A Quinoa Protein Hydrolysate Fractionated by Electrodialysis with Ultrafiltration Membranes Improves Maternal and Fetal Outcomes in a Mouse Model of Gestational Diabetes Mellitus.

SCOPE: Quinoa intake exerts hypoglycemic and hypolipidemic effects in animals and humans. Although peptides from quinoa inhibit key enzymes involved in glucose homeostasis in vitro, their in vivo antidiabetic properties have not been investigated. METHODS AND RESULTS: This study evaluated the effect of oral administration of a quinoa protein hydrolysate (QH) produced through enzymatic hydrolysis and fractionation by electrodialysis with ultrafiltration membrane (EDUF) (FQH) on the metabolic and pregnancy outcomes of Lepdb/+ pregnant mice, a preclinical model of gestational diabetes mellitus. The 4-week pregestational consumption of 2.5 mg mL-1 of QH in water prevented glucose intolerance and improves hepatic insulin signaling in dams, also reducing fetal weights. Sequencing and bioinformatic analyses of the defatted FQH (FQHD) identified 11 peptides 6-10 amino acids long that aligned with the quinoa proteome and exhibited putative anti-dipeptidyl peptidase-4 (DPP-IV) activity, confirmed in vitro in QH, FQH, and FDQH fractions. Peptides homologous to mouse and human proteins enriched for biological processes related to glucose metabolism are also identified. CONCLUSION: Processing of quinoa protein may be used to develop a safe and effective nutritional intervention to control glucose intolerance during pregnancy. Further studies are required to confirm if this nutritional intervention is applicable to pregnant women.

[Maternal-fetal outcomes in women with gestational diabetes in an intensive control program]. / Desenlaces materno-fetales en mujeres con diabetes gestacional en un programa de control intensivo.

Background: Gestational diabetes mellitus (GDM) is first diagnosed during pregnancy and it is the most frequent maternal hyperglycemia. Objective: To know fetal and maternal outcomes in an intensive control program in pregnant women with and without DMG at the Instituto Mexicano del Seguro Social (Mexican Institute for Social Security) Regional General Hospital No. 6, in Ciudad Madero, Tamaulipas. Material and methods: A descriptive and retrospective study, which included 800 outcomes of pregnant women between January 2009 and June 2020. Anthropometric data and pregnancy outcomes were collected. The intensive control program consisted of face-to-face consultations of 1 to 4 weeks, granted according to the degree of metabolic control, with which it was given nutritional counseling, recommendations for physical activity, and in some cases pharmacological treatment. Results: The prevalence of GDM was 36.2%. There were no statistically significant differences between the two groups, except for respiratory distress syndrome, which was more common in GDM (9.4%, p = 0.06). Patients with GDM had a lower prevalence of macrosomy (6.1%) compared to the control group (6.6%). All women admitted to the program in the first trimester had fewer fetal and maternal complications. Conclusions: This study demonstrates the effectiveness and efficiency of implementing an intensive control program in women with GDM, by reducing and equalizing maternal and fetal outcomes compared to a group of women without the disease.

Introducción: la diabetes mellitus gestacional (DMG) se diagnóstica por primera vez en el embarazo y es la hiperglucemia materna más frecuente. Objetivo: conocer los desenlaces fetales y maternos en un programa de control intensivo en mujeres embarazadas con y sin DMG en el Hospital General Regional No. 6 del Instituto Mexicano del Seguro Social (IMSS) en Ciudad Madero, Tamaulipas. Material y métodos: estudio descriptivo y retrospectivo que incluyó 800 desenlaces de mujeres gestantes entre enero de 2009 y junio de 2020. Se recopilaron datos antropométricos y desenlaces del embarazo. El programa de control intensivo consistió en consultas presenciales de una a cuatro semanas, otorgadas según el grado de control metabólico, en las que se proporcionó consejería nutricional, recomendaciones de actividad física y en algunos casos tratamiento farmacológico. Resultados: la prevalencia de DMG fue de 36.2%. No hubo diferencias estadísticamente significativas en ambos grupos, a excepción del síndrome de distrés respiratorio, que fue más frecuente en DMG (9.4%, p = 0.06). Las pacientes con DMG tuvieron menor prevalencia de macrosomía (6.1%) a diferencia del grupo control (6.6%). Toda mujer ingresada al programa en el primer trimestre tuvo menores complicaciones fetales y maternas. Conclusiones: este estudio demuestra la eficacia y eficiencia de implementar un programa de control intensivo en mujeres con DMG, al reducir e igualar los desenlaces maternos y fetales en comparación con un grupo de mujeres sin la enfermedad.

Diabetes gestacional: necesidad del asesoramiento genético preconcepcional en Matanzas / Gestational diabetes: need for preconception genetic counseling in Matanzas

RESUMEN Introducción: muchas gestantes que se atienden en consulta de Genética prenatal provienen de familias con diabetes mellitus y desarrollan diabetes gestacional, por lo que requieren el asesoramiento genético preconcepcional sobre factores de riesgo, que en muchos casos no reciben. Objetivo: identificar los antecedentes familiares de diabetes mellitus en las gestantes que debutan con diabetes gestacional, sin haber tenido asesoramiento genético preconcepcional. Materiales y métodos: se realizó un estudio descriptivo retrospectivo durante el período 2017 a 2019 en 186 embarazadas diagnosticadas con diabetes gestacional, del municipio Matanzas. Resultados: el 39,7 % de las gestantes con diabetes gestacional pertenecían a familias con diabetes mellitus; el 27,02 % tenía un familiar de primer grado afectado; en el 59,45 % predominó la vía materna de transmisión hereditaria; un 22,58 % presentó defectos congénitos, y el 54,05 % no recibió asesoramiento genético preconcepcional. Conclusiones: no todas las embarazadas con antecedentes familiares de diabetes mellitus recibieron asesoramiento genético preconcepcional, indispensable para minimizar el riesgo de diabetes gestacional (AU).

ABSTRACT Introduction: many pregnant women attended in prenatal genetic consultation come from families with diabetes mellitus and develop gestational diabetes, so they require preconception genetic counseling on risk factors, which they do not receive in many cases. Objective: to identify family antecedents of diabetes mellitus in pregnant women who debut with gestational diabetes, without having received preconceptional genetic counseling. Materials and methods: a retrospective descriptive study was carried out during the period 2017 to 2019 in 186 pregnant women from the municipality of Matanzas, diagnosed with gestational diabetes. Results: 39.7 % of the pregnant with gestational diabetes came from families with diabetes mellitus; 27.02 % of them had an affected first-grade relative; maternal hereditary transmission predominated in 59.45 %; 22.58 % presented congenital defects, and 54.05 % did not received preconceptional genetic counseling. Conclusions: not all the pregnant women with family antecedents of diabetes mellitus received preconceptional genetic counseling, which is essential to minimize the risk of gestational diabetes (AU).

Gestational diabetes mellitus and COVID-19, clinical characteristics and review of the literature.

There is a lack of information about the maternal-fetal outcomes in patients with gestational diabetes and concomitant COVID-19; and there is even less information about the outcomes of pregnant women with gestational diabetes and COVID-19. We present a case of a primigravidae of 20-year-old woman with gestational diabetes and COVID-19 and a review of the literature.

Gestational diabetes and overt diabetes first diagnosed in pregnancy: characteristics, therapeutic approach and perinatal outcomes in a public healthcare referral center in Brazil

ABSTRACT Objective: To describe the clinical characteristics, management, and fetal outcomes of patients diagnosed with gestational diabetes mellitus (GDM) or overt diabetes (OD) during pregnancy who followed up at a public healthcare referral center in Brazil. Materials and methods: A retrospective cohort study based on the medical records of women diagnosed with dysglycemia during pregnancy between January 2015 and July 2017 was conducted. Results: Out of 224 pregnant women evaluated, 70% were overweight/obese. GDM was observed in 78.6% of pregnant women, while 21.4% presented with OD. Approximately 59% of patients could be diagnosed with GDM or OD by fasting plasma glucose (FPG) alterations alone. Exclusive diet therapy was used in 50.9% of patients. The need for insulin therapy was higher in OD patients (60.4%) than in GDM patients (38.1%) (p = 0.006). Women who needed insulin (n = 96) had a mean initial dose of 0.33 IU/kg (±0.27) and a final value of 0.39 IU/kg (±0.34). The cesarean rate was 74.3%. The fetal outcomes evaluated were macrosomia (2.15%), large for gestational age (LGA) fetus (15.83%), intensive care unit (ICU) need (4.32%), Apgar score ≤7 (6.47%), hypoglycemia (14.39%) and jaundice (16.55%). Conclusions: Patients with GDM and OD presented with several similar clinical features. Approximately half of the patients presented with adequate glycemic control only with diet management. Patients with OD presented a higher need for insulin therapy. Although overweight and obesity were frequent within both groups, they could possibly explain many of our findings.

Obesity and Gestational Diabetes in Pregnant Care and Clinical Practice.

Obesity and Gestational Diabetes Mellitus (GDM) are the most frequent pathologies affecting mothers and offspring during pregnancy. Both conditions have shown a sustained increase in their prevalence in recent years, and they worsen the outcome of pregnancy and the long-term health of mothers. Obesity increases the risk of GDM and pre-eclampsia during pregnancy and elevates the risk of developing metabolic syndrome in later life. Offspring of obese mothers have an increased risk of obstetric morbidity and mortality and, consistent with the developmental origins of health and disease, a long term risk of childhood obesity and metabolic dysfunction. On the other hand, GDM also increases the risk of pre-eclampsia, caesarean section, and up to 50% of women will develop type 2 diabetes later in life. From a fetal point of view, it increases the risk of macrosomia, large-for-gestational-age fetuses, shoulder dystocia and birth trauma. The insulin resistance and inflammatory mediators released by a hypoxic trophoblast are mainly responsible for the poor pregnancy outcome in obese or GDM patients. The adequate management of both pathologies includes modifications in the diet and physical activity. Drug therapy should be considered when medical nutrition therapy and moderate physical activity fail to achieve treatment goals. The antenatal prediction of macrosomia is a challenge for physicians. The timing and the route of delivery should consider adequate metabolic control, gestational age, and optimal conditions for a vaginal birth. The best management of these pathologies includes pre-conception planning to reduce the risks during pregnancy and improve the quality of life of these patients.

Stromal Cell-Derived Factor (SDF) 2 and the Endoplasmic Reticulum Stress Response of Trophoblast Cells in Gestational Diabetes Mellitus and In vitro Hyperglycaemic Condition.

BACKGROUND AND AIM: The endoplasmic reticulum (ER) stress response and the unfolded protein response (UPR) are essential cellular mechanisms to ensure the proper functioning of ER in adverse conditions. However, activation of these pathways has also been associated with insulin resistance and cell death in pathological conditions such as diabetes mellitus. In the present study, we investigated whether stromal cell-derived factor 2 (SDF2)-an ER stress-responsive factor-is related to ER response in placental cells exposed to maternal gestational diabetes mellitus (GDM) or to a hyperglycaemic in vitro condition. OBJECTIVE: The study aimed to investigate the role of SDF2 in BeWo cells , a trophoblast cell line originating from choriocarcinoma , and in placental tissue under hyperglycaemic conditions. METHODS: Protein levels of SDF2 and UPR factors, glucose-related protein 78 (GRP78) and eukaryotic initiation factor 2 alpha (elF2 alpha) were evaluated in the placentae of pregnant women diagnosed with GDM and treated by diet-control (insulin was added when necessary). The mRNA expression of SDF2 and UPR factors CHOP and sXBP1 were assessed in cultured BeWo cells challenged with glucose and treated with or without insulin. RESULTS: SDF2 expression was increased in the placentae of GDM women treated with diet. However, its values were similar to those of normoglycemic controls when the GDM women were treated with insulin and diet. BeWo cells cultured with high glucose and insulin showed decreased SDF2 expression, while high glucose increased CHOP and sXBP1 expression, which was then significantly reverted with insulin treatment. CONCLUSION: Our findings extend the understanding of ER stress and SDF2 expression in placentae exposed to hyperglycaemia, highlighting the relevance of insulin in reducing the levels of ER stress factors in placental cells. Understanding the effect of ER stress partners such as SDF2 on signalling pathways involved in gestation, complicated by hyperglycaemia, is pivotal for basic biomedical research and may lead to new therapeutic possibilities.

Gestational diabetes and overt diabetes first diagnosed in pregnancy: characteristics, therapeutic approach and perinatal outcomes in a public healthcare referral center in Brazil.

OBJECTIVE: To describe the clinical characteristics, management, and fetal outcomes of patients diagnosed with gestational diabetes mellitus (GDM) or overt diabetes (OD) during pregnancy who followed up at a public healthcare referral center in Brazil. METHODS: A retrospective cohort study based on the medical records of women diagnosed with dysglycemia during pregnancy between January 2015 and July 2017 was conducted. RESULTS: Out of 224 pregnant women evaluated, 70% were overweight/obese. GDM was observed in 78.6% of pregnant women, while 21.4% presented with OD. Approximately 59% of patients could be diagnosed with GDM or OD by fasting plasma glucose (FPG) alterations alone. Exclusive diet therapy was used in 50.9% of patients. The need for insulin therapy was higher in OD patients (60.4%) than in GDM patients (38.1%) (p = 0.006). Women who needed insulin (n = 96) had a mean initial dose of 0.33 IU/kg (±0.27) and a final value of 0.39 IU/kg (±0.34). The cesarean rate was 74.3%. The fetal outcomes evaluated were macrosomia (2.15%), large for gestational age (LGA) fetus (15.83%), intensive care unit (ICU) need (4.32%), Apgar score ≤7 (6.47%), hypoglycemia (14.39%) and jaundice (16.55%). CONCLUSION: Patients with GDM and OD presented with several similar clinical features. Approximately half of the patients presented with adequate glycemic control only with diet management. Patients with OD presented a higher need for insulin therapy. Although overweight and obesity were frequent within both groups, they could possibly explain many of our findings.

Tratamento para o diabetes mellitus gestacional: uma revisão de literatura / Treatment for gestational diabetes mellitus: a literature review

O diabetes mellitus gestacional (DMG) é uma complicação que atinge o metabolismo da gestante, resultando em intolerância à glicose e consequente hiperglicemia, originada pela insuficiência de insulina materna. Este estudo tem como objetivo identificar os tratamentos disponíveis e mais utilizados para o DMG. Trata-se de um uma revisão de literatura, feita a partir de 22 referências, acerca dos tratamentos para o DMG. As bases de dados escolhidas foram Google Acadêmico, UpToDate, SciELO e o acervo da Universidade do Planalto Catarinense. Estudos apontam a insulina humana ­ NPH e regular ­ como a principal escolha, quando comparada aos seus análogos, apesar de ainda existirem muitas controvérsias quanto ao início do tratamento, o esquema terapêutico e os ajustes das doses. Pesquisas têm demonstrado bons resultados sobre a eficácia e a segurança dos hipoglicemiantes orais ­ gliburida e metformina ­ no tratamento de gestantes diabéticas, mas é evidente a necessidade de mais estudos para confirmar a efetividade deles e garantir um bom desenvolvimento do concepto. Concluiu-se que o controle dietético e o exercício físico são a primeira opção de tratamento para o DMG. Todavia, caso a euglicemia não seja atingida, opta-se pelo tratamento medicamentoso por meio da insulinoterapia ou hipoglicemiantes orais, o que possibilita a redução da incidência dos efeitos adversos ao binômio materno-fetal.(AU)

Gestational diabetes mellitus (DMG) is a complication that affects the pregnant woman's metabolism, resulting in glucose intolerance and consequent hyperglycemia, caused by insufficient maternal insulin. This study aims to identify the available and most used treatments for DMG. This is a literature review, based on 22 references, about treatments for Gestational Diabetes; the databases chosen were Google Scholar, UpToDate, SciELO and the collection of the Universidade do Planalto Catarinense. Studies point to human insulin ­ NPH and regular ­ as the main choice when compared to its analogues, although there are still many controversies about the beginning of treatment, therapeutic scheme and dose adjustments. Researches have shown good results on the efficacy and safety of oral hypoglycemic agents ­ glyburide and metformin ­ in the treatment of diabetic pregnant women, but it is evident the need for further studies to confirm their effectiveness and to guarantee a good development of the fetus. It was concluded that dietary control and physical exercise are the first treatment option for DGM. However, if euglycemia is not achieved, drug treatment is chosen through insulin therapy or oral hypoglycemic agents, which makes it possible to reduce the incidence of adverse effects to the maternal-fetal binomial.(AU)

Cuban Contributions to Latin American Clinical Care and Research on Diabetes and Pregnancy.

Cuban participation in and contributions to education, medical care and research on diabetes and pregnancy in Latin America dates back to the 1970s when the Latin American Diabetes Association was founded. The Cuban health system and its professionals recognized early the problems presented by diabetes during pregnancy for the health of an expectant mother and her children and assimilated and disseminated important lessons that became infl uential in the region. These included: importance of adopting a program within primary health care that offers national coverage for diabetic pregnant women, with a special focus on pre-conception monitoring of diabetic women; benefi ts of defi ning a specifi c range for application of a fasting glucose test to identify risk of gestational diabetes through selective screening for the disease; using insulin to treat gestational diabetes; controlling excessive weight at the beginning and during pregnancy; and underscoring the importance of interdisciplinary treatment of diabetes in pregnancy. The goal was to improve care and research in reproductive health for diabetic pregnant women and their children in Cuba. KEYWORDS: Gestational diabetes, pregnancy, Latin America, Cuba.

Enfermedades cardio-metabólicas en el embarazo: revisión sobre diagnóstico, tratamiento y proyección del riesgo cardiovascular a largo plazo / Cardio-metabolic diseases in pregnancy: a review on diagnosis, treatment and projection of long-term cardiovascular risk

Las enfermedades cardiovasculares representan la mayor causa de morbimortalidad a nivel mundial. Si bien presenta un descenso en la población general, en las mujeres tiende a mantenerse estable la prevalencia de enfermedad coronaria. Varios factores propios de la mujer predisponen a que esto ocurra, incluyendo el embarazo, mediado tanto por los cambios hematológicos y cardiovasculares característicos de la gestación; como por patologías asociadas, principalmente trastornos hipertensivos del embarazo y diabetes gestacional. Su presencia se ha asociado fuertemente a la aparición a futuro de otras patologías de alto riesgo cardiovascular como hipertensión crónica, dislipidemia y diabetes mellitus. Dado el impacto que esto representa, se hace imperante la identificación de grupos de alto riesgo y la implementación de medidas preventivas, así como de diagnóstico precoz y tratamientos adecuados con el fin de disminuir complicaciones materno-fetales en las etapas perinatal y posparto.

Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Although there is a decrease in general population, the prevalence of coronary heart disease remains stable in women. Several factors typical of womenkind predispose to cardiovascular disease, including pregnancy, mediated by hematological and cardiovascular changes characteristic of it; and by associated pathologies, mainly hypertensive disorders and diabetes. The presence of these diseases has been strongly associated with future presence of other conditions of high cardiovascular risk such as chronic hypertension, dyslipidemia and diabetes mellitus. Given this impact, the identification of high-risk groups and the implementation of preventive measures, as well as early diagnosis and adequate treatment in order to reduce both maternal and fetal complications in perinatal and postpartum stages becomes imperative.

Uso de metformina no tratamento da diabetes mellitus durante a gestação: revisão bibliográfica / Use of metformin in the treatment of diabetes mellitus during pregnancy: a literature review

Introdução: A Diabetes Mellitus engloba um conjunto de distúrbios metabólicos que levam a hiperglicemia e consequente deficiência insulínica. A incidência de Diabetes Mellitus Gestacional vem aumentando em conjunto com o aumento de casos de Diabetes Mellitus, constituindo um relevante problema de saúde atual. Dentre os principais fatores de risco para Diabetes Mellitus Gestacional aparecem a idade materna ≥ 35 anos, sobrepeso/ obesidade, história familiar de Diabetes Mellitus, entre outros, que levam muitas vezes à desfechos perinatais desfavoráveis como a macrossomia fetal e hipoglicemia neonatal. Como medida de tratamento inicial indica-se a mudança de estilo de vida, evoluindo para os tratamentos farmacológicos caso haja falha de tratamento inicial. Estes incluem a insulinoterapia (o padrão-ouro de tratamento) ou hipoglicemiantes orais, notadamente a metformina. Esta última desponta recentemente como uma alternativa de tratamento. Método: Trabalho elaborado através de revisão de literatura, com pesquisa realizada nas bases de dados Pubmed, LILACS e Cochrane. Foram selecionados artigos sobre diabetes gestacional contendo resultados sobre o uso de metformina e insulina, tanto no quesito de desfecho materno como perinatal, analisando os dados concordantes, discordantes ou indiferentes. Discussão: Alguns fatores têm sido comparados com relação ao uso das medicações disponíveis (metformina x insulina), a fim de constatar quais seriam as vantagens e desvantagens de cada método e seus desfechos perinatais. Os principais fatores estudados foram o ganho de peso materno, desenvolvimento de pré-eclampsia, prematuridade, necessidade de internação em UTI neonatal, Apgar de primeiro e quinto minuto, hipoglicemia neonatal, controle da glicemia materna, efeitos colaterais das medicações, peso de nascimento do recém nascido (RN) e seguimento do RN a longo prazo. Conclusão: Apesar de a insulinoterapia ainda ser padrão ouro no tratamento de diabetes mellitus gestacional, a metformina vem se mostrando método seguro e eficaz no controle da mesma, sem grandes diferenças nos resultados maternos e perinatais a curto e longo prazo.

Capacity Building and Innovation in Caring for Non-communicable Diseases in Maternal Global Health: The Example of Haiti.

Non-communicable diseases (NCDs) are important contributors to maternal morbidity and mortality worldwide. Yet, data on their prevalence and related outcomes in low-income countries are currently lacking. Additionally, screening and treatment protocols adapted for resource-limited settings are urgently required. This collaborative research initiative on the screening and management of hypertensive disorders of pregnancy and gestational diabetes was conducted in Saint-Nicolas Hospital in Saint-Marc, Haiti. The report discusses methods used to overcome several local challenges to implementation of care for NCDs. It also describes how collaborative research initiatives are efficient strategies to innovate and build research capacity for NCD care delivery during pregnancy in low-income countries.

Do probiotics effectively ameliorate glycemic control during gestational diabetes? A systematic review.

BACKGROUND: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The aim of this work was to systematically review all studies in which probiotic supplements were used during pregnancy and analyse the effects on GDM. METHODS: The data were collected using the medical subheading (MeSH) terms: ("diabetes, gestational"[MeSH Terms] OR ("diabetes"[All Fields] AND "gestational"[All Fields]) OR "gestational diabetes"[All Fields] OR ("gestational"[All Fields] AND "diabetes"[All Fields])) AND ("probiotics"[MeSH Terms] OR "probiotics"[All Fields]). The search included original articles written in English/Portuguese and published between 2012 and 2017. RESULTS: Of the 31 articles identified, seven met the inclusion criteria and were included in this review. In these studies, the sample size ranged from 60 to 373 women with GDM, which was between 24 and 40 weeks of pregnancy (second and third trimesters). Results demonstrated that probiotics used during pregnancy in women with GDM may improve glycaemic control and reduce VDL cholesterol, triglycerides, and inflammatory markers. CONCLUSIONS: The present systematic review highlights the importance of probiotics for glycemic control and decrease of inflammatory markers in GDM. Further long-term studies should be conducted to elucidate this interaction.

Manejo integral de la diabetes durante el embarazo / An integral management of the diabetes during the pregnacy

La diabetes gestacional es un padecimiento caracterizado por la intolerancia a los carbohidratos con diversos grados de severidad que se reconoce por primera vez durante el embarazo y que puede o no resolverse después de éste. En las gestantes con diabetes se presentan mayor riesgo de complicaciones maternas y fetales, por este motivo realizamos la actualización del tema a través de gestión y consulta de información de fuentes de información nacionales y foráneas sobre dicho tema actual(AU)

Gestational diabetes is a condition characterized by carbohydrate intolerance with varying degrees of severity that is recognized for the first time during pregnancy and may or may not resolve after pregnancy. In pregnant women with diabetes, there is a greater risk of maternal and fetal complications, for this reason we update the topic through management and consultation of information from national and foreign sources on this current issue(AU)

Use of a clinical-laboratory score to guide treatment of gestational diabetes.

OBJECTIVE: To assess the outcomes of implementing a clinical-laboratory score in the treatment of pregnant women with gestational diabetes. METHODS: A retrospective before-and-after implementation analysis was undertaken using data and neonatal outcomes for pregnant women with gestational diabetes treated before (January 2011-December 2012; control group) and after (January 2013-December 2014; score group) introduction of a newly developed score. To evaluate the effects of score adoption, odds ratios with 95% confidence intervals were calculated after adjustment for confounding factors. RESULTS: The control group included a greater proportion of women treated with diet alone (170/312 [54.5%]) than the study group did (122/391 [31.2%]; P<0.001). By contrast, more women in the study group received metformin (172 [44.0%] vs 77 [24.7%]; P<0.001). The neonatal outcomes, including low Apgar scores at 1 minute and at 5 minutes and neonatal intensive care unit admission, were similar in both groups. Multivariate logistic regression analysis showed that the adoption of the score did not significantly affect the choice of treatment or the birth weight rating. CONCLUSION: The score served well as an orientation tool in therapeutic decision making and had no negative effect on the treatment choice and perinatal outcomes.

Manejo integral de la diabetes durante el embarazo / Gestão abrangente de diabetes durante a gravidez / An integral management of the diabetes during the pregnancy

Introducción: la diabetes gestacional es un padecimiento caracterizado por la intolerancia a los carbohidratos con diversos grados de severidad que se reconoce por primera vez durante el embarazo y que puede o no resolverse después de éste. En las gestantes con diabetes se presentan mayor riesgo de complicaciones maternas y fetales. Objetivo: realizar una actualización sobre el manejo de la diabetes mellitus durante la gestación. Desarrollo: se gestionaron y consultaron fuentes de información, nacionales y foráneas, sobre dicho tema actual. Se abordaron aspectos como la educación diabetológica, la alimentación, la actividad física, el autocontrol, uso de medicamentos, en especial la insulina, y tratamiento de otras condiciones asociadas al embarazo. Conclusiones: es importante asegurar la atención preconcepcional cuando la mujer diabética y su pareja deseen el embarazo. Sin dudas, que la mujer con diabetes mellitus durante el embarazo debe recibir una atención obstétrica diferenciada con un enfoque multidisciplinario(AU)

Introduction: gestational diabetes is a condition characterized by carbohydrate intolerance with varying degrees of severity that is recognized for the first time during pregnancy and may or may not resolve after this. In pregnant women with diabetes there is a greater risk of maternal and fetal complications. Objective: to carry out an update on the management of diabetes mellitus during pregnancy. Development: information sources, national and foreign, were managed and consulted on this current topic. They addressed aspects such as diabetes education, nutrition, physical activity, self-control, use of medications, especially insulin, and treatment of other conditions associated with pregnancy. Conclusions: it is important to ensure preconception care when the diabetic woman and her partner desire pregnancy. Undoubtedly, the woman with diabetes mellitus during pregnancy should receive a differentiated obstetric care with a multidisciplinary approach(AU)

Introdução: diabetes gestacional é uma condição caracterizada por intoler�ncia a carboidratos com diferentes graus de gravidade, que é reconhecida pela primeira vez durante a gravidez e pode ou não se resolver depois disso. Em mulheres grávidas com diabetes, existe um risco maior de complicações maternas e fetais. Objetivo: realizar uma atualização sobre o manejo do diabetes mellitus durante a gravidez. Desenvolvimento: fontes de informação, nacionais e estrangeiras, foram gerenciadas e consultadas sobre o tema atual. Eles abordaram aspectos como educação em diabetes, nutrição, atividade física, autocontrole, uso de medicamentos, especialmente insulina, e tratamento de outras condições associadas à gravidez. Conclusões: é importante garantir o cuidado pré-concepcional quando a mulher diabética e seu parceiro desejam engravidar. Indubitavelmente, a mulher com diabetes mellitus durante a gestação deve receber atendimento obstétrico diferenciado, com abordagem multidisciplinar(AU)

TeleCondutas: diabetes e gestação / TeleGuides: diabetes and gestation

Os quadros hiperglicêmicos que são diagnosticados na gravidez são classificados pela Organização Mundial da Saúde (OMS) em duas categorias: 1) "Diabetes Mellitus (DM) na gestação": hiperglicemia compatível com DM fora na gestação, mas que o diagnóstico é feito na gestação (overt Diabetes em inglês) e; 2) "Diabetes Mellitus Gestacional" (DMG): estado de hiperglicemia, em valores que não preenchem critérios para DM, usualmente diagnosticado após a metade da gestação e que tende a se resolver com o término da gestação. No Brasil, a prevalência de DMG no Sistema Único de Saúde (SUS) passou de 7,5% para 18%, conforme os critérios diagnósticos atuais. Tanto o DM na gestação quanto o DMG aumentam o risco de desfechos maternos e fetais graves, devendo, portanto, ser identificados, adequadamente tratados na Atenção Primária à Saúde (APS) e, quando indicado, nos serviços especializados em Pré-natal de alto risco. Esta guia apresenta informação que orienta a conduta para casos de diabetes e gestação no contexto da Atenção Primária à Saúde, incluindo: fatores de risco para dmg, classificação, rastreamento, tratamento dm gestacional, tratamento dm na gestação, controle glicêmico, avaliação pré-concepcional em diabéticas, avaliação complementar, momento e via de parto, acompanhamento pós-parto, encaminhamento para serviço especializado, referências anexo 1 - orientações nutricionais.

Manejo integral de la diabetes durante el embarazo / An integral management of the diabetes during the pregnacy

La diabetes gestacional es un padecimiento caracterizado por la intolerancia a los carbohidratos con diversos grados de severidad que se reconoce por primera vez durante el embarazo y que puede o no resolverse después de éste. En las gestantes con diabetes se presentan mayor riesgo de complicaciones maternas y fetales, por este motivo realizamos la actualización del tema a través de gestión y consulta de información de fuentes de información nacionales y foráneas sobre dicho tema actual(AU)

Gestational diabetes is a condition characterized by carbohydrate intolerance with varying degrees of severity that is recognized for the first time during pregnancy and may or may not resolve after pregnancy. In pregnant women with diabetes, there is a greater risk of maternal and fetal complications, for this reason we update the topic through management and consultation of information from national and foreign sources on this current issue(AU)