = 0.0208) only. Conclusions -- The CBMN assay is a robust and reproducible method for measuring genome damage caused by folate deficiency within the physiological range; however only the MNi and apoptosis measures are reliable enough for measuring inter-individual variation in spontaneous and folate-deficiency induced genome damage. [ABSTRACT FROM AUTHOR]

Objective: Does low-molecular-weight heparin (LMWH) added to low-dose aspirin influence fetal growth and flow velocity in uterine and umbilical arteries in women with an inheritable thrombophilia and previous early-onset uteroplacental insufficiency?, Design: Secondary outcomes of the FRUIT-RCT., Setting: Multicentre, international., Population: The FRUIT-RCT included 139 women with inheritable thrombophilia before 12 weeks of gestation. Inclusion criteria were previous delivery before 34 weeks of gestation with a hypertensive disorder of pregnancy and/or small-for-gestational-age infant and an inheritable thrombophilia., Methods: After randomisation to either daily LMWH with aspirin, or aspirin only, ultrasound measurements were performed at 22-24, 28-30 and 34-36 weeks of gestation. Development during gestation of growth, birthweight and flow velocity of the umbilical artery was examined using the linear mixed model. Uterine artery flow velocity at a single time-point (22-24 weeks) was examined using a chi-square test., Main Outcome Measures: Fetal growth over time including birthweight, using Scandinavian, Dutch and customised growth curves; and flow velocity within the uterine and umbilical arteries., Results: No difference of fetal growth over time could be demonstrated between the study arms, regardless of which reference criteria were used. The flow velocity within the uterine artery and umbilical artery did not differ between study arms., Conclusion: The addition of LMWH to aspirin did not influence fetal growth or umbilical artery flow velocity over time; nor did it influence uterine artery flow velocity., Tweetable Abstract: LMWH does not influence fetal growth or uterine or umbilical flow velocities., (© 2015 Royal College of Obstetricians and Gynaecologists.)

Background: This study assessed the views of the women who participated in the DIAMIND randomised trial of postpartum SMS reminders to test for type 2 diabetes after gestational diabetes (GDM) on their preferred type of postpartum reminder system and barriers and facilitators to completion of postpartum diabetes testing., Method: A written questionnaire was sent to women with recent GDM who participated in the DIAMIND trial (n=276) via post or email at six months after the birth of their baby., Results: 208 women (75%) returned the study questionnaires. Preferred postpartum reminder types were: SMS (67%), email (17%), postal (12%) and voice call (1%). Women who had not yet completed an OGTT indicated that they planned to undertake one in the future (61%). Common barriers to postpartum OGTT completion included: not having enough time (73%), inadequate childcare (30%), and a need to focus on the health of the baby (30%). The most common facilitator was having a shorter test (33%)., Conclusions: Improved childcare quality and access as well as more research into a shorter, more convenient test procedure for type 2 diabetes screening are needed. Reminder systems for postpartum diabetes screening should be electronic where possible., (Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

This chapter reviews the treatment of endocrine disease in pregnancy, including diabetes mellitus, hypo- and hyperthyroidism, adrenal and pituitary disorders, and hyper- and hypoparathyroidism. Pregnancy in some of these disorders is relatively rare, so that management is often based on limited information and clinical judgement rather than on strong evidence-based criteria., (Copyright 2001 Harcourt Publishers Ltd.)