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3.
Medicine (Baltimore) ; 99(40): e22152, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019392

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) produces numerous problems for maternal and fetal outcomes. However, the precise molecular mechanisms of GDM are not clear. METHODS: In our study, we randomly assigned 22 pregnant women with fasting glucose concentrations, 1 hour oral glucose tolerance test (1H-OGTT) and 2 hour oral glucose tolerance test (2H-OGTT), different than 28 normal pregnant women from a sample of 107 pregnant women at the First Affiliated Hospital of Jinan University in China. Lipopolysaccharide (LPS), interleukin 1 alpha (IL-1α), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor alpha (TNF-α) were measured from blood plasma of pregnant women and umbilical arteries using ultraviolet spectrophotometry. Hematoxylin & Eosin (H&E), Periodic acid-Schiff (PAS) or Masson staining were performed to examine whether diabetes mellitus altered the morphology of placenta. Quantitative PCR (Q-PCR), western blotting and immunofluorescent staining were performed to examine whether diabetes mellitus and autophagy altered the gene expressions of the placental tissue. RESULTS: We found that women with GDM exhibited increased placental weight and risk of neonatal infection. The concentrations of IL-6 protein and IL-8 protein in GDM were increased in both maternal and umbilical arterial blood. H&E, Masson and PAS staining results showed an increased number of placental villi and glycogen deposition in patients with GDM, but no placental sclerosis was found. Q-PCR results suggested that the expression levels of HIF-1α and the toll like receptor 4 (TLR4)/ myeloid differential protein-88 (MyD88)/ nuclear factor kappa-B (NF-κB) pathway were increased in the GDM placenta. Through Western Blotting, we found that the expression of NF-kappa-B inhibitor alpha (IKBα) and Nuclear factor-κB p65 (NF-κB p65) in GDM placenta was significantly enhanced. We also showed that the key autophagy-related genes, autophagy-related 7 (ATG7) and microtubule-associated protein 1A/1B-light chain 3 (LC3), were increased in GDM compared with normal pregnant women. CONCLUSIONS: Our results suggest that women with GDM exhibit an increased risk of neonatal infection via inflammation and autophagy in the placenta.


Assuntos
Diabetes Gestacional/sangue , Placenta/patologia , Adulto , Diabetes Gestacional/genética , Feminino , Sangue Fetal , Teste de Tolerância a Glucose , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/sangue , Recém-Nascido , Inflamação/sangue , Inflamação/genética , Placenta/microbiologia , Gravidez , Resultado da Gravidez , Receptor 4 Toll-Like/sangue
4.
Diabetes Metab Syndr ; 14(5): 1535-1539, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32947751

RESUMO

BACKGROUND AND AIM: The outbreak of the emerging coronavirus disease 2019 (COVID-19) is a global public health emergency. According to the findings, women with gestational diabetes mellitus (GDM) are at increased risk of this virus. Due to the need for quarantine and social distancing in the current disease situation and need to receive repeated medical care in GDM patients, this review study aimed to evaluate the self-care strategies for women with GDM during COVID-19 pandemic. METHODS: 25 related articles from 2011 to 2020 and 3 guidelines were reviewed with the keywords of gestational diabetes mellitus, diabetes, pregnancy and COVID-19 in combination with self-care and self-management in PubMed, Google Scholar, Scopus, Science Direct, Elsevier, Springer, Wiley Online Library and SID. RESULTS: According to the results of the studies, face-to-face visits should be limited and instead, telemedicine services recommended. Self-care throughout telemedicine services were improved maternal and neonatal outcomes in women with GDM. CONCLUSION: Although self-care program through telemedicine services is beneficial for women with GDM, performing clinical trials are recommended to assess maternal and neonatal outcomes in this condition.


Assuntos
Diabetes Gestacional , Autocuidado , Infecções por Coronavirus , Feminino , Humanos , Pandemias , Pneumonia Viral , Gravidez , Telemedicina
5.
Isr Med Assoc J ; 9(22): 503-509, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32954697

RESUMO

BACKGROUND: The incidence of gestational diabetes mellitus (GDM) is increasing in parallel to the worldwide obesity and type 2 diabetes pandemic. Both GDM and pre-gestational diabetes mellitus (PGDM) are associated with short- and long-term consequences in the offspring. There are few recent studies addressing outcomes of newborns born to women diagnosed with GDM and PGDM in Israel. OBJECTIVES: To assess perinatal complications in offspring of women with GDM and PGDM. METHODS: The authors conducted a single-center retrospective case-control study of outcomes of all newborns whose mothers had been diagnosed with diabetes in pregnancy compared to randomly assigned controls born on the same date, whose mothers had no diabetes. RESULTS: In the study period 2015-2017, 526 mothers diagnosed with GDM or PGDM and their newborn infants were identified. The authors randomly assigned 526 control infants. The rate of women with diabetes in pregnancy was 5.0%. Mothers with GDM and PGDM had higher rates of pre-eclampsia, multiple pregnancies, and preterm deliveries. Mothers with PGDM had significantly higher rates of intrauterine fetal demise (4.3%), congenital anomalies (12.8%), and small-for-gestational-age neonates (10.6%) compared to controls (0%, 3.2%, and 4.2%, respectively, P < 0.001). The risks for preterm or cesarean delivery, large-for-gestational-age neonate, respiratory morbidity, hypoglycemia, and polycythemia were increased in offspring of mothers with diabetes, especially PGDM. CONCLUSIONS: Despite all the advancements in prenatal care, diabetes in pregnancy, both PGDM and GDM, is still associated with significant morbidities and complications in offspring. Better preconception and inter-pregnancy care might reduce these risks.


Assuntos
Diabetes Gestacional/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Gravidez em Diabéticas/epidemiologia , Adulto , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Israel , Masculino , Gravidez , Cuidado Pré-Natal/métodos , Estudos Retrospectivos
7.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(8): 1303-1307, 2020 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-32867440

RESUMO

Objective: To examine the relationship between pre-pregnancy BMI, gestational diabetes (GDM) and different indicators of childhood obesity at the age of 4. Methods: Based on Ma'anshan Birth Cohort Study, singleton children who were born in Ma'anshan of Anhui province from October 2013 to April 2015, were followed for 4 years, consecutively. During the first questionnaire survey, data including pre-pregnancy weight, height and socio-demography were collected. During 24-28 week of gestation, 75 g oral glucose tolerance test was conducted for them. Childhood height, weight, waist circumference and body composition were measured at the age of 4. Comparisons between groups were performed using chi-square test, analysis of variance or t-test. The relationship between pre-pregnancy overweight/obesity, GDM and childhood obesity-related characteristics were analyzed by logistic regression model and generalized linear model analysis. Results: The prevalence rates of overweight and obesity in children at the age of 4 were 13.08% and 6.03%, respectively. After adjustment for characteristics related to mothers and their children, significantly increased risk of obesity (OR=3.27, 95%CI: 2.15-4.98), larger waist circumference (OR=2.32, 95%CI: 1.72-3.14) and higher waist-to-weight ratio (OR=2.29, 95%CI: 1.73-3.02) were seen in the offspring of women with pre-pregnancy overweight/obesity. Body composition (skeletal muscle, body fat, body fat percentage) of the offspring were strongly correlated with pre-pregnancy overweight/obesity of the mothers (P<0.05). Maternal GDM was associated with higher risk of childhood obesity (OR=1.78, 95%CI: 1.14-2.79), on mothers without GDM during pregnancy. However, neither larger waist circumference, or higher waist-to-weight ratio seemed to increase the risk. Moreover, maternal GDM was not associated with body composition measures (skeletal muscle, body fat, body fat percentage). Conclusion: Pre-pregnancy BMI and maternal GDM were independent risk factors for obesity in 4-year-old children, and pre-pregnancy BMI was correlated with various indicators of body composition in children.


Assuntos
Índice de Massa Corporal , Diabetes Gestacional/epidemiologia , Obesidade Pediátrica/epidemiologia , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Gravidez , Estudos Prospectivos , Fatores de Risco
8.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(8): 1352-1358, 2020 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-32867449

RESUMO

Objective: To explore the effects of dietary glycemic load (GL) during first trimester on the risk of gestational diabetes mellitus (GDM). Methods: A prospective study was conducted among healthy women with singleton pregnancy at 8-14 weeks of gestation in a maternity out-patient clinic of maternal-and-child health care institution in Chengdu, Sichuan province. Information on dietary intake during the first trimester was collected through a 3-day 24-hour dietary recall. Glycemic index (GI) values were obtained from China Food Composition Tables (Standard Edition) and International Tables of Glycemic Index and Glycemic Load Values (2008). Dietary GL and GLs of staple foods were calculated based on GI values and the amount of carbohydrate consumed per day. Diagnostic criteria of GDM was followed the Guidelines for Diagnosis and Treatment of Pregnancy Diabetes in China (2014), and used on participants who underwent an oral glucose tolerant test during 24-28 weeks of gestation. Log-binomial regression models were used to explore the associations between both quartiles of dietary GL, GLs of staple foods and the risks of GDM,respectively. Results: The medians of dietary GL and GL of staple foods were 145.70 (113.23-180.85) and 121.05 (89.08-155.70), respectively. The median GL of both rice and tubers were 73.14 (43.89-107.50) and 3.43 (0.00-9.84), respectively. After adjusting for the age at pregnancy, pre-pregnancy body mass index and other confounding factors, results of log-binomial regressions analysis showed that when compared with the lowest quartile of dietary GL group, the third and highest quartiles of dietary GL groups increased the risk of GDM (RR=1.47, 95%CI: 1.20-1.80; RR=1.31, 95%CI: 1.04-1.64), respectively. Compared with the lowest quartile of GL of staple foods, the third and highest quartiles of GL of staple foods groups also increased the risk of GDM (RR=1.28, 95%CI: 1.04-1.58; RR=1.27, 95%CI: 1.02-1.60), respectively. The third and highest quartiles of GL of rice groups increased the risk of GDM (RR=1.30, 95%CI: 1.06-1.59; RR=1.28, 95%CI: 1.03-1.59), respectively, than the lowest quartile of GL of rice group. When compared with the lowest quartile of GL of tubers group, the highest quartile of GL of tubers group increased the risk of GDM (RR=1.30, 95%CI: 1.09-1.54). However, we did not notice the effects of wheat GL and coarse grain GL on the risk of GDM. Conclusions: A positive association was found between dietary glycemic load and the risk of GDM. Higher dietary glycemic load, especially in rice and tubers during first trimester, seemed to have increased the risk of GDM.


Assuntos
Diabetes Gestacional/epidemiologia , Carboidratos da Dieta/efeitos adversos , Carga Glicêmica , Fenômenos Fisiológicos da Nutrição Materna , Primeiro Trimestre da Gravidez , China/epidemiologia , Feminino , Humanos , Gravidez , Estudos Prospectivos , Medição de Risco
9.
J UOEH ; 42(3): 275-279, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32879192

RESUMO

The Japan Environment Health and Children's Study (JECS) is an ongoing cohort study designed to evaluate the impact of various environmental factors on children's health. In this study, more than 100,000 pregnant women were recruited in 15 regional centers throughout Japan. Within the University of Occupational and Environmental Health, the departments of Pediatrics, Obstetrics and Gynecology, Environmental Health, and the School of Health Sciences collaborate with the JECS University of Occupational and Environmental Health Subunit Center in advancing research in this study. Several original articles based on JECS and written by our unit members were published in recent years. The aim of this review is to summarize these studies by JECS and University of Occupational and Environmental Health Subunit Center based on the data from JECS. We introduce research articles covering the following categories; environmental health, occupational health, and maternal and child health. Studies found associations between concentrations of metals and maternal health, such as premature birth, placenta previa and placenta accrete, associations between metals and IgE, dietary differences among occupational groups, associations between work-related factors and dietary behaviors, associations between job changes and pregnancy/delivery, mental and physical stress among pregnant women and influence on work, associations between sleep and gestational diabetes, and associations between an ability to push up in the prone position and infant development. This review may promote the development of new research, such as collaborative research projects, including clinical and social medicine, epidemiological studies and laboratory investigations.


Assuntos
Saúde da Criança , Saúde Ambiental , Saúde do Trabalhador , Universidades , Estudos de Coortes , Diabetes Gestacional , Comportamento Alimentar , Feminino , Humanos , Imunoglobulina E , Japão , Metais/metabolismo , Placenta Acreta , Placenta Prévia , Gravidez , Nascimento Prematuro , Trabalho
10.
Medicine (Baltimore) ; 99(35): e21654, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871878

RESUMO

The aim of this study is to investigate the levels of 25(OH)D, inflammation markers and glucose and fat metabolism indexes in pregnant women with Gestational diabetes mellitus (GDM).One hundred and ten cases GDM and 100 cases healthy pregnant women in the First People's Hospital of Lianyungang City from October 2016 to December 2018 were recruited for this observational cross-sectional study. Each participant's anthropometric and demographic data was recorded. Blood samples were collected and analyzed to determine the levels of 25(OH)D, high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), fasting blood glucose, fasting blood insulin, hemoglobin A1c (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), cholesterol and triglycerides.Inflammatory markers and glucose and fat metabolism indexes were all significantly higher in the GDM group than that in the control group, while Serum 25(OH)D level in the GDM group was significantly lower. Serum 25(OH)D levels were negatively correlated with hs-CRP, while not with TNF-α. Furthermore, Serum 25(OH)D, hs-CRP and TNF-α levels were all associated with increased risk of developing GDM.Nowadays, the reports on the association between 25(OH)D level and GDM were controversial. Our results are consistent with the view that there was association between 25(OH)D level and GDM, and expand the literature by showing the roles of 25(OH)D, inflammation markers as well as glucose and fat metabolism indexes in the risk of developing GDM in the pregnant women with the low overall levels of 25(OH)D before delivery. This broadens our knowledge on the pathophysiology of GDM, which may be helpful in prevention and treatment of GDM.


Assuntos
Glicemia/metabolismo , Diabetes Gestacional/sangue , Vitamina D/análogos & derivados , Adulto , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , China , Colesterol/sangue , Estudos Transversais , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Insulina/sangue , Resistência à Insulina , Gravidez , Triglicerídeos/sangue , Fator de Necrose Tumoral alfa/sangue , Vitamina D/sangue
12.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(9): 968-973, 2020 Sep 06.
Artigo em Chinês | MEDLINE | ID: mdl-32907287

RESUMO

Objective: To estimate the effect of comorbid gestational diabetes mellitus (GDM) and depression on glucose metabolism and neonatal morphology. Methods: From March 2015 to October 2018, recruited 18 to 28 weeks pregnant women who met the criteria in the Hefei First People's Hospital or First Affiliated Hospital of Anhui Medical University or Anhui Maternal and Child Health Hospital, including a total of 4 380 study subjects, of which the birth outcome information of 3 827 newborns were collected. The self-made questionnaire "Maternal Health Questionnaire for Hefei City" and Edinburgh Postpartum Depression Scale were used to obtain basic demographic characteristics and emotional state of depression. Data from the 75-g oral-glucose-tolerance test were obtained at 24-28 weeks of gestation. After delivery, delivery outcome information were collected from the hospital medical records. Covariance analysis was used to analyze the differences in glucose metabolism indicators and neonatal outcome indicators in pregnant women with different GDM and depression status. Multiple logistic regression model was used to analyze the correlation between GDM and depression, with different groups of GDM and depression status (no GDM and depression, simple depression, simple GDM, comorbid GDM and depression)as independent variables and whether they were large for gestational age as dependent variables. The interaction between GDM and depression was also analyzed. Results: The 4 380 pregnant women were (28.8±4.2) years old. The incidence of GDM was 19.5% (852/4 380), and the detection rates of depression in the second and third trimesters were 12.1% (526/4 380) and 12.3% (536/4 367). PG-1h and AUC in the comorbid GDM and depression group were significantly higher than those in the group with no GDM and depression (P<0.05) and the single GDM group (P<0.05). After adjusting for factors such as the childbirth age, education level, family's main economic income, BMI before pregnancy, parity, number of physical activities, and weight gain during pregnancy, compared with the group with no GDM and depression, the RR(95%CI) of LGA occurred in the single depression group, the single GDM group and the comorbid group were 1.31(0.89-1.91), 1.51(1.14-2.00) and 2.43(1.29-4.57), respectively. Further analysis showed that the association between GDM pregnant women with depression and newborn LGA ï¼»RR (95%CI): 2.12 (1.01-4.49)ï¼½ was stronger than that between GDM pregnant women without depression and newborn LGA ï¼»RR (95%CI): 1.50 (1.12-1.99)ï¼½, the P interaction value was<0.05. Conclusion: The status of comorbid GDM and depression can impair glucose metabolism and increase the risk of LGA.


Assuntos
Diabetes Gestacional/epidemiologia , Adulto , Criança , Depressão/epidemiologia , Feminino , Glucose , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Ganho de Peso , Adulto Jovem
17.
Rev. Soc. Argent. Diabetes ; 54(2): 52-66, mayo-ago. 2020. tab, graf
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1119327

RESUMO

Introducción: se ha observado un incremento en el diagnóstico de diabetes gestacional (DG) en mujeres embarazadas a nivel mundial durante los últimos años, siendo la prevalencia estimada de 14% a nivel global y de 10,36% en Argentina según el criterio diagnóstico de la Asociación Latinoamericana de Diabetes (ALAD). El plan de alimentación adecuado y el cambio en el estilo de vida asociados al automonitoreo de la glucemia capilar (AMGC) constituyen pilares fundamentales para alcanzar el objetivo glucémico en dos tercios de los casos de DG. A pesar de su importancia y de su recomendación en la práctica clínica, existe información científica limitada respecto de cuál es la prescripción alimentaria óptima para mejorar los resultados tanto en la madre como en el niño. Objetivos: analizar el componente nutricional en el tratamiento de la mujer embarazada con diabetes y conocer cuáles podrían ser las recomendaciones para lograr los objetivos mencionados a través del análisis de la evidencia científica actual. La información proveniente de estudios randomizados y controlados es heterogénea, pero de dichos estudios surge que la intervención temprana con dieta, ejercicio y consejos sobre cambios de estilo de vida durante el primer trimestre o al inicio del segundo puede disminuir el riesgo de DG. El tratamiento médico nutricional en DG se basa en el control de la cantidad y la distribución de los hidratos de carbono para obtener el control glucémico óptimo sin hipoglucemias ni cetosis. El otro componente esencial es la ingesta calórica para la adecuada ganancia de peso. Conclusiones: dada la creciente prevalencia de exceso de peso en la población general y en especial en las mujeres en edad fértil, deberían realizarse estudios donde ponderar la intervención con cambios del estilo de vida (dieta y actividad física) en este particular sector poblacional. Deberían elaborarse guías basadas en la evidencia donde se evalúe el impacto de los componentes de la dieta e ingesta calórica total como factores para mejorar los resultados materno-feto-neonatales


Introduction: in recent years, there has been a worldwide increase in the diagnosis of gestational diabetes (GD) in pregnant women, with the estimated prevalence of GD being 14% globally and 10,36% in Argentina according to the Latin American Diabetes Association (LADA) diagnostic criteria. An adequate dietary plan in association with a healthy lifestyle change and glucose self-monitoring, are the cornerstones to achieve the glycemic goal in two thirds of GD cases. Despite its importance and being broadly advised in clinical practice, there is limited scientific information regarding the optimal dietary prescription to improve results for both mother and child. Objectives: to analyze the nutritional aspects of the treatment of GD and to investigate what the recommendations would be to achieve the aforesaid outcomes, through the analysis of current scientific evidence. Although there is heterogenous evidence from randomized controlled trials, it comes out from these studies that early intervention with diet, exercise and advice on healthy lifestyle during the first trimester or early in the second trimester, may decrease the risk of GD. Nutritional treatment in GD is based on the control of the quantity and distribution of carbohydrates to attain optimal glycemic control without hypoglycemia or ketosis. Caloric intake is as well important for proper weight gain. Conclusions: given the increasing prevalence of excess weight in the general population and especially in women of childbearing age, clinical trials should be carried out to study the results of interventions with lifestyle changes (diet and physical activity) in this special population. Evidence-based guidelines should be developed evaluating the impact of diet components and total caloric intake as factors to improve maternal-fetus-neonatal outcomes.


Assuntos
Humanos , Feminino , Gravidez , Diabetes Gestacional , Terapêutica , Glicemia , Gestantes , Dieta , Glucose
18.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(7): 1097-1102, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32741178

RESUMO

Objective: The aim of this study is to investigate the relationship between fat mass and obesity associated (FTO) gene polymorphism and the risk of gestational diabetes mellitus (GDM), and provide clues and basis for the study of GDM mechanism. Methods: The case group of GDM pregnant women who delivered at the First Affiliated Hospital of Shanxi Medical University from March 1, 2012 to July 30, 2014 were selected, and matched the control group among non-GDM pregnant women by age, gestational age and residential address, and 324 cases and 318 controls were finally included. DNA was extracted and genotyped, and min P test and unconditional logistic regression model were used to estimate the relationship between FTO gene polymorphism and GDM. Results: At gene level, we did not find the association between FTO and the risk of GDM (P>0.05). After adjusted for family history of diabetes, pre-pregnancy body mass index and multiple comparisons using false discovery rate method, unconditional logistic regression analysis showed that pregnant women who carried the rs11075995 TT genotype (OR=0.59, 95%CI: 0.35-0.89), rs3826169 GG genotype (OR=0.59, 95%CI: 0.35-0.88), and rs74245270 GA genotype (OR=0.69, 95%CI: 0.49-0.98), GA or AA genotype(OR=0.70, 95%CI: 0.50-0.97) had reduced risk of GDM. However, pregnant women who carried the rs74018601 GA genotype (OR=1.51, 95%CI: 1.07-2.12), GA or AA genotype (OR=1.46, 95%CI: 1.06-2.02), rs7205009 AA genotype (OR=1.83, 95%CI: 1.18-2.86), GA or AA genotype (OR=1.53, 95%CI: 1.08-2.19), and rs9888758 AG genotype (OR=1.43, 95%CI: 1.02-2.00) had elevated risk of GDM. Conclusion: The polymorphisms of FTO gene rs11075995,rs3826169, rs74245270, rs74018601, rs7205009 and rs9888758 were associated with the risk of GDM.


Assuntos
Tecido Adiposo , Diabetes Gestacional/epidemiologia , Obesidade/genética , Polimorfismo Genético , Estudos de Casos e Controles , China/epidemiologia , Feminino , Genótipo , Humanos , Gravidez , Fatores de Risco
19.
Rev Med Suisse ; 16(703): 1498-1501, 2020 Aug 26.
Artigo em Francês | MEDLINE | ID: mdl-32852171

RESUMO

Gestational diabetes mellitus is a frequent complication of pregnancy. Its diagnosis and management tend now to a better uniformization than in the past years, even if some guidelines still remain debated. Nevertheless, useful actions in GDM's management, as well as the follow-up regarding the long-term metabolic risk for women who underwent this dysglycaemia in a limited time are now quite well described in the literature. In this review, we aim to discuss recent data related to this very particular metabolic disease.


Assuntos
Diabetes Gestacional , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/terapia , Feminino , Humanos , Gravidez , Risco
20.
Diabetes Res Clin Pract ; 167: 108353, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32739381

RESUMO

AIMS: We assessed how altered diagnostic processes and criteria for gestational diabetes mellitus (GDM) recommended by the United Kingdom (UK), Canada and Australia for use during the COVID-19 pandemic would affect both GDM frequency and related adverse outcomes. METHODS: Secondary analysis of 5974 HAPO study women with singleton pregnancies who underwent 75 g OGTTs and HbA1c assays between 24 and 32 weeks' gestation and who received no treatment for GDM. RESULTS: All post COVID-19 modified pathways reduced GDM frequency - UK (81%), Canada (82%) and Australia (25%). Canadian women whose GDM would remain undetected post COVID-19 (missed GDMs) displayed similar rates of pregnancy complications to those with post COVID-19 GDM. Using UK modifications, the missed GDM group were at slightly lower risk whilst the women missed using the Australian modifications were at substantially lower risk. CONCLUSIONS: The modifications in GDM diagnosis proposed for the UK, Canada and Australia result in differing reductions of GDM frequency. Each has both potential benefits in terms of reduction in potential exposure to COVID-19 and costs in terms of missed opportunities to influence pregnancy and postpartum outcomes. These factors should be considered when deciding which protocol is most appropriate for a particular context.


Assuntos
Glicemia/metabolismo , Infecções por Coronavirus/prevenção & controle , Diabetes Gestacional/diagnóstico , Teste de Tolerância a Glucose/métodos , Diagnóstico Ausente/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Adulto , Austrália , Betacoronavirus , Canadá , Diabetes Gestacional/metabolismo , Jejum , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Guias de Prática Clínica como Assunto , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Reino Unido
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