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R W Beard

Publications and source records attributed to R W Beard.

205 records · Page 12Linked to original sources
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Clinical perspectives in the care of the pregnant diabetic patient.

Despite the considerable improvement in the care of the diabetic mother and the prognosis for her baby, a number of clinical problems remain unresolved. Apart from the increased incidence of major and minor fetal anomalies, morbidity amongst the newborn and the high incidence of diabetes in later life of women who have had relatively minor carbohydrate intolerance during pregnancy are a cause for concern. In this paper the outstanding clinical problems and thier possible solutions are considered. The elucidation of the origin of congenital malformations is discussed. The prevention of congenital anomalies in the diabetic requires a precise knowledge of their aetiology which is currently not available. However, on the hypothesis that diabetes creates an abnormal biochemical environment which may well disturb embryogenesis, it is logical to try and control maternal blood sugar as soon as possible in pregnancy or even before conception. To extend this argument further, it follows naturally that the maintenance of normoglycaemia throughout pregnancy until delivery is also desirable. The practicalities of various methods of screening for diabetes in pregnancy and new approaches in the medical and obstetric problems of the pregnant diabetic are also considered. Finally, the question of contraception and its implication for the woman who is known to have carbohydrate intolerance in pregnancy is discussed.

Congenital Abnormalities↗
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Congenital malformations in babies of diabetic mothers.

In 1979-80 a national survey of the incidence of congenital malformations in babies born to diabetic mothers in the United Kingdom was carried out by questionnaire. Of the 1034 mothers reported, 773 were known to have diabetes before the index pregnancy. The incidence of congenital malformations ws 7.1% which is significantly higher than the 2.1% in the offspring reported to the Office of Population, Censuses and Surveys (OPCS) for England and Wales in 1979-80. The increase was most pronounced for malformations of the heart, spine, lungs, and brain. In 40% of the diabetic mothers blood glucose was not recorded during the first trimester of pregnancy, and in this group the malformation rate was twice that in babies born of mothers who had had at least one reported blood glucose estimation during this time. We conclude that there is an urgent need to improve health education and supervision before and during pregnancy in all diabetic women if the prevalence of malformations amongst their offspring is to be reduced.

Blood Glucose↗
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Increased maternal fasting proinsulin as a predictor of insulin requirement in women with gestational diabetes.

Circulating proinsulin was assessed during a 75g OGTT in 55 pregnant women who fulfilled WHO criteria for impaired glucose tolerance before the 32nd gestational week. Proinsulin was assayed retrospectively using a two-site immunoradiometric assay and immunoreactive insulin by radioimmunoassay. Of the 55 women, 19 required insulin treatment in addition to diet later in pregnancy. Fasting proinsulin concentrations were significantly higher in the 19 women who later required insulin treatment compared with the 36 women treated with diet alone (3.4 +/- 0.7 vs 1.8 +/- 0.2 pmol l-1, p < 0.005). There was no difference between the treatment groups of 60 and 120 min proinsulin values during the OGTT. Fasting plasma glucose and immunoreactive insulin were similar in the insulin-treated and diet-treated women and remained similar during the OGTT. No women within the insulin-treated group had a fasting plasma proinsulin value < 1.1 pmol l-1 in contrast with 12 women in the diet-treated group (p = 0.0123). Ten of the 19 insulin-treated women had a fasting plasma proinsulin > 2.5 pmol l-1 compared with 8 of the 36 diet-treated women (p = 0.0346). Fasting proinsulin values early in pregnancy have prognostic implications in women with gestational diabetes.

Adult↗