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Diabetes in pregnancy has been shown to induce long-term effects in offspring. While considerable attention is focused on the increased incidence of type 2 diabetes mellitus (T2DM) in adult offspring from diabetic mothers, cardiovascular alterations, including hypertension, are also part of the lifelong consequences of in-utero exposure to increased glucose concentrations. This review examines the epidemiologic and mechanistic issues involved in the developmental programming of long-term consequences in the offspring of diabetic mothers, with a particular emphasis on the renal and vascular mechanisms of hypertension. The factors of increased incidence of T2DM and of obesity in adults born after exposure to diabetes during pregnancy are also discussed, as evidence is accumulating that a vicious circle involving lifelong consequences of diabetes in pregnancy in offspring contributes to the current worldwide epidemic of T2DM.
DOI: https://doi.org/10.1016/j.siny.2009.01.002

Summary
In spite of clinicians apparently appreciating the risks of maternal diabetes to the baby, babies of mothers with diabetes are still at increased risk compared to those of non-diabetic women. The rate of prematurity in infants of diabetic mothers is five times that of the general population. Women with pre-gestational diabetes give birth to larger babies. In a recent study, half were above the 90th centile for weight. The postnatal management of these babies continues to give cause for concern. In a recent UK study, over half of all infants of diabetic mothers were admitted to a neonatal unit. One-third of these were at term. This admission rate is three times the UK average and an examination of cases showed that two-thirds of admissions were unnecessary. It is likely that a high maternal blood glucose concentration is the most important factor causing this increased risk. Babies of women with type 1 and type 2 DM have similar complication rates. Tighter preconceptional glycaemic control as well as during the pregnancy is likely to be important in improving outcomes for the babies of diabetic mothers.

DOI:https://doi.org/10.1016/j.siny.2008.11.007

LGBTQIA+: Abbreviation for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual.
The additional “+” stands for all of the other identities not encompassed in the short acronym.
An umbrella term that is often used to refer to the community as a whole

1)      Drug-induced water retention – use of NSAIDs, prednisolone, dexamethasone,  estrogen, vasodilators, calcium antagonists,

2)      Premenstrual tension syndrome

3)      Pregnancy

4)      Hypothyroidism –

5)      Idiopathic edema – females, periodic episodes of generalized body swelling, usually accompanied by abdominal distension, orthostatic water retention (as demonstrated by several hours of standing causes body weight to rise by several pounds),

6)      CCF -  dyspnea, orthopnea, paroxysmal nocturnal dyspnea, generalized edema, JVP elevation, heart enlargement, gallop rhythm, basal lung crepts, liver enlargement,

7)      Alcoholic liver disease

1)      Acute water retention of NSAIDs, steroids

2)      Decompensated cirrhosis

3)      Acute nephritic syndrome

4)      Nephrotic syndrome

5)      CCF

6)      Pregnancy – minor symptoms of pregnancy

1)      Generalized aches and pains, malaise (general ill feeling), headache, blurred vision,  sudden onset oliguria (< 400 ml/day), generalized edema manifested as generalized body swelling (facial swelling, periorbital swelling, arms, hand, feet and legs swelling or dependent edema), hypertension, abnormal heart and lung sounds, JVP elevation, enlarged liver, red blood cell casts, dysmorphic red cells, leucocytes, proteinuria, hematuria (blood in the urine appearing as dark, tea-colored, cloudy urine) (microscopic and/or macroscopic), illness onset days-weeks (acute nephritic syndrome), elevated urea and creatinine, (Acute nephritic syndrome)

2)      Massive proteinuria (> 3 g/24 hrs), hypoalbuminemia, generalized edema, hyperlipidemia, lipiduria, hypercoagulability (manifested as peripheral arterial thrombosis, venous thrombosis, renal vein thrombosis, pulmonary embolism) (Nephrotic syndrome)

3)      Ascities, SGPT, and SGOT elevation raised serum bilirubin, abdominal collateral veins, spider angiomas (Liver failure)

1)      Somatic anxiety syndrome

2)      Somatic depression syndrome

3)      Primary Fibromyalgia – generalized body aches, sleep disturbance, fatigue, depression, generalized body aches for more than 3/12, usually on both sides of the body, and both above and below the waist, and also the axial skeleton involvement, tender points at 11 out of 18 according to the American College of Rheumatology criteria (N), however, subsyndromal cases may have about 5 out of 11 classical sites, associated allodynia, hyperalgesia, hypersensitivity, sensitive to smells, sounds, light, odors, pressure and temperature fluctuations, bright lights, noises, touch, and even smells may be converted to pain, flickering lights, staccato or repetitive noise intolerable, Tx – antidepressants, analgesics, exercises, oral interferon, NMDA receptor blockers

4)      Myofascial Pain Syndrome – MFPS – local or regional muscular pain, burning, stabbing, aching, nagging quality, usual sites are neck, mid thorax region, chest wall, elbow, lumbar region, abdominal pain, hip pain, foot pain, pain aggravated by strenuous use of muscle,  passive stretching of the muscle, pressure on the trigger point, placing the muscle in a shortened position for a prolonged period, sustained contraction of the involved muscle, repeated contraction of the involved muscle, cold, damp weather, viral infection, stress, exposure to cold drafts, myofascial pain is reduced by rest, slow, steady, passive, stretching of the involved muscle, moist heat applied over the trigger point, short periods of light activity with movements, specific myofascial therapy, myofascial trigger points usually at abdominis rectus, obliques, levator ani, obturator internus, piriformis, ilopsoas, hip adductors, trigger points are hard, palpable, hypersensitive nodules in the muscles, spot tenderness over the trigger point, taut band and a nodule at the site of pain, trigger point compression elicits local and referred pain which reproduces patient’s usual pain, snapping compression of trigger point elicits a muscle twitch, passive stretch of a muscle with a trigger point painful, muscle may also show painful weakness, satellite trigger points – these are trigger points which develop in the muscles of referral zones or synergistic muscles of the original primary trigger point muscle.  Tx – Trigger point release with spray and stretch, voluntary contraction and release, trigger point pressure release, deep stroking massage, trigger point injection.

5)      Hypothyroidism

6)      Depression

7)      GAD

8)      SFD

9)      Steroid withdrawal syndrome

10)    Alcoholic myopathy – acute onset generalized body aches, alcohol binging episodes, muscle swelling

11)    Chronic fatigue syndrome

12)    Hypermobility syndrome – Mx – patient education, activity modification, muscle strengthening program

13)    Somatoform Pain disorders

14)    Hypochondriasis

15)    Infections – Fasiocoliasis, amebiasis, giardia, chronic candida yeast infection (particularly in those given multiple courses of antibiotics for UTI, sinusitis, otitis media, sore throat)

16)    Drugs - statins

17)    Osteomalacia

18)    Hypokalemia

1)      Persistent unexplained bone pain (FBC, X-ray, urea, electrolytes, liver and bone profile, PSA, ESR, CRP)

2)      Increasing, unexplained or persistent bone pain OR tenderness, particularly at rest

3)      Elderly, proximal muscle pain and weakness, malaise, weight loss, headache, raised ESR (exclude polymyalgia rheumatica)

4)      Temporal headaches and/or jaw claudication (temporal arteritis)

5)      Weight loss, malaise, anorexia, fever (connective tissue diseases)

6)      Hypercalcemia (metabolic, endocrine or malignant diseases)

7)      Elevated alkaline phosphatase (metabolic, endocrine or malignant diseases)

8)      Hyperuricemia (metabolic, endocrine or malignant diseases)

9)      Hypokalemia (metabolic, endocrine or malignant diseases)

10)    Diffuse bone pain predominantly in the hip girdle, bone tenderness (use moderate force on sternum or anterior tibia with thumb and if it elicits tenderness suggestive of osteomalacia), muscle weakness, particularly proximal muscle weakness with Tredelenburg gait, easy fatiguability, pathological fractures, perioral paresthesiae, acroparesthesiae, carpopedal spasms (Osteomalacia – confirm by low serum Vit D, varying levels of serum Ca and P )

11)    Family history of hemochromatosis, fatigue, weakness, weight loss, abdominal pain, joint pain, mild elevations of aminotransferase levels, asymptomatic hepatomegaly (See under MMSCs for hemochromatosis)

12)    Alcohol abuse, muscle overexertion, muscle compression, HMgCoA reductase inhibitors, cyclosporine, itraconazole, erythromycin, colchicine, zidovudine,  corticosteroids, muscle pain, tenderness, swelling, bruising, weakness, tea-colored urine, fever, malaise, nausea, vomiting, acute confusional state, complications like acute renal failure, DIC, hyperkalemia, hypocalcemia, cardiac arrest, (Rhabdomyolysis)

13)    Hypalgesia, paresthesia, dysesthesia in the limbs and trunk (painful electric shock-like sensations down the spine on neck flexion, painful leg spasms), particularly with a sensory level, loss of vibration sense, loss of positional sense, associated cerebellar signs (ataxia, intention tremor, ataxic gait), eye signs (irregular areas of visual loss in 1 eye, loss of color intensity, eye pain made worse with eye movements, these symptoms initially recurrent but later progressive, nystagmus, INO or MLF syndrome which causes diplopia on lateral gaze), spinal cord signs (manifested as incontinence, impotence, impairment of gait, incontinence initially in sleep and during sexual intercourse, recurrent episodes of retention of urine, finally total loss of control, psychosexual dysfunction include erectile dysfunction, loss of sexual desire, premature or retrograde ejaculation) (Multiple sclerosis) 

1)      Persistent bone pain (FBC)

2)      Unexplained bone pain (FBC)

(NCC-PC Referral Guidelines for Suspected Cancer  in Adults and Children)

(Singer et.al. 1995)

(Alvarez and Rockwell 2002)

(Froese 2001)

(Sauret and Marinides 2002)

(Kaufman 2007)

(CDC – Sexually Transmitted Diseases Treatment Guidelines 2006)