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Biomedical subjects

P R Garner

Publications and source records attributed to P R Garner.

At least 19 recordsLinked to original sources
PubMed1999

Changes in homocysteine levels during normal pregnancy.

OBJECTIVE: The objective of this study was to determine the changes in total plasma homocysteine concentration that occur during normal pregnancy. STUDY DESIGN: In this cross-sectional study homocysteine was measured in 155 normal women in the first, second, and third trimesters and in nonpregnant controls. In addition, albumin, serum B12, serum folate, and red blood cell folate concentrations were measured and correlated to homocysteine values. RESULTS: The mean homocysteine concentration (in micromoles per liter) was 5.6 (95% confidence interval 3.9-7.3) at 8-16 weeks' gestation, 4.3 (95% confidence interval 3.5-5.3) at 20-28 weeks' gestation, 5.5 (95% confidence interval 3.3-7.5) at 36-42 weeks' gestation, and 7.9 (95% confidence interval 6.2-9.6) in the nonpregnant control group. Homocysteine was significantly lower in all 3 trimesters of pregnancy compared with nonpregnant controls (P <.001). Homocysteine levels were directly correlated with albumin levels, which decreased during pregnancy. Homocysteine concentrations were decreased in subjects taking folic acid supplementation. CONCLUSION: Serum concentrations of homocysteine decrease during pregnancy. This occurs in association with the physiologic fall in albumin during pregnancy, as well as with folic acid supplementation.

Adult↗
PubMed1998

Congenital adrenal hyperplasia in pregnancy.

The congenital adrenal hyperplasias (CAH) are a group of inherited enzymatic defects of adrenal steroid biosynthesis. Deficiencies of each enzyme required in the steroid biosynthesis pathway are known, and these deficiencies are all inherited as autosomal recessive disorders. During pregnancy, maternal and fetal problems are confined to women who have 21-hydroxylase deficiency (P450c21 deficiency), 11-hydroxylase deficiency (P450c11 deficiency), and 3 beta-hydroxysteroid dehydrogenase deficiency (3 beta HSD deficiency), because other adrenal enzyme deficiencies are not compatible with fertility. The interposition of the placenta on the hypothalamic-pituitary-adrenal axis and other endocrine changes during pregnancy impact considerably on the clinical evaluation of the congenital adrenal hyperplasias. Successful management of CAH in pregnancy requires a firm knowledge of normal adrenal anatomic and endocrine changes that occur during gestation. Women with severe forms of CAH have decreased fertility rates because of oligo-ovulation, and successful conception requires a combination of good therapeutic compliance, careful endocrine monitoring, and often ovulation induction. From a fetal and neonatal standpoint, accurate prenatal diagnosis of 21-hydroxylase deficiency and 11-hydroxylase deficiency is now possible, which allows for prenatal treatment in an attempt to minimize clinical problems in the neonates. Prevention of masculinization of affected female fetuses by corticosteroid suppression has been attempted in both 21-hydroxylase deficiency and 11beta-hydroxylase deficiency CAH, with variable degrees of success. This review provides an overview of the congenital adrenal hyperplasias and their management during pregnancy.

Adrenal Hyperplasia, Congenital↗
PubMed1997

Report of the Canadian Hypertension Society Consensus Conference: 2. Nonpharmacologic management and prevention of hypertensive disorders in pregnancy.

OBJECTIVE: To provide Canadian physicians with comprehensive, evidence-based guidelines for the nonpharmacologic management and prevention of gestational hypertension and pre-existing hypertension during pregnancy. OPTIONS: Lifestyle modifications, dietary or nutrient interventions, plasma volume expansion and use of prostaglandin precursors or inhibitors. OUTCOMES: In gestational hypertension, prevention of complications and death related to either its occurrence (primary or secondary prevention) or its severity (tertiary prevention). In pre-existing hypertension, prevention of superimposed gestational hypertension and intrauterine growth retardation. EVIDENCE: Articles retrieved from the pregnancy and childbirth module of the Cochrane Database of Systematic Reviews; pertinent articles published from 1966 to 1996, retrieved through a MEDLINE search; and review of original randomized trials from 1942 to 1996. If evidence was unavailable, consensus was reached by the members of the consensus panel set up by the Canadian Hypertension Society. VALUES: High priority was given to prevention of adverse maternal and neonatal outcomes in pregnancies with established hypertension and in those at high risk of gestational hypertension through the provision of effective nonpharmacologic management. BENEFITS, HARMS AND COSTS: Reduction in rate of long-term hospital admissions among women with gestational hypertension, with establishment of safe home-care blood pressure monitoring and appropriate rest. Targeting prophylactic interventions in selected high-risk groups may avoid ineffective use in the general population. Cost was not considered. RECOMMENDATION: Nonpharmacologic management should be considered for pregnant women with a systolic blood pressure of 140-150 mm Hg or a diastolic pressure of 90-99 mm Hg, or both, measured in a clinical setting. A short-term hospital stay may be required for diagnosis and for ruling out severe gestational hypertension (preeclampsia). In the latter case, the only effective treatment is delivery. Palliative management, dependent on blood pressure, gestational age and presence of associated maternal and fetal risk factors, includes close supervision, limitation of activities and some bed rest. A normal diet without salt restriction is advised. Promising preventive interventions that may reduce the incidence of gestational hypertension, especially with proteinuria, include calcium supplementation (2 g/d), fish oil supplementation and low-dose acetylsalicylic acid therapy, particularly in women at high risk for early-onset gestational hypertension. Pre-existing hypertension should be managed the same way as before pregnancy. However, additional concerns are the effects on fetal well-being and the worsening of hypertension during the second half of pregnancy. There is, as yet, no treatment that will prevent exacerbation of the condition. VALIDATION: The guidelines share the principles in consensus reports from the US and Australia on the nonpharmacologic management of hypertension in pregnancy.

Female↗
PubMed1997

Changes in activated protein C resistance during normal pregnancy.

OBJECTIVE: The objective of this study was to determine the changes in activated protein C resistance that occur during normal pregnancy. STUDY DESIGN: In this cross-sectional study activated protein C was measured in 128 women with normal pregnancies in the first, second, and third trimesters and in nonpregnant control subjects with 24 to 39 women in each group. In addition, factor V, factor VIII, free protein S, and functional protein C were measured and correlated with activated protein C levels. Polymerase chain reaction for factor V Leiden mutation was performed. RESULTS: There was a significant fall in the activity of activated protein C in the second and third trimesters of pregnancy (p < 0.05). This was related to increased factor VIII and decreased free protein S levels (p = 0.002, R2 = 0.20). The prevalence of the factor V Leiden mutation was 7.3%. CONCLUSION: Resistance to activated protein C is increased in the second and third trimesters of pregnancy. This is related to the alterations in other coagulation proteins, a phenomenon normally occurring during pregnancy.

Adult↗
PubMed1995

Glucose metabolism assessment in pregnancy.

OBJECTIVES: To review the literature regarding screening and definitive testing for Gestational Diabetes (GDM) and to assess whether treatment after identification changes perinatal/neonatal outcome. DATA RESOURCES: Directed medline searches. RESULTS: Gestational Diabetes Mellitus is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. The fetal and neonatal risks resulting from GDM continue to be controversial. There is an increased risk of macrosomia, birth trauma, and neonatal hypoglycemia but other metabolic complications are uncommon. There is still continuing debate as to whether there is an increase in congenital anomaly or stillbirth rate. Maternal risks include increased operative intervention, infections and hydramnios. Screening and definitive testing for GDM is undertaken to identify those pregnancies at risk for macrosomia, birth trauma and neonatal hypoglycemia in the hope that treatment will reduce this risk. However, at the present time there is inadequate evidence as to whether intensive management aimed at euglycemia meaningfully changes perinatal/neonatal outcome. CONCLUSION: In spite of conflicting evidence that treatment of GDM changes pregnancy outcome, screening and definitive testing for GDM should continue until large prospective trials confirm or refute the accepted standard of care.

Blood Glucose↗
PubMed1990

Preeclampsia in diabetic pregnancies.

Diabetic pregnancies complicated by preeclampsia are of concern because of poor perinatal outcome. However, with improved maternal and fetal surveillance the impact of preeclampsia in diabetic pregnancies is declining. This prospective controlled study compared the incidence of preeclampsia and maternal-fetal outcome in 334 diabetic pregnancies and 16,534 nondiabetic pregnancies. The incidence of preeclampsia was 9.9% (33/334) in diabetic pregnancies compared with 4.3% (716/16,534) in nondiabetic controls. The incidence of preeclampsia rose with increasing severity of diabetes by White classification, but was still 8.9% after exclusion of diabetic patients with nephropathy or chronic hypertension. The perinatal mortality rate per 1000 births was 60 for preeclamptic diabetic patients compared with 3.3 for normotensive diabetic patients. Parity, maternal age, and blood glucose control were similar in preeclamptic diabetic patients compared with normotensive diabetic patients. We conclude that preeclampsia is twice as common in diabetic pregnancies compared with normal controls.

Blood Glucose↗
PubMed1989

Insulinoma complicating pregnancy presenting with hypoglycemic coma after delivery: a case report and review of the literature.

The incidence of insulinoma in pregnancy is unknown. All of the eight previously reported cases presented in the first trimester with hypoglycemic episodes. We report a case of a 24-year-old multigravida who presented with hypoglycemic coma after delivery. We discuss the possible protective role of pregnancy counter-regulatory hormones in keeping the patient asymptomatic until delivery, and present the difficulties in both diagnosis and differential diagnosis of insulinoma in the peripartum period. Chronic hypoglycemia in pregnancy has been associated with intrauterine growth retardation and increased perinatal mortality. However, this infant was at the 90th percentile for body weight, suggesting that asymptomatic maternal hypoglycemia had not been present during the gestation. Insulinoma complicating pregnancy, though very rare, should now be included in the differential diagnosis of postpartum hypoglycemia.

Adenoma, Islet Cell↗
PubMed1987

Elevated serum dehydroepiandrosterone sulfate levels in patients with insulin resistance, hirsutism, and acanthosis nigricans.

The association of insulin resistance, hyperandrogenism, and acanthosis nigricans is well established. The ovary is thought to be the site of the excess androgen production. The purpose of this study was to assess the adrenal contribution to the hyperandrogenic state in these women. Twenty-three patients presenting with the combination of hyperinsulinemia, elevated testosterone (T) levels, and acanthosis nigricans were investigated for the source of the increased androgen production. Twelve patients had elevated serum dehydroepiandrosterone sulfate (DS) levels (high DS group) suggestive of increased adrenal androgen production. Eleven patients had normal DS levels (normal DS group). Both normal DS and high DS groups had similar basal serum insulin levels and similar insulin response curves after a 3-hour, 75-gm, oral glucose tolerance test. No correlation was found between serum T or DS levels and either basal serum insulin levels or the area under the insulin response curve. These data suggest that DS levels are frequently elevated in patients with hirsutism, acanthosis, and hyperinsulinemia. Furthermore, the lack of association between serum DS and serum insulin levels suggests that insulin does not directly affect adrenal androgen production, or vice versa.

Acanthosis Nigricans↗
PubMed1987

Primary amenorrhea associated with hyperprolactinemia: four cases with normal sellar architecture and absence of galactorrhea.

Hyperprolactinemia is an uncommon cause of primary amenorrhea. The diagnosis should be sought even in the absence of galactorrhea and sellar abnormality, particularly when thelarche and pubarche have occurred. Reduction of serum PRL levels followed by menarche can be anticipated within a few months of starting bromocriptine therapy in the majority of cases.

Adolescent↗
PubMed1987

Homologous artificial insemination for oligoasthenospermia: a randomized controlled study comparing intracervical and intrauterine techniques.

Homologous artificial insemination (AIH) is used to treat infertility caused by oligoasthenospermia, despite the lack of controlled studies confirming its benefit. This prospective randomized controlled trial was undertaken to determine whether intracervical (IC-AIH) or intrauterine (IU-AIH) homologous artificial insemination improves pregnancy rates in couples with infertility attributable to oligoasthenospermia alone. Twenty couples were randomized to receive IC-AIH or IU-AIH. Sixty-three insemination cycles were completed. During the same study period, 35 cycles with timed vaginal intercourse alone were assessed. Four pregnancies occurred, all following timed vaginal intercourse. No pregnancies resulted from IC-AIH or IU-AIH. This suggests that neither IC-AIH nor IU-AIH is of benefit when oligoasthenospermia is the cause of infertility. Pregnancies previously attributed to AIH may also have been conceived as a result of vaginal intercourse. This confounding effect on the results of AIH should always be considered.

Adult↗
PubMed1987

Endometrial prostaglandins and menorrhagia: influence of a prostaglandin synthetase inhibitor in vivo.

Prostaglandin levels in the human endometrium were determined on day 2 of the menstrual cycle in eumenorrheic subjects and in patients with menorrhagia, dysmenorrhea, or both. Menorrhagic subjects had significantly higher levels of endometrial prostaglandins of the E and F series when compared with eumenorrheics. Prostaglandin E levels were markedly higher than prostaglandin F. In 10 menorrhagic subjects who completed a double-blind clinical study on the effectiveness of mefenamic acid in lowering menstrual blood loss, 9 exhibited statistically significant reduction in endometrial prostaglandin levels. A decrease in menstrual blood loss was also noted during mefenamic acid treatment in these patients. These findings are consistent with the concept that abnormally high uterine prostaglandin levels may be an important etiologic factor in menorrhagia and support the notion that one of the mechanisms of action of nonsteroidal anti-inflammatory agents in the treatment of this menstrual disorder is inhibition of endometrial prostaglandin production.

Adult↗
PubMed1986

Pregnancies after premature ovarian failure.

Six women who conceived after a diagnosis of premature ovarian failure are discussed. Two pregnancies occurred while the women were receiving conjugated estrogen therapy, two while taking oral contraceptives, and two women conceived spontaneously. The possible role of exogenous estrogens in sensitizing the granulosa cells to the effect of follicle-stimulating hormone and thereby inducing ovulation and conception in some women with premature ovarian failure is examined.

Adolescent↗
PubMed1986

Pregnancy rates after hysterosalpingography with oil- and water-soluble contrast media.

Hysterosalpingography can be accomplished with either oil or water-soluble contrast medium. This randomized prospective study compared pregnancy rates in women who had hysterosalpingography with either water- or oil-soluble contrast material and were followed for six months. Fifteen of 60 (25%) patients who received water-soluble dye conceived compared with 14 of 46 (30%) patients in the oil-soluble group, a statistically insignificant difference. Furthermore, no difference in pregnancy rates within each subgroup of fertility diagnosis was detected. Intravasation was more common in patients administered oil-based contrast materials (six of 46 versus one of 60 patients, P = .02), although no serious consequences occurred. No difference in the amount of pain as assessed by pain scoring was experienced by patients in each group. The authors conclude that pregnancy rates are similar after hysterosalpingography with oil- and water-soluble contrast material, during at least the first six months after the procedure.

Adult↗
PubMed1986

Premature ovarian failure. Current concepts.

Premature ovarian failure is not uncommon. It can occur at any age and has important implications for both patient and clinician. Various therapeutic options are available, including in vitro fertilization with donor oocytes.

Adult↗
PubMed1985

Premature ovarian failure: its relationship to autoimmune disease.

Thirty-three patients with the diagnosis of chromosomally competent premature ovarian failure were reviewed for evidence of autoimmune disease. Thirty-nine percent of subjects had an associated autoimmune disorder, of which thyroid disease was the most common. One patient had vitiligo and one had adrenal insufficiency. A family history of autoimmune disease was elicited from 18% of subjects, all of whom proved to have an autoimmune disease themselves. From these findings, and a review of other studies, the authors conclude that an associated autoimmune disease, or other evidence of autoimmunity, is present in 30 to 50% of patients with premature ovarian failure.

Adolescent↗