Objective: To determine gestational weekly changes in continuous glucose monitoring (CGM) metr... more Objective: To determine gestational weekly changes in continuous glucose monitoring (CGM) metrics and 24hr glucose profiles, and their relationship to infant birthweight in pregnant women with type 1 diabetes. Research Design and Methods: An analysis of >10.5 million CGM glucose measures from 386 pregnant women with type 1 diabetes, from two international, multicentre studies. CGM glucose metrics and 24hr glucose profiles were calculated for each gestational week and the relationship to normal (10-90th percentile) and large (>90th percentile) for gestational age (LGA) birthweight infants determined. Results: Mean CGM glucose concentration fell and percentage of time spent in the pregnancy target range 3.5-7.8 mmol/L (63-140mg/dL) increased in the first 10 weeks of pregnancy, plateaued until 28 weeks gestation, before further improvements in mean glucose and percentage time-in-range until delivery. The maternal CGM glucose metrics diverged at 10 weeks gestation, with signif...
We present a case of the successful treatment of severe amniotic fluid embolism in a 41-year-old ... more We present a case of the successful treatment of severe amniotic fluid embolism in a 41-year-old woman undergoing emergency caesarean section at 36 weeks of gestation for placental abruption and intrauterine fetal demise. The treatment included prolonged cardiopulmonary resuscitation, emergency hysterectomy, re-operation with intra-abdominal packing and intra-aortic balloon pump insertion. The patient made a remarkable recovery and to date has minimal residual morbidity. Amniotic fluid embolism syndrome (AFES) is a rare and often fatal obstetric condition that remains one of the main causes of maternal mortality in developed countries. The incidence varies from 2 to 6 per 100,000 and suggested mortality rates exceed 60%.1-2 The classic triad of sudden hypoxia, hypotension and coagulopathy with acute onset during labour or immediately after delivery forms the hallmark of the AFES diagnosis, however AFES is primarily a clinical diagnosis of exclusion. We present a case of successful m...
Continuous glucose monitoring (CGM) provides detailed information about glucose level fluctuation... more Continuous glucose monitoring (CGM) provides detailed information about glucose level fluctuations over time. The method is increasingly being used in pregnant women with type 1 diabetes. However, only one previous study compared CGM results related to pregnancy outcomes in women using insulin pumps with those administering multiple daily injections (MDI). We performed a secondary analysis of CGM metrics from an observational cohort of pregnant women with type 1 diabetes and compared insulin pump and MDI therapies in relation to maternal and neonatal outcomes.
BJOG: An International Journal of Obstetrics & Gynaecology
OBJECTIVE Determination of lactate in fetal scalp blood (FBS) during labour has been recognized s... more OBJECTIVE Determination of lactate in fetal scalp blood (FBS) during labour has been recognized since the 1970s. The internationally accepted cut-off of >4.8mmol/L indicating fetal acidosis is exclusive for the point-of-care device (POC) LactateProTM , which is no longer in production. The aim of this study was to establish a new cut-off for scalp lactate based on neonatal outcomes with the use of StatstripLactate®/StatstripXpress® Lactate system, the only POC designed for hospital use. DESIGN Observational Study SETTING: January 2016 to March 2020 labouring women with indication for FBS were prospectively included from seven Swedish and one Australian delivery unit. POPULATION Inclusion criteria: singleton pregnancy, vertex presentation, ≥35+0 weeks. METHOD Based on the optimal correlation between FBS lactate and cord pH/lactate, only cases with ≤25 minutes from FBS to delivery were included in the final calculations. MAIN OUTCOME MEASURES Metabolic acidosis in cord blood defined as pH <7.05 plus BDecf >10 mmol/L and/or lactate >10mmol/L. RESULTS 3334 women were enrolled of which 799 were delivered within 25 minutes. The areas under the ROC curves (AUC) and corresponding optimal cut-off values were as follows; metabolic acidosis AUC 0.87 (95% CI:0.77-0.97), cut-off 5.7mmol/L; pH <7.0 AUC 0.83(95% CI:0.68-0.97), cut-off 4.6mmol/L; pH <7.05 plus BDecf ≥12mmol/L AUC 0.97(95% CI:0.92-1), cut-off 5.8mmol/L; Apgar score <7 at 5th minute AUC 0.74(95% CI:0.63-0.86), cut-off 5.2mmol/L; and pH <7.10 plus composite neonatal outcome AUC 0.76(95% CI:0.67-0.85), cut-off 4.8mmol/L. CONCLUSION A scalp lactate level of <5.2mmol/L using the StatstripLactate®/StatstripXpress® system will safely rule out fetal metabolic acidosis.
Aims: This study investigated whether single nucleotide polymorphisms (SNPs) reported by previous... more Aims: This study investigated whether single nucleotide polymorphisms (SNPs) reported by previous genome-wide association studies (GWAS) to be associated with impaired insulin secretion, insulin resistance, and/or type 2 diabetes are associated with disposition index, the homeostasis model assessment of insulin resistance (HOMA-IR), and/or development of diabetes following a pregnancy complicated by gestational diabetes mellitus (GDM).Methods: Seventy-two SNPs were genotyped in 374 women with previous GDM from Southern Sweden. An oral glucose tolerance test was performed 1–2 years postpartum, although data on the diagnosis of diabetes were accessible up to 5 years postpartum. HOMA-IR and disposition index were used to measure insulin resistance and secretion, respectively. Results: The risk A-allele in the rs11708067 polymorphism of the adenylate cyclase 5 gene (ADCY5) was associated with decreased disposition index (beta = -0.90, SE 0.38, p = 0.019). This polymorphism was an expres...
Background It is discussed whether fetal scalp stimulation (FSS) test is a reliable complimentary... more Background It is discussed whether fetal scalp stimulation (FSS) test is a reliable complimentary tool to cardiotocography (CTG) to assess fetal wellbeing during labor. The test is based on the assumption that a well-oxygenated fetus, in contrast to the depressed fetus, will respond to a certain stimulus. The aim of this study was to investigate the effectiveness of the FSS-test. Methods A retrospective observational study carried out Copenhagen University Hospital, Herlev, Denmark. Laboring women with singleton pregnancies in cephalic presentation after gestation week 33 and indication for fetal blood sampling (FBS) were eligible for inclusion. The FSS-test was classified as positive when an acceleration was absent at the time of FBS and negative when an acceleration was present. Lactate in scalp blood was measured by the point-of-care device LactatePro™ and pH in artery umbilical cord blood by the stationary blood gas analyzer ABL800. Lactate level 7.1 were cut-offs for normality...
Obstetricians routinely use biochemical parameters from non‐pregnant women to assess the conditio... more Obstetricians routinely use biochemical parameters from non‐pregnant women to assess the condition of the laboring mother. However, it is well known that pregnancy leads to significant physiological changes in most organ systems. The aim of this study was to determine normal values for maternal arterial blood gases during vaginal deliveries as compared with control values from planned cesarean sections. We also wanted to elucidate the effect of various maternal characteristics, mode of delivery and obstetric interventions on blood gas values.
ObjectiveTo determine a reference interval for maternal arterial blood values during vaginal deli... more ObjectiveTo determine a reference interval for maternal arterial blood values during vaginal delivery and to elucidate the effect of common maternal characteristics and obstetric interventions on maternal acid base values during vaginal and planned cesarean section (CS).DesignProspective, observational study of randomly selected women undergoing vaginal deliveries and planned CS at Skåne University Hospital, Malmö, Sweden.ResultsTwo hundred and fifty women undergoing vaginal delivery (VD) and fifty-eight women undergoing planned CS were recruited. We found significant differences for gestational age, parity, artery pH, pCO2, pO2, sO2 and cord venous pH, pCO2 and lactate between the two study groups (P < 0.005). For women undergoing vaginal delivery, we found significant changes in base deficit, hemoglobin, bilirubin, potassium, glucose and lactate values as compared to women with planned CS (P < 0.02). Maternal characteristics did not significantly affect acid base parameters ...
Background. In Sweden, both glucose analyzers in accredited laboratories and point-of-care glucos... more Background. In Sweden, both glucose analyzers in accredited laboratories and point-of-care glucose devices are used for gestational diabetes mellitus (GDM) diagnosis. The aim of this study was to compare the diagnostic performance of the HemoCue Glucose 201+ (HC201+) and RT (HC201RT) systems with that of the hospital central laboratory hexokinase method (CL) based on lyophilized citrate tubes, using the isotope dilution gas chromatography-mass spectrometry (ID GC-MS) as reference. Methods. A 75 g oral glucose tolerance test was performed on 135 women screened positive for GDM. Diagnosis was based on the World Health Organization 2013 diagnostic thresholds for fasting (n=135), 1 h (n=52), and 2 h (n=135) glucose measurements. Bland-Altman analysis and surveillance error grids were used to evaluate analytical and clinical accuracy. Results. Significantly more women were diagnosed with GDM by HC201+ (80%) and CL (80%) than with the reference (65%, P<0.001) based on fasting and/or 2 ...
Objective: To determine gestational weekly changes in continuous glucose monitoring (CGM) metr... more Objective: To determine gestational weekly changes in continuous glucose monitoring (CGM) metrics and 24hr glucose profiles, and their relationship to infant birthweight in pregnant women with type 1 diabetes. Research Design and Methods: An analysis of >10.5 million CGM glucose measures from 386 pregnant women with type 1 diabetes, from two international, multicentre studies. CGM glucose metrics and 24hr glucose profiles were calculated for each gestational week and the relationship to normal (10-90th percentile) and large (>90th percentile) for gestational age (LGA) birthweight infants determined. Results: Mean CGM glucose concentration fell and percentage of time spent in the pregnancy target range 3.5-7.8 mmol/L (63-140mg/dL) increased in the first 10 weeks of pregnancy, plateaued until 28 weeks gestation, before further improvements in mean glucose and percentage time-in-range until delivery. The maternal CGM glucose metrics diverged at 10 weeks gestation, with signif...
We present a case of the successful treatment of severe amniotic fluid embolism in a 41-year-old ... more We present a case of the successful treatment of severe amniotic fluid embolism in a 41-year-old woman undergoing emergency caesarean section at 36 weeks of gestation for placental abruption and intrauterine fetal demise. The treatment included prolonged cardiopulmonary resuscitation, emergency hysterectomy, re-operation with intra-abdominal packing and intra-aortic balloon pump insertion. The patient made a remarkable recovery and to date has minimal residual morbidity. Amniotic fluid embolism syndrome (AFES) is a rare and often fatal obstetric condition that remains one of the main causes of maternal mortality in developed countries. The incidence varies from 2 to 6 per 100,000 and suggested mortality rates exceed 60%.1-2 The classic triad of sudden hypoxia, hypotension and coagulopathy with acute onset during labour or immediately after delivery forms the hallmark of the AFES diagnosis, however AFES is primarily a clinical diagnosis of exclusion. We present a case of successful m...
Continuous glucose monitoring (CGM) provides detailed information about glucose level fluctuation... more Continuous glucose monitoring (CGM) provides detailed information about glucose level fluctuations over time. The method is increasingly being used in pregnant women with type 1 diabetes. However, only one previous study compared CGM results related to pregnancy outcomes in women using insulin pumps with those administering multiple daily injections (MDI). We performed a secondary analysis of CGM metrics from an observational cohort of pregnant women with type 1 diabetes and compared insulin pump and MDI therapies in relation to maternal and neonatal outcomes.
BJOG: An International Journal of Obstetrics & Gynaecology
OBJECTIVE Determination of lactate in fetal scalp blood (FBS) during labour has been recognized s... more OBJECTIVE Determination of lactate in fetal scalp blood (FBS) during labour has been recognized since the 1970s. The internationally accepted cut-off of >4.8mmol/L indicating fetal acidosis is exclusive for the point-of-care device (POC) LactateProTM , which is no longer in production. The aim of this study was to establish a new cut-off for scalp lactate based on neonatal outcomes with the use of StatstripLactate®/StatstripXpress® Lactate system, the only POC designed for hospital use. DESIGN Observational Study SETTING: January 2016 to March 2020 labouring women with indication for FBS were prospectively included from seven Swedish and one Australian delivery unit. POPULATION Inclusion criteria: singleton pregnancy, vertex presentation, ≥35+0 weeks. METHOD Based on the optimal correlation between FBS lactate and cord pH/lactate, only cases with ≤25 minutes from FBS to delivery were included in the final calculations. MAIN OUTCOME MEASURES Metabolic acidosis in cord blood defined as pH <7.05 plus BDecf >10 mmol/L and/or lactate >10mmol/L. RESULTS 3334 women were enrolled of which 799 were delivered within 25 minutes. The areas under the ROC curves (AUC) and corresponding optimal cut-off values were as follows; metabolic acidosis AUC 0.87 (95% CI:0.77-0.97), cut-off 5.7mmol/L; pH <7.0 AUC 0.83(95% CI:0.68-0.97), cut-off 4.6mmol/L; pH <7.05 plus BDecf ≥12mmol/L AUC 0.97(95% CI:0.92-1), cut-off 5.8mmol/L; Apgar score <7 at 5th minute AUC 0.74(95% CI:0.63-0.86), cut-off 5.2mmol/L; and pH <7.10 plus composite neonatal outcome AUC 0.76(95% CI:0.67-0.85), cut-off 4.8mmol/L. CONCLUSION A scalp lactate level of <5.2mmol/L using the StatstripLactate®/StatstripXpress® system will safely rule out fetal metabolic acidosis.
Aims: This study investigated whether single nucleotide polymorphisms (SNPs) reported by previous... more Aims: This study investigated whether single nucleotide polymorphisms (SNPs) reported by previous genome-wide association studies (GWAS) to be associated with impaired insulin secretion, insulin resistance, and/or type 2 diabetes are associated with disposition index, the homeostasis model assessment of insulin resistance (HOMA-IR), and/or development of diabetes following a pregnancy complicated by gestational diabetes mellitus (GDM).Methods: Seventy-two SNPs were genotyped in 374 women with previous GDM from Southern Sweden. An oral glucose tolerance test was performed 1–2 years postpartum, although data on the diagnosis of diabetes were accessible up to 5 years postpartum. HOMA-IR and disposition index were used to measure insulin resistance and secretion, respectively. Results: The risk A-allele in the rs11708067 polymorphism of the adenylate cyclase 5 gene (ADCY5) was associated with decreased disposition index (beta = -0.90, SE 0.38, p = 0.019). This polymorphism was an expres...
Background It is discussed whether fetal scalp stimulation (FSS) test is a reliable complimentary... more Background It is discussed whether fetal scalp stimulation (FSS) test is a reliable complimentary tool to cardiotocography (CTG) to assess fetal wellbeing during labor. The test is based on the assumption that a well-oxygenated fetus, in contrast to the depressed fetus, will respond to a certain stimulus. The aim of this study was to investigate the effectiveness of the FSS-test. Methods A retrospective observational study carried out Copenhagen University Hospital, Herlev, Denmark. Laboring women with singleton pregnancies in cephalic presentation after gestation week 33 and indication for fetal blood sampling (FBS) were eligible for inclusion. The FSS-test was classified as positive when an acceleration was absent at the time of FBS and negative when an acceleration was present. Lactate in scalp blood was measured by the point-of-care device LactatePro™ and pH in artery umbilical cord blood by the stationary blood gas analyzer ABL800. Lactate level 7.1 were cut-offs for normality...
Obstetricians routinely use biochemical parameters from non‐pregnant women to assess the conditio... more Obstetricians routinely use biochemical parameters from non‐pregnant women to assess the condition of the laboring mother. However, it is well known that pregnancy leads to significant physiological changes in most organ systems. The aim of this study was to determine normal values for maternal arterial blood gases during vaginal deliveries as compared with control values from planned cesarean sections. We also wanted to elucidate the effect of various maternal characteristics, mode of delivery and obstetric interventions on blood gas values.
ObjectiveTo determine a reference interval for maternal arterial blood values during vaginal deli... more ObjectiveTo determine a reference interval for maternal arterial blood values during vaginal delivery and to elucidate the effect of common maternal characteristics and obstetric interventions on maternal acid base values during vaginal and planned cesarean section (CS).DesignProspective, observational study of randomly selected women undergoing vaginal deliveries and planned CS at Skåne University Hospital, Malmö, Sweden.ResultsTwo hundred and fifty women undergoing vaginal delivery (VD) and fifty-eight women undergoing planned CS were recruited. We found significant differences for gestational age, parity, artery pH, pCO2, pO2, sO2 and cord venous pH, pCO2 and lactate between the two study groups (P < 0.005). For women undergoing vaginal delivery, we found significant changes in base deficit, hemoglobin, bilirubin, potassium, glucose and lactate values as compared to women with planned CS (P < 0.02). Maternal characteristics did not significantly affect acid base parameters ...
Background. In Sweden, both glucose analyzers in accredited laboratories and point-of-care glucos... more Background. In Sweden, both glucose analyzers in accredited laboratories and point-of-care glucose devices are used for gestational diabetes mellitus (GDM) diagnosis. The aim of this study was to compare the diagnostic performance of the HemoCue Glucose 201+ (HC201+) and RT (HC201RT) systems with that of the hospital central laboratory hexokinase method (CL) based on lyophilized citrate tubes, using the isotope dilution gas chromatography-mass spectrometry (ID GC-MS) as reference. Methods. A 75 g oral glucose tolerance test was performed on 135 women screened positive for GDM. Diagnosis was based on the World Health Organization 2013 diagnostic thresholds for fasting (n=135), 1 h (n=52), and 2 h (n=135) glucose measurements. Bland-Altman analysis and surveillance error grids were used to evaluate analytical and clinical accuracy. Results. Significantly more women were diagnosed with GDM by HC201+ (80%) and CL (80%) than with the reference (65%, P<0.001) based on fasting and/or 2 ...
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