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Biomedical subjects

H W Sutherland

Publications and source records attributed to H W Sutherland.

At least 19 recordsLinked to original sources
PubMed1994

Maternal glucose response to a standardized test meal throughout pregnancy and postnatally.

OBJECTIVE: Our purpose was to determine the maternal blood glucose response to food throughout pregnancy. STUDY DESIGN: Forty-five normal, healthy primiparous women with singleton pregnancies were studied longitudinally throughout pregnancy. Blood glucose levels were determined at each stage of pregnancy after a standardized test meal. RESULTS: Fasting plasma glucose decreased throughout gestation and rose again significantly post partum. Glucose values at 30, 60, 90, and 120 minutes after a standardized test meal were similar at all gestational ages studied. CONCLUSIONS: Plasma glucose levels after a physiologic challenge with food do not alter with advancing gestation. This has implications both for the management of insulin-dependent diabetes during pregnancy and for the diagnosis of gestational diabetes.

Adult↗
PubMed1992

The ranges of insulin response and glucose tolerance in lean, normal, and obese women during pregnancy.

OBJECTIVE: We characterized insulin secretion and glucose disposal in a large unselected group of women, encompassing the full spectrum of glucose tolerance in pregnancy, and related the findings to maternal obesity. STUDY DESIGN: Intravenous glucose tolerance and first-phase insulin response were measured at about 32 weeks' gestation in 690 unselected pregnancies. The women were designated as "lean," "normal," or "obese" on weight-for-height criteria. RESULTS: The distribution of insulin response was bimodal, but there was no corresponding dichotomy in maternal glucose disposal rate. Insulin response was greatest and glucose disposal rate slowest in obese women. In general, "poor" glucose tolerance was associated with relatively low insulin output. It was not possible to identify any cluster of women, obese or otherwise, in whom poor glucose tolerance was specifically associated with an unusually high insulin response. CONCLUSION: The data indicate that the distribution of glucose tolerance in pregnancy is a continuum. Glucose intolerance represents one end of that spectrum and is attributable to insufficient insulin secretion. This relative insufficiency is most frequent with maternal obesity.

Blood Glucose↗
PubMed1990

Insulin management during labour and delivery in mothers with diabetes.

A standardized intravenous regimen has been assessed, in 25 insulin-treated diabetic women, for insulin and dextrose therapy in labour and delivery. Adjustments to insulin infusion rate are determined by trends in blood glucose as well as by absolute concentration, in order to approach normoglycaemia. Blood glucose was 5.0 (SD 1.7) mmol l-1 on arrival in labour (or at 0800 h before planned delivery) and was maintained at 6.0 (SD 1.8) mmol l-1 with insulin 0-5 U h-1 for up to 29 h before delivery, when it was 6.3 (SD 2.1, range 3.0-9.0) mmol l-1 with insulin infusion rate 0-4 U h-1. Neonatal blood glucose (less than 2.0 mmol l-1 in 11 babies) correlated with both maternal HbA1c (rs = -0.47, p less than 0.02) and maternal blood glucose at delivery (rs = -0.58, p less than 0.01). During 12 months observation on the intravenous regimen, 339 measurements of blood glucose were made; 10 were less than 3.0 mmol l-1, 242 were 3.0-8.0 mmol l-1, and 81 were greater than 8.0 mmol l-1 (mean 6.5, range 2.7-13.5 mmol l-1). Insulin infusion rate ranged from 0 to 5 U h-1, with 139 rate adjustments. Only one mild clinical hypoglycaemic episode, responding to increased dextrose infusion, was recorded. This simple flexible regimen proved clinically reliable for both midwifery and medical staff.

Cesarean Section↗
PubMed1990

A comparison between the diets of pregnant diabetic women and pregnant non-diabetic women.

In order to assess the effect of dietary advice for pregnant diabetic women, the habitual dietary intake of 8 pregnant diabetic women was assessed by 7-day weighed food records. These results were compared with records from 8 non-diabetic women, matched for age and gestation. Despite intense personalized dietetic advice to the diabetic women, there were no statistically significant differences in macro-nutrient intake between the two groups. The diabetic women were encouraged to increase their carbohydrate intake slightly, but failed to achieve current British Diabetic Association dietary recommendations with respect to percent energy from carbohydrate (41 +/- 5 (+/- SE)(range 29-47)%, BDA recommendation greater than 50%) and percentage from fat 43 +/- 6 (33-51)%, BDA recommendation less than 30%). Intake of bread and cereals was increased in the diabetic women, but increases in complex carbohydrates were insufficient to compensate for a reduced intake of high-sugar foods. Intakes of energy from simple sugars were significantly lower (p less than 0.05) in the diabetic group (12 +/- 2 (5-20)%) than in the non-diabetic group (21 +/- 2 (12-28)%). There was no detectable difference in sources of fats in the diet between the two groups.

Adult↗
PubMed1989

Fetal fat measurement by magnetic resonance imaging.

A method to assess the average percentage of fetal fat with respect to other fetal tissue is described. This method was then used to assess the percentage of fat in 13 normal fetuses who had a magnetic resonance imaging (MRI) examination late in pregnancy (38-41 weeks). The scans of a further 13 fetuses of diabetic mothers and one case of intrauterine growth retardation (IUGR), all of whom had MRI examinations in the last 3 years, were reviewed and similar calculations were carried out. Whilst the percentage fat range in the normal group was large, it was still possible to discern a difference between the normal, diabetic and IUGR cases.

Adipose Tissue↗
PubMed1988

The influence of maternal glucose metabolism on fetal growth, development and morbidity in 917 singleton pregnancies in nondiabetic women.

To study the effects on the fetus of variations in maternal glucose tolerance, a 25 g rapid intravenous glucose tolerance test was performed at or about 32 weeks gestation in 917 randomly selected nondiabetic women with singleton pregnancies. The results were withheld from the patients and their obstetricians and paediatricians, and no treatment or advice was offered. Fasting plasma glucose and indices of glucose disposal (including a new index which we have termed "summed glucose") were distributed unimodally, with no evidence of a separate pathological group towards the diabetic end of the distributions. Significant associations were found between maternal glucose metabolism and various measures of neonatal nutrition and morbidity, including the incidence of congenital malformations and morbidity related to asphyxia, suggesting that variations within the normal range in maternal glucose metabolism can influence growth and development in the fetus. These relationships were continuous throughout the range of maternal glucose tolerance and were not of predictive value in individual cases.

Birth Weight↗
PubMed1988

Management of the pregnant diabetic patient.

The prognosis in diabetic pregnancy has greatly improved as a result of patient education and the availability of home blood glucose monitoring techniques enabling the implementation of good metabolic control pre-pregnancy, antenatal and intrapartum. These in turn have made possible the benefits to the offspring of vaginal delivery at term. Screening for gestational diabetes is important and the prognosis is also good where maternal normoglycaemia is achieved. All diabetic pregnancies should be cared for in specialist units under the supervision of an integrated team comprising an obstetrician, diabetologist and paediatrician, and for optimal results care should start prior to conception.

Female↗
PubMed1987

Increased incidence of spontaneous abortion in pregnancies complicated by maternal diabetes mellitus.

A retrospective sample of 164 pregnancies in the years 1956 to 1975 of 78 insulin-dependent diabetic women was examined to assess the extent of the risk of clinically recognizable spontaneous abortion relative to the expected risk in a comparable population. This study was done before the implementation of the policy to establish good control of maternal diabetes before conception was attempted. After control of data for pregnancy number, maternal age, and epoch, the risk of spontaneous abortion among the diabetic women was almost double the estimate of the expected risk (p less than 0.001).

Abortion, Spontaneous↗
PubMed1985

Nuclear magnetic resonance imaging--a new look at the fetus.

A new form of obstetric imaging using nuclear magnetic resonance (NMR) has been assessed for use in pregnancy. A total of 92 examinations were performed in 62 women during the second and third trimesters in both normal and complicated pregnancies including 14 with diabetes, six with pre-eclampsia and four with intrauterine growth retardation. Our experience has shown that NMR imaging gives excellent differentiation of both maternal and fetal tissues, and because of complete penetration both superficial and deep structures have been clearly identified. The best fetal images were obtained most consistently in the third trimester providing good detail of brain, lungs, liver, heart, bladder, subcutaneous fat, placenta and umbilical cord while maternal tissues were clearly seen at all gestations. As this form of imaging uses no ionizing radiation it offers an alternative means with unique capabilities for investigating pregnancy.

Biometry↗
PubMed1985

Long-range implications for the mother. The Aberdeen experience.

One hundred twelve women with impaired glucose tolerance (IGT) diagnosed by intravenous glucose tolerance test (IVGTT) after pregnancy were followed up for a period of up to 22 yr (mean 12.9 yr). About one-third have been treated with chlorpropamide and the others by diet only. At the final assessment, approximately 35% had abnormal intravenous glucose tolerance and less than 7% overt diabetes. Chlorpropamide did not prove significantly more effective than diet only. Factors associated with deterioration in glucose tolerance were age at diagnosis and follow-up and the initial fasting plasma glucose (FPG) level (greater than or equal to 5.8 mM), but obesity was less important, although it was associated with an increased rate of vascular complications. Tests for islet cell antibodies (ICA) were weakly positive in 12.5% of 72 subjects and in only 0.5% of an unselected population; they did not correlate with the final state of glucose tolerance. Only three patients developed insulin-dependent diabetes (IDDM) and did so before the ICA study was started. A comparison is made between the results reported by O'Sullivan in patients diagnosed as having gestational diabetes, only 2% of whom still had abnormal oral glucose tolerance postpartum, and the results of our patients, all of whom had IGT after pregnancy. In spite of differences of technique and in the populations studied, the prevalence of IGT and overt diabetes at follow-up was significantly less in the Aberdeen series, who were initially a higher risk group. It seems probable that this is mainly attributable to dietary treatment in the follow-up period as O'Sullivan's cases were treated only during pregnancy.

Adolescent↗
PubMed1983

Birthweight and paternal height.

The distributions of standardized birthweights of babies born to women of given heights married to short and tall husbands were compared. The standardized birthweights were consistently greater for babies born to women with tall husbands. It is concluded that tall parental stature relates to favourable environmental and genetic components among those influencing birthweight.

Birth Weight↗