Seventy two-hour glucose monitoring profiles in mild gestational diabetes mellitus: differences from healthy pregnancies and influence of diet counseling.

OBJECTIVE: To study glucose profiles of gestational diabetes (GDM) patients with 72 h of continuous glucose monitoring (CGM) either before (GDM1) or after (GDM2) dietary counseling, comparing them with nondiabetic (NDM) controls. DESIGN AND METHODS: We performed CGM on 22 GDM patients; 11 before and 11 after dietary counseling and compared them to 11 healthy controls. Several physiological and clinical characteristics of the glucose profiles were compared across the groups, including comparisons for pooled 24-h measures and hourly median values, summary measures representing glucose exposure (area under the median curves) and variability (amplitude, standard deviation, interquartile range), and time points related to meals. RESULTS: Most women (81.8%) in the GDM groups had fasting glucose <95mg/dL, suggesting mild GDM. Variability, glucose levels 1 and 2h after breakfast and dinner, peak values after dinner and glucose levels between breakfast and lunch, were all significantly higher in GDM1 than NDM (P<0.05 for all comparisons). The GDM2 results were similar to NDM in all aforementioned comparisons (P>0.05). Both GDM groups spent more time with glucose levels above 140mg/dL when compared with the NDM group. No differences among the groups were found for: pooled measurements and hourly comparisons, exposure, nocturnal, fasting, between lunch and dinner and before meals, as well as after lunch (P>0.05 for all). CONCLUSION: The main differences between the mild GDM1 group and healthy controls were related to glucose variability and excursions above 140mg/dL, while glucose exposure was similar. Glucose levels after breakfast and dinner also discerned the GDM1 group. Dietary counseling was able to keep glucose levels to those of healthy patients.

Obesidade e gravidez / Obesity and pregnancy

A obesidade é um grave problema de saúde pública e afeta mulheres em idade reprodutiva. Durante as últimas décadas, as mulheres tornaram-se mais obesas, com prevalência duas vezes mais que em homens. Em países como os EUA, cerca de 2/3 das mulheres estão acima do peso e, destas, 1/3 é de obesas. Nos anos 70, a obesidade em mulheres em idade reprodutiva era de 9%, porém, em 2004 (dados do NHANES 2003-2004), elevou-se para 29%.1 No Brasil, entre as mulheres, dados da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por InquéritoTelefônico (VIGITEL) fornecidos pelo Instituto Brasileiro de Geografia e Estatística (IBGE) mostram excesso de peso (IMC > 25 kg/m2) em 24,9, 36 e 45,7% nas faixas etárias de 18-24, 25-34 e 35- 44 anos, respectivamente.2 A gestação está incluída na lista dos fatores clássicos desencadeantes da obesidade. O início ou manutenção da obesidade nessa fase está associado a inúmeros riscos maternos e fetais. A obesidade materna predispõe a mãe ao diabetes gestacional (DMG) e ao diabetes tipo 2 (DM2) no futuro, à hipertensão, a doenças cardiovasculares e câncer. Filhos de mães obesas também exibem elevada incidência de obesidade no futuro, de DM2, hipertensão e doenças cardiovasculares.

Obesity is a serious public health problem and affects women of reproductive age. During the last decades, women have become more obese, with twice the prevalence found among men. In countries like the U.S., about two thirds of women are overweight, and of these, one third is obese. In the seventies, the prevalence of obesity in women of reproductive age was 9%. In 2004 (data from NHANES 2003-2004), it rose to 29% .1 In Brazil, data from the Risk Factors Surveillance and Protection for Chronic Diseases Telephone Survey (VIGITEL) provided by the Brazilian Institute of Geography and Statistics (IBGE) show excess weight (BMI> 25 kg/m2) prevalences of 24.9, 36 and 45.7% in women aged 18-24, 25-34 and 35-44 years, respectively.2 Pregnancy is considered a classical risk factor of obesity. The onset or maintenance of obesity in this phase is associated with numerous maternal and fetal risks. Maternal obesity predisposes the mother to gestational diabetes (GDM) and type 2 diabetes (T2DM) in the future, to hypertension, cardiovasculardisease and cancer. Children of obese mothers also present with a high incidence of obesity in the future, as well as of T2DM, hypertension and cardiovascular disease.