Pregnancy Induced Hypertension (PIH)

Pregnancy induced hypertension is a condition where a mother develops high blood pressure in later part of the pregnancy (after 20 weeks of gestation). About a third of mothers who develop hypertension during pregnancy can develop a more sinister condition known as pre-eclampsia.

PIH is one of the leading causes of maternal mortality in developed world. It affects the development of  fetus resulting in low birth weight babies. It has been found that having hypertension during pregnancy predisposes the mother to pregnancy complications like placental abruption more frequently. Once a mother develops pregnancy induced hypertension, they are at a higher risk of developing chronic hypertension later in life.

Identifying if a mother is having elevated levels of blood pressure is one of the key things done at an antenatal clinic. Once high blood pressures are detected, blood pressure need to be monitored frequently and controlled with appropriate therapy. With these appropriate therapies, healthcare providers try to prevent development of complications and to deliver a healthy appropriately weighing baby as the end result.

Following is a diagnostic work up of a patient detected of having high blood pressure during pregnancy.

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Gestational Diabetes Mellitus (GDM)

Gestational diabetes mellitus or GDM is a condition where there is increased glucose levels in maternal blood. In pregnancy it is quite normal to have an elevated glucose level than a normal adult, thus having positive urine test for glucose is quite normal. But having too much of glucose in blood is detrimental to the fetus.

GDM can cause variety of pregnancy complications as well as problems for the baby in the future. While in pregnancy high glucose levels in maternal blood results in high glucose levels in fetus, thus hormones like insuline, insuline like growth factor and growth hormone are produced in excess. This leads to increased growth and fat deposition in fetus. Intern this increased growth results in a macrosomic baby, who will eventually have problems while delivery such as "shoulder distocia".

Not only the problems at delivery, but these babies may develop developmental stigmata as well. Sacral agenesis is one of the commonest recognized malformations secondary to gestational diabetes mellitus. Just after birth these babies are at a high risk of developing neonatal hypoglycemia as a result of sudden cut off of glucose supply from the mother as well as due to high insuline production by baby's pancreatic beta cells.

As stated earlier, because these babies produce high levels of insuline before birth, they tend to exhaust their insuline reserves (beta cell function) later in life, thus they are at a high risk of developing Diabetes Mellitus as adults. If the baby is a girl, she will have high risk of developing GDM, thus this whole process goes in a vicious cycle.

Over the years there has been many researches on how best to treat gestational diabetes mellitus by many researchers around the world. Currently accepted way of treatment is to meticulously control blood sugar levels while monitoring closely.

As well as treatment, prevention plays a major role in maternal care. High risk mothers need to be identified and screened so that the condition can be diagnosed early and treatment can begin early to minimize any unwanted effects to the baby and the mother.

This diagram shows the protocol which we use to diagnose GDM in high risk, medium risk and low risk mothers.

So you may be wondering, "am i a high risk mother?". Following is a list of criteria we use to identity high risk mothers. If you have any of the following criteria, you should get pre-conceptional advice on the expected pregnancy and you should be screened as early as possible for possible GDM.

Once GDM is diagnosed, treatment should start immediately. Any delay can be detrimental to the fetus. Following a diagram showing a currently accepted treatment regime.

( MNT stands for Medical and nutritional therapy.)

If you have any queries or doubts just drop in a message and we will give you further information on this topic. http://www.mediconsults.com/p/contact-us.html

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Medical Specialities.. ;)

Really cool work of art with different types of medical specialties on demonstration.. ;)

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2012 Nobel prize in Medicine goes to discovery of Induced Pleuripotent stem cells (iPSC)

Stem cell research is rapidly advancing with the discovery of induced pleuripotent stem cells in 2006. This award is indeed a great encouragement for advancement of stem cell research which may unveil many more surprises in the near future.

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Link between Prenatal Mercury Exposure and ADHD, a new study shows

Over the years there have been many theories linking ADHD to both prenatal and postnatal factors. A new study shows a link between prenatal mercury exposure and ADHD.

October 11, 2012 — Eating certain types of fish with even low levels of mercury while pregnant can increase the risk for attention-deficit/hyperactivity disorder (ADHD) in offspring, whereas consumption of several other types of fish during pregnancy may protect against the disorder, new research suggests.

A cohort study of almost 400 children showed that the risk for inattention and impulsivity at the age of 8 years was significantly associated with maternal mercury levels of at least 1 μg/g. In addition, as the mercury levels increased, so did risk.

However, when the mothers ate at least 2 servings of fish a week, the risk for ADHD symptoms decreased.

"I was a little surprised by the strength of the protective effect of fish consumption," senior author Susan Korrick, MD, MPH, assistant professor of medicine at Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, told Medscape Medical News.
Dr. Susan Korrick

"But the study also adds to literature that suggests that low-level contaminant exposures prenatally can alter behavior in kids," said Dr. Korrick.

The investigators suggest that more research is needed, because they did not assess a clinical diagnosis of ADHD in their study, nor did they examine types of fish consumed.

"Although a single estimate combining these beneficial vs detrimental effects vis-à-vis fish intake is not possible with these data, these findings are consistent with a growing literature...and are important for informing dietary recommendations for pregnant women," they write.

The study was published online October 8 in the Archives of Pediatrics and Adolescent Medicine.

Dose-Dependent Effect

Between 1993 and 1998, 788 infants from Massachusetts were enrolled in this study, which was designed to assess a possible link between exposure to polychlorinated biphenyls (PCBs) and neurodevelopment.

Soon after birth, hair samples were collected from the mothers and analyzed for mercury levels. The mothers also filled out a questionnaire regarding fish consumption during pregnancy.

At 8-year follow-up, 421 of these children were assessed for possible ADHD behaviors through the use of the Connors Rating Scale–Teachers, the Neurobehavioral Evaluation System 2 Continuous Performance Test, and 2 subscales of the Weschler Intelligence Scale for Children–Third Edition.

Results showed that not only was mercury exposure associated with inattention and impulsivity/hyperactivity, but the risk for these behaviors increased with maternal hair mercury levels.

The threshold for first association with ADHD symptoms appeared to be at least 1 μg/g or more of mercury.

"For example, at 1 μg/g or greater, the adjusted risk ratios for mild/markedly atypical inattentive and impulsive/hyperactive behaviors were 1.4 (95% CI [confidence interval], 1.0 -1.8) and 1.7 (95% CI, 1.2 - 2.4), respectively, for an interquartile range (0.5 μg/g) mercury increase," write the researchers.

In addition, these associations were more notable in boys than girls.

Balancing Act

However, offspring of mothers who consumed at least 2 servings of fish a week, which is currently more than the current recommended amounts from the US Food and Drug Administration and the Environmental Protection Agency, had a decrease in ADHD-related behaviors — especially in impulsivity/hyperactivity (relative risk [RR], 0.4 vs 2 servings or fewer of fish per week).

"These findings underscore the difficulties of balancing the benefits of fish intake with the detriments of low-level mercury exposure in developing dietary recommendations in pregnancy," write the investigators.

Although the researchers did not assess which fish are worst and best to consume while pregnant, they noted in a release that previous studies have shown that shark, fresh tuna, and swordfish should be avoided by pregnant women, whereas fish such as haddock, salmon, and flounder are good because of their low levels of mercury and their nutritional value.

"Women need to know that nutrients in fish are good for the brain of a developing fetus, but women [also] need to be aware that high mercury level in some fish pose a risk," said lead author Sharon Sagiv, PhD, MPH, from Boston University School of Public Health in Massachusetts, in the same release.

Time to Examine Environmental Risk Factors

"The study by Sagiv et al...is an important and rigorously conducted prospective birth cohort study," Bruce Lanphear, MD, MPH, from the Child and Family Research Institute and the Simon Fraser University in Vancouver, British Columbia, Canada, writes in an accompanying editorial.

He notes that implications from the study include that "we can take some comfort in recent legislation to reduce mercury contamination, at least from domestic sources."

In addition, Dr. Lanphear writes that the findings show that the time is now right to form a national scientific advisory panel to examine ADHD environmental risk factors, including known factors such as lead and tobacco.

Both this and recent studies "reinforce the urgency of revising the regulatory framework for environmental contaminants and toxicants," he writes.

Find the original article here

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polycystic ovarian syndrome

It is one of the commonest female endocrine diseases we encounter at the clinics. This condition is characterized by physical signs like excessive weight gain (high Body mass index), acne, hirsuitism (excessive body hair) and acanthosis negricans (dark pigmented patches specially seen behind the neck and arm pit). Most of the patients present with sub fertility and infrequent menstrual periods (with heavy menstrual bleeding).

Polycystic ovarian syndrome (PCOS) is diagnosed based on clinical findings (signs and sympotoms) as well as ultrasound findings. Typical ultrasound findings in a patient with polycystic ovarian syndrome would show many fluid filled spaces inside the ovaries, which usually confirms the presence of polycystic ovarian syndrome when combined with clinical features.

Although there are hormonal imbalances in patients with PCOS, exactly why this particular syndrome occurs is still unclear. The process of ovulation is a delicate processes finely controlled by various hormones. When these hormonal control is lost process of ovulation doesn't happen, thus there will not be any ovum (egg) for the conception to occur.

Evidence increasingly shows that PCOS is part of a multi system metabolic syndrome, thus patients with PCOS need to be aware of their future health risks. Once this condition is diagnosed, patients need to be educated about these other risk factors as well as the available treatment modalities. These patient may develop cardiovascular diseases, Diabete melltus and their complications later in life if the condition is not controlled from the beginning.

First step in treating a patient with polycystic ovarian disease is to implement life style modifications to reduce weight and have a healthy BMI. This step can be achieved with dietary changes as well as proper / adequate exercise. along with the life style modifications, medical as well as surgical interventions can be implemented. Metformin is one of the leading drugs we use to control the metabolic effects of PCOS. It has been shown by many clinical trials that metformin has a positive outcome in controlling PCOS.

Laparoscopic ovarian drilling is one of the best and most effective ways in treating women with sub fertility due to PCOS. Since it enhance ovulation and thus improves hormonal balance in the body, signs and symptoms of PCOS will also be controlled thorough this procedure.

Ovarian drilling is a minimally invasive procedure done using only two very small abdominal incisions, thus cosmetic effects of this surgery is very minimal or no. surface of ovaries are punctured using an electrical current to increase the chance of ovulation happening. The procedure is a safe procedure with minimal side effects and currently accepted as the best treatment modality for this condition in centers with laparoscopic facilities.

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