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To provide evidence-based recommendations for appropriate management of women with diabetes and pregnancy. Systematic review with a particular focus on current guidelines. MEDLINE (1950 to March, 2004) and Embase (1980 to January 2004) were searched. Inclusion criteria were that the article was in English, primary publications in peer-reviewed journals, and related to management of diabetes mellitus in pregnancy. There were no publication date restrictions. Reference lists of identified studies were also checked. Abstracts were judged according to whether they contained relevant information and, in the case of the latter, the full paper was retrieved. Where consensus was not possible, the panel discussed points of disagreement and voted on the issue. There is evidence that the outcomes of pregnancy are not as benign in women with pre-existing diabetes as conventionally thought and some evidence that diabetes treatment should be administered in a timely fashion. The extent to which improvements in perinatal and maternal outcomes can be achieved is dependent on the achievement of glycaemic control in the pregnancy, as these improvement is directly related to the degree of control. The practical approach to managing diabetic women during pregnancy has been evolving in recent years. There is currently clear evidence on when insulin treatment should be commenced and to what extent maternal hypoglycaemia should be avoided. There is also evidence on insulin regimens, when to commence treatment, rates of treatment failure and gestational diabetes, as well as evidence concerning the management of diabetic ketoacidosis, gestational hypertension and the use of oral hypoglycaemic agents. There is less evidence regarding when and how to treat diabetic pre-eclampsia, the timing of delivery and the timing and method of infant delivery.The effect of pathogenicity of a Haemophilus influenzae serotype a strain with a deletion of the a to f genes on adherence to cells of the respiratory tract and on complement opsonophagocytosis.
An isogenic pair of Haemophilus influenzae serotype a strains differing in their adherence to cells of the human respiratory tract and their ability to survive the human complement was compared. A mutant strain with an a to f gene deletion had a reduced capacity to bind cells of the human respiratory tract and to survive complement
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