Effects of the COVID-19 pandemic on gestational diabetes in Castilla-La Mancha (Spain).

SUBJECT-MATTER: To assess the effect of the 2019 coronavirus (COVID-19) pandemic on gestational diabetes (GDM). MATERIAL AND METHODS: In this retrospective, multicentre, non-interventional study carried out in Castilla-La Mancha, Spain, we compared 663 women with GDM exposed to the pandemic (pandemic group), with 622 women with GDM seen one year earlier (pre-pandemic group). The primary endpoint was a Large for Gestational Age (LGA) newborn as an indicator of poor GDM control. Secondary endpoints included obstetric and neonatal complications. RESULTS: During the pandemic, the gestational week at diagnosis (24.2 ±â€¯7.4 vs 22.9 ±â€¯7.7, p = 0.0016) and first visit to Endocrinology (26.6 ±â€¯7.2 vs 25.3 ±â€¯7.6, p = 0.0014) were earlier. Face-to-face consultations were maintained in most cases (80.3%). The new diagnostic criteria for GDM were used in only 3% of cases. However, in the pandemic group, the final HbA1c was higher (5.2 ±â€¯0.48 vs 5.29 ±â€¯0.44%, p = 0.047) and there were more LGA newborns (8.5% vs 12.8%, p = 0.015). There were no differences in perinatal complications. CONCLUSIONS: Care for GDM in our Public Health System did not significantly deteriorate during the COVID-19 pandemic. However, this did not prevent a higher number of LGA newborns.

Diabetes mellitus e saúde materna durante a pandemia de covid-19 no Brasil / Diabetes mellitus and maternal health during the COVID-19 pandemic in Brazil / Diabetes mellitus y salud materna durante la pandemia de la COVID-19 en Brasil

A pandemia do novo coronavírus (covid-19) é um grave problema de saúde pública. Adicionalmente, a hiperglicemia na gestação (diabetes preexistente, diabetes diagnosticado pela primeira vez na gestação e diabetes mellitus gestacional) é uma das complicações maternas mais frequentes na população obstétrica. A sobreposição desses problemas pode refletir na saúde materna e fetal. Desse modo, o objetivo deste estudo é reunir evidências acerca da saúde materna de mulheres com hiperglicemia na gestação durante a pandemia de covid-19 no Brasil. Trata-se de uma revisão narrativa, em que a fonte de dados compreendeu artigos publicados até maio de 2023 nas bases de dados Medline, via PubMed, Lilacs e WHO COVID-19 Research Database. Foram listados 167 artigos e, após a aplicação dos critérios de elegibilidade, cinco estudos foram incluídos, compreendendo 1.469 gestantes e puérperas com diabetes mellitus gestacional ou diabetes preexistente. Quanto à saúde materna, os principais desfechos foram relacionados à infecção por covid-19, como gravidade da doença e risco de morte. Além disso, foi observada maior prevalência de transtornos mentais comuns, como ansiedade e depressão. Portanto, a saúde materna de mulheres com hiperglicemia na gestação foi impactada negativamente durante a pandemia de covid-19 no país.

The new coronavirus (COVID-19) pandemic is a major public health issue. Hyperglycemia during pregnancy (pre-existing diabetes, diabetes first diagnosed in pregnancy and gestational diabetes mellitus) is a frequent maternal complication in the obstetric population. Their overlap may impact maternal and fetal health. Thus, this narrative review gathered evidence on the maternal health of women with gestational hyperglycemia during the COVID-19 pandemic in Brazil. Articles published until May 2023 in the Medline (via PubMed), Lilacs and WHO COVID-19 Research Database online databases were eligible. Bibliographic search retrieved a total of 167 articles, of which five remained after applying the inclusion criteria, resulting in a sample of 1,469 pregnant and postpartum women with gestational diabetes or pre-existing diabetes. Regarding maternal health, the main outcomes were related to COVID-19 infection, such as disease severity and risk of death. Additionally, results showed a higher prevalence of common mental disorders such as anxiety and depression. In conclusion, the maternal health of women with gestational hyperglycemia was negatively impacted during the COVID-19 pandemic.

La pandemia del nuevo coronavirus (COVID-19) es un grave problema de salud pública. Además, la hiperglucemia durante el embarazo (diabetes preexistente, diabetes diagnosticada por primera vez durante el embarazo y diabetes mellitus gestacional) es una de las complicaciones maternas más frecuentes en la población obstétrica. La superposición de estos problemas puede afectar la salud materna y fetal. Por lo tanto, el objetivo de este estudio es recopilar evidencia sobre la salud materna de las mujeres con hiperglucemia en el embarazo durante la pandemia de la COVID-19 en Brasil. Se trata de una revisión narrativa, y la fuente de datos comprendió artículos publicados hasta mayo de 2023 en las bases de datos MEDLINE vía PubMed, LILACS y WHO COVID-19 Research Database. Se enumeró un total de 167 artículos y, después de aplicar los criterios de elegibilidad, se incluyeron cinco estudios con 1.469 mujeres embarazadas y puérperas con diabetes gestacional o diabetes preexistente. En cuanto a la salud materna, los principales resultados se relacionaron con el contagio por COVID-19, como la gravedad de la enfermedad y el riesgo de muerte. Además, se observó una mayor prevalencia de trastornos mentales comunes, como la ansiedad y la depresión. Por lo tanto, la salud materna de las mujeres con hiperglucemia durante el embarazo se ha visto afectada negativamente durante la pandemia de la COVID-19 en Brasil.

[Effect of weight gain on the development of gestational diabetes]. / Efecto de la ganancia ponderal en el desarrollo de diabetes gestacional.

Background: Gestational diabetes mellitus (GDM) refers to diabetes diagnosed in the second or third trimester of pregnancy. Assessing the weight gain in each pregnant women's appointment is a common task of primary care during their visit. However, the implications of this increase in weight for the development of GDM are unknown. Objective: Evaluate if the greater than expected weight gain (HEWG) in pregnancy is a risk factor for the development of GDM. Methods: Analytical, observational, longitudinal, retrolective study, which included pregnant women between 15 and 40 years of age with complete follow-up of the preg-nancy with > 2 prenatal check-ups, somatometry and complete medical history was made. During follow-up, the GPME was determined. Odds ratio (OR) and 95% confi-dence intervals (95% CI) were calculated. Variables with significance were entered into a multiple logistic regression model (MLR), where the dependent variable was DMG. The sample size calculation was for convenience. Results: 1000 pregnant women with a median age of 28 years were included. In the MLR The pre-gestational body mass index (BMI) with overweight had an RM of 1.3 (95% CI 0.86-1.98), BMI with obesity an OR of 2.57 (95% CI 1.6-4.14), the HEWG during pregnancy had an OR 1.14 95% CI (0.71-1.81), Age> 30 years shows an RM of 2.24 (95% CI 1.55-3.25). Conclusions: HEWG during pregnancy is not an independent risk factor for the devel-opment of GDM. The main ones are age> 30 years and pre-gestational obesity.

Introducción: la diabetes mellitus gestacional (DMG) se refiere a la diabetes diagnosti-cada a partir del segundo trimestre del embarazo. Evaluar el incremento de peso de mu-jeres embarazadas es una labor habitual en la consulta del primer nivel de atención. Sin embargo, se desconocen las implicaciones que tiene este incremento ponderal para el desarrollo de DMG. Objetivo: evaluar si la ganancia ponderal mayor a la esperada (GPME) en el embarazo es factor de riesgo para el desarrollo de DMG. Métodos: estudio analítico, observacional, longitudinal, retrolectivo, que incluyó a em-barazadas de 15 a 40 años con seguimiento completo del embarazo con más de dos consultas de control prenatal, somatometría e historia clínica completa. Durante el se-guimiento se determinó la GPME. Se calculó razón de momios (RM) e intervalos de confianza del 95% (IC95%). Las variables con significancia se ingresaron a un modelo de regresión logística múltiple (RLM), en donde la variable de desenlace fue DMG. Resultados: se incluyeron a 1000 embarazadas con mediana de edad de 28 años. En la RLM el índice de masa corporal (IMC) pre-gestacional con sobrepeso tuvo una RM de 1.3 (IC95%: 0.86-1.98), IMC con obesidad una RM de 2.57 (IC95%: 1.6-4.14), la GPME durante el embarazo tuvo una RM de 1.14 (IC95%: 0.71-1.81) y la edad > 30 años una RM de 2.24 (IC95%: 1.55-3.25). Conclusiones: la GPME durante el embarazo no es un factor de riesgo independiente para el desarrollo de DMG. Los principales son la edad >30 años y la obesidad preges-tacional.

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 asociados al requerimiento de insulina en pacientes con diabetes gestacional en un hospital de referencia en Buenos Aires, Argentina: estudio de cohorte retrospectiva / Risk factors associated with the need for insulin in patients with gestational diabetes in a reference hospital in Buenos Aires, Argentina: retrospective cohort study

Objetivos: Describir las características clínicas y sociodemográficas de las gestantes con diagnóstico de diabetes mellitus gestacional (DMG) y evaluar posibles factores asociados al control glucémico fuera de objetivo y requerimiento de insulina. Materiales y métodos: Cohorte retrospectiva descriptiva. Se incluyeron mujeres con DMG atendidas en un hospital de referencia entre enero de 2018 y septiembre de 2020; se excluyeron mujeres con parto realizado en otra Institución. Las variables medidas fueron edad, índice de masa corporal al inicio del embarazo, antecedentes familiares de diabetes, edad gestacional al diagnóstico, glucemia basal y glucemia post prueba de tolerancia oral a la glucosa, fructosamina, prueba de hemoglobina glicosilada (HbAlc), y uso de insulinoterapia. Se realizó un análisis descriptivo y exploratorio de los factores asociados al mal control glucémico por medio del análisis uni y multivariado. Resultados: El 44 % de las pacientes con DMG presentaron control glucémico fuera de objetivo con medidas higiénico-dietéticas. El análisis exploratorio mostró que podría haber un incremento en el riesgo del mal control glucémico asociado al valor inicial de la glucemia durante la PTOG (OR crudo: 3,57, IC 95 %: 2,1 - 6,1), el IMC > 25 kg/m2 (OR crudo: 1,97, IC 95 %: 1,15 - 3,34) y la mayor edad gestacional al momento del diagnóstico como factor protector del requerimiento de la insulinoterapia (OR crudo: 0,45, IC 95 %: 0,27 - 0,75). Sin embargo, estas asociaciones no se confirmaron en el análisis multivariado. Conclusiones: El valor de la glucemia basal mayor a 95 mg/dl, el IMC mayor a 25 kg/m2 podrían estar asociadas al mal control glucémico en las mujeres con DMG. Se necesitan estudios que evalúen estas variables con control de los factores de confusión para determinar los factores que indican el uso de insulina en mujeres gestantes.

Objectives: To describe the clinical and sociodemographic characteristics of pregnant women diagnosed with gestational diabetes mellitus (GDM) and to assess factors potentially associated with out-of-target glycemic control and the need for insulin. Material and methods: Retrospective descriptive cohort. Women with GDM delivered at a reference hospital between January 2018 and September 2020 were included; women delivered in a different institution were excluded. Measured variables were age, body mass index (BMI) at the start of pregnancy, family history of diabetes, gestational age at the time of diagnosis, blood glucose levels at baseline and following oral glucose tolerance test, fructosamine, Hemoglobin A1c (HBA1c), and insulin therapy use. A descriptive analysis was done. An exploratory analysis of factors associated with poor glycemic control was also conducted using uni and multivariate analyses. Results: Of the patients with GDM, 44 % were out of target for blood glucose with lifestyle and dietary measures. The exploratory analyses revealed a potential increase in the risk of poor glycemic control associated with initial blood glucose level on OGTT (crude OR: 3.57; 95 % CI:2.1-6.1), BMI > 25 kg/m2 (crude OR:1.97,95 % CI: 1.15 - 3.34), and more advanced gestational age at the time of diagnosis as a protective factor against the need for insulin therapy (crude OR: 0.45, 95 % CI: 0.27- 0.75). However, these associations were not confirmed in the multivariate analysis. Conclusions: A baseline blood glucose value greater than 95 mg/dl and BMI of more than 25 kg/m2 could be associated with poor glycemic control in women with GDM. Studies that assess these variables and control for confounding factors are needed in order to identify the factors associated with insulin requirement in pregnant women.

Prevalencia de diabetes gestacional en Colombia: una revisión sistemática y estudio comparativo

Introducción: Las mujeres embarazadas con diabetes mellitus gestacional DMG tienen un mayor riesgo de tener resultados adversos materno-infantiles, debido a lo cual es importante estimar la prevalencia de DMG en Colombia de acuerdo con los criterios de la Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo (IADPSG). Materiales y métodos: Se realizó una revisión sistemática mediante búsquedas en las bases de datos PubMed/Medline y Cochrane en inglés y español. La evaluación de la calidad se hizo mediante la metodología GRADE. Resultados: En la revisión sistemática se incluyó un total de 7 estudios con 37 795 participantes colombianas. La prevalencia de DMG en Colombia fue de 8,7 %. Conclusiones: Esta revisión sistemática se constituye en un primer estudio exploratorio en estimar la prevalencia de DMG en Colombia según criterios de la IADPSG. La estimación de la prevalencia global se sitúa cercana a la media mundial, sin embargo, estos resultados deben ser valorados con precaución por limitaciones en la opción de la guía para detección de diabetes gestacional y subregistro. WDF 15-955 Project, Barranquilla, Colombia.

Introduction: Pregnant women with GDM gestational diabetes mellitus have a higher risk of having adverse maternal-infant outcomes. Objective: To estimate the prevalence of GDM in Colombia according to the criteria of the International Association of Diabetes and Pregnancy Study Groups [IADPSG]. Materials and methods: A systematic review was carried out by searching the PubMed / Medline and Cochrane databases in English and Spanish. The quality assessment was done using the GRADE methodology. Results: A total of 7 articles with 37,795 Colombian participants were included in the systematic review. The prevalence of GDM in Colombia was 8.7 %. Conclusions: As far as we know, this systematic review is the first study to estimate the prevalence of GDM in women in Colombia according to criteria of the IADPSG. The results suggest a GDM prevalence in Colombia in the world average. Be careful with these results because there could be un-der-records.

Overexpression of circRNAs LRP6 in gestational diabetes mellitus predicts foetal malformation and intrauterine death.

INTRODUCTION: circRNA LRP6 participates in high-glucose-regulated cellular behaviours, while its role in gestational diabetes mellitus (GDM) is unclear. Our preliminary sequencing analysis revealed the altered expression of LRP6, suggesting its potential involvement in GDM and possible clinical value. This study explored the involvement of LRP6 in GDM. METHODS: In this study, a total of 300 pregnant women were enrolled and followed up until delivery. The occurrence of GDM and adverse outcomes was recorded. These 300 participants were grouped into high and low LRP6 level groups (n=150; cutoff=median). Occurrence of GDM and adverse outcomes were compared between the two groups. ROC curve analysis was conducted to explore the role of LRP6 expression on the day of admission in predicting GDM. Associations between LRP6 expression and adverse outcomes were analysed with the Chi-squared test. RESULTS: We observed that participants in the high LRP6 level group experienced a higher incidence of GDM during follow-up (33/150) compared to those in the low LRP6 level group (10/150). Compared to participants who developed GDM during follow-up, participants who did not develop GDM showed lower expression levels of LRP6 in plasma. ROC curve analysis showed that high expression levels of LRP6 on the day of admission effectively distinguished potential GDM patients from other participants. Interestingly, LRP6 was only closely associated with foetal malformation and intrauterine death, but not premature delivery, hypertension, macrosomia, intrauterine distress, miscarriage and intrauterine infection in all participants. CONCLUSION: Therefore, increased expression levels of LRP6 in GDM predicts foetal malformation and intrauterine death.

Intervenciones nutricionales para la reducción de diabetes mellitus gestacional: una revisión sistemática / Nutritional interventions for the reduction of gestational diabetes mellitus: a systematic review

Fundamentos: La diabetes mellitus gestacional (DMG) representa un problema de salud pública silenciosocuyo crecimiento paulatino en los últimos años ha motivado en las autoridades sanitarias el planteamiento dedistintas estrategias de prevención, cuyo efecto aún genera controversia. El objetivo de la presente revisiónes sistematizar la evidencia científica publicada en los últimos cuatro años, relacionada al efecto de lasintervenciones nutricionales para la reducción de la DMG.Métodos: El estudio consiste en una revisión sistemática, que incluyó exclusivamente ensayos clínicospublicados en la base de datos Pubmed dentro del periodo 2019 - 2022. Se usó como algoritmo de búsqueda“(pregnan* OR gestation*) AND intervention AND (diet* OR nutrition) AND diabetes”. Los artículos fueronagrupados en dos categorías según el tipo de intervención: las que realizaban asesorías nutricionales (60%;n=12) y las que administraban dietas o tratamientos (40%; n=8).Resultados: El mayor grado de asociación se encontró en el caso de la intervención con educaciónpersonalizada sobre dieta, actividad física y control de peso a través de mensajes en WeChat; mientras que,las recomendaciones de MedDiet alcanzaron el mayor número de estudios con efecto significativo.Conclusiones: Las intervenciones nutricionales del tipo asesoría dietética, especialmente sobre dietamediterránea, tienen un efecto más positivo en la reducción de la diabetes mellitus gestacional. (AU)

Background: Gestational diabetes mellitus (GDM) represents a silent public health problem whose gradualgrowth in recent years has led health authorities to propose different prevention strategies, the effect ofwhich is still controversial. The objective of this review is to systematize the scientific evidence published inthe last four years, related to the effect of nutritional interventions for the reduction of GDM.Methods: The study consists of a systematic review, which exclusively included clinical trials published in thePubmed database within the period 2019 - 2022. The search algorithm used was “(pregnan* OR gestation*)AND intervention AND (diet* OR nutrition) AND diabetes. The articles were grouped into two categoriesaccording to the type of intervention: those that provided nutritional counseling (60%; n=12) and those thatadministered diets or treatments (40%; n=8).Results: The highest degree of association was found in the case of the intervention with personalizededucation on diet, physical activity and weight control through messages on WeChat; while the MedDietrecommendations reached the largest number of studies with a significant effect.Conclusions: Nutritional interventions such as dietary advice, especially on the Mediterranean diet, have amore positive effect in reducing gestational diabetes mellitus. (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.

Efecto de la interrupción en la conducta sedentaria sobre el control glicémico en la diabetes gestacional

La actividad física produce efectos benéficos en la mujer embarazada; a pesar de ello, la mayoría presentan altos niveles de conducta sedentaria. El objetivo del estudio fue evidenciar el efecto del quiebre en la conducta sedentaria sobre el control metabólico en una paciente de 36 años con diabetes gestacional. La intervención consistió en reorganizar su rutina diaria y realizar un protocolo de quiebre en la conducta sedentaria. La paciente logró un control metabólico óptimo luego del comienzo de la intervención y hasta el final del embarazo. El protocolo de quiebre en la conducta sedentaria sumado a la reorganización en la rutina de la paciente resultó ser efectivo para lograr el control glicémico y evitar complicaciones propias asociadas a la diabetes gestacional.

Physical activity produces beneficial effects in pregnant women. In spite of this, most of them present high levels of sedentary behavior. The objective of the study was to demonstrate the effect of a break in sedentary behavior on metabolic control in a 36-year-old patient with gestational diabetes. The intervention consisted of reorganizing her daily routine and performing a sedentary behavior break protocol. The patient achieved optimal metabolic control after the beginning of the intervention and until the end of pregnancy. The sedentary behavior break protocol added to the reorganization of the patient's routine proved to be effective in achieving glycemic control and avoiding complications associated with gestational diabetes.

Evidências científicas relacionadas aos conhecimentos, atitudes e prática de gestantes sobre o controle glicêmico / Scientific evidence related to knowledge, attitudes and practice of pregnant women on glycemic control: an integrative review / Evidencia científica relacionada con los conocimientos, actitudes y prácticas de las mujeres embarazadas sobre el control glucémico

Objetivo: analisar a produção científica acerca do conhecimento, atitude e prática de gestantes sobre o controle glicêmico. Métodos: revisão integrativa da literatura, a partir de artigos publicados no período de 2016 a 2022, nas bases de dados CINAHL, Medline e Web of Science e nas ferramentas de busca PubMed, BVS e Google Scholar. Dos 686 artigos identificados, 19 foram selecionados para compor a presente revisão. Resultados: O conhecimento das gestantes sobre controle glicêmico se mostrou satisfatório quando associado às que já sabiam do diagnóstico da doença. Os Conteúdos mais abordados nos estudos foram manejo da glicemia, efeito materno-fetal, seguimento da dieta, fatores de risco, definição da doença e tratamento. A atitude e a prática foram insatisfatórias na maioria dos achados, com preocupações centradas na incapacidade de viver uma vida normal no futuro. As principais práticas no manejo da diabetes por gestantes estão relacionadas ao uso da insulina. Conclusão: investimentos em educação em saúde sobre diabetes mellitus gestacional são essenciais para favorecer o autocuidado desde o diagnóstico até o acompanhamento pós-parto, podendo contribuir a prevenção de complicações durante o período gestacional e parto.

Objective: to analyze the scientific production about the knowledge, attitude and practice of pregnant women about glycemic control. Method: integrative review of the literature, based on articles published from 2016 to 2022, in the CINAHL, Medline and Web of Science databases and in the search engines PubMed, VHL and Google Scholar. Of the 686 articles identified, 14 were selected to make up the present review. Results: The knowledge of pregnant women about glycemic control was satisfactory when associated with those who already knew about the diagnosis of the disease. The contents most addressed in the studies were glucose management, maternal- fetal effect, diet follow-up, risk factors, disease definition and treatment. Attitude and practice were unsatisfactory in most findings, with concerns centered on the inability to live a normal life in the future. The main practices in the management of diabetes by pregnant women are related to the use of insulin. Conclusion: investments in health education on gestational diabetes mellitus are essential to favor self-care from diagnosis to postpartum follow-up, and may contribute to the prevention of complications during pregnancy and delivery.

Objetivo: analizar la producción científica sobre el conocimiento, actitud y práctica de las gestantes sobre el control glucémico. Método: revisión integradora de la literatura, basada en artículos publicados de 2016 a 2022, en las bases de datos CINAHL, Medline y Web of Science y en los motores de búsqueda PubMed, VHL y Google Scholar. De los 686 artículos identificados, 19 fueron seleccionados para conformar la presente revisión. Resultados: El conocimiento de las gestantes sobre el control glucémico fue satisfactorio cuando se asoció con aquellas que ya conocían el diagnóstico de la enfermedad. Los contenidos más abordados en los estudios fueron el manejo de la glucosa, el efecto materno-fetal, el seguimiento de la dieta, los factores de riesgo, la definición de la enfermedad y el tratamiento. La actitud y la práctica fueron insatisfactorias en la mayoría de los hallazgos, con preocupaciones centradas en la incapacidad de vivir una vida normal en el futuro. Las principales prácticas en el manejo de la diabetes por parte de las mujeres embarazadas están relacionadas con el uso de insulina. Conclusión: las inversiones en educación para la salud sobre la diabetes mellitus gestacional son esenciales para favorecer el autocuidado desde el diagnóstico hasta el seguimiento posparto, y pueden contribuir a la prevención de complicaciones durante el embarazo y el parto.

(Des)conhecimentos de gestantes atendidas na atenção primária à saúde sobre diabetes mellitus gestacional / (De)knowledge of pregnant women cared for in primary health care about gestational diabetes mellitus / (De)conocimiento de los gestantes asistidos a la atención primaria de la salud sobre la diabetes gestacionales mellitus

Introdução: O Diabetes Mellitus Gestacional é uma das síndromes metabólicas mais comuns em gestantes e é caracterizada pela baixa tolerância à glicose, resultando em graves consequências materno-fetais. Objetivo: Traçar o perfil epidemiológico de gestantes atendidas na Atenção Primária à Saúde; elencar os fatores de risco sobre Diabetes Mellitus Gestacional entre gestantes atendidas na Atenção Primária à Saúde e analisar os conhecimentos de gestantes sobre Diabetes Mellitus Gestacional na Atenção Primária à Saúde. Metodologia: Estudo com abordagem quanti- qualitativa, descritiva e exploratória, realizado em uma Unidade de Saúde da Família na Bahia, com 15 gestantes maiores de 18 anos, em qualquer trimestre gestacional e que tivessem realizado ao menos uma consulta de pré-natal. A coleta dos dados foi feita através de um roteiro de entrevista semiestruturada e do acesso ao prontuário físico de cada participante. A análise dos dados do perfil foi feita por estatística descritiva simples e as questões abertas da entrevista pela técnica de conteúdo temática proposta por Bardin. Principais Resultados: Percebe-se que a maioria das gestantes era jovem, negra, possuía ensino médio, tinha mais de três filhos, encontrava-se no segundo trimestre gestacional e detinha baixa renda. Com relação aos fatores de risco, destacam-se o histórico familiar de diabetes mellitus, o sobrepeso/obesidade e o sedentarismo. Aponta-se ainda o desconhecimento total ou insuficiência nas informações sobre diabetes mellitus gestacional entre as participantes. Conclusão: O desconhecimento aliado aos fatores de risco evidenciados e à situação de vulnerabilidade social e econômica pode contribuir para o desenvolvimento do Diabetes Mellitus Gestacional na população estudada, sendo fundamental estratégias multidisciplinares para a sua prevenção e/ou controle.

Introduction: Gestational Diabetes Mellitus is one of the most common metabolic syndromes in pregnant women and is characterized by low glucose tolerance, resulting in severe maternal-fetal consequences. Objective: To trace the epidemiological profile of pregnant women attended in Primary Health Care; to list the risk factors about Gestational Diabetes Mellitus among pregnant women attended in Primary Health Care and to analyze the knowledge of pregnant women about Gestational Diabetes Mellitus in Primary Health Care. Methodology: A study with a quanti-qualitative, descriptive and exploratory approach, carried out in a Family Health Unit in Bahia, with 15 pregnant women over 18 years of age, in any gestational trimester and who had carried out at least one prenatal visit. The data collection was done through a semi-structured interview script and access to the physical records of each participant. The analysis of the profile data was done by simple descriptive statistics and the open questions of the interview by the thematic content technique proposed by Bardin. Main Results: It is noticed that most pregnant women were young, black, had high school, had more than three children, was in the second gestational trimester and had low income. With regard to risk factors, family history of diabetes mellitus, overweight/obesity and sedentary lifestyle are highlighted. It is also pointed out the total lack of knowledge or insufficiency in the information about gestational diabetes mellitus among the participants. Conclusion: The lack of knowledge coupled with the risk factors evidenced and the situation of social and economic vulnerability can contribute to the development of Gestational Diabetes Mellitus in the studied population, being fundamental multidisciplinary strategies for its prevention and/or control.

Introducción: La diabetes mellitus gestacional es uno de los síndromes metabólicos más comunes en mujeres embarazadas y se caracteriza por una baja tolerancia a la glucosa, lo que tiene graves consecuencias maternofetales. Objetivo: Seguir el perfil epidemiológico de las mujeres embarazadas a las que se presta atención primaria de la salud; enumerar los factores de riesgo de la diabetes mellitus gestacional entre las mujeres embarazadas a las que se presta atención primaria de la salud y analizar los conocimientos de las mujeres embarazadas sobre la diabetes mellitus gestacional en la atención primaria de la salud. Metodología: estudio con enfoque cuantitativo- cualitativo, descriptivo y exploratorio, realizado en una Unidad de Salud Familiar de Bahía, con 15 mujeres embarazadas mayores de 18 años, en cualquier trimestre gestacional y que hayan realizado al menos una consulta prenatal. Los datos se recopilaron mediante una hoja de ruta semiestructurada para las entrevistas y el acceso a los registros físicos de cada participante. El análisis de los datos del perfil se realizó por simple estadística descriptiva y las preguntas abiertas de la entrevista por la técnica de contenido temático propuesta por Bardin. Principales resultados: Se observó que la mayoría de las mujeres embarazadas eran jóvenes, negras, tenían educación secundaria, tenían más de tres hijos, estaban en el segundo trimestre gestacional y tenían bajos ingresos. En cuanto a los factores de riesgo, destacan la historia familiar de diabetes mellitus, sobrepeso/obesidad y estilo de vida sedentario. Además, la información sobre la diabetes mellitus gestacional es totalmente desconocida o insuficiente entre los participantes. Conclusión: El desconocimiento, junto con los factores de riesgo evidenciados y la situación de vulnerabilidad social y económica, puede contribuir al desarrollo de la Diabetes Mellitus Gestacional en la población estudiada, y las estrategias multidisciplinarias son fundamentales para su prevención y/o control.

Fisiopatología de la programación fetal y su repercusión en la salud futura / Pathophysiology of fetal programming and its impact on the future health

Resumen ANTECEDENTES: Durante la vida intrauterina, las alteraciones en el microambiente fetal causadas por desequilibrios nutricionales y metabólicos de la madre pueden dejar huellas epigenéticas y efectos persistentes en la vida adulta de su hijo que habrán de predisponerlo a enfermedades crónicas futuras. OBJETIVO: Llevar a cabo una revisión sistemática de la fisiopatología de la programación fetal y su repercusión en la salud futura del feto. METODOLOGÍA: Búsqueda en la base de datos de PubMed de artículos publicados, en los últimos 10 años, en inglés o español, con los MeSH "fetal programming"; "pathophysiology", con su correspondiente traducción. Se incluyeron artículos originales y de revisión con criterios PRISMA para revisiones sistemáticas. RESULTADOS: Se encontraron 38 artículos, y se agregaron 7 de información complementaria y sustento para la discusión. En su análisis queda clara la relación entre las condiciones fisiopatológicas reportadas de desnutrición, sub y sobrealimentación, diabetes mellitus gestacional, obesidad, resistencia a la insulina, glucocorticoides y preeclampsia con enfermedades de la infancia, adolescencia y adultez. Se encontró evidencia de disruptores endocrinos, melatonina y disbiosis con enfermedades de la infancia y vida adulta. Así mismo, la interrupción de la angiogénesis durante el desarrollo pulmonar que conduce a hipertensión arterial pulmonar y enfisema, todo ello originado por la programación fetal epigenética. Se encontraron diferencias en el patrón de metilación de placentas prematuras en comparación con las de término. CONCLUSIONES: Las anormalidades que sobrevienen durante el embarazo modifican la programación fetal y dan pie a las enfermedades que aparecerán durante la infancia, adolescencia y adultez, como consecuencia de los cambios en el patrón de metilación de los genes.

Abstract BACKGROUND: During intrauterine life, alterations in the fetal microenvironment caused by maternal nutritional and metabolic imbalances may leave epigenetic imprints and persistent effects on fetal adult life that will predispose the fetus to future chronic diseases. OBJECTIVE: To carry out a systematic review of the pathophysiology of fetal programming and its impact on the future health of the fetus. METHODOLOGY: Search in the PubMed database of articles published in the last 10 years, in English or Spanish, with the MeSH "fetal programming"; "pathophysiology", with their corresponding translation. Original and review articles with PRISMA criteria for systematic reviews were included. RESULTS: Thirty-eight articles were found, and seven were added for complementary information and support for discussion. In their analysis the relationship between the reported pathophysiological conditions of under-, under- and over-nutrition, gestational diabetes mellitus, obesity, insulin resistance, glucocorticoids and pre-eclampsia with diseases of childhood, adolescence and adulthood is clear. Evidence of endocrine disruptors, melatonin and dysbiosis was found with diseases of childhood and adulthood. Also, disruption of angiogenesis during lung development leads to pulmonary arterial hypertension and emphysema, all caused by epigenetic fetal programming. Differences were found in the methylation pattern of preterm placentas compared to term placentas. CONCLUSIONS: Abnormalities that occur during pregnancy modify fetal programming and give rise to the diseases that will appear during childhood, adolescence, and adulthood, because of changes in the methylation pattern of genes.

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.

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.

Prevalence of gestational diabetes and gestational hypertension in pregnant women with pregestational obesity / Prevalencia de diabetes e hipertensión gestacional en embarazadas con obesidad pregestacional

Resumen OBJETIVO: Describir la prevalencia de diabetes gestacional e hipertensión arterial en pacientes embarazadas con obesidad pregestacional. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y descriptivo llevado a cabo en mujeres embarazadas con diagnóstico previo de obesidad (índice de masa corporal superior a 29.99) y con control prenatal. Parámetros evaluados: estilo de vida (alimentación, actividad física, consumo de alcohol, tabaco o alguna toxicomanía) y características físicas, clínicas y bioquímicas durante el embarazo actual por trimestre (índice de masa corporal, glucosa, presión arterial sistólica y diastólica). El diagnóstico de diabetes gestacional se estableció mediante una prueba de tolerancia a la glucosa entre las semanas 24 y 28 de embarazo. La hipertensión gestacional se diagnosticó por cifras de presión arterial mayores e iguales a 140-90 mmHg a partir de la semana 20 de embarazo y en ausencia de proteinuria. El análisis estadístico incluyó porcentajes, promedios e intervalos de confianza. RESULTADOS: La prevalencia de diabetes gestacional en embarazadas con obesidad fue 13.7% (IC95%: 9.6 a 17.9) y la de hipertensión gestacional en embarazadas con obesidad 7.4% (IC95%: 4.3 a 10.6). CONCLUSIÓN: La obesidad es un factor conocido de riesgos, en particular de diabetes e hipertensión en el embarazo. Su alta prevalencia hace necesario implementar campañas de prevención que favorezcan su reducción.

Abstract OBJECTIVE: To describe the prevalence of gestational diabetes and arterial hypertension in pregnant patients with pre-pregnancy obesity. MATERIALS AND METHODS: Retrospective, cross-sectional and descriptive study in pregnant women with a diagnosis of obesity prior to pregnancy (body mass index greater than 29.99) and with prenatal care. The sample size was 269 pregnant women. Lifestyle (diet, physical activity, alcohol, tobacco or drug addiction) and physical, clinical and biochemical characteristics during the current pregnancy were evaluated by gestational trimester (body mass index, glucose, systolic and diastolic blood pressure). The diagnosis of gestational diabetes was established by a glucose tolerance test between the 24th and 28th week of gestation and gestational hypertension was diagnosed by blood pressure figures greater than or equal to 140/90 mmHg from the 20th week of gestation and in the absence of proteinuria. Statistical analysis included percentages, means, and confidence intervals. RESULTS: The prevalence of gestational diabetes in obese pregnant women was 13.7% (95%CI: 9.6-17.9) and the prevalence of gestational hypertension in obese pregnant women was 7.4% (95%CI: 4.3-10.6). CONCLUSION: Obesity is a known risk factor, particularly for diabetes and hypertension in pregnancy. Its high prevalence makes it necessary to implement prevention campaigns to reduce it.

Duplicidad intestinal y diagnóstico diferencial prenatal de lesiones quísticas intraabdominales / Intestinal duplication and prenatal differential diagnosis of intra-abdominal cysts

Resumen ANTECEDENTES: Las duplicaciones del aparato digestivo son una variante poco frecuente de malformación congénita. Si bien la mejora de los equipos de ecografía ha aumentado la tasa diagnóstica, solo el 30% se diagnostican antes del nacimiento. El diagnóstico diferencial de lesiones quísticas intraabdominales es amplio e incluye, por ejemplo, a los quistes de ovario, colédoco, mesenterio o pseudoquistes de meconio. El tratamiento es quirúrgico mediante la resección y restauración de la continuidad intestinal. CASO CLÍNICO: Paciente de 32 años, con un embarazo previo y en el segundo trimestre del actual, con sospecha de un quiste de duplicación intestinal. El estudio genético no evidenció anomalía alguna. La lesión, de morfología quística tubular, fue aumentando progresivamente de tamaño conforme avanzaban las semanas de embarazo. En la semana 39 se indicó, por diabetes gestacional insulinodependiente, la inducción del parto. Nació un varón, asintomático, mediante parto eutócico, sin complicaciones. La ecografía abdominal, resonancia magnética nuclear y estudio del tránsito intestinal del periodo neonatal temprano confirmó el diagnóstico prenatal de sospecha. Mediante una laparoscopia exploradora, a las dos semanas de vida se practicó la resección del defecto que se reportó como: duplicación intestinal ileal, sin comunicación con la luz intestinal. El curso posoperatorio fue favorable. CONCLUSIONES: El diagnóstico prenatal de quistes de duplicación en el aparato digestivo está en aumento debido a la mejoría en las técnicas de diagnóstico prenatal. La valoración multidisciplinaria es decisiva para procurar una adecuada vigilancia médica del embarazo y del recién nacido.

Abstract BACKGROUND: Duplications of the digestive tract are a rare variant of congenital malformation that can occur anywhere in the digestive tract. Although improved ultrasound equipment has increased the diagnostic rate, only 30% are diagnosed before birth. The differential diagnosis of intra-abdominal cystic lesions is broad and includes, for example, cysts of the ovary, common bile duct, mesentery or meconium pseudocysts. Treatment is surgical by resection and restoration of intestinal continuity. CLINICAL CASE: 32-year-old patient, with a previous pregnancy and in the second trimester of the current pregnancy, with suspicion of an intestinal duplication cyst. The genetic study did not reveal any abnormality. The lesion, of tubular cystic morphology, progressively increased in size as the weeks of pregnancy progressed. Induction of labour was indicated in week 39 due to insulin-dependent gestational diabetes. An asymptomatic male was born by euthecological delivery, without complications. Abdominal ultrasound, nuclear magnetic resonance imaging and intestinal transit study of the early neonatal period confirmed the suspected prenatal diagnosis. By means of exploratory laparoscopy, at two weeks of life, resection of the defect was performed, which was reported as: ileal intestinal duplication, without communication with the intestinal lumen. The postoperative course was favourable. CONCLUSIONS: Prenatal diagnosis of duplication cysts in the digestive tract is increasing due to improved prenatal diagnostic techniques. Multidisciplinary assessment is crucial to ensure adequate medical surveillance of the pregnancy and the newborn.

Gestational diabetes prevalence and outcomes in women undergoing assisted reproductive techniques (ART).

Infertility affects millions worldwide and use of assisted reproductive techniques (ART) is in high demand. AIMS: To investigate whether women that underwent ART at our hospital had a higher incidence of GDM than women who conceived spontaneously, if the ART subtype affects the GDM rate and to study obstetrical outcomes in women with GDM in both groups. METHODS: This was a retrospective analysis of prospectively collected data of singleton pregnancies attended at Hospital Universitari Dexeus between 2008 and 2019. Age<18 years, pregestational diabetes, metformin prior to pregnancy and multiple pregnancies were excluded. RESULTS: A total of 29,529 patients were included. Pregnancy was achieved by ART in 2596 (8.8%): in vitro fertilisation (IVF/ICSI) 32.8%, frozen embryo transfer (FET) 37.7%, oocyte donor receptors (ODR) 17.2% and insemination 12.2%. The GDM rate was 8.9% (12.7% in ART vs 8.5% in non-ART, p<0.001). The GDM was 11.2% in IVF/ICSI, 17.7% in ODR, 13% in FET and 9.1% in the insemination group (p=0.001). In a multivariable analysis adjusting for age, parity and BMI, ART was not associated with GDM [OR 1.03 (0.90-1.19)], nor was type of ART. Pregnancy outcomes in GDM patients were similar in both groups except for C-section rates (30.0% in ART vs 15.9% in non-ART (p<0.001). CONCLUSIONS: Despite a higher prevalence of GDM in ART pregnancies, ART was not associated with an increased risk of GDM when adjusting for age, parity and BMI. The prognosis of GDM in ART and non-ART was similar except for C-section rates.

Programa de actividades físicas terapéuticas para embarazadas con diabetes gestacional / Programa de atividade física terapêutica para mulheres grávidas com diabetes gestacional / Program of therapeutic physical activities for pregnant women with gestational diabetes

RESUMEN Introducción: El profesional de actividad física contribuye con aportes importantes en los programas, aplica la educación sanitaria y fortalece la preparación física y psicológica en la población. De ahí que la investigación estuvo centrada en mostrar los resultados de un programa de actividades físicas terapéuticas. Objetivo: El objetivo de este trabajo consistió en elaborar un programa de actividades físicas terapéuticas, caracterizado por un enfoque integral en educación para la salud que permita una mejor prescripción en la preparación biopsicosocial de las embarazadas con diabetes gestacional en el logro de un parto satisfactorio. Materiales y métodos: Para ello, se realizó un estudio de diseño preexperimental de control mínimo, con tres años de duración (2019-2021). La muestra seleccionada se realizó a partir de un muestreo intencional estratificado, no probabilístico. Se emplearon métodos de los niveles teórico y empírico, así como técnicas de investigación entre los que destacan análisis y síntesis, inductivo-deductivo, sistémico-estructural funcional, análisis documental, observación estructurada, entrevista y encuesta respectivamente. Resultados: El programa se realizó mediante implementación de ejercicios físicos terapéuticos. Participaron 16 embarazadas con diabetes gestacional, más del 56 % mostró altos niveles de ansiedad, depresión y estrés. El 88 % evidenció bajos niveles de condición física. El 100 % logró modificar de forma positiva el comportamiento hacia estilos de vida saludables con buen control metabólico. El 94 % alcanzó buena condición física y psicosocial, también disminuyeron la dosis de insulina. Conclusiones: El estudio mostró que se mejoró la prescripción en la preparación biopsicosocial orientada al logro de un parto satisfactorio en embarazadas con diabetes gestacional.

SÍNTESE Introdução: O profissional de atividade física contribui com importantes contribuições em programas, aplica educação sanitária e fortalece a preparação física e psicológica da população. Assim, a pesquisa foi focada em mostrar os resultados de um programa de atividades físicas terapêuticas. Objetivo: O objetivo deste trabalho foi elaborar um programa de atividades físicas terapêuticas, caracterizado por uma abordagem integral na educação sanitária que permite uma melhor prescrição na preparação biopsicossocial de gestantes com diabetes gestacional na realização de um parto satisfatório. Materiais e métodos: Para este fim, foi realizado um estudo de controle mínimo pré-experimental de três anos (2019-2021). A amostra selecionada foi baseada em amostragem estratificada, não probabilística e propositada. Foram utilizados métodos teóricos e empíricos e técnicas de pesquisa, incluindo análise e síntese, indutivo-dedutiva, sistêmico-estrutural-funcional, análise documental, observação estruturada, entrevista e pesquisa, respectivamente. Resultados: O programa foi realizado através da implementação de exercícios físicos terapêuticos. Dezesseis mulheres grávidas com diabetes gestacional participaram, mais de 56% mostraram altos níveis de ansiedade, depressão e estresse. Oitenta e oito por cento mostraram baixos níveis de aptidão física. 100% foram capazes de modificar positivamente o comportamento em direção a estilos de vida saudáveis com bom controle metabólico. 94 % conseguiram uma boa aptidão física e psicossocial, eles também diminuíram a dosagem de insulina. Conclusões: O estudo mostrou uma melhor prescrição na preparação biopsicossocial com o objetivo de obter um parto bem sucedido em mulheres grávidas com diabetes gestacional.

ABSTRACT Introduction: The physical activity professional helps with important contributions to the programs, applies health education and strengthens the physical and psychological preparation of the population. Hence, the research was focused on showing the results of a program of therapeutic physical activities. Objective: The objective of this work was to develop a program of therapeutic physical activities, characterized by a comprehensive approach in health education that allows a better prescription in the biopsychosocial preparation of pregnant women with gestational diabetes in achieving a satisfactory delivery. Materials and methods: For this, a study of pre-experimental of minimum control design was carried out, with a duration of three years (2019-2021). The selected sample was made from a stratified, non-probabilistic intentional sampling. Theoretical and empirical methods were used, as well as research techniques, among which analysis and synthesis, inductive-deductive, systemic-structural functional, documentary analysis, structured observation, interview and survey stand out. Results: The program was carried out through the implementation of therapeutic physical exercises. Sixteen pregnant women with gestational diabetes participated, more than 56% showed high levels of anxiety, depression and stress. The 88% showed low levels of physical fitness. The 100% managed to positively modify behavior towards healthy lifestyles with good metabolic control. The 94% achieved good physical and psychosocial condition, they also decreased the dose of insulin. Conclusions: The study showed that the prescription in the biopsychosocial preparation aimed at achieving a satisfactory delivery in pregnant women with gestational diabetes was improved.

Assessment of Pelvic Floor Disorders due to the Gestational Diabetes Mellitus Using Three-Dimensional Ultrasonography: A Narrative Review / Avaliação das desordens do assoalho pélvico decorrentes do diabetes gestacional usando a ultrassonografia tridimensional: Uma revisão narrativa

Abstract Gestational diabetes mellitus (GDM)is an entity with evolving conceptual nuances that deserve full consideration. Gestational diabetes leads to complications and adverse effects on the mother's and infants' health during and after pregnancy. Women also have a higher prevalence of urinary incontinence (UI) related to the hyperglycemic status during pregnancy. However, the exact pathophysiological mechanism is still uncertain. We conducted a narrative review discussing the impact of GDM on the women's pelvic floor and performed image assessment using three-dimensional ultrasonography to evaluate and predict future UI.

Resumo O diabetes gestacional (DG)é uma entidade com nuances conceituais em evolução que merecem total consideração. O DG leva a complicações e efeitos adversos na saúde da mãe e do bebê durante e após a gravidez. As mulheres também apresentam maior prevalência de incontinência urinária (IU) relacionada ao estado hiperglicêmico durante a gravidez. No entanto, o mecanismo fisiopatológico exato ainda é incerto. Realizamos uma revisão narrativa discutindo o impacto do DG no assoalho pélvico das mulheres e utilizamos o exame de ultrassonografia tridimensional para avaliar e predizer a ocorrência de IU.