Endocrine Abstracts

The pregnancies conceived after chemotherapy for trophoblastic neoplasia should be followed with clinical surveillance due to higher rates of some pregnancy complications especially when associated with diabetes mellitus. We report the case of a 30-year-old nulliparous woman, obese, had been diagnosed with type 2 diabetes mellitus for 10 years, without micro or macrovascular complications, treated by conventional insulin therapy, with a history of low-risk gestational choriocarcinoma complicating a hydatidiform mole, treated with 11 sessions of Methotrexate chemotherapy in remission for four months. Pregnancy was allowed to proceed by an obstetrics–gynecology specialist after a 3-month preconception program with optimization of insulin therapy and switching to Asparte and Detemir insulin analogues, allowing a decrease in glycated hemoglobin (HbA1c) from 8.4% to 7.7%. Folic acid and iron supplementations were also carried out as well as progestin and salicylic acid. The patient was hospitalized once every three months in order to carry out the assessment of the impact of her diabetes by monitoring of glycemic control as attested by (HbA1c) and fasting blood glucose (FBG), as well as an ophthalmological examination and the search for albuminuria.In the gestational diabetes unit, the patient maintained a strict regimen of capillary blood glucose measurements six times a day weekly as well as dietary avoidance of fat.Blood glycemic control required high doses of insulin (1.2 UI/kg per day) to maintain the HbA1c and FBG levels in the range of 7% and 0.98 mg/dl, respectively.The cardiac and ophthalmologic examinations showed normal findings at each visit.No rise of albuminuria was detected.However, the patient had gained weight more than recommended (11 kg).All measurements of beta-hCG titer showed normal findings throughout pregnancy. Pregnancy progressed favorably up to a term of 27 weeks of gestation when the patient was hospitalized in a gynecology–obstetrics department because of a threat of premature delivery.The contractions were stopped and an obstetrical ultrasound showed a progressive pregnancy with fetal hypotrophy with an estimated weight of 830 g and hydramnios. After a regularly monitored pregnancy, the patient gave birth by caesarean section at 37 weeks of gestation and 2 days. The newborn weighed 4.050 g and had normal Apgar score at 1 and 5 minutes, respectively and was devoid of serious metabolic complications. No similar case has been described in the literature, hence the originality of our case.