Later in the progression, a prolonged QT interval may be indicative of fibrosis. Given that diabetic cardiomyopathys definition excludes concomitant atherosclerosis or hypertension, there are no changes in perfusion or in atrial natriuretic peptide levels up until the very late stages of the disease, when the hypertrophy and fibrosis become very pronounced. Pathophysiology
Defects in cellular processes such as autophagy and mitophagy are thought to contribute to the development of diabetic cardiomyopathy. Diabetic cardiomyopathy is characterized functionally by ventricular dilation, enlargement of heart cells, prominent interstitial fibrosis and decreased or preserved systolic function in the presence of a diastolic dysfunction.While it has been evident for a long time that the complications seen in diabetes are related to the hyperglycemia associated to it, several factors have been implicated in the pathogenesis of the disease. Etiologically, four main causes are responsible for the development of heart failure in diabetic cardiomyopathy: microangiopathy and related endothelial dysfunction, autonomic neuropathy, metabolic alterations that include abnormal glucose use and increased fatty acid oxidation, generation and accumulation of free radicals, and alterations in ion homeostasis, especially calcium transients. Additional effects include inflammation and upregulation of local angiotensin systems. Diabetic cardiomyopathy may be associated with restrictive (HFPEF) and dilated phenotypes (HFREF). HFPEF results predominantly from hyperinsulinemia, hyperglycemia, lipotoxicity, AGEs and microvascular rarefication. HFREF is associated with autoimmunity, hyperglycemia, lipotoxicity, microvascular rarefication and AGE formation. Microangiopathy
Microangiopathy can be characterized as subendothelial and endothelial fibrosis in the coronary microvasculature of the heart. This endothelial dysfunction leads to impaired myocardial blood flow reserve as evidence by echocardiography.
The way mothers speak to their children ("motherese") is better suited to support very young children in their efforts to understand speech (in context of the reference English) than fathers.Since the 1970s, in vitro fertilization has made pregnancy possible at ages well beyond "natural" limits, generating ethical controversy and forcing significant changes in the social meaning of motherhood. This is, however, a position highly biased by Western world locality: outside the Western world, in-vitro fertilization has far less prominence, importance or currency compared to primary, basic healthcare, womens basic health, reducing infant mortality and the prevention of life-threatening diseases such as polio, typhus and malaria. Traditionally, and still in most parts of the world today, a mother was expected to be a married woman, with birth outside of marriage carrying a strong social stigma. Historically, this stigma not only applied to the mother, but also to her child. This continues to be the case in many parts of the developing world today, but in many Western countries the situation has changed radically, with single motherhood being much more socially acceptable now. For more details on these subjects, see Legitimacy (family law) and single parent. The total fertility rate (TFR), that is, the number of children born per woman, differs greatly from country to country. The TFR in 2013 was estimated to be highest in Niger (7.03 children born per woman) and lowest in Singapore (0.79 children/woman).In the United States, the TFR was estimated for 2013 at 2.06 births per woman.