The prognostic value of a normal oral glucose tolerance test in pregnant women who tested positive at screening: a validation study.

BACKGROUND: Controversies surround a diagnosis of gestational diabetes mellitus (GDM). The objective of this study was to evaluate the oral glucose tolerance test (OGTT) for the prediction of adverse gestational and perinatal outcomes in pregnant women with a positive screening test for diabetes mellitus and a negative diagnosis, i.e. a normal 3-hour OGTT. METHODS: This validation study evaluated 409 pregnant women who tested positive for diabetes mellitus at screening. Perinatal and maternal outcomes were considered. Sensitivity and specificity were calculated for each of the values of the OGTT as a diagnostic test, with the gold standard being perinatal outcome. RESULTS: The most frequent risk factors were obesity, arterial hypertension and advanced maternal age. The most common neonatal outcomes were large-for-gestational-age infants, Cesarean delivery and preterm birth. A fasting blood glucose level of 87 mg/dL was the most powerful predictor of adverse perinatal outcome. CONCLUSIONS: At the cut-off level adopted by the American Diabetes Association, gestational OGTT was able to successfully identify in which pregnant women outcome would be unfavorable.

Fetal cardiotocography before and after water aerobics during pregnancy.

OBJECTIVE: To evaluate the effect of moderate aerobic physical activity in water on fetal cardiotocography patterns in sedentary pregnant women. METHOD: In a non-randomized controlled trial, 133 previously sedentary pregnant women participated in multiple regular sessions of water aerobics in a heated swimming pool. Cardiotocography was performed for 20 minutes before and just after the oriented exercise. Cardiotocography patterns were analyzed pre- and post-exercise according to gestational age groups (24-27, 28-31, 32-35 and 36-40 weeks). Student's t and Wilcoxon, and McNemar tests were used, respectively, to analyze numerical and categorical variables. RESULTS: No significant variations were found between pre- and post-exercise values of fetal heart rate (FHR), number of fetal body movements (FM) or accelerations (A), FM/A ratio or the presence of decelerations. Variability in FHR was significantly higher following exercise only in pregnancies of 24-27 weeks. CONCLUSIONS: Moderate physical activity in water was not associated with any significant alterations in fetal cardiotocography patterns, which suggests no adverse effect on the fetus.

Distúrbio hipertensivo na gravidez acompanhado por síndrome HELLP / Hypertensive disorder during pregnancy followed by HELLP syndrome

A Síndrome HELLP (SH) é uma complicaçao da pré-eclâmpsia e eclâmpsia associada com anemia hemolítica microangiopática, produzindo hemólise, elevaçao de enzimas hepáticas e plaquetopenia. Apresentamos uma série de dez casos, diagnosticados e seguidos na Maternidade do Centro de Assistência Integral à Saúde da Mulher (CAISM) da UNICAMP. Foram analisadas características pré-gestacionais como idade, paridade e antecedentes mórbidos, assim como a idade gestacional no início do quadro clínico, dados do parto, da puerpério e do recém-nascido. Nao houve morte materna e o resultado perinatal dependeu diretamente do peso do recém-nascido e da idade gestacional no momento do parto. Os autores discutem os aspectos diagnósticos e acreditam que a conduta intervencionista possa melhorar o prognóstico materno.