Desfechos neonatais adversos e fatores associados entre gestantes com diabetes mellitus gestacional e de risco habitual / Neonatal adverse outcomes and associated factors among pregnant women with gestational and usual risk of diabetes mellitus

Objetivo: Avaliar os desfechos neonatais adversos e fatores associados entre gestantes com diabetes mellitus gestacional e de risco gestacional habitual. Métodos: Estudo transversal, de âmbito nacional e de base hospitalar, conduzido entre fevereiro de 2011 e outubro de 2012. Foram excluídas as mulheres com gestações múltiplas ou natimortos. As informações foram coletadas via questionário padronizado, cartão de pré-natal e/ou prontuário. Resultados: Das 12.712 puérperas avaliadas, 1.915 tinham diabetes mellitus gestacional e 10.797 foram classificadas em risco gestacional habitual. Verificou-se que 74,1% das mulheres com diabetes receberam assistência pré-natal adequada/mais que adequada em relação a 65% das mulheres com risco gestacional habitual. Em contrapartida, o grupo das mulheres com diabetes foi composto em sua maioria por mulheres acima de 35 anos, com hipertensão prévia, excesso de peso pré-gestacional e ganho de peso gestacional excessivo, multíparas, com histórico de cesárea e abortos. Os desfechos "prematuridade" e "nascimento de recém-nascido grande para idade gestacional" foram superiores entre as mulheres com diabetes. Conclusão: As mulheres com diabete detiveram condições demográficas, antecedentes clínicos/obstétricos e desfechos neonatais mais desfavoráveis em relação às mulheres de risco gestacional habitual. Apesar disso, o pré-natal foi um dos fatores que exerceu extrema importância para que outros desfechos negativos (óbito neonatal e o Apgar<5) não fossem superiores entre as mulheres com diabete sem relação às de risco gestacional habitual. Portanto, reitera-se o papel do pré-natal entre as mulheres brasileiras, sobretudo as de alto risco gestacional.

Objective: To assess adverse neonatal outcomes and associated factors between pregnant women with gestational diabetes mellitus and usual gestational risk. Methods: Cross-sectional, nationwide, hospital-based study, conducted from February 2011 to October 2012. Women with multiple pregnancies or stillbirths were excluded. Information was collected using a standardized questionnaire, prenatal card and/or medical records. Results: Out of a total of 12,712 postpartum women evaluated, 1,915 had gestational diabetes mellitus and 10,797 were classified as usual gestational risk. It was observed that 74.1% of diabetics received adequate/more than adequate prenatal care compared to 65% of women with usual gestational risk. On the other hand, the group of diabetics was composed mostly of women over 35 years of age, with underlying hypertension, pre-gestational excess weight and excess gestational weight gain who were multiparous, with history of cesarean deliveries and abortions. The outcomes of "prematurity" and "birth of large-sized newborn" for the gestational age were higher among diabetics. Conclusion: Diabetic women had more unfavorable demographic conditions, clinical/obstetric history and neonatal outcomes compared to women with usual gestational risk. Nevertheless, prenatal care was a factor of extreme importance to prevent other negative outcomes (neonatal death and Apgar <5) to increase among diabetic women compared to those with usual gestational risk. Therefore, the role of prenatal care among Brazilian women is reiterated, especially among the high gestational risk women.

Metformin versus insulin in the management of gestational diabetes mellitus: A meta‑analysis / Philippine Journal of Obstetrics and Gynecology

Objective@#To determine the efficacy of metformin and insulin in the management of gestational diabetes mellitus (GDM). @*Methodology@#Randomized controlled trials (RCT) were retrieved from the databases. All references cited in the articles were also searched by hand to identify additional publications. Studies included were limited to trials on metformin and insulin in the management of GDM in singleton pregnancies. Four RCTs were analyzed in the study. The risk of bias was assessed using Preferred Reporting Items for Systematic reviews and Meta-Analyses Cochrane Collaboration’s tool (Rob 2). Random effects meta-analysis was carried out to pool the data. All analyses were conducted in Review Manager 5.3.5 (2014). @*Results@#Meta-analysis of four RCT involving 807 participants (405 were treated with metformin and 402 were treated with insulin) shows that there was no significant difference between metformin and insulin in achieving glycemic control as to fasting blood sugar (FBS), postprandial blood glucose (PPBG), and glycosylated hemoglobin, mean difference (MD) −0.43 (95% confidence interval [CI] −2.77–1.91; P = 0.72), MD −2.13 (95% CI −5.16–0.90, P = 0.17), MD −0.09 (95% CI −0.20–0.02, P = 0.10), respectively. For maternal outcomes, there was a statistically significant 69% decreased risk of hypoglycemia in the metformin group (risk ratio [RR] 0.31, 95% CI 0.20–0.49; P < 0.001). There was no difference in terms of risk of preterm birth (RR 1.11, 95% CI 0.75–1.64, P = 0.60); hypertensive disorders (RR 1.06, 95% CI 0.71–1.60, P = 0.77); polyhydramnios (RR 1.04, 95% CI 0.51–2.14, P = 0.91); and risk of cesarean delivery (RR 0.90, 95% CI 0.75–1.08, P = 0.27). For neonatal outcomes, there was statistically significant 34% reduction on the risk of neonatal hypoglycemia (RR 0.66, 95% CI 0.46–0.94; P = 0.02) in the metformin group. There was no statistical difference in terms of mean birthweight (MD − 81.34, 95% CI −181.69–19.02, P = 0.11). Metformin has decreased the risk of newborns weighing more than 4000 g, babies with birthweight >90th percentile by 27% (RR 0.73, 95% CI 0.28–1.90, P = 0.52), and 20% (RR 0.80, 95% CI 0.54–1.18,P = 0.26), respectively, but these were not statistically significant. There was no significant difference in terms of risk of birthweight <10th percentile (RR 1.17, 95% CI 0.60–2.31, P = 0.65); APGAR <7 (RR 1.17, 95% CI 0.65–2.08, P = 0.60), birth trauma (RR 0.77, 95% CI 0.23–2.58, P = 0.67), and jaundice requiring phototherapy RR 1.04, 95% CI 0.66–1.65, P = 0.85). Neonatal intensive care unit admission (RR 0.89, 95% CI 0.64–1.23, P = 0.48), respiratory distress syndrome (RR 0.73, 95% CI 0.36–1.50, P = 0.39), transient tachypnea (RR 0.78, 95% CI 0.27–2.19, P = 0.63), and any congenital anomaly (RR 0.58, 95% CI 0.20–1.67, P = 0.31) were decreased in the metformin group but was not statistically significant. @*Conclusion@#There was no significant difference between metformin and insulin in achieving glycemic control as to FBS and PPBG among patients with GDM. There was a statistically significant reduction in the risk of maternal and neonatal hypoglycemia in the use of metformin.

Enhancing gestational diabetes management in Filipino patients: Evaluating the impact of education on knowledge, attitude, and pregnancy outcomes at a Tertiary Medical Center

Introduction@#Patient education is integral in the management of gestational diabetes mellitus (GDM), a common pregnancy complication that may cause adverse perinatal outcomes. This study evaluated the effect of diabetes education on the knowledge and attitude among patients with GDM, comparing pre- vs post-diabetes session scores and determining pregnancy outcomes.@*Methodology@#A one-group pre-test and post-test experimental design study was conducted on 75 patients after one- session diabetes counseling using the Gestational Diabetes Mellitus Knowledge Questionnaire (GDMKQ) and the third version of the Diabetes Attitude Scale (DAS-3).@*Results@#Of the 75 subjects, 84% exhibited adequate knowledge of diabetes. Post-education, a significant increase in the total scores was seen among those less than 35 years of age (p-value: 0.003), both employed and unemployed (p-value: 0.0.026, 0.047, respectively), with a secondary level of education (p-value: 0.014) and multigravid (p-value: 0.015). An overall median positive attitude score of 3.6 was documented. For neonatal outcomes, no adverse events existed. For maternal outcomes, 17.9% had elevated fasting blood glucose while 7.1% had elevated 2-hour post-glucose tolerance test.@*Conclusion@#Diabetes education improves patient’s knowledge but not their attitude. Hence, improvement in attitude interventions should be incorporated into the current diabetes education program.

Edad materna avanzada: complicaciones más frecuentes en el Hospital Regional de Talca / Advanced maternal age: most frequent complications in Talca's Regional Hospital

Professional development, the search for economic stability and personal fulfillment have been some of the reasons why an increasing number of women have decided to delay pregnancy beyond the third decade of life. By definition, a pregnancy of advanced maternal age is considered to be those over 35 years of age, and it is known that this age group faces a higher risk of complications during pregnancy, intrapartum and postpartum, in addition to perinatal morbidity and mortality that is usually associated with chromosomal abnormalities. In Chile, pregnancies over 35 years of age or late pregnant women have increased significantly in recent decades, however there are no statistical data at a local level. The objective of this study is to evaluate the prevalence of pregnancies of advanced maternal age and their most frequent complications in the Maule Region with data obtained between 2017 - 2022 at the Regional Hospital of Talca (RHT).

Características de la descendencia de gestantes diabéticas atendidas en el Hospital "Comandante Ciro Redondo García", Artemisa / Characteristics of the Offspring of Pregnant Women Who Received Attention in the Hospital Comandante Ciro Redondo García, of Artemisa

Introducción: Múltiples investigaciones demuestran el efecto teratogénico de la diabetes mellitus durante el embarazo, considerada causa frecuente de morbilidad fetal. Objetivo: Describir las características del producto de la concepción de mujeres con diabetes pregestacional o gestacional, atendidas en el Hospital Provincial Comandante Ciro Redondo García, de Artemisa. Métodos: Se realizó un estudio observacional, descriptivo, transversal, en la Provincia Artemisa, Cuba, en el período de febrero 2016 a febrero 2018, en 316 mujeres con diabetes mellitus durante su gestación. La información se obtuvo mediante revisión documental y entrevista, conservando los datos en hoja de cálculo Excel. Resultados: El 69,9 por ciento de las pacientes diabéticas estudiadas presentaron morbilidades en su descendencia, entre las que predominaron los defectos congénitos en 139 casos; 34 neonatos macrosómicos; 21 pretérminos; 9 con retardo del crecimiento intrauterino y 5 fallecidos antes del año de vida. La diabetes, tanto pregestacional como gestacional, se relacionó con afecciones en la descendencia; sin embargo, un control preconcepcional adecuado de la enfermedad redujo el riesgo de tener hijos afectados. Los defectos congénitos fueron la alteración más frecuente cuando la madre padecía diabetes pregestacional. Si la diabetes materna era gestacional los hijos presentaron con frecuencia macrosomía y otras anomalías asociadas. Conclusiones: Alrededor de 70 de cada 100 mujeres diabéticas presentan morbilidades en su descendencia. Si la diabetes materna no es controlada antes de la concepción, estas morbilidades en sus hijos son predominantemente defectos congénitos con posible origen disruptivo, mientras que la diabetes gestacional se relaciona más con recién nacidos macrosómicos(AU)

Introduction: Multiple investigations show the teratogenic effect of diabetes mellitus during pregnancy, being considered a frequent cause of fetal morbidity. Objective: To describe the characteristics of the offspring of women with pregestacional or gestational diabetes who received attention at the Hospital Provincial Comandante Ciro Redondo García of Artemisa. Methods: An observational, descriptive, cross-sectional and descriptive study was conducted in Artemisa Province, Cuba, in the period from February 2016 to February 2018, with 316 pregnant women with diabetes mellitus. The information was obtained through documentary review and interview; the data were kept in an Excel spreadsheet. Results: 69.9 percent of the studied diabetic patients presented morbidities in their offspring, among which congenital defects predominated, accounting for 139 cases; 34 were macrosomic neonates; 21 were preterm; 9 presented intrauterine growth retardation; and 5 died within one year of life. Diabetes, both pregestational and gestational, was associated with conditions in the offspring; however, adequate preconception control of the disease reduced the risk for having affected children. Congenital defects were the most frequent alteration when the mother had pregestational diabetes. If maternal diabetes was gestational, the offspring frequently presented macrosomia and other associated anomalies. Conclusions: About 70 out of 100 diabetic women present morbidities in their offspring. If maternal diabetes is not controlled before conception, these morbidities in their offspring are predominantly congenital defects with a possible disruptive origin, while gestational diabetes is more related to macrosomic newborns(AU)

Factores de riesgo psicosocial asociados con la diabetes mellitus gestacional: revisión sistemática / Psychosocial risk factors associated with gestational diabetes mellitus: systematic review

La diabetes mellitus gestacional DMG es una enfermedad con consecuencias mortales, incapacitantes y costosas para las personas, las familias, las comunidades y los países. Con el fin de establecer de manera sistemática los factores de riesgo psicosocial asociados con la DMG que deberían ser monitoreados durante y después del embarazo se realizó una revisión sistemática en las bases de datos PubMed/Medline y Cochrane. Se encontraron 1188 artículos y se seleccionaron 41. Algunos temas principales fueron conflictos con prácticas culturales, estigma social, influencia de la etnia/raza, bajo nivel educativo, calidad del sueño, problemas con la lactancia materna, preocupación por la propia salud o la del bebé, baja percepción de riesgo de DMG o de diabetes mellitus tipo 2 en el futuro, estrés, ansiedad y depresión, conocimiento limitado, falta de apoyo de la pareja, de la familia o social y de los profesionales de la salud, bajos niveles de autocuidado/autoeficacia y dificultades con cambios en el estilo de vida. Estos factores deberían monitorearse en las embarazadas durante y después del parto. Los tratamientos deberían considerar el impacto psicológico y el riesgo de desarrollar diabetes mellitus tipo 2 después del parto, y deberían ser incluidos en las guías de práctica clínica. Las poblaciones multiétnicas y los grupos más vulnerables demográficamente y socioeconómicamente son más susceptibles de desarrollar DMG.

Gestational diabetes mellitus (GDM) is a disease with fatal, disabling, and costly consequences for individuals, families, communities and countries. To systematically establish the psychosocial risk factors associated with GDM that should be monitored during and after pregnancy. Systematic review in PubMed/Medline and Cochrane databases. 1188 articles were found and 41 were selected. Some main themes were conflicts with cultural practices, social stigma, ethnicity/race influence, low educational level, sleep quality, breastfeeding problems, concern for ones own health/baby, low perception of the risk of GDM/DM2 in the future, stress, anxiety and depression, limited knowledge, lack of support from the partner/family/social and health professionals, low levels of self-care/self-efficacy and difficulties with changes in the lifestyle. These factors should be monitored in pregnant women during and after delivery. Treatments should consider the psychological impact and the risk of developing DM2 after childbirth and should be included in clinical practice guidelines. Multi-ethnic populations and the most demographically and socioeconomically vulnerable groups are more susceptible to developing GDM.

Biochemical analysis of oxidative stress and purinergic system in pregnant women with gestational diabetes mellitus / Análise bioquímica do estresse oxidativo e do sistema purinérgico em gestantes com diabetes mellitus gestacional

Background: Pregnancy is characterized as a physiological period with greater sensitivity to insulin resistance and changes in oxidative stress. Purinergic signaling is directly related to diabetes, as this condition modifies the concentration of extracellular ATP and the level of degradation of ATP to adenosine. Objective: Analyze oxidative stress and the purinergic system in pregnant women with Gestational Diabetes Mellitus (GDM) and compare them with low-risk pregnant women (LR). Materials and Methods: The research was of a quantitative approach of an experimental nature. The study was carried out at the Clínica da Mulher, which serves high-risk pregnant women, and at the Family Health Centers, which serves low-risk pregnant women, both located in Chapecó, Santa Catarina, Brazil. Results: From the analysis, it was observed that oxidative stress was increased in pregnant women in LR compared to pregnant women with GDM by increasing the concentration of TBARS and reducing the concentration of Carbonyl Protein in pregnant women with LR. Regarding the purinergic system, there was a significant decrease in the hydrolysis of the nucleotides ATP, ADP, and AMP in pregnant women with GDM, and a significant increase in the hydrolysis of ADA, also in pregnant women with GDM. Conclusion: Therefore, pregnant women with GDM have less oxidative stress compared to pregnant women in LR concerning TBARS and Carbonyl Protein markers, thus allowing a greater antioxidant defense mechanism. Furthermore, concerning the purinergic system, there is an increase in the activity of ADA, which is directly related to the immunosuppression process, a necessary condition for the protection of the fetus during the gestational period (AU).

Introdução: A gravidez é caracterizada como um período fisiológico em que há uma maior sensibilidade a resistência à insulina e alterações no estresse oxidativo. A sinalização purinérgica está diretamente relacionada ao diabetes, pois esta condição modifica a concentração de ATP extracelular e o nível de degradação de ATP em adenosina. Objetivo:Analisar o estresse oxidativo e o sistema purinérgico em gestantes com Diabetes Mellitus Gestacional (DMG) e compará-los com gestantes de baixo risco (BR). Materiais e Métodos: A pesquisa foi de abordagem quantitativa, de caráter experimental. O estudo foi realizado na Clínica da Mulher, que atende gestantes de alto risco, e nas Unidades de Saúde da Família, que atendem gestantes de baixo risco, ambas localizadas no município de Chapecó, Santa Catarina, Brasil. Resultados: A partir das análises, observou-se que o estresse oxidativo apresentou-se aumentado em gestantes de BR quando comparado a gestantes com DMG. No que tange ao sistema purinérgico, houve uma diminuição significativa na hidrólise dos nucleotídeos ATP, ADP e AMP em gestantes com DMG, bem como um aumento significativo na hidrólise de ADA, também em gestantes com DMG. Conclusão: Portanto, gestantes com DMG possuem menor estresse oxidativo quando comparado a gestantes de BR, permitindo assim, um maior mecanismo de defesa antioxidante. Para mais, no que se refere ao sistema purinérgico, verifica-se o aumento da concentração de ADA está diretamente relacionada ao processo de imunossupressão, condição necessária à proteção do feto durante o período gestacional (AU).

Quality of Life and Depression Conditions of Women with Gestational Diabetes during Pregnancy and Postpartum Period / Qualidade de vida e condições de depressão em mulheres com diabetes gestacional durante a gravidez e o período pós-parto

Abstract Objective The study was conducted to determine the quality of life and depression of women with gestational diabetes during pregnancy and the postpartum period. Methods 100 pregnant women with gestational diabetes and 100 healthy pregnant women were included in the present study. Data were obtained from pregnant women in their third trimester who agreed to take part in the study. The data was collected during the third trimester and six to eight weeks after the baby was born. The data were obtained by socio-demographic characteristics form, postpartum data collection form, the MOS 36 Item Short Form Health Survey and Center for Epidemiologic Studies Depression Scale (CESD). Results The mean age of pregnant women with gestational diabetes in the study was the same as the average age of healthy pregnant women. The CESD score of pregnant women with gestational diabetes was 26,77 ± 4,85 while the corresponding score was 25,19 ± 4,43 for healthy women. Additionally, the score in the postpartum period was 32.47 ± 5.94 for pregnant women with gestational diabetes and 35.47 ± 8.33 for healthy pregnant women. CESD scores were found to be higher than the cut-off score of 16 in both groups, and the mean scores increased during the postpartum period. Conclusion During the postpartum period, the quality of life of pregnant women with gestational diabetes was affected more negatively than healthy pregnant women. Depressive symptoms of women with both gestational diabetes and healthy pregnancy were found to be high in pregnancy and postpartum periods.

Resumo Objetivo O estudo foi realizado para determinar a qualidade de vida e depressão de mulheres com diabetes gestacional durante a gravidez e período pós-parto. Métodos 100 gestantes com diabetes gestacional e 100 gestantes saudáveis incluídas no presente estudo. Os dados foram obtidos de mulheres grávidas no terceiro trimestre que concordaram em participar do estudo. Os dados foram coletados durante o terceiro trimestre e seis a oito semanas após o nascimento do bebê. Os dados foram obtidos por meio do formulário de características sociodemográficas formulário de coleta de dados pós-parto MOS 36 Item Short Form Health Survey e Center for Epidemiologic Studies Depression Scale (CESD). Resultados A idade média das gestantes com diabetes gestacional no estudo foi igual à idade média das gestantes saudáveis. O escore CESD de gestantes com diabetes gestacional foi de 26 77 ± 4 85 enquanto o escore correspondente foi de 25 19 ± 4 43 para mulheres saudáveis. Além disso o escore no pós-parto foi de 32 47 ± 5 94 para gestantes com diabetes gestacional e 35 47 ± 8 33 para gestantes saudáveis. Os escores do CESD foram maiores do que o ponto de corte de 16 em ambos os grupos e os escores médios aumentaram durante o período pós-parto. Conclusão Durante o período pós-parto a qualidade de vida de gestantes com diabetes gestacional foi mais afetada negativamente do que gestantes saudáveis. Os sintomas depressivos de mulheres com diabetes gestacional e gravidez saudável foram elevados na gravidez e nos períodos pós-parto.

Association between maternal gestational diabetes mellitus and the risk of autism spectrum disorder in offspring / 中国当代儿科杂志

OBJECTIVES@#To explore the association between maternal gestational diabetes mellitus (GDM) exposure and the development of autism spectrum disorder (ASD) in offspring.@*METHODS@#A case-control study was conducted, recruiting 221 children with ASD and 400 healthy children as controls. Questionnaires and interviews were used to collect information on general characteristics of the children, socio-economic characteristics of the family, maternal pregnancy history, and maternal disease exposure during pregnancy. Multivariate logistic regression analysis was used to investigate the association between maternal GDM exposure and the development of ASD in offspring. The potential interaction between offspring gender and maternal GDM exposure on the development of ASD in offspring was explored.@*RESULTS@#The proportion of maternal GDM was significantly higher in the ASD group compared to the control group (16.3% vs 9.4%, P=0.014). After adjusting for variables such as gender, gestational age, mode of delivery, parity, and maternal education level, maternal GDM exposure was a risk factor for ASD in offspring (OR=2.18, 95%CI: 1.04-4.54, P=0.038). On the basis of adjusting the above variables, after further adjusting the variables including prenatal intake of multivitamins, folic acid intake in the first three months of pregnancy, and assisted reproduction the result trend did not change, but no statistical significance was observed (OR=1.94, 95%CI: 0.74-5.11, P=0.183). There was an interaction between maternal GDM exposure and offspring gender on the development of ASD in offspring (P<0.001). Gender stratified analysis showed that only in male offspring of mothers with GDM, the risk of ASD was significantly increased (OR=3.67, 95%CI: 1.16-11.65, P=0.027).@*CONCLUSIONS@#Maternal GDM exposure might increase the risk of ASD in offspring. There is an interaction between GDM exposure and offspring gender in the development of ASD in offspring.

Prontidão para via oral, aleitamento materno e diabetes mellitus gestacional: estudo caso-controle / Readiness for way oral, breastfeeding and gestational diabetes mellitus: a case-control study

RESUMO Objetivo verificar a prontidão para via oral e aleitamento materno em recém-nascidos de mães diagnosticadas com diabetes mellitus gestacional (DMG). Métodos estudo observacional, analítico, quantitativo, do tipo caso-controle. Para avaliação da sucção não nutritiva, foi utilizado o Protocolo de Prontidão do Prematuro para Início da Alimentação por Via Oral - POFRAS e, para avaliação do desempenho em seio materno, o Protocolo de Acompanhamento Fonoaudiológico - Aleitamento Materno. A amostra foi estratificada em dois grupos, sendo o grupo experimental composto por recém-nascidos de mães diagnosticadas com DMG e o grupo-controle, por recém-nascidos de mães hígidas. Para a análise estatística, foram utilizados os testes Mann-Whitney, Shapiro Wilk e t de Student. Resultados a amostra total foi composta por 46 recém-nascidos, sendo 21 do grupo experimental e 25 do grupo-controle. Observou-se p<0,05 na comparação entre os grupos nas seguintes variáveis: oscilação do estado de consciência, hipotonia global, reflexo de procura débil, menos de cinco sucções por pausa na avaliação da sucção não nutritiva, pega em seio, adormecimento após iniciar sucção e posicionamento mãe-bebê. Conclusão recém-nascidos de mães diagnosticadas com DMG apresentaram maior dificuldade na prontidão para via oral e na prática do aleitamento materno nas primeiras 72 horas de vida, comparados aos filhos de mães hígidas.

ABSTRACT Purpose to verify the readiness for oral feeding and breastfeeding in newborns of mothers diagnosed with gestational diabetes mellitus (GDM). Methods observational, analytical, quantitative case-control study. For the evaluation of non-nutritive sucking, the PROFAS protocol was used and for the evaluation of performance at the mother's breast, the protocol of Speech Therapy - Breastfeeding. The sample was stratified into two groups, the experimental group, composed of newborns of mothers diagnosed with GDM, and the control group, with newborns of healthy mothers. For statistical analysis, the Mann-Whitney, Shapiro Wilk and Student's t tests were used. Results the total sample consisted of 46 newborns, 21 from the experimental group and 25 from the control group. P<0.05 was observed in the comparison between the groups in the variables: oscillation in the state of consciousness, global hypotonia, weak search reflex, less than five suctions per pause in the assessment of non-nutritive sucking, holding on to the breast, falling asleep after starting suction and mother-infant positioning. Conclusion newborns of mothers diagnosed with GDM had greater difficulty in readiness for oral feeding and in the practice of breastfeeding in the first 72 hours of life, compared to children of healthy mothers.

The effect of fruit consumption time on glucose regulation in pregnancy with gestational diabetes / O efeito do tempo de consumo de fruta na regulação da glicose na gravidez com diabetes gestacional

ABSTRACT Objective This study aims to determine the effect of fruit consumption time on blood glucose regulation in pregnant women with gestational diabetes. Methods The study was carried out with 64 volunteer participants diagnosed with gestational diabetes. Participants who were directed to the Department of Nutrition and Dietetics were divided into two groups according to the order of application; Group 1 was included in the nutrition treatment program for a week, consuming fruit for the main meal and Group 2 for the snack. During this process, the participants were applied a personalized nutrition plan that was adjusted equally for macronutrients of all meals containing isocaloric 3 main and 4 snacks. In this process, blood glucose values were measured six times a day by the participants and the blood glucose results of both groups before starting the nutrition therapy and on the seventh day after starting the medical nutrition therapy were compared. Results The mean age of the women participating in the study was 33.50±4.95 years and 32.28±5.18 years for the 1st and 2nd groups, respectively, and the groups were similar in terms of anthropometric measurements. The post-diet average of postprandial blood glucose levels in the morning within each group dropped from 180mg/d to 115mg/dL (p<0,001) for Group 1 and from 185mg/dL to 110mg/dL (p<0,001) for Group 2. There was a decrease in the fasting plasma glucose and postprandial blood glucose levels measured in the morning, noon and evening before and after the medical nutrition therapy of the groups, but no statistically significant difference was found between the groups (p>0.05). All participants on the gestational diabetes diet had normal blood sugar levels without the need for insulin. A statistically significant decrease was observed in the postprandial blood glucose-fasting plasma glucose difference levels of the pregnant women in the group that consumed fruit for snacks (Group 2) on the seventh day of the study (p<0,001). There was no significant difference in the pre-diet and post-diet morning fasting plasma glucose values of both groups (p>0,05). Conclusion This study found that medical nutrition therapy in pregnant women with gestational diabetes led to a decrease in blood glucose levels, but consuming fruits as a snack or at the main meal did not make a significant difference on fasting plasma glucose and postprandial blood glucose. It was concluded that the type and amount of carbohydrates consumed daily in gestational diabetes are determinative on blood glucose level.

RESUMO Objetivo O objetivo deste estudo é determinar o efeito do tempo de consumo de fruta na regulação da glucose no sangue em mulheres grávidas com diabetes gestacional. Métodos Este estudo foi realizado com 64 participantes voluntários diagnosticados com diabetes gestacional. Os participantes que foram encaminhados para o Departamento de Nutrição e Dietética foram divididos em dois grupos, de acordo com a ordem da sua aplicação. O grupo 1 foi incluído no programa de tratamento médico nutricional durante uma semana, consumindo fruta para a refeição principal e o grupo 2 para os lanches. Neste processo, foi aplicado aos participantes um plano de nutrição personalizado, com isocalórico, 3 refeições principais e 4 lanches, os macronutrientes de todas as refeições foram ajustados igualmente. Neste processo, os valores de glicemia foram medidos seis vezes por dia pelos participantes, e foram comparados os resultados da glicemia de ambos os grupos antes de se iniciar a terapia nutricional médica e no sétimo dia após o início da terapia nutricional médica. Resultados A idade média das mulheres que participaram no estudo foi de 33,50±4,95 e 32,28±5,18 anos para o 1º e 2º grupos, respetivamente, e não houve diferença entre os grupos em termos de medidas antropométricas. A glicemia média pós-prandial de manhã após terapia nutricional médica dentro dos grupos variou entre 180mg/d a 115mg/dL (p<0,001) para o Grupo 1, e de 185mg/dL a 110mg/dL para o Grupo 2 (p<0,001). Houve uma diminuição nos níveis de glicemia em jejum e glicemia média pós-prandial medidos de manhã, meio-dia e noite antes e depois da terapia nutricional médica dos grupos, mas não houve diferença estatisticamente significativa entre os grupos (p>0,05). Os níveis de açúcar no sangue de todos os participantes na dieta diabetes gestacional baixaram para níveis normais sem necessidade de terapia com insulina. Uma diminuição estatisticamente significativa foi observada no sétimo dia do estudo nos níveis de diferença do glicemia média pós-prandial-glicemia em jejum das mulheres grávidas do grupo que consumiram fruta como aperitivo (Grupo 2). (p<0.001). Não houve diferença significativa nos valores de glicemia em jejum matinal de ambos os grupos antes e depois da dieta (p>0,05). Conclusão Como resultado deste estudo, verificou-se que a terapia nutricional levou a uma diminuição do açúcar no sangue em mulheres grávidas com diabetes gestacional, mas o consumo de fruta como lanche ou refeição principal não fez uma diferença significativa no jejum e na glucose do sangue pós-prandial. Concluiu-se que o tipo e a quantidade de hidratos de carbono consumidos diariamente na diabetes gestacional são determinantes para o nível de glicose no sangue.