Gestational diabetes mellitus and obesity are related to persistent hyperglycemia in the postpartum period / Diabetes mellitus gestacional e obesidade estão relacionados à hiperglicemia persistente no período pós-parto

Abstract Objective To evaluate the obstetric and sociodemographic characteristics of gestational diabetic women who maintained hyperglycemia in the postpartum period (6-12 weeks postpartum). Methods This is a longitudinal cohort study with women who have had gestational diabetes and/or macrosomic children between March 1st, 2016 and March 1st, 2017. Between 6 and 12 weeks after birth, women who had gestational diabetes collected fasting glycemia, glucose tolerance test, and glycated hemoglobin results. The data were collected from medical records and during an interview in the first postpartum consultation. A statistical analysis was performed using frequency, percentage, Chi- Squared test, Fisher exact test, Mann-Whitney test, and multivariate Poisson regression. The significance level adopted for the statistical tests was 5%. Results One hundred and twenty-two women were included. Most of the women were younger than 35 years old (70.5%), white, multiparous, and with no history of gestational diabetes. Thirteen percent of the participants developed persistent hyperglycemia. A univariate analysis showed that maternal age above 35 years, being overweight, having grade 1 obesity and weight gain under 5 kg was related to the persistence of hyperglycemia in the postpartum period. Conclusion Maternal age above 35 years, obesity and overweight, and the diagnosis of gestational diabetes in the first trimester of pregnancy are associated with hyperglycemia during the postpartum period.

Resumo Objetivo Avaliar características sociodemográficas e obstétricas de mulheres com diabetes gestacional que mantêm hiperglicemia no período pós-parto (6-12 semanas pós-parto). Métodos Este é um estudo longitudinal de coorte com mulheres com diagnóstico de diabetes gestacional e/ou macrossomia fetal entre 1° de março de 2016 a 1° de março de 2017. As mulheres coletaram glicemia de jejum, teste de tolerância a glicose e hemoglobina glicada entre 6 a 12 semanas pós-parto. Os dados foram coletados de prontuários médicos e durante entrevista na primeira consulta de revisão pós-parto. Uma análise estatística foi realizada através do cálculo de frequências, porcentagens, teste do qui-quadrado, teste exato de Fisher, teste de Mann-Whitney e regressão multivariada de Poisson. A significância estatística adotada foi de 5%. Resultados Cento e vinte e duas mulheres foram incluídas. A maioria delas tinha menos de 35 anos de idade (70,5%), eram brancas, multíparas, e não tinham história de diabetes gestacional. Treze por cento das participantes desenvolveu hiperglicemia persistente. A análise univariada mostrou que os fatores relacionados com a persistência de hiperglicemia no período pós-natal foram: idade materna acima de 35 anos, sobrepeso, obesidade grau 1 e ganho de peso abaixo de 5 quilos. A análisemultivariada incluiu o diagnóstico no primeiro trimestre como fator de risco para hiperglicemia persistente. Conclusão Mulheres acima de 35 anos, obesidade, sobrepeso e diagnóstico de diabetes gestacional no primeiro trimestre estão relacionados com hiperglicemia persistente no período pós-parto.

Implicações da deficiência materna de vitamina D: uma revisão sistemática / Implication of maternal vitamin D deficiency: a systematic review

O estudo objetiva avaliar a relação dos níveis de vitamina D em gestantes com as principais complicações gestacionais. A pesquisa foi realizada nas bases de dados PubMed, LILACS e BIREME, sendo selecionados artigos relevantes publicados de 2013 a 2018, usando os descritores: "vitamin D" AND "maternity" OR "pregnancy". Foram revisados 14 estudos observacionais incluindo casos-controles e coortes que investigaram a relação dos níveis de vitamina D maternos com pré-eclâmpsia, diabetes mellitus gestacional e prematuridade, sendo excluídos os estudos que utilizaram suplementação de vitamina D. Os dados foram extraídos por meio de uma tabulação com as seguintes informações: autor, ano da publicação, país do estudo, score obtido no downs and black, ano da coleta da amostra, tipo do estudo, número de participantes, método de obtenção da amostra de 25(OH)D, tempo da gestação na obtenção da amostra, complicação obstétrica, fatores de confusão ajustados e os principais desfechos. Foi obtido um total de 32.505 pacientes após a soma das amostras de todos os artigos analisados. O principal resultado encontrado, abrangendo as três comorbidades analisadas, relaciona níveis menores que 30 nmol/L de vitamina D como potencial fator de risco para pré-eclâmpsia, diabetes mellitus gestacional e prematuridade.(AU)

The study aims to assess the relationship between vitamin D levels in pregnant women and the main gestational complications. The research was carried out in the PubMed, LILACS and BIREME databases, with the selection of relevant articles published from 2013 to 2018, using the descriptors: "vitamin D" AND "maternity" OR "pregnancy". 14 observational studies were reviewed including control cases and cohorts that investigated the relationship between maternal vitamin D levels and pre-eclampsia, gestational diabetes mellitus and prematurity, and studies that used vitamin D supplementation were excluded. Data were extracted using a tabulation with the following information: author, year of publication, country of study, score obtained in downs and black, year of sample collection, type of study, number of participants, method of obtaining the sample of 25(OH)D, time of pregnancy in obtaining the sample, obstetric complication, adjusted confounding factors and the main outcomes. A total of 32,505 patients were obtained after adding the samples of all analyzed articles. The main result found, covering the three comorbidities analyzed, lists levels below 30 nmol/L of vitamin D as a potential risk factor for pre-eclampsia, gestational diabetes mellitus and prematurity.(AU)

Association between excessive maternal weight, periodontitis during the third trimester of pregnancy, and infants' health at birth

Abstract Excessive weight is associated with periodontitis because of inflammatory mediators secreted by the adipose tissue. Periodontal impairments can occur during pregnancy due to association between high hormonal levels and inadequate oral hygiene. Moreover, periodontitis and excessive weight during pregnancy can negatively affect an infant's weight at birth. Objective This observational, cross-sectional study aimed to evaluate the association between pre-pregnancy overweight/obesity, periodontitis during the third trimester of pregnancy, and the infants' birth weight. Methodology The sample set was divided into 2 groups according to the preconception body mass index: obesity/overweight (G1=50) and normal weight (G2=50). Educational level, monthly household income, and systemic impairments during pregnancy were assessed. Pocket probing depth (PPD) and clinical attachment level (CAL) were obtained to analyze periodontitis. The children's birth weight was classified as low (<2.5 kg), insufficient (2.5-2.999 kg), normal (3-3.999 kg), or excessive (≥4 kg). Bivariate analysis (Mann-Whitney U test, t-test, chi-squared test) and logistic regression (stepwise backward likelihood ratio) were performed (p<0.05). Results G1 showed lower socioeconomic levels and higher prevalence of arterial hypertension and gestational diabetes mellitus during pregnancy than G2 (p=0.002). G1 showed higher means of PPD and CAL (p=0.041 and p=0.039, respectively) and therefore a higher prevalence of periodontitis than G2 (p=0.0003). G1 showed lower infants' birth weight than G2 (p=0.0004). Excessive maternal weight and educational levels were independent variables associated with periodontitis during the third trimester of pregnancy (X2[2]=23.21; p<0.0001). Maternal overweight/obesity was also associated with low/insufficient birth weight (X2[1]=7.01; p=0.008). Conclusion The present findings suggest an association between excessive pre-pregnancy weight, maternal periodontitis, and low/insufficient birth weight.

Comparison of maternal and fetal outcomes in parturients with and without a diagnosis of gestational diabetes / Comparação de desfechos maternos e fetais entre parturientes com e sem o diagnóstico de diabetes gestacional

Abstract Objective The present study aims to compare the maternal and fetal outcomes of parturients with and without a gestational diabetes diagnosis. Methods A case-control study including parturients with (cases) and without (control) a gestational diabetes diagnosis, who delivered at a teaching hospital in Southern Brazil, between May and August 2018. Primary and secondary data were used. Bivariate analysis and a backward conditionalmultivariate logistic regression were used to make comparisons between cases and controls, which were expressed by odds ratio (OR), with a 95% confidence interval (95%CI) and a statistical significance level of 5%. Results The cases (n=47) weremore likely to be 35 years old or older compared with the controls (n=93) (p<0.001). The cases had 2.56 times greater chance of being overweight (p=0.014), and a 2.57 times greater chance of having a positive family history of diabetes mellitus (p=0.01). There was no significant difference regarding weight gain, presence of a previous history of gestational diabetes, height, or delivery route. The mean weight at birth was significantly higher in the infants of mothers diagnosed with diabetes (p=0.01). There was a 4.7 times greater chance of macrosomia (p<0.001) and a 5.4 times greater chance of neonatal hypoglycemia (p=0.01) in the infants of mothers with gestational diabetes. Conclusion Therefore, maternal age, family history of type 2 diabetes, obesity and pregestational overweightness are important associated factors for a higher chance of developing gestational diabetes.

Resumo Objetivo O presente estudo tem como objetivo comparar os desfechos maternos e fetais das parturientes com e sem diagnóstico de diabetes gestacional. Métodos Estudo caso-controle, incluindo parturientes com (casos) e sem (controle) diagnóstico de diabetes gestacional, que tiveram parto em um hospital de ensino no Sul do Brasil, entre maio e agosto de 2018. Foram utilizados dados primários e secundários. Análise bivariada e regressão logística multivariada condicional retrógrada foram utilizadas para fazer comparações entre casos e controles, expressas por razão de probabilidades (RP), com intervalo de confiança de 95% (IC95%) e nível de significância estatística de 5%. Resultados Os casos (n=47) tiveram maior chance de ter idade superior a 35 anos em comparação com os controles (n=93) (p<0,001), chance 2,56 vezes maior de estarem acima do peso (p=0,014), e chance 2,57 vezes maior de terem história familiar positiva de diabetes mellitus (p=0,01). Não houve diferença significativa relacionada ao ganho de peso, história pregressa de diabetes gestacional, estatura ou via de parto. O peso médio ao nascer foi significativamente maior nos lactentes de mães com diabetes gestacional (p=0,01). Houve 4,7 vezes maior chance de macrossomia (p<0,001), e 5,4 vezes maior chance de hipoglicemia neonatal (p=0,01) em lactentes de mães com diabetes gestacional. Conclusão Portanto, idade materna, história familiar de diabetes tipo 2, obesidade e excesso de peso pré-gestacional são importantes fatores associados a uma maior chance de desenvolvimento de diabetes gestacional.

Influence of maternal weight gain on birth weight: a gestational diabetes cohort

ABSTRACT Objective Our objective was to evaluate gestational weight gain (GWG) patterns and their relation to birth weight. Subjects and methods We prospectively enrolled 474 women with gestational diabetes mellitus (GDM) at a university hospital (Porto Alegre, Brazil, November 2009-May 2015). GWG was categorized according to the 2009 Institute of Medicine guidelines; birth weight was classified as large (LGA) or small (SGA) for gestational age. Adjusted relative risks (aRRs) and 95% confidence intervals (95% CIs) were determined. Results Adequate GWG occurred in 121 women [25.5%, 95% CI: 22, 30%]; excessive, in 180 [38.0%, 95% CI: 34, 43%]; and insufficient, in 173 [36.5%, 95% CI: 32, 41%]. In women with normal body mass index (BMI), the prevalence of SGA was higher in those with insufficient compared to adequate GWG (30% vs. 0%, p < 0.001). In women with BMI ≥ 25 kg/m2, excessive GWG increased the prevalence of LGA [aRR 2.58, 95% CI: 1.06, 6.29] and protected from SGA [aRR 0.25, 95% CI: 0.10, 0.64]. Insufficient vs. adequate GWG did not influence the prevalence of SGA [aRR 0.61, 95% CI: 0.31, 1.22]; insufficient vs. excessive GWG protected from LGA [aRR 0.46, 95% CI: 0.23, 0.91]. Conclusions One quarter of this cohort achieved adequate GWG, indicating that specific ranges have to be tailored for GDM. To prevent inadequate birth weight, excessive GWG in women with higher BMI and less than recommended GWG in normal BMI women should be avoided; less than recommended GWG may be suitable for overweight and obese women.

Secuencia de regresión caudal: caso clínico-radiológico / Caudal regression sequence: clinical-radiological case

El síndrome de regresión caudal es una malformación congénita poco frecuente que abarca un gran espectro de formas de presentación. Caracterizado por el compromiso musculoesquelético caudal, se puede asociar a defectos neurológicos, gastrointestinales, renales y genitourinarios. Aunque su etiología aún no se encuentra aclarada, se ha asociado a la presencia de diabetes materna y a mutaciones en el gen homeobox HBLX9. Su diagnóstico se basa en un buen estudio ecográfico prenatal, un examen físico detallado y estudio imagenológico posnatal con radiografía y/o resonancia magnética. El síndrome de regresión caudal requiere un manejo multidisciplinario en el cual el control metabólico de la diabetes gestacional constituye la mejor medida preventiva disponible en la actualidad. Se presenta el caso e imágenes de un recién nacido de término de sexo masculino, hijo de madre diabética pregestacional con mal control metabólico y diagnóstico ecográfico prenatal de malformación de columna lumbar, huesos iliacos y extremidades inferiores. Nace en buenas condiciones y se confirma el diagnóstico de síndrome de regresión caudal mediante estudio radiográfico y resonancia magnética compatibles.

Caudal regression syndrome is an uncommon congenital malformation that includes a wide spectrum of clinical presentations. Characterised by caudal musculoskeletal compromise, it can be associated to neurological, gastrointestinal, renal and genitourinary defects. Although the specific aetiology has not been clarified, it has been associated with the presence of maternal diabetes and mutations in homeobox gene HBLX9. Its diagnosis is based on a good prenatal ultrasound detection, detailed physical examination, and post-natal imaging study using radiography and magnetic resonance. Caudal regression syndrome requires multidisciplinary management, and it seems that good metabolic control of gestational diabetes constitutes the best preventive measure available. We present the clinical case and images of a male term newborn, born to a pregestational diabetic mother with poor metabolic control and a prenatal ultrasound diagnosis of lumbar spine, iliac bones and lower limbs malformation. Born in good conditions, the diagnosis was confirmed using X-rays and magnetic resonance.

Estado nutricional de mujeres con diabetes gestacional y características del recién nacido

El propósito fue determinar la relación entre el estado nutricional de la madre y las características de gestación del recién nacido de un grupo de embarazadas con diabetes gestacional. Se estudiaron 149 mujeres con diabetes gestacional de la Unidad de Alto Riesgo Obstétrico del Consultorio de Especialidades y Maternidad del Hospital Clínico Herminda Martin de Chillán, Chile, cuyos hijos nacieron en el año 2010. Los datos se obtuvieron de la historia clínica perinatal y la ficha del recién nacido. Las variables registradas en la madre fueron estado nutricional, vía de parto, número de gestaciones, control metabólico de la diabetes gestacional. Del niño se obtuvo el peso, circunferencia craneana y diagnóstico gestacional. Los datos fueron estudiados mediante análisis descriptivo univariado, bivariado y multivariado, ANOVA de un factor, Chi cuadrado y análisis de correspondencia múltiple. Se encontró que las mujeres con estado nutricional normal, eran multigestas, tuvieron parto vaginal, su hijo recién nacido fue adecuado para la edad gestacional, normocefálico;por otro lado, la condición de obesidad materna se relacionó con partos por cesárea, recién nacidos grandes para edad gestacional y macrocefalia; las mujeres con sobrepeso en general fueron primigestas y el recién nacido pequeño para edad gestacional con microcefalia p<0,01. Se concluyó que la obesidad en las mujeres con diabetes gestacional explica variables como la vía de parto, el número de gestaciones y el diagnóstico del recién nacido.

Nutritional status of women with gestational diabetes and characteristics of newborn. The objective was to determine the relationship between the mother’s nutritional status and the newborn’s gestational characteristics. A sample of 149 women with gestational diabetes was controlled in the High Risk Obstetric Unit of the Medical Specialties Public Health Center before delivery in the maternity ward of the Hospital Clínico Herminda Martín de Chillán, Chile in 2010. Data were obtained from the perinatal clinical history and the newborn’s chart. The variables recorded for the mother were nutritional status, type of delivery, number of pregnancies,and metabolic control. Data for the newborn were weight, length, head circumference, and gestational diagnosis.These data were analyzed by ANOVA, Chi-square test, and Multiple Correspondence. Women with a normal nutritional status were multiparous with natural childbirth; the newborn had an adequate gestational age and normal head circumference. On the other hand, maternal obesity was related to a Cesarean; the newborn was large for gestational age and had a larger head circumference. Overweight women were primiparous and the newborn was small for gestational age with a smaller head circumference (p<0,01). It was concluded that obesity in women with gestational diabetes explains variables such as type of delivery, number of gestations, and the newborn’s diagnosis.

Macroscopic placental changes associated with fetal and maternal events in diabetes mellitus

OBJECTIVES: The current study sought to identify macroscopic placental changes associated with clinical conditions in women with or without diabetes and their newborns. METHODS: The study population consisted of 62 pregnant women clinically diagnosed with diabetes and 62 healthy women (control group). RESULTS: Among the subjects with diabetes, 43 women (69.3%) were diagnosed with gestational diabetes mellitus, 15 had diabetes mellitus I (24.2%), and four had diabetes mellitus II (6.5%). The mean age of the women studied was 28.5 ± 5.71 years, and the mean gestational age of the diabetic women was 38.51 weeks. Of the 62 placentas from diabetic pregnancies, 49 (79%) maternal surfaces and 59 (95.2%) fetal surfaces showed abnormalities, including calcium and fibrin deposits, placental infarction, hematoma, and fibrosis. A statistical association was found between newborn gender and fetal and maternal placental changes (p = 0.002). The mean weight of the newborns studied was 3,287 ± 563 g for women with diabetes mellitus, 3,205 ± 544 g for those with gestational diabetes mellitus, 3,563 ± 696 g forthose with diabetes mellitus II, and 3,095 ± 451 g forthose with diabetes mellitus I. CONCLUSIONS: Infarction, hematoma, calcification, and fibrin were found on the maternal and fetal placental surfaces in women with diabetes. Women with gestational diabetes and post-term infants had more calcium deposits on the maternal placental surface as compared to those with type I and type II diabetes.

Estudo do perfil hemodinâmico da artéria oftálmica em gestantes com diabetes mellitus gestacional / Study of ophthalmic artery hemodynamic pattern in pregnant women with gestational diabetes mellitus

OBJETIVOS: Avaliar os padrões hemodinâmicos da artéria oftálmica, por meio da doplervelocimetria, em portadoras de diabetes mellitus gestacional (DMG), e comparar os achados com os obtidos em gestantes normais. MÉTODOS: Estudo prospectivo caso-controle que analisou os índices doplervelocimétricos das artérias oftálmicas. Foram constituídos dois grupos: um com 40 gestantes com diagnóstico de DMG e o outro por 40 gestantes normais. Foram incluídas gestantes com DMG segundo critérios da American Diabetes Association - 2012, com gravidez de 27 semanas até o termo, e excluídas gestantes hipertensas, em uso de drogas vasoativas ou com diagnóstico prévio de diabetes. O estudo foi realizado em um olho com transdutor linear de 10 MHz Sonoace 8000 Live Medison ®. As variáveis analisadas foram: índice de pulsatilidade (IP), índice de resistência (IR), razão entre picos de velocidade (RPV), pico de velocidade sistólica (PVS) e velocidade diastólica final (VDF). Para análise de normalidade das amostras foi empregado o teste de Lillefors, e os testes t de Student e Mann-Whitney, para comparação entre as médias e medianas conforme normalidade dos dados, e adotado nível de significância de 95%. RESULTADOS: As medianas e médias com desvio padrão das variáveis doplervelocimétricas da artéria oftálmica dos grupos de DMG e gestantes normais foram, respectivamente: IP=1,7±0,6 e 1,6±0,4 (p=0,7); IR=0,7 e 0,7 (p=0,9); RPV=0,5±0,1 e 0,5±0,1 (p=0,1); PVS=33,6 e 31,9 cm/seg (p=0,7); VDF=6,3 e 7,9 cm/seg (p=0,4). Não houve diferença significante entre as médias e medianas das variáveis analisadas entre os dois grupos de gestantes. CONCLUSÕES: Os padrões hemodinâmicos das artérias oftálmicas permaneceram inalterados no grupo de gestantes com DMG em relação ao grupo de gestantes normais, sugerindo que o tempo de exposição à doença durante a gestação é curto para causar vasculopatias importantes no território materno central.

PURPOSES: To evaluate the hemodynamic patterns of the ophthalmic artery by Doppler analysis in women with gestational diabetes mellitus (GDM), comparing them to normal pregnant women. METHODS: A prospective case-control study that analyzed the ophthalmic artery Doppler indices in two groups: one consisting of 40 women diagnosed with GDM and the other of 40 normal pregnant women. Included were pregnant women with GDM criteria of the American Diabetes Association - 2012, with 27 weeks of pregnancy to term, and excluded were women with hypertension, use of vasoactive drugs on or previous diagnosis of diabetes. Doppler analysis was performed in one eye with a 10 MHz linear transducer and the Sonoace 8000 Live Medison® equipment . The following variables were analyzed: pulsatility index (PI), resistance index (RI), peak velocity ratio (PVR), peak systolic velocity (PSV) and end diastolic velocity (EDV). To analyze the normality of the samples we used the Lillefors test, and to compare means and medians we used the Student's t-test and Mann-Whitney test according to data normality, with the level of significance set at 95%. RESULTS: The median and mean values with standard deviation of the variables of the ophthalmic artery Dopplervelocimetry group GDM and normal pregnant women were: IP=1.7±0.6 and 1.6±0.4 (p=0.7); IR=0.7 and 0.7 (p=0.9); RPV=0.5±0.1 and 0.5±0.1 (p=0.1), PSV=33.6 and 31.9 cm/sec (p=0.7); VDF=6.3 and 7.9 cm/sec (p=0.4). There was no significant difference in the means and medians of these variables between the two groups of pregnant women. CONCLUSIONS: The ophthalmic artery hemodynamic patterns, analyzed by means of a Doppler technique remained unchanged in the group of pregnant women with GDM compared to the group of normal pregnant women, suggesting that the time of exposure to the disease during pregnancy was too short to cause significant vascular disorders in the central territory.

La adolescente diabética embarazada / The pregnant diabetic adolescent

INTRODUCCIÓN: El embarazo en la adolescencia ha sido asociado con problemas adversos para la salud. OBJETIVO: Identificar la morbimortalidad materna y perinatal en adolescentes con diabetes. MÉTODOS: Estudiamos retrospectivamente 138 embarazadas adolescentes (< 20 años) con diabetes. De ellas 101 eran diabéticas pregestacionales (B 2, C 64, D 30, F 1, R 3, y F-R 1 de Priscilla White) y 37 diabÚticas gestacionales (A1 24. A2 8 y A3 5 de Freinkel y Metzger). Comparamos los resultados maternos y perinatales con 242 adolescentes no diabéticas y 482 embarazadas no adolescentes y no diabéticas de la misma institución obtenidas al azar. Para el análisis de las variables se utilizó el test X2 de Fisher y Z para las proporciones, con un significado estadístico de p< 0,05. RESULTADOS: El grado de control metabólico fue calificado de "no óptimo" en el 42,0 por ciento de las diabéticas, lo cual pudo haber contribuido a la significativa mayor frecuencia de parto pretérmino, morbimortalidad perinatal y recién nacidos con peso = o > 4 000 g, esto último fue probablemente responsable de la mayor frecuencia de parto por cesárea. La frecuencia de malformaciones congénitas 11 (8,0 por ciento) resultó muy superior a lo reportado en nuestro país para población general e inclusive para gestantes diabéticas en el Servicio Central de Diabetes y Embarazo. CONCLUSIÓN: Los resultados perinatales adversos en las adolescentes diabéticas pudieron estar en relación, según nuestros resultados, con hiperglucemia de difícil control en estas gestantes y a la falta de asistencia a la consulta de control preconcepcional

INTRODUCTION: Pregnancy in adolescence has been associated with adverse health problems. OBJECTIVE: To identify the maternal and perinatal morbidity and mortality in adolescents presenting with diabetes. METHODS: A retrospective study was conducted in 138 adolescent pregnant patients (< 20 years) with diabetes. From them, 101 were pregestional diabetics (B2, C64, D30, F1, R3 and F-R 1 of Priscilla White) and 37 gestational diabetics (A1 24, A2 8 and A3-5 of Freinkel and Metzger). The maternal and perinatal results were compared to that of 242 non-diabetic adolescents and 482 non-adolescents pregnant and non-diabetics from the same institution at random. For variables' analysis the Fisher X2 test was used and Z for the ratios with a statistical significance of p< 0.05. RESULTS: The level of metabolic control was qualified as "non-optimal" in the 42.0 percent of the diabetics which may be contributed to the significant greater frequency of pre-term labor, morbidity and mortality and of newborns weighing = o > 4 000 g, it was probably the responsible of the greater frequency of cesarean section. The frequency of the eleven congenital malformations (8.0 percent was higher than the reported in our country for the general population and even for pregnants and to the non-attendance to pre-conception control consultation. CONCLUSION: The adverse perinatal results in diabetic adolescents could be in relation, according our results, to hyperglycemia of difficult control in these pregnants and to non-attendance to preconception control consultation

Terapia nutricional no diabetes gestacional / Nutritional therapy in gestational diabetes

Trata-se de uma revisão da literatura científica sobre a terapia nutricional no Diabetes Mellitus Gestacional, sem restrição de data e com fontes primárias indexadas nas bases de dados SciELO, PubMed, Medline. Os resultados desta revisão apontam a intervenção nutricional como uma importante aliada no controle do Diabetes Mellitus Gestacional, trazendo potenciais benefícios à saúde materno-fetal. Na avaliação do estado nutricional materno devem ser empregados os indicadores antropométricos, dietéticos, bioquímicos, clínicos e funcional. Neste sentido, a avaliação dietética deve ser detalhada, com atenção para o fracionamento e composição das refeições, e grupos de alimentos presentes. No planejamento nutricional a distribuição de macronutrientes em relação ao consumo energético diário deve ser 45-65 por cento de carboidratos, 15-20 por cento de proteínas e 20-35 por cento de lipídeos. Quanto a recomendação dos edulcorantes, são liberados para gestantes acesulfame K, aspartame, neotame, sacarina e sucralose. A atividade física também deve fazer parte da estratégia de tratamento do Diabetes Mellitus Gestacional, embora o impacto do exercício nas complicações neonatais ainda mereça ser rigorosamente testado. Ademais, estudos associam a habilidade de aconselhamento nutricional com a melhorara na adesão ao cuidado nutricional. Diante desses achados, para sucesso no controle do DMG são necessários: a participação da equipe inter e multidisciplinar, o cuidado pré-natal precoce, com assistência nutricional oportuna e a garantia da assistência de qualidade ao longo da gestação.

This is a scientific literature review about nutritional therapy in gestational diabetes mellitus, without date restriction and using the SciELO, PubMed and Medline databases. The results of this review show that nutritional intervention is an important tool for managing gestational diabetes mellitus, and potentially benefits the mother's and fetal health. Nutritional status assessment of the mother should include anthropometric, dietary, biochemical, clinical and functional indicators. In this way, dietary assessment should be thorough, paying attention to the number and kind of meals, and the food groups present. The distribution of macronutrients in relation to the total energy intake per day should be 45-65 percent carbohydrates, 15-20 percent proteins and 20-35 percent lipids. The allowed sweeteners are acesulfame K, aspartame, neotame, saccharin and sucralose. Physical activity should also be included in the strategy to treat diabetes mellitus but the impact of physical activity on neonatal complications still requires minute testing. In addition, some studies have associated nutritional counseling skill with greater adherence to dietary recommendations. Several measures should be taken to ensure successful management of gestational diabetes mellitus, including participation of an inter and multidisciplinary team, early prenatal care with opportune nutritional care, and guaranteed quality care during pregnancy.

Fatores relacionados à insulinoterpia no diabete melito gestacional / Factors related to Insulin therapy on gestational diabetes mellitus

Objetivo: Avaliar as características das gestantes que necessitaram de insulinoterapia para o tratamentodo Diabete Gestacional. Métodos: Estudo retrospectivo descritivo. Foramselecionadas 231 gestantes com Diabete Gestacional, no período de janeiro de 2004 até julho de 2006, divididas em dois grupos, um que necessitou de insulinoterapia para controle glicêmico (n=78) e outro que utilizou apenas dietoterapia (n=173).Resultados: 33,8% das gestantes utilizaram insulina. A idade materna (p<0,01) e o número de gestaçõesanteriores (p<0,01) foram maiores no grupo que utilizou insulina, e a idade gestacional de início do tratamento(p=0,02) foi menor neste grupo. O índice de massa corporal, ganho de peso durante a gestação, as glicemiano teste de tolerância oral à glicose com 75 gramas não apresentaram diferença (p>0,05). Conclusão: As gestantes com idade elevada, maior número de gestações anteriores e com chegada mais precoce ao serviço são as que mais necessitaram insulina para controle glicêmico.

Purpose: To evaluate the characteristics of pregnant patients who required insulin therapy for Gestational Diabetes management. Methods: A descriptive retrospective study. Were chosen 231 pregnant woman with Gestational Diabetes, on period of January 2004 to July 2006, divided into two groups, one which required insulin therapy for glucose control (n=78) and another group that used only diet control (n=173). Results: 33,8% of patients used insulin. Maternal age (p<0,01) and number or previous pregnancies (p<0,01) were higher in the group using insulin and gestational age at start of treatment (p=0,02) was lower. Body mass index, weight gain during pregnancy, glucose on oral glucose tolerance test with 75 grams did not show difference (p>0,05). Conclusion: older pregnant patients, those withhigher number of previous pregnancies and earlier beginning of management were those who most needed insulin for glucose control.

Síndrome metabólica: identificando fatores de risco: [revisão] / Metabolic syndrome: identifying the risk factors: [review]

OBJETIVOS Discutir a síndrome metabólica e a identificação de seus fatores de risco, inclusive na faixa etária pediátrica. FONTES DE DADOS: Artigos de revisão indexados. SÍNTESE DOS DADOS:A síndrome metabólica caracteriza-se pela resistência à insulina e pela presença de fatores de risco para doenças cardiovasculares e diabetes melito tipo 2. Não existe ainda um consenso com relação a seus critérios diagnósticos. Na presente revisão, os critérios diagnósticos da Associação Americana de Cardiologia (US National Cholesterol Education Program), Associação Americana de Endocrinologistas Clínicos, Organização Mundial da Saúde e Federação Internacional de Diabetes são apresentados, e as possibilidades de aplicação dos mesmos na infância são discutidas. São também abordados os aspectos fisiopatológicos da síndrome, principalmente aqueles relacionados ao período perinatal e à infância. CONCLUSÃO: A síndrome metabólica tem sido identificada de forma cada vez mais freqüente, principalmente durante a adolescência. Mudanças de estilo de vida, como alimentação e atividade física, são fundamentais na sua prevenção e tratamento. Tratamento medicamentoso e, eventualmente, tratamento cirúrgico também devem ser considerados, dependendo da gravidade, mesmo nesta fase da vida.

OBJECTIVES: To discuss the metabolic syndrome and identify its risk factors, including in the pediatric age group. SOURCES: Indexed review articles. SUMMARY OF THE FINDINGS: The metabolic syndrome is characterized by insulin resistance and the presence of risk factors for cardiovascular diseases and diabetes mellitus type 2. Consensus has not yet been reached on its diagnostic criteria. This review presents diagnostic criteria defined by the American Heart Association (US National Cholesterol Education Program), the American Association of Clinical Endocrinologists, the World Health Organization and the International Diabetes Federation and discusses the possibilities of applying them to children. Pathophysiologic features of the syndrome are also covered, principally those related to the perinatal period and childhood. CONCLUSIONS: The metabolic syndrome is being diagnosed with ever greater frequency, principally during adolescence. Lifestyle changes, such as to diet and level of physical activity are fundamental to prevention. Treatment with medication and, in extreme cases, with surgery should also be considered, depending on severity and age.

Excursion index of the septum primum in Thai fetuses of gestational diabetic mothers at 32 to 35 weeks' gestation.

OBJECTIVE: To compare excursion index of the septum primum (EISP) among Thai fetuses of gestational diabetic mothers (FGDMs) with and without septal hypertrophy (SH) and those of nondiabetic mothers from 32 to 35 weeks' gestation. MATERIAL AND METHOD: Fetuses of Thai pregnant women were recruited for prenatal 2-dimensional echocardiographic measurements of the EISP (the ratio between the linear displacement of the flap valve of septum primum and the left atrial diameter) at 32 to 35 weeks' gestation. All had confirmed gestational age and normal structural scanning. The EISP was compared among gestational age--matched 15 FGDMs with SH, 18 FGDMs with normal septal thickness, and 20 fetuses of nondiabetic mothers. The data were presented as mean and standard deviation (SD). Analysis of variance (ANOVA) was used to compare the EISP of the three groups. RESULTS: Fifty-three measurements were obtained. Comparison among the three groups showed that the mean and SD of the EISP were 0.27 +/- 0.04, 0.50 +/- 0.04 and 0.51 +/- 0.05 in FGDMs with SH, normal septal thickness and those of nondiabetic mothers, respectively. The analysis demonstrated that the EISP was significantly less than in FGDMs with SH when compared to the FGDMs with normal septal thickness and those of nondiabetic mothers (p < 0.01). There was no significant difference in the EISP of the FGDMs with normal septal thickness and those of nondiabetic mothers (p = 0.16). CONCLUSION: Mobility of the septum primum in FGDMs with septal hypertrophy is reduced. This may indicate a higher preload compared to FGDMs with normal septal thickness and those of nondiabetic mothers.

Vascular change in the placenta of diabetic mothers and hypertensive diabetic mothers.

Pregnancy complicated by diabetes and/or hypertension is a significant medical problem not only affecting maternal health, but also jeopardizing fetal normalcy. The placenta being the bridge between maternal fetal activity, this structure is considered as a window through which understanding of maternal dysfunctions as well as of their impacts on fetal wellbeing can be obtained. And as it is an almost all-vessel organ, its functional status depends primarily on the structural status of its vessels. To observe vascular changes in the placenta, a study was carried out on 44 placentas.19 from overt diabetic mothers having no hypertension and 5 from hypertensive diabetic mothers, and 20 from control group having no hypertension or diabetes. These were collected just after delivery though caesarian section. Macroscopic findings of the study was that there was a trend of increase weight, volume and number of cotyledons in overt diabetes group, where as the in the hypertensive diabetes group was the opposite. But none of these levels has reached a significant level. For all these variables, the hypertensive diabetes group had smaller values than the overt diabetes group, significantly so for the number of cotyledons. The placental diameter was non-significantly larger in the overt diabetes group than in the control group, but a smaller than control value was found in the hypertensive diabetes group. Although neonatal weight did not show any significant change in either group, but in overt diabetes group, it showed a significant positive correlation with placental weight.

Pregnancy associated complications of mothers with gestational diabetes mellitus.

This study was conducted in Mymensingh Medical College and Hospital, Mymensingh. It lasted for one year commencing in July 2003, and was designed to find out and compare the outcomes of gestational diabetes mellitus (GDM) with a view to reducing the complications. Forty cases of GDM with single pregnancy were selected as experimental group, while forty other cases of pregnant women without GDM constituted the control group. Questionnaire and observation chart were the research instrument in this study. Statistical analyses were done manually. It was found that the GDM mothers had a higher risk of complications like pre-eclampsia, hypertension, urinary tract infection and cesarean delivery. On the basis of these findings, however, appropriate measures for prevention, treatment and management of GDM may be adopted for better pregnancy outcomes.

Effect of gestational diabetes and maternal hypertension on gross morphology of placenta

Gestational diabetes is much more common than pre-existing diabetes i.e. it complicates 2% to 5% of pregnancies. When metabolic control is good, perinatal mortality should be no higher than in general population. However, macrosomia continuous to be a problem in higher than average proportions of such cases. Macrosomia also involves placenta within the chronic hypertensive disease, the most common diagnosis is essential vascular hypertension. Total 60 full term placenta, 20 from normal and 20 each from gestational diabetics and chronic hypertensive mothers were studied grossly. Shape, attachment of umbilical cord, weight, diameter and central thickness of all placentas were noted. The study demonstrates that there is change of shape i.e. two lobes in one placenta from diabetic group. All other placentae were singly lobed and discoidal shape with central attachment of umbilical cord to the foetal surface of placenta. Weight central thickness and diameter were significantly greater in diabetic group as compared to normal and hypertensive group. Hypertensive group shows non significant decrease in weight of placentae while there was no change in central thickness and diameter of placenta in hypertensive than the normal group. Conclusions: On the basis of results of present study, it is concluded that diabetic's placentae showed increase in weight, central thickness and diameter. One out of 20 placentae in diabetic group also showed change of shape and attachment of umbilical cord to one love. Hypertensive's placentae showed no significant change in weight, shape central thickness and attachment of umbilical cord when compared with normal group