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Biomedical subjects

D R Hollingsworth

Publications and source records attributed to D R Hollingsworth.

At least 19 recordsLinked to original sources
PubMed1996

The Hopelessness Scale for Children: psychometric properties with hospitalized adolescents.

This study examined the internal consistency and factor structure of the Hopelessness Scale for Children with 201 adolescent inpatients (M age = 15.4 years). In comparison to the psychometric properties of the scale found with younger children, our findings suggest adequate, but lower, internal consistency reliability and a weak core factor structure. The results are discussed in terms of possible changes in the child scale or the alternative use of an adult measure of hopelessness with adolescents.

Adolescent↗
PubMed1992

Caloric restriction in pregnant diabetic women: a review of maternal obesity, glucose and insulin relationships as investigated at the University of California, San Diego.

Caloric restriction during pregnancy is contraindicated for women with a normal body mass index (BMI) of 19.8-26 kg/m2. Reduction of caloric intake in obese pregnant normal and diabetic women has been a controversial topic for many years. This paper reviews several clinical studies initiated in 1978 at the University of California, San Diego. One focus of this review concerns modest caloric reduction in obese women with gestational diabetes mellitus (GDM). Metabolic observations of diabetes during pregnancy in the past decade include extensive use of a 400 kcal isocaloric breakfast meal tolerance test to assess maternal glucose:insulin relationships and the degree of insulin resistance in obese pregnant subjects. We have previously reported that maternal hyperinsulinemia with or without maternal hyperglycemia is an important factor in fetal macrosomia. We suggest for obese pregnant diabetic women implementation of nutritional recommendations of the 1990 Committee on Nutritional Status During Pregnancy and Lactation, Food and Nutrition Board, Institute of Medicine, National Academy of Sciences that advise a lower caloric intake for obese normal pregnant women with BMIs greater than 26. In obese noninsulin-dependent diabetic women and those with GDM, we urge that a large prospective epidemiologic study be undertaken to assess the respective roles of modest maternal caloric restriction and maternal glucose:insulin relationships on neonatal and long-term longitudinal measurements of growth and development of children of diabetic mothers.

Adult↗
PubMed1991

Effects of in-utero exposure to oral hypoglycaemic drugs.

The observation that several Mexican-American women were taking oral hypoglycaemic agents while pregnant led to a study to confirm reports of associations between these agents and congenital abnormalities. 20 non-insulin-dependent (NIDDM) pregnant diabetic women with exposure to oral hypoglycaemic drugs during embryogenesis and 40 pregnant NIDDM women matched for age, race, parity, weight, and glycaemic control but not exposed to oral hypoglycaemic drugs were followed up. 10 infants (50%) in the exposed group had congenital malformations, compared with only 6 (15%) in the control group (p less than 0.002). 5 (25%) infants in the exposed group had ear malformations, anomalies not commonly described in diabetic embryopathy. Hyperbilirubinemia (p less than 0.04), polycythaemia, and hyperviscosity requiring partial exchange transfusions (p less than 0.03) were commoner among babies in the exposed than in the control group. 3 babies in the exposed group but none in the comparison group had severe prolonged neonatal hypoglycaemia lasting 2, 4, and 7 days; 2 of the 3 had been exposed for 22 and 28 weeks during gestation, whereas the third had been exposed throughout the first trimester. Although exposure to oral hypoglycaemic drugs during fetal life seems to be associated with congenital malformations and neonatal hypoglycaemia, a large, prospective study is needed to exclude the confounding effect of maternal metabolic derangement secondary to diabetes.

Abnormalities, Drug-Induced↗
PubMed1991

Diabetes in pregnancy in Mexican Americans.

Diabetes in pregnant Mexican-American women is a serious and expensive health problem. At the University of California, San Diego Medical Center, 44% of pregnant women are Mexican American. In the Diabetes in Pregnancy Clinic, only 7% of women with insulin-dependent diabetes are in this ethnic group compared with 66% of non-insulin-dependent diabetic patients and 51% of those with gestational diabetes mellitus (GDM). GDM is the most common complication of pregnancy in Mexican Americans with a prevalence approximately three times higher than that of whites (4.5 vs. 1.5%). Mexican-American obese GDM subjects had more frequent cesarean sections and were more likely to have complications of premature rupture of membranes and preterm labor (NS). Polycythemia and sepsis also occurred more often in their infants. Anthropometric measurements in infants of both lean and obese GDM subjects differed from those of infants of mothers without GDM. Infants of lean mothers with GDM were heavier and longer than those of lean mothers without GDM. In addition, they had increased waist-hip ratio and triceps and subscapular skin folds. Infants of obese mothers with GDM were heavier than those of lean mothers with GDM. Moreover, they were longer (P less than 0.04); had a higher body mass index (P less than 0.04); and larger waist and hip circumferences (P less than 0.03) and buccal (P less than 0.01), subscapular (P less than 0.01), and sum of skin-fold measurements (P less than 0.03). Our observations indicate that pregnant diabetic Mexican-American women have predominantly GDM and non-insulin-dependent diabetes. They represent a major public health problem because of increased maternal and neonatal morbidity.

Adult↗
PubMed1989

Is repeat pregnancy in adolescents a "planned" affair?

This study assessed whether girls who become pregnant more than once do so for different reasons than girls who are pregnant for the first time. Girls in group 1 (G1) were pregnant for the first time (n = 104, 69%) and those in group 2 (G2) were pregnant for the second time or more (n = 46, 31%). About 60% of the girls in G2 had living children at home, but they were more likely than those in G1 to state that they became pregnant because they wanted a baby (G2 44%, G1 21%; p less than 0.01) and, conversely, girls in G1 were more likely than those in G2 to state that the pregnancy was an accident and "just happened" (G1 61%, G2 37%; p less than 0.01). Many girls who become pregnant more than once appear to do so intentionally.

Adolescent↗
PubMed1988

Routine screening for gestational diabetes in white, black, and Mexican-American teenagers.

This study assesses the frequency of gestational diabetes in a multiethnic teenage pregnancy clinic. One hundred thirty-seven women age 12-18 years were screened with a 1-hour 50-gm glucola test at 24-34 weeks gestation. Screening tests were positive in 5.8% of these teenagers, of whom half were obese. Gestational diabetes was documented in two primiparas (1.4%). Maternal weight gain was excessive in 54%, and 8.7% of the total group had macrosomic infants. We conclude that gestational diabetes should be screened for in all young pregnant women with the screening test recommended by the Second International Workshop-Conference on Gestational Diabetes.

Adolescent↗
PubMed1988

Glycosylated and nonglycosylated prolactin in serum during pregnancy.

To study the pattern of release of glycosylated (G-PRL) and nonglycosylated (PRL) under various physiological conditions, we studied normal women from the first trimester of pregnancy through the postpartum period. Immunoreactive PRL variants were immunoprecipitated from 100-microL aliquots of serum, and the precipitates were subjected to gel electrophoresis in the presence of sodium dodecyl sulfate, electrotransferred to nitrocellulose paper, immunoblotted with anti-PRL serum and [125I]protein-A, and autoradiographed. The relative concentrations of the two forms of PRL were indicated by the intensity of the electrophoretic bands. Before pregnancy, serum G-PRL was the predominant PRL form. As pregnancy progressed, increasing amounts of PRL, compared to G-PRL, appeared in the serum, and it reached a maximum by the third trimester. G-PRL was found at all stages of pregnancy, even when the amount of PRL was greatest. After parturition in nonnursing mothers the PRL band again decreased; however, in nursing mothers the PRL band remained prominent. We conclude that the G-PRL and PRL variants may fulfill different physiological roles and, under certain conditions, such as pregnancy and lactation, more of the nonglycosylated PRL may be produced to fill special requirements.

Adult↗
PubMed1987

Psychosocial aspects of Mexican-American, white, and black teenage pregnancy.

This study assesses whether pregnant Mexican-American adolescents have psychosocial characteristics different from their pregnant white or black peers. The study population consisted of 199 consecutive Mexican-American, white, and black pregnant adolescents, ages 11-19 years, followed prospectively at the University of California San Diego Medical Center Teen Obstetric Clinic from 1978 to 1981 (79 whites, 76 Mexican-Americans, and 44 blacks). Although all three groups had the same chronologic age (X = 16.4 +/- 1.4 years), and the same number of years of schooling, pregnant black adolescents were more likely to be in school at the time of registration for prenatal care (p less than 0.01). Mexican-American teens were more likely to be married at conception and/or delivery (p less than 0.001), and to breastfeed their infants (p less than 0.05). The fathers of the Mexican-American babies were more likely than other fathers to be full-time students or employed (p less than 0.001). Although pregnant Mexican-American teens came from the largest families (p less than 0.001), black teenagers most frequently reported a good mother-daughter relationship (p less than 0.05). White pregnant teens most frequently reported a family history of psychiatric illness (p less than 0.01), parental death (p less than 0.05), or runaway behavior (p less than 0.01). These data suggest that pregnant teenagers from these three racial/ethnic backgrounds have different psychosocial profiles and hence different psychosocial problems and needs.

Adolescent↗
PubMed1987

Postprandial walking exercise in pregnant insulin-dependent (type I) diabetic women: reduction of plasma lipid levels but absence of a significant effect on glycemic control.

In this study 42 pregnant women with type I diabetes and 28 nondiabetic controls were recruited to participate in a postprandial walking exercise program. Exercise patients were instructed to walk 20 minutes (1 mile) after each meal and were divided into two groups: group 1 were normal nondiabetic controls and group 2 were women with type I diabetes. There were two nonexercise comparison groups: group 3, nondiabetic controls, and group 4, women with type I diabetes. Diabetic women were followed weekly in an intensive perinatal program. Glycemic control was assessed by serial hemoglobin A1 concentration measurements, home blood glucose monitoring, 24-hour glucose profiles, and 24-hour quantitative urinary glucose loss. Glycemic control was modestly but not significantly superior in the diabetic exercise group 2 compared with the diabetic nonexercise group 4. Exercise was associated with lower fasting cholesterol and triglyceride values in both controls and diabetic women, with significantly lower fasting plasma triglyceride levels in the diabetic exercise group (p less than 0.02). There were no adverse effects of postprandial walking exercise in mothers or infants.

Adult↗
PubMed1987

Continuous subcutaneous insulin infusion in an obese insulin-resistant pregnant woman with type II diabetes: accelerated fetal growth and neonatal complications.

This is the first report to describe prolonged continuous subcutaneous insulin infusion in a massively obese insulin-resistant pregnant woman with type II diabetes. Maternal 24-hour plasma glucose levels became normal by 48 hours, and normoglycemia was maintained with high daily doses of insulin (530 U-333 U/24 hours) from 29 weeks' gestation until delivery at 38.5 weeks. Excellent diabetic control was associated with euglycemia, normal glycosylated hemoglobin concentration, and a significant decrease in mean 24-hour plasma C-peptide (P less than .004) and glucagon (P less than .003) levels. Unexpectedly, fetal growth accelerated during constant insulin infusion despite normal maternal plasma glucose levels. The newborn infant was large (4530 g), with a striking truncal accumulation of fat, hypoglycemia (30-minute plasma glucose 11 mg/dL), and polycythemia (central venous hematocrit 71%). Normalization of maternal plasma glucose levels failed to ameliorate established macrosomia, and did not prevent the neonatal complications that are common in infants of diabetic mothers.

Adult↗
PubMed1986

Teenage pregnancy: a multiracial sociologic problem.

Teenage pregnancy is not an epidemic in the United States. Because this is an emotional topic that receives high-decibel publicity in the press and on television, we wish to present the most recent factual information available on the subject and a more balanced perspective of the problem for physicians and other health professionals who care for women at the youngest age of the reproductive spectrum. Pregnancy during adolescence is a multiethnic sociologic problem that crosses all socioeconomic, ethnic, cultural, and geographic boundaries. Pregnancies in teenagers are decreasing (except in teenagers under age 15), not accelerating. New approaches for premature adolescent pregnancy and childbearing focus on adolescent peer pressure for behavior modification, prevention of pregnancy at a younger age, continuation of secondary education, and job training for both adolescent fathers and mothers.

Adolescent↗
PubMed1986

Clinical observations of Mexican-American, Caucasian, and black pregnant teenagers.

Few data are available on the prenatal health problems and postnatal outcomes of Mexican-American pregnant teenagers. Our study population consisted of 199 consecutive Caucasian, Mexican-American, or Black pregnant adolescents, ages 11-19 years, followed prospectively at the University of California San Diego Medical Center Teen Obstetric Clinic from 1978 to 1981. The patients included 79 Caucasians, 76 Mexican-Americans, and 44 Blacks. Mexican-American adolescents were shorter, less likely to be cigarette smokers, and delivered heavier babies than their non-Hispanic peers. More than 50% of the teenagers in all three groups gained more than the recommended upper limit of 12 kg during the pregnancy, but excessive gain was most pronounced in the Mexican-American group. Black pregnant adolescents were more likely to be anemic and had a higher frequency of goiter. It is recommended that data concerning Hispanic mothers and infants be analyzed separately from data of Caucasian and Black adolescents to more accurately define their pregnancy problems.

Adolescent↗
PubMed1985

Goiter in pregnant teenagers.

Enlargement of the thyroid gland is common in adolescent girls, but there have been no previous reports of the frequency of goiter in pregnant teenagers. This study was undertaken to determine the prevalence of goiter in 309 consecutive pregnant adolescent patients, ages 11 to 19 years, who presented for prenatal care at the University of California (San Diego) Medical Center Teen OB Clinic. Eighteen patients (6%) were found to have a goiter. Subsequent diagnostic tests revealed that 28% of the patients had autoimmune thyroid disorders (chronic thyroiditis or Graves' disease), and the remainder had nontoxic goiters or subacute thyroiditis. Black patients had significantly more thyroid disease than Mexican-American (p less than 0.01) or white patients (p less than 0.005). The incidence of thyroid problems during pregnancy did not differ significantly from that of 600 nonpregnant teenagers who came to the general Adolescent Medicine Clinic for other health problems. Because abnormalities in thyroid function may have potentially adverse implications for mothers and their infants, we recommend careful evaluation of all pregnant teenagers with goiter to assess maternal thyroid function and to provide treatment if necessary.

Adolescent↗
PubMed1985

Metabolic and therapeutic assessment of gestational diabetes by two-hour and twenty-four-hour isocaloric meal tolerance tests.

Lean and obese women with gestational diabetes (GDM) were given two different isocaloric meal challenge tests to assess glucose and insulin responses. Forty-three pregnant women received a 400-kcal isocaloric breakfast meal tolerance test (mini-MTT). Twenty of the subjects were also given a 2000-kcal isocaloric diet with three meals and three snacks during a 24-h period (maxi-MTT). This was the first study to utilize the physiologic challenge of mixed meals to compare insulin and glucose responses of both obese and lean normal pregnant women and women with GDM around the clock. Normal obese pregnant women had higher integrated glucose and insulin values around the 24-h clock (P less than 0.003 and less than 0.03, respectively) than lean pregnant women. Lean and obese women with GDM also responded differently to the physiologic challenge of mixed meals. Some, but not all, obese diabetic subjects were markedly hyperinsulinemic in contrast to lean diabetic women who were relatively insulin deficient. One normoglycemic massively obese 18-yr-old pregnant woman was unexpectedly found to be severely hyperinsulinemic. The two meal tolerance tests clearly defined a delay in the release of insulin in women with GDM (lean and obese) and markedly different quantitative insulin responses to identical meal challenges in obese diabetic subjects. Maternal hyperinsulinemia was positively correlated with prepregnancy body mass index (kg/m2) and heavier infants, but not with plasma glucose levels. These studies provide evidence that GDM is a heterogeneous syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Moderate caloric restriction in obese women with gestational diabetes.

The effect of moderate caloric restriction on weight gain during pregnancy and fetal outcome in 22 obese women with gestational diabetes mellitus was assessed. A new tool was used to assess dietary compliance in an outpatient setting. The authors observed that obese gestational diabetics gained less weight during pregnancy than ten normal pregnant women or 31 lean women with gestational diabetes. Paradoxically, the placentas of obese gestational diabetics were larger (P not significant), and infants of these mothers were significantly heavier than those of normal women or lean women with gestational diabetes (P less than .03). The authors suggest that the currently recommended daily caloric allowances for normal women may be excessive for obese gestational diabetics who are not prone to ketosis but have a complex metabolic problem characterized by hyperinsulinemia and insulin resistance.

Birth Weight↗
PubMed1984

Glycosylated hemoglobin as a screening test for carbohydrate intolerance in pregnancy.

The usefulness of glycosylated hemoglobin as a prenatal screening test for carbohydrate intolerance was studied in 806 consecutive subjects by correlating glycosylated hemoglobin to 1-hour post-50 gm Glucola plasma glucose (1 degree G) levels, and 3-hour oral glucose tolerance tests (3 degrees GTT). Sixty-seven subjects whose 1 degree G greater than or equal to 150 mg/100 ml received a 3 degrees GTT; 12 were diagnostic of carbohydrate intolerance. Compared to carbohydrate-tolerant controls, carbohydrate-intolerant gravid patients had higher 1 degree G (p less than 0.001) and glycosylated hemoglobin (p less than 0.05) levels. Linear regression analysis of 1 degree G and glycosylated hemoglobin demonstrated r = 0.35 (p less than 0.0001). Compared to the glycosylated hemoglobin test, the 1 degree G screening test has greater specificity, sensitivity, and predictive value for a positive diagnosis. Consequently, the 1 degree G is a better routine screening test for carbohydrate intolerance than is glycosylated hemoglobin.

Diabetes Mellitus↗