Glycemic Control in Diabetic Pregnancies: Effects on Fetal and Maternal Outcome

Background: Both maternal and fetal complications are increased in diabetic pregnancies. Although hypertensive complications are increased in pregnant women with pregestational diabetes, reports on hypertensive complications in women with gestational diabetes mellitus (GDM) have been contradictory. Congenital malformations and macrosomia are the main fetal complications in Type 1 diabetic pregnancies, whereas fetal macrosomia and birth trauma but not congenital malformations are increased in GDM pregnancies. Aims: To study the frequency of hypertensive disorders in gestational diabetes mellitus. To evaluate the risk of macrosomia and brachial plexus injury (Erb’s palsy) and the ability of the 2-hour glucose tolerance test (OGTT) combined with the 24-hour glucose profile to distinguish between low and high risks of fetal macrosomia among women with GDM. To evaluate the relationship between glycemic control and the risk of fetal malformations in pregnancies complicated by Type 1 diabetes mellitus. To assess the effect of glycemic control on the occurrence of preeclampsia and pregnancy-induced hypertension in Type 1 diabetic pregnancies. Subjects: A total of 986 women with GDM and 203 women with borderline glucose intolerance (one abnormal value in the OGTT) with a singleton pregancy, 488 pregnant women with Type 1 diabetes (691 pregnancies and 709 offspring), and 1154 pregnant non-diabetic women (1181 pregnancies and 1187 offspring) were investigated. Results: In a prospective study on 81 GDM patients the combined frequency of preeclampsia and PIH was higher than in 327 non-diabetic controls (19.8% vs 6.1%, p<0.001). On the other hand, in 203 women with only one abnormal value in the OGTT, the rate of hypertensive complications did not differ from that of the controls. Both GDM women and those with only one abnormal value in the OGTT had higher pre-pregnancy weights and BMIs than the controls. In a retrospective study involving 385 insulin-treated and 520 diet-treated GDM patients, and 805 non-diabetic control pregnant women, fetal macrosomia occurred more often in the insulin-treated GDM pregnancies (18.2%, p<0.001) than in the diet-treated GDM pregnancies (4.4%), or the control pregnancies (2.2%). The rate of Erb’s palsy in vaginally delivered infants was 2.7% in the insulin-treated group of women and 2.4% in the diet-treated women compared with 0.3% in the controls (p<0.001). The cesarean section rate was more than twice as high (42.3% vs 18.6%) in the insulin-treated GDM patients as in the controls. A major fetal malformation was observed in 30 (4.2%) of the 709 newborn infants in Type 1 diabetic pregnancies and in 10 (1.4%) of the 735 controls (RR 3.1, 95% CI 1.6–6.2). Even women whose levels of HbA1c (normal values less than 5.6%) were only slightly increased in early pregnancy (between 5.6 and 6.8%) had a relative risk of fetal malformation of 3.0 (95% CI 1.2–7.5). Only diabetic patients with a normal HbA1c level (<5.6%) in early pregnancy had the same low risk of fetal malformations as the controls. Preeclampsia was diagnosed in 12.8% and PIH in 11.4% of the 616 Type 1 diabetic women without diabetic nephropathy. The corresponding frequencies among the 854 control women were 2.7% (OR 5.2; 95% CI 3.3–8.4) for preeclampsia and 5.6% (OR 2.2, 95% CI 1.5–3.1) for PIH. Multiple logistic regression analysis indicated that glycemic control, nulliparity, diabetic retinopathy and duration of diabetes were statistically significant independent predictors of preeclampsia. The adjusted odds ratios for preeclampsia were 1.6 (95% CI 1.3–2.0) for each 1%-unit increment in the HbA1c value during the first trimester and 0.6 (95% CI 0.5–0.8) for each 1%-unit decrement during the first half of pregnancy. In contrast, changes in glycemic control during the second half of pregnancy did not alter the risk of preeclampsia. Conclusions: In type 1 diabetic pregnancies it is extremely important to achieve optimal glycemic control before pregnancy and maintain it throughout pregnancy in order to decrease the complication rates both in the mother and in her offspring. The rate of fetal macrosomia and birth trauma in GDM pregnancies, especially in the group of insulin-treated women, is still relatively high. New strategies for screening, diagnosing, and treatment of GDM must be developed in order to decrease fetal and neonatal complications.

Quantity and tone in Finnish lexically stressed syllables

This paper presents results from a study on the tonal aspects of quantity in Finnish lexically stressed syllables. Fourteen speakers produced a set of 66 utterances where the quantity and structure of the lexically stressed syllable was system- atically varied. The tonal aspects of the syllable nucleus and nucleus and coda in case of closed syllables was stud- ied in the framework of the Target Approximation theory as formulated by Yi Xu. The results show a clear tendency to- wards the quantity distinction and bimoracity in general in Finnish to be signalled tonally by a dynamic falling tone as opposed to a static high tone in short (one mora) nuclei.

Word order and tonal shape in the production of focus in short Finnish utterances

This paper presents results from a study on the production of Finnish prosody. The effect of word order and the tonal shape in the production of Finnish prosody was studied as produced by 8 native Finnish speakers. Predictions formulated with regard to results from an earlier study pertaining to the perception of promi- nence were tested. These predictions had to do with the tonal shape of the utterances in the form of a flat hat pattern and the effect of word order on the so called top-line declination within an adver- bial phrase in the utterances. The results from the experiment give support to the following claims: the temporal domain of prosodic focus is the whole utterance, word order reversal from unmarked to marked has an effect on the production of prosody, and the pro- duction of the tonal aspects of focus in Finnish follows a basic flat hat pattern. That is the prominence of a word can be produced by an f 0 rise or a fall, depending on the location of the word in an utterance. The basic accentual shape of a Finnish word is then not a pointed rise/fall hat shape as claimed before since it can vary depending on the syllable structure and the position within an ut- terance.

New Method for Delexicalization and its Application to Prosodic Tagging for Text-to-Speech Synthesis

This paper describes a new flexible delexicalization method based on glottal excited parametric speech synthesis scheme. The system utilizes inverse filtered glottal flow and all-pole modelling of the vocal tract. The method provides a possibil- ity to retain and manipulate all relevant prosodic features of any kind of speech. Most importantly, the features include voice quality, which has not been properly modeled in earlier delex- icalization methods. The functionality of the new method was tested in a prosodic tagging experiment aimed at providing word prominence data for a text-to-speech synthesis system. The ex- periment confirmed the usefulness of the method and further corroborated earlier evidence that linguistic factors influence the perception of prosodic prominence.

Two Scenarios for How Scholarly Publishers Could Change Their Business Model to Open Access

The Internet has made possible the cost-effective dissemination of scientific journals in the form of electronic versions, usually in parallel with the printed versions. At the same time the electronic medium also makes possible totally new open access (OA) distribution models, funded by author charges, sponsorship, advertising, voluntary work, etc., where the end product is free in full text to the readers. Although more than 2,000 new OA journals have been founded in the last 15 years, the uptake of open access has been rather slow, with currently around 5% of all peer-reviewed articles published in OA journals. The slow growth can to a large extent be explained by the fact that open access has predominantly emerged via newly founded journals and startup publishers. Established journals and publishers have not had strong enough incentives to change their business models, and the commercial risks in doing so have been high. In this paper we outline and discuss two different scenarios for how scholarly publishers could change their operating model to open access. The first is based on an instantaneous change and the second on a gradual change. We propose a way to manage the gradual change by bundling traditional “big deal” licenses and author charges for opening access to individual articles.

Kiehuva veri

Abstract: Boiling blood : anger at the start of the modern era in England