Autoimmunity in gestational diabetes mellitus in Sardinia: a preliminary case-control report

<p>Abstract</p> <p>Background</p> <p>We previously reported a high prevalence (22.3%) of gestational diabetes mellitus (GDM) in a large group of Sardinian women, in contrast with the prevalence of Type 2 diabetes. Sardinia has an unusual distribution of haplotypes and genotypes, with the highest population frequency of HLA DR3 in the world, and after Finland, the highest prevalence of Type 1 diabetes and Autoimmune-related Diseases. In this study we preliminarily tested the prevalence of serological markers of Type 1 diabetes in a group of Sardinian GDM patients.</p> <p>Methods</p> <p>We determined glutamic decarboxylase antibodies (anti-GAD65), protein tyrosine phosphatase ICA 512 (IA2) antibodies (anti-IA2), and IAA in 62 GDM patients, and in 56 controls with matching age, gestational age and parity.</p> <p>Results</p> <p>We found a high prevalence and very unusual distribution of antibodies in GDM patients (38.8%), the anti-IA2 being the most frequent antibody. Out of all our GDM patients, 38.8% (24 of 62) were positive for at least one antibody. Anti-IA2 was present in 29.0 % (18 out of 62) vs. 7.1% (4 out of 56) in the controls (P < 0.001). IAA was present in 14.5% (9 out of 62) of our GDM patients, and absent in the control subjects (P < 0.001). Anti-GAD65 was also present in GDM patients, with a prevalence of 3.2% (2 out of 62) while it was absent in the control group (P = NS). Pre-gestational weight was significantly lower (57.78 ± 9.8 vs 65.9 ± 17.3 <it>P </it>= 0.04) in auto-antibodies- positive GDM patients.</p> <p>Conclusion</p> <p>These results are in contrast with the very low prevalence of all antibodies reported in Italy. If confirmed, they could indicate that a large proportion of GDM patients in Sardinia have an autoimmune origin, in accordance with the high prevalence of Type 1 diabetes.</p

Use of oral contraceptives in the management of acne

The pathogenesis of acne (the most common disorder involving the sebaceous gland) originates from increased sebum production by the sebaceous gland followed by colonization of the hair follicle with Propionibacterium acnes, hyperkeratinization of the upper follicle, and release of inflammatory mediators into the skin. Androgens are the main stimulators of sebum production. Androgens originate from the gonads and adrenal glands, but can also be locally produced within the sebaceous gland from dehydroepiandrosterone sulfate. In the presence of high androgen levels, which can be either a normal pattern of adolescence or a consequence of gonadal or adrenal disease, overproduction of sebum triggers the pathogenesis of acne which, mainly in adolescent women, has deleterious psychological consequences. Estrogens exert the opposite action on sebum production, probably due to the reduction of androgen availability, a direct consequence of estrogen-related increased production of hepatic sex hormone-binding globulin (SHBG). The inhibition of the hypothalamus-pituitary axis induced by oral contraceptives is followed by reduced androgen production. Oral contraceptives containing ethinyl estradiol, which has strong estrogenic activity, amplify the hypoandrogenic effect via estrogenrelated stimulation of SHBG. The hypoandrogenic effect of oral contraceptives is modulated by the progestin compound. Progestins derived from 19-nortestosterone bind androgenic receptors, whereas others exert antiandrogenic properties by antagonizing the binding of androgens to their receptors, reduce 5α-reductase, and do not bind SHBG. Through this last effect, SHBG is freely available to bind androgens, and the same progestin is totally free to exert its antiandrogenic properties. After correct evaluation of the cause of acne, appropriate management can be undertaken using oral contraceptives containing low daily doses of ethinyl estradiol (20 or 30 μg) associated with a progestin compound, such as cyproterone acetate, drospirenone, or chlormadinone acetate, the antiandrogenic activity of which has been demonstrated by many studies in animals and in humans

The 12-month treatment with the oral contraceptive formulation containing dienogest (DNG) and estradiol valerate (E2V) shows beneficial effects on psychological symptoms: results from a prospective comparative study with a formulation containing ethinyl estradiol (EE) and drospirenone (DRSP)

The COCs evolution has been obtained with new and differents progestinic compounds associated with lower doses of EE (ethinylestradiol). The revolution in the COCs field is the introduction of estradiol valerate (E2V), ester of the natural estrogen, estradiol (E2) instead of EE. Dienogest (DNG) is the progestinic compound of the COC Klaira® associated with E2V in a multiphase formulation. DNG has a strong antiandrogenetic action without the mineralcorticoid and glucocorticoid action and E2V acts in this association improving the subjective sleep quality, somatic complaints, anxiety, vigilance, cognition and numerical memory. The EE/DRSP (drospirenone) association (Yaz®) has a progestinic compound characterized by antimineralcorticoid and antiandrogenic properties with a positive effect on psychological symptoms. In this prospective study we evaluated if E2V is able to exert the same psychological symptoms as EE/DRSP formulation. Psychological changes were evaluated with SCL90 for 5 cycles. In comparison with the basal value the score was significantly reduced (p<0,001) during both treatments. This effects observed confirm that DNG and DRSP act with beneficial effects on CN

Alcohol and pregnancy

Alcohol exerts teratogenic effects in all the gestation times, with peculiar features in relationship to the trimester of pregnancy in which alcohol is assumed. Alcohol itself and its metabolites modify DNA synthesis, cellular division, cellular migration and the fetal development. The characteristic facies of feto-alcoholic syndrome (FAS)-affected baby depends on the alcohol impact on skull facial development during the first trimester of pregnancy. In association there are cerebral damages with a strong defect of brain development up to the life incompatibility. Serious consequences on fetal health also depends on dangerous effects of alcohol exposure in the organogenesis of the heart, the bone, the kidney, sensorial organs, et al. It has been demonstrated that maternal binge drinking is a high factor risk of mental retardation and of delinquent behaviour. Unfortunately, a lower alcohol intake also exerts deleterious effects on fetal health. In several countries of the world there is a high alcohol use, and this habit is increased in the women. Therefore, correct information has to be given to avoid alcohol use by women in the preconceptional time and during the pregnancy. Preliminary results of a study performed by the authors show that over 80% of pregnant and puerperal women are not unaware that more than 2 glasses of alcohol/week ingested during pregnancy can create neurological abnormalities in the fetus. However, after the information provided on alcoholic fetopathy, all women are conscious of the damage caused by the use of alcohol to the fetus during pregnancy. This study confirms the need to provide detailed information on the negative effects of alcohol on fetal health.   Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy) · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge researc

Progestin compounds in hormone replacemnt therapy

The role of progestogens in Hormone Replacement Therapy (HRT) is to counteract the estrogen- dependent endometrial mitotic stimulation, thus significantly reducing hyperplasia/carcinoma risk of endometrial cells. Progestogens are different for pharmacological potency, secondary effects on other receptors than progestin receptor, and metabolic effect on various tissues (e.g., breast) and systems (e.g., cardiovascular, central nervous system) of the women’s body. This review summarizes current data on progestogen’s pharmacological role in HRT use for menopause managemen

Effect of Estradiol valerate plus dienogest on body composition of healthy women in the menopausal transition: A prospective one-year evaluation

In the menopausal transition (MT), combined oral contraceptive (COC) should be chosen accordingly to its neutrality on liver metabolism and to its ability to counter the increase of fat mass (FM) that occurs in this reproductive period of life. This prospective multi-centric observational study was conducted on 36 women in their MT at the Universities of Cagliari, Modena and Naples. The body weight (BW), the Body Mass Index (BMI), the waist to hip ratio (WHR), the measurement of body composition (BC) with the Multi-frequency Bioelectrical Impedance (MF-BIA) were performed before, at the 6th and at the 12th month of the study in which a group of women (control group; N.18) did not assume COC, whereas the other 18 women assumed the four-phasic COC containing estradiol valerate (EV) associated with dienogest (EV/DNG group). In comparison to controls in the EV/DNG group, a significant decrease (p50.05) of BW (58.8 \ub1 7.6 to 57.3 \ub1 7.0), BMI (24.1 \ub1 2.7 to 23.5 \ub1 2.8), WHR (0.82 \ub1 0.052 to 0.79 \ub1 0.048) and FM (17.7 \ub1 5.4 to 16.4 \ub1 5.6) was observed. In controls, FM significantly increased (17.0 \ub1 11 to 17.7 \ub1 2.7; p50.05). In conclusion, these results suggest that the anti-androgenic and progestinic activities of DNG associated with a weak estrogenic activity of EV, is a contraceptive method capable of counteracting the negative changes of BC occurring in the MT