Diabetic ketoacidosis and insulin resistance with subcutaneous terbutaline infusion: a case report

Article Abstract:

Beta-adrenergic drugs, such as ritodrine and terbutaline, may be given intravenously to pregnant women to achieve tocolysis, which is the inhibition of uterine contractions. However, in diabetic women, tocolysis with beta-adrenergic drugs can cause diabetic ketoacidosis, which is increased acidity of body fluids due to excess amounts of ketone bodies, the end products of fat metabolism. One study reported that terbutaline can be given subcutaneously (under the skin) to prevent preterm or early labor. A case is described of a 25-year-old pregnant woman with insulin-dependent diabetes mellitus who developed diabetic ketoacidosis during treatment with terbutaline given subcutaneously. Terbutaline was given to prevent uterine contractions, which developed at 25 weeks gestation. Terbutaline treatment was associated with: hyperglycemia, or excessive blood levels of glucose; ketonuria, the presence of ketone bodies in the urine; and acidosis, increased acidity of body fluids. She was treated with increasing doses of insulin and a diabetic diet, and the hyperglycemia and ketoacidosis resolved. The patient was maintained on terbutaline until the thirty-fifth week of gestation, when she underwent a cesarean section. This case shows that terbutaline given subcutaneously may cause brief episodes of insulin resistance, the decreased ability of tissues to respond to insulin, as well as diabetic ketoacidosis in pregnant women with diabetes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Insulin resistance, Adrenergic beta agonists, Adrenergic beta-agonists, Ketoacidosis, Diabetic ketoacidosis

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High glucose levels decrease proliferation of cultured human fetal cells from placenta

Article Abstract:

Studies indicate that abnormally high blood sugar, or glucose, levels in pregnant diabetic women may affect the developing fetus. Hyperglycemia, high blood glucose, has been associated with fetal loss, abnormal development, and growth retardation. To see how glucose affects the cells of the fetus, rapidly growing cells were removed from placentas after delivery and grown in the laboratory in varying levels of glucose. Fewer cells grew in the specimens exposed to higher levels of glucose. The proliferation of cells is essential for normal development throughout pregnancy. When cell growth is adversely affected, particularly during critical stages of fetal development, severe abnormalities can result. Previous studies examining the effects of high glucose on fetal development in diabetic pregnancies have used animal models. This model, which uses human cells derived from products of conception, may provide a more accurate assessment. However, these cells were obtained from completed pregnancies which may not be representative of cellular activity during early embryonic development. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Evaluation, Physiological aspects, Morphogenesis, Hyperglycemia, Fetal tissues, Epigenesis

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Fetal cardiac hypertrophy and cardiac function in diabetic pregnancies

Article Abstract:

Fetuses of diabetic mothers may develop abnormalities in heart structure and function even though the mothers' diabetes is controlled with insulin. Researchers performed ultrasonography and echocardiography studies on the fetuses of 23 diabetic pregnant women whose diabetes was controlled by diet and insulin. Fetuses were grouped by gestational age and compared to normal fetuses of similar ages. Fetal hearts of diabetic mothers were enlarged and heavier than fetal hearts of nondiabetic mothers. The walls of the heart ventricles were thicker, especially on the the right side. The right ventricle contracted more strongly in fetal hearts of diabetic mothers. Maternal diabetes may cause fetuses to grow faster and larger, even if diabetes is under control.

Fetal heart

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