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.

Diagnóstico prenatal de miocardiopatía hipertrófica septal en hijos de madres diabéticas a través de estudio ecocardiógráfico fetal y su relación con los valores de hemoglobina glicosilada materna / Prenatal diagnosis of septal hypertrophic cardiomyopathy in children of diabetic mothers through a fetal echocardiographic study and its relation to the values of maternal glycosylated hemoglobin

Introducción: Los niveles elevados de glicemia materna generan un incremento en el metabolismo ycrecimiento de las estructuras cardiacas fetales. Por lo que un adecuado control metabólico de la madre sepuede relacionar con el crecimineto del ventrículo izquierdo. Objetivos: Evaluar la frecuencia demiocardiopatia hipertrófica en fetos de madres con diabetes durante el embarazo, a través deecocardiograma fetal. Correlacionar la presencia de miocardiopatia hipertrófica con el grado de controlmetabólico materno. Determinar si existe relación entre los niveles de hemoglobina glucosilada materna y/olos niveles de glucosa preprandial con la presencia de hipetrofia septal. Resultados: 44% de pacientes condiabetes mostraron hipertrofia septal, siendo estos casos con niveles de hemoglobina glicosilada elevados.Miocardiopatía hipertrófica septal se encontró en 89% de pacientes con diabetes gestacional, 5% enpacientes con diabetes mellitus tipo II, 5% en pacientes con intolerancia a los carbohidratos y no seobservaron casos en los pacientes con diabetes tipo I; No se encontró cambios en la frecuencia cardiacafetal, ni arritmias en los fetos hijos de madre diabética similar a lo observado en los controles. Conclusión:Hemoglobina glicosilada de 6% - 8% se correlacionaron con mayor riesgo de miocardiopatía hipertróficaseptal. Ecocardiograma fetal es adecuado para diagnóstico prenatal.

Background: Elevated levels of maternal glucose generate an increase, in the metabolism and growth of fetalcardiac structures. An adequate metabolic control of the mother may be related to growth of the left ventricle.Objectives: Evaluate the frequency of hypertrophic cardiomyopathy in fetuses of mothers with diabetesduring pregnancy, through fetal echocardiography. Correlate the presence of hypertrophic cardiomyopathywith the degree of maternal metabolic control. To determine the correlation between maternal glycatedhemoglobin levels and / or preprandial glucose levels with the presence of septal hypertrophy. Results: 44%of patients with diabetes show septal hypertrophy, and these cases at high levels of glycated hemoglobin.Septal hypertrophic cardiomyopathy was found in 89% of patients with gestational diabetes, 5% in patientswith diabetes mellitus type II, 5% in patients with carbohydrate intolerance and no cases were observed inpatients with type I diabetes; No changes were found in the fetal heart rate or fetal arrhythmias in children ofdiabetic mother similar to that observed in controls. Conclusion: Glycated hemoglobin between 6% - 8%,was correlated with increased risk of septal hypertrophic cardiomyopathy. Fetal echocardiogram is suitable forprenatal diagnosis.

Lesser than diabetes hyperglycemia in pregnancy is related to perinatal mortality: a cohort study in Brazil.

BACKGROUND: Gestational diabetes related morbidity increases along the continuum of the glycemic spectrum. Perinatal mortality, as a complication of gestational diabetes, has been little investigated. In early studies, an association was found, but in more recent ones it has not been confirmed. The Brazilian Study of Gestational Diabetes, a cohort of untreated pregnant women enrolled in the early 1990's, offers a unique opportunity to investigate this question. Thus, our objective is to evaluate whether perinatal mortality increases in a continuum across the maternal glycemic spectrum. METHODS: We prospectively enrolled and followed 4401 pregnant women attending general prenatal care clinics in six Brazilian state capitals, without history of diabetes outside of pregnancy, through to birth, and their offspring through the early neonatal period. Women answered a structured questionnaire and underwent a standardized 2-hour 75-g oral glucose tolerance test (OGTT). Obstetric care was maintained according to local protocols. We obtained antenatal, delivery and neonatal data from hospital records. Odds ratios (OR) were estimated using logistic regression. RESULTS: We ascertained 97 perinatal deaths (67 fetal and 31 early neonatal). Odds of dying increased according to glucose levels, statistically significantly so only for women delivering at gestational age ≥34 weeks (p < 0.05 for glycemia-gestational age interaction). ORs for a 1 standard deviation difference in glucose, when analyzed continuously, were for fasting 1.47 (95% CI 1.12, 1.92); 1-h 1.55 (95% CI 1.15, 2.07); and 2-h 1.53 (95% CI 1.15, 2.02). The adjusted OR for IADPSG criteria gestational diabetes was 2.21 (95% CI 1.15, 4.27); and for WHO criteria gestational diabetes, 3.10 (95% CI 1.39, 6.88). CONCLUSIONS: In settings of limited detection and treatment of gestational diabetes mellitus, women across a spectrum of lesser than diabetes hyperglycemia, experienced a continuous rise in perinatal death with increasing levels of glycemia after 34 weeks of pregnancy. Current GDM diagnostic criteria identified this increased risk of mortality.

Morbilidad y mortalidad neonatal asociada a la diabetes gestacional / Neonatal morbidity and mortality asociated with gestational diabetes

Objetivo: Determinar la asociación de la morbilidad y mortalidad neonatal con la diabetes gestacional. Método: Estudio tipo cohortes. Se realizó un estudio en embarazadas desde diciembre de 2007 a noviembre de 2008 en el servicio de tococirugía del Hospital General Regional No. 1 de Querétaro, México, se formaron dos grupos de 71 pacientes, uno con diabetes gestacional y otro sin ella. El muestreo fue por cuota pareado por edad. En ambos grupos se midieron variables sociodemográficas, antecedentes obstétricos, vía de interrupción del embarazo, morbilidad y mortalidad neonatal. Los resultados se analizaron con Chi cuadrado y riesgo relativo con un poder alfa de 0,05. Resultados: La tasa de morbilidad en el grupo expuesto fue de 60 por ciento. Las variables que tuvieron significancia estadística fueron: la obesidad pregestacional (RR: 2,7), cesßrea (RR: 3,3), complicaciones metabólicas (RR: 10), morbilidad respiratoria (RR: 6,7), macrosomía (RR: 4,1), hipoglucemia (RR: 14,2) y taquipnea transitoria del recién nacido (RR: 7,7). La edad materna, sobrepeso gestacional, nivel socioeconómico, escolaridad, antecedentes de macrosómicos, de cesáreas y de malformaciones congénitas; malformaciones congénitas, bajo peso neonatal, prematurez, enfermedad de membrana hialina, hiperbilirru-binemia, hipocalcemia, mortalidad neonatal y la asfixia no tuvieron asociación significativa. La complicación metabólica más frecuente fue: hipoglucemia (17,2 por ciento). No hubo muertes perinatales. Conclusiones: El grupo expuesto estudiado mostró mayor morbilidad asociada a la diabetes gestacional que el grupo no expuesto, es necesario el diagnóstico temprano en mujeres con factores de riesgo para esta entidad y establecer un programa de tratamiento con vigilancia estrecha.

Objectives: To determine the association of neonatal morbidity and mortality with gestational diabetes. Methods: Study cohort. A study of pregnant women from December 2007 to November 2008 in the service of ginecology and obstetrics HGR No. 1 Querétaro, were divided into two groups of 71 patients, one gestational diabetic and one without it. The quota sampling was matched by age. In both groups were measured sociodemographic, obstetric history, via interruption of birth, neonatal morbidity and mortality. The results were analyzed with Chi square and relative risk with a power alpha of 0.05. Results: The morbidity rate in the exposed group was 60 percent. Variables that were statistically significant were: pregestational obesity (RR: 2.7), cesarean (RR 3.3), metabolic complications (RR 10), respiratory illness (RR: 6.7), macrosomia (RR: 4.1), hypoglycemia (RR: 14.2) and transient tachypnea of the newborn (RR: 7.7). Maternal age, gestational overweight, socioeconomic status, education, history of macrosomic, and cesarean birth defects, congenital malformations, low birth weight, prematurity, hyaline membrane disease, hyperbilirubinemia, hypocalcemia, and neonatal asphyxia had no significant association. The most common metabolic complication was hypoglycemia (17.2 percent). There were no perinatal deaths. Conclusions: The exposed group showed higher morbidity associated with gestational diabetes that the unexposed group, early screening is necessary in women with risk factors for this disease and establish a treatment program with close monitoring.

Normas para diabetes y embarazo, diabetes gestacional y recién nacido hijo de madre diabética / Standards for diabetes and pregnancy, gestational diabetes and newborn IDM

La diabetes mellitus ha sido declarada, para los países en vías de desarrollo, la epidemia del siglo xxi. Cada día la población de niños y niñas, hombres y mujeres no sólo modifican sus hábitos alimenticios, sino que además son poblaciones más sedentarias que no desarrollan ningún tipo de actividad física complementaria y esto contribuye a desmejorar su salud, siendo la diabetes mellitus una de las principales enfermedades emergentes secundaria a esta situación....

Diabetes gestacional en embarazadas adolescentes / Gestational diabetes in pregnant adolescents

Se realizó un estudio observacional analítico de tipo caso control con el objetivo de identificar la frecuencia de la diabetes gestacional y su relación con algunas variables maternas y neonatales en el embarazo en la adolescencia. El grupo de estudio estuvo constituido por 16 adolescentes diabéticas gestacionales y el grupo control, por 48 adolescentes no diabéticas, que fueron atendidas en el período 2003-2006 en el Hospital Ginecoobstétrico "América Arias" con el objetivo de analizar el comportamiento de la entidad en un grupo de adolescentes que parió en dicho período de tiempo. Se encontró una baja frecuencia de diabetes gestacional...