Maternal visceral adipose tissue during the first half of pregnancy predicts gestational diabetes at the time of delivery - a cohort study.

BACKGROUND: Gestational diabetes mellitus (GDM) is a common condition, often associated with high maternal and fetal morbidity. The use of new tools for early GDM screening can contribute to metabolic control to reduce maternal and fetal risk. This study aimed to ascertain whether maternal visceral adipose tissue (VAT) measurement by ultrasound during the first half of pregnancy can predict the occurrence of GDM during the third trimester. METHODS: A prospective cohort study of 133 pregnant women with gestational age ≤20 weeks in an outpatient setting. VAT depth was measured by ultrasound at the maternal periumbilical region. GDM status was obtained through hospital charts during hospitalization to delivery. A Receiver Operator Characteristic (ROC) curve was used to determine the optimum threshold to predict GDM. RESULTS: According to the ROC curve, a 45mm threshold was identified as the best cut-off value, with 66% of accuracy to predict GDM. Crude and adjusted odds ratios (OR) for GDM were 13.4 (95%CI 2.9-61.1) and 8.9 (95%CI 1.9-42.2), respectively. A similar result was obtained among pre-gravid non-obese women, with crude and adjusted OR of 16.6 (95%CI 1.9-142.6) and 14.4 (95%CI 1.7-125.7), respectively. Among pre-gravid obese patients, a 45mm threshold did not reach statistical significance to predict GDM. CONCLUSION: The high and significant OR found before and after adjustments provides additional evidence of a strong association between VAT and GDM. It appears that VAT measurement during the first half of pregnancy has great potential in identifying non-obese women at high risk for GDM. This evidence can assist obstetricians in correctly allocating resources among populations of pregnant women at risk, determined not only by pre-gravid body mass index (BMI).

Acompanhamento familiar a criancas hospitalizadas / Family follow-up of hospitalized children

Os autores avaliam, em uma amostra de 96 criancas hospitalizadas, o acompanhamento familiar durante o periodo de internacao. As variaveis utilizadas foram estado nutricional, tempo de permanencia hospitalar e o numero de visitas recebidas pelos pacientes. E introduzido o indice de visitacao, o qual avalia quantitativamente o acompanhamento familiar das criancas hospitalizadas. Verificou-se baixo indice de visitacao (53 por cento ), principalmente nos desnutridos de terceiro grau (8 por cento ), os quais tiveram um periodo de internacao superior a 25 dias. Os pacientes eutroficos foram significativamente mais visitados do que os desnutridos de terceiro grau p<0,01 e z calc.=3,24). Enfatiza-se a necessidade de atencao especial as criancas desnutridas de terceiro grau e com perspectivas de hospitalizacao de longo curso. Nao obstante, o tempo de hospitalizacao foi similar entre as criancas que tiveram um acompanhamento familiar diario em comparacao as criancas nao visitadas (p<0,01 e z calc.=1,31). Sugere-se uma avaliacao especifica de cada instituicao hospitalar sobre as atuais condicoes que concernem ao acompanhamento familiar a crianca internada, com o objetivo de minimizar os danos psicologicos na formacao da personalidade destes pacientes