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1.
Acta Obstet Gynecol Scand ; 99(3): 341-349, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31654401

RESUMO

INTRODUCTION: Women with diabetes, and their infants, have an increased risk of adverse events due to excess fetal growth. Earlier delivery, when fetuses are smaller, may reduce these risks. This study aimed to evaluate the week-specific risks of maternal and neonatal morbidity/mortality to assist with obstetrical decision making. MATERIAL AND METHODS: In this population-based cohort study, women with type 1 diabetes (n = 5889), type 2 diabetes (n = 9422) and gestational diabetes (n = 138 917) and a comparison group without diabetes (n = 2 553 243) who delivered a singleton infant at ≥36 completed weeks of gestation between 2004 and 2014 were identified from the Canadian Institute of Health Information Discharge Abstract Database. Multivariate logistic regression was used to determine the week-specific rates of severe maternal and neonatal morbidity/mortality among women delivered iatrogenically vs those undergoing expectant management. RESULTS: For all women, the absolute risk of severe maternal morbidity/mortality was low, typically impacting less than 1% of women, and there was no significant difference in gestational age-specific severe maternal morbidity/mortality between iatrogenic delivery and expectant management among women with any form of diabetes. Among women with gestational diabetes, iatrogenic delivery was associated with an increased risk of neonatal morbidity/mortality compared with expectant management at 36 and 37 weeks' gestation (76.7 and 27.8 excess cases per 1000 deliveries, respectively) and a lower risk of neonatal morbidity/mortality at 38, 39 and 40 weeks' gestation (7.9, 27.3 and 15.9 fewer cases per 1000 deliveries, respectively). Increased risks of severe neonatal morbidity following iatrogenic delivery compared with expectant management were also observed for women with type 1 diabetes at 36 (98.3 excess cases per 1000 deliveries) and 37 weeks' gestation (44.5 excess cases per 1000 deliveries) and for women with type 2 diabetes at 36 weeks' gestation (77.9 excess cases per 1000 deliveries) weeks. CONCLUSIONS: The clinical decision regarding timing of delivery is complex and contingent on maternal-fetal wellbeing, including adequate glycemic control. This study suggests that delivery at 38, 39 or 40 weeks' gestation may optimize neonatal outcomes among women with diabetes.


Assuntos
Parto Obstétrico , Diabetes Gestacional/mortalidade , Gravidez em Diabéticas/mortalidade , Adulto , Canadá , Estudos de Coortes , Bases de Dados Factuais , Tomada de Decisões , Diabetes Mellitus Tipo 1/mortalidade , Diabetes Mellitus Tipo 2/mortalidade , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Masculino , Mortalidade Materna , Gravidez , Fatores de Risco
2.
Acta Obstet Gynecol Scand ; 99(3): 333-340, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31654523

RESUMO

INTRODUCTION: Gestational diabetes is on the rise and demographics are changing in many countries due to increased migration. Simultaneously, the treatment of gestational diabetes in our clinic has shifted towards metformin with substantially less insulin treatment. The aim was to study the impact of these changes on metabolic control and pregnancy outcome by comparing women diagnosed with gestational diabetes during 2012-2013 and 2016-2017. MATERIAL AND METHODS: Our universal Oral Glucose Tolerance Test screening program for gestational diabetes diagnosed 199 women with singleton pregnancies during 2012-2013 and 203 during 2016-2017. Treatment and achieved metabolic control in the two different time periods were compared. Pregnancy outcome data related to gestational diabetes were retrieved from case notes and compared between the different time periods. RESULTS: When comparing results from 2016-2017 with 2012-2013 there was no difference in maternal weight or weight gain. There was a higher frequency of heredity (52.6 vs 35.4%; P = 0.001) and non-Scandinavian ethnicity (46.5 vs 33.8%; P = 0.011).The frequency of smoking during pregnancy was significantly lower (2.6 vs 7.7%; P = 0.023) There was an improved metabolic control as measured by median glucose in 2016-2017 compared with 2012-2013 (5.8 vs 6.2 mmol/L; P < 0.001). Insulin was less frequently used in 2016-2017 than in 2012-2013 (32.5 vs 44.7%; P = 0.012). There was a significant increase in the use of metformin (14.8 vs 0%; P < 0.001). There were no differences regarding the frequency of large-for-gestational-age infants (8.2% vs 7.3%; P = 0.762) or macrosomia (16.3 vs 15.1%; P = 0.745), median birthweight (3510 vs 3521; P = 0.879), frequency of cesarean section (28.1 vs 27.8%; P = 0.951) or Apgar scores at 10 minutes (10 [3-10] vs 10 [7-10]; P = 0.290). CONCLUSIONS: In an increasing but changing population of gestational diabetes women in our region, with more hereditary and non-Scandinavian origins, but with fewer smokers, metabolic control has improved with maintained favorable pregnancy outcomes, with more frequent use of metformin and substantially less use of insulin treatment.


Assuntos
Diabetes Gestacional/epidemiologia , Cuidado Pré-Natal , Adulto , Demografia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/mortalidade , Diabetes Gestacional/prevenção & controle , Feminino , Humanos , Hipoglicemiantes/administração & dosagem , Recém-Nascido , Estudos Longitudinais , Gravidez , Resultado da Gravidez , Suécia/epidemiologia
3.
J Cardiovasc Med (Hagerstown) ; 20(9): 575-583, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31246698

RESUMO

: Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in women.Some authors highlighted that the female risk profile consists of traditional and emerging risk factors. Despite the lower prevalence of type 2 diabetes, years of life lost owing to the disease for women are substantially higher compared with men. In addition, pregnancy complicated by gestational diabetes represents a risk factor for CVD. Women with gestational diabetes have a higher prevalence of coronary artery disease that occur at a younger age and are independent of T2DM.Hypertension is an important cardiovascular risk factor in women. Estrogens and progesterone, known to have an impact on blood pressure levels, have also been proposed to be protective against sleep-disordered breathing. It is very difficult to understand whereas obstructive sleep apnea in women is independently associated with hypertension or if many confounders acting at different stages of the woman lifespan mediate this relation.The cardioprotective effect of physical activity in women of all ages is well known. Women are generally more physically inactive than men. During and after menopause, most women tend to reduce their physical activity levels and together with the reduction in basal metabolic rate, women experience loss of skeletal muscle mass with a negative change in the ratio of fat-to-lean mass.In conclusion, sex differences in the cardiovascular system are because of dissimilarities in gene expression and sex hormones; these result in variations in prevalence and presentation of CVD and associated conditions, such as diabetes, hypertension and vascular and cardiac remodeling.Changes in lifestyle and increase in physical activity could help in prevention of cardiovascular disease in women.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Sistema Cardiovascular/fisiopatologia , Exercício Físico , Disparidades nos Níveis de Saúde , Estilo de Vida Saudável , Hipertensão/terapia , Comportamento de Redução do Risco , Saúde da Mulher , Adulto , Fatores Etários , Idoso , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/mortalidade , Diabetes Gestacional/fisiopatologia , Diabetes Gestacional/terapia , Feminino , Humanos , Hipertensão/mortalidade , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Gravidez , Prevalência , Prognóstico , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores Sexuais
4.
J Perinat Neonatal Nurs ; 33(2): 136-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31021939

RESUMO

The postpartum period represents a critical window to initiate targeted interventions to improve cardiometabolic health following pregnancies complicated by gestational diabetes mellitus and/or a hypertensive disorder of pregnancy. The purpose of this systematic review was to examine studies published since 2011 that report rates of postpartum follow-up and risk screening for women who had gestational diabetes and/or a hypertensive disorder of pregnancy and to identify disparities in care. Nine observational studies in which postpartum follow-up visits and/or screening rates were measured among US women following pregnancies complicated by gestational diabetes and/or a hypertensive disorder of pregnancy were reviewed. Rates of postpartum follow-up ranged from 5.7% to 95.4% with disparities linked to black race and Hispanic ethnicity, low level of education, and coexisting morbidities such as mental health disorders. Follow-up rates were increased if the provider was an obstetrician/endocrinologist versus primary care. Payer source was not associated with follow-up rates. The screening rate for diabetes in women who had gestational diabetes did not exceed 58% by 4 months across the studies analyzed, suggesting little improvement in the last 10 years. While women who had a hypertensive disorder appear to have had a postpartum blood pressure measured, it is unclear whether follow-up intervention occurred. Overall, postpartum screening rates for at-risk women remain suboptimal and vary substantially. Further research is warranted including reliable population-level data to inform equitable progress to meeting the evidence-informed guidelines.


Assuntos
Diabetes Gestacional/diagnóstico , Disparidades em Assistência à Saúde/economia , Hipertensão Induzida pela Gravidez/diagnóstico , Programas de Rastreamento/normas , Morte Materna/prevenção & controle , Cuidado Pós-Natal/métodos , Diabetes Gestacional/mortalidade , Diabetes Gestacional/terapia , Feminino , Seguimentos , Disparidades em Assistência à Saúde/etnologia , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão Induzida pela Gravidez/terapia , Programas de Rastreamento/tendências , Período Pós-Parto , Gravidez , Resultado da Gravidez , Gravidez de Alto Risco , Medição de Risco
6.
Matern Child Health J ; 19(10): 2303-13, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26045058

RESUMO

OBJECTIVES: Women with gestational diabetes mellitus (GDM) may be able to reduce their risk of recurrent GDM and progression to type 2 diabetes mellitus through lifestyle change; however, there is limited population-based information on GDM recurrence rates. METHODS: We used data from a population of women delivering two sequential live singleton infants in Massachusetts (1998-2007) to estimate the prevalence of chronic diabetes mellitus (CDM) and GDM in parity one pregnancies and recurrence of GDM and progression from GDM to CDM in parity two pregnancies. We examined four diabetes classification approaches; birth certificate (BC) data alone, hospital discharge (HD) data alone, both sources hierarchically combined with a diagnosis of CDM from either source taking priority over a diagnosis of GDM, and both sources combined including only pregnancies with full agreement in diagnosis. Descriptive statistics were used to describe population characteristics, prevalence of CDM and GDM, and recurrence of diabetes in successive pregnancies. Diabetes classification agreement was assessed using the Kappa statistic. Associated maternal characteristics were examined through adjusted model-based t tests and Chi square tests. RESULTS: A total of 134,670 women with two sequential deliveries of parities one and two were identified. While there was only slight agreement on GDM classification across HD and BC records, estimates of GDM recurrence were fairly consistent; nearly half of women with GDM in their parity one pregnancy developed GDM in their subsequent pregnancy. While estimates of progression from GDM to CDM across sequential pregnancies were more variable, all approaches yielded estimates of ≤5 %. The development of either GDM or CDM following a parity one pregnancy with no diagnosis of diabetes was <3 % across approaches. Women with recurrent GDM were disproportionately older and foreign born. CONCLUSION: Recurrent GDM is a serious life course public health issue; the inter-pregnancy interval provides an important window for diabetes prevention.


Assuntos
Diabetes Mellitus Tipo 2/mortalidade , Diabetes Gestacional/mortalidade , Adolescente , Adulto , Índice de Massa Corporal , Estudos de Coortes , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Paridade , Gravidez , Prevalência , Recidiva
7.
Rev. guatem. cardiol. (Impresa) ; 24(1): 12-14, ene.-jun. 2014.
Artigo em Espanhol | LILACS | ID: biblio-869904

RESUMO

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


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


Assuntos
Humanos , Cardiomiopatia Hipertrófica/sangue , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/mortalidade , Hemoglobina A Glicada/análise
8.
Duodecim ; 129(3): 228-34, 2013.
Artigo em Finlandês | MEDLINE | ID: mdl-23457773

RESUMO

Perinatal mortality has not decreased in type 1 diabetic pregnancies during the last 30 years. Fetal deaths are five times and neonatal deaths three times higher compared with the general population. Chronic intrauterine hypoxia caused by maternal diabetes is the most likely cause of stillbirths during the last weeks of pregnancy. Both fetal hyperglycemia and hyperinsulinemia can independently cause fetal chronic hypoxia by increasing fetal oxygen consumption. Fetal chronic hypoxia can be detected antenatally by measuring amniotic fluid erythropoietin concentration. Prepregnancy visits for advice and glycemic control should be increased among diabetic women. Furthermore, pregnancy surveillance should be enhanced and therapeutic strategies changed in order to improve perinatal outcome among diabetic pregnancies.


Assuntos
Diabetes Gestacional , Hipóxia Fetal/etiologia , Hipóxia Fetal/mortalidade , Gravidez em Diabéticas , Líquido Amniótico/química , Diabetes Gestacional/mortalidade , Eritropoetina/análise , Feminino , Morte Fetal/etiologia , Humanos , Mortalidade Infantil , Recém-Nascido , Gravidez , Gravidez em Diabéticas/mortalidade , Fatores de Risco
9.
BMC Pregnancy Childbirth ; 11: 92, 2011 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-22078268

RESUMO

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


Assuntos
Diabetes Gestacional/mortalidade , Adulto , Peso ao Nascer , Glicemia , Brasil/epidemiologia , Estudos de Coortes , Diabetes Gestacional/sangue , Feminino , Idade Gestacional , Teste de Tolerância a Glucose , Humanos , Hiperglicemia/sangue , Hiperglicemia/mortalidade , Recém-Nascido , Gravidez , Cuidado Pré-Natal , Estudos Prospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários
10.
Ann N Y Acad Sci ; 1205: 94-8, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20840259

RESUMO

Perinatal mortality rate (PMR) is one of the most important perinatal health indicators. PMR in diabetic pregnancies varies throughout the world and is higher than the background PMR. The prevalence of pregestational diabetes is increasing and is associated with an elevated risk of congenital malformations, macrosomia, preeclampsia, and preterm delivery. The incidence of PMR in preexisting diabetes mellitus ranges considerably, with congenital abnormalities and preterm labor the main factors contributing to the higher PMR. Women with gestational diabetes mellitus or impaired glucose tolerance are a mixed group that may have low to a high PMR, especially if they require insulin in their pregnancy. All the known diabetic women should plan their pregnancies and optimize glycemic control periconceptually and throughout pregnancy, as this reduces the frequency of congenital abnormalities, obstetric complications, and perinatal mortality.


Assuntos
Diabetes Gestacional/mortalidade , Mortalidade Perinatal , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/metabolismo , Feminino , Glucose/metabolismo , Homeostase/fisiologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Gravidez em Diabéticas/sangue , Gravidez em Diabéticas/epidemiologia , Gravidez em Diabéticas/metabolismo
11.
Rev. chil. obstet. ginecol ; 75(1): 35-41, 2010. tab
Artigo em Espanhol | LILACS | ID: lil-561830

RESUMO

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


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


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adolescente , Adulto , Diabetes Gestacional/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Mortalidade Infantil , Anormalidades Congênitas/epidemiologia , Estudos de Coortes , Diabetes Gestacional/mortalidade , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Idade Materna , México/epidemiologia , Medição de Risco , Fatores de Risco , Fatores Socioeconômicos
13.
Rev. centroam. obstet. ginecol ; 14(2): 69-82, abr.-jun. 2009. ilus
Artigo em Espanhol | LILACS | ID: lil-733746

RESUMO

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


Assuntos
Gravidez , Desenvolvimento Fetal/fisiologia , Diabetes Gestacional/mortalidade , Diabetes Gestacional/prevenção & controle , Gestantes , Fatores de Risco , Retinopatia Diabética/patologia
14.
BJOG ; 115(11): 1436-42, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18823491

RESUMO

OBJECTIVE: The purpose of this study was to determine whether there is a difference, by gender, in perinatal mortality in chronically hypertensive women compared with normotensive women. DESIGN: Population-based prospective cohort study. SETTING: Sweden. POPULATION: A total of 866,188 women with singleton pregnancies registered in the Swedish Medical Birth Registry 1992-2004, of which 4749 were diagnosed with chronic hypertension. METHODS: Multivariate logistic regression analysis was performed. In a first step, we adjusted for maternal characteristics and in a second step for mild and severe pre-eclampsia, gestational diabetes, placental abruption and small for gestational age. An effect modification by gender was included in the model. MAIN OUTCOME MEASURES: Odds ratios (OR) for intrauterine death, neonatal death and post-neonatal death with respect to gender of offspring. RESULTS: The unadjusted OR of intrauterine death was 4.12 (95% CI: 2.84-5.96) and 1.29 (95% CI: 0.67-2.48) for male and female offspring, respectively, and of neonatal death, it was 3.45 (95% CI: 2.13-5.59) and 2.17 (95% CI: 1.08-4.35) for male and female offspring, respectively. After multivariate analysis, the OR of intrauterine death was 3.07 (95% CI: 2.12-4.46) and neonatal death was 2.99 (95% CI: 1.84-4.85) for male offspring. For female offspring, the OR of intrauterine death was 0.98 (95% CI: 0.51-1.89) and neonatal death was 1.88 (95% CI: 0.93-3.79). CONCLUSION: Mothers with chronic hypertension have an increased risk of perinatal mortality of their male offspring.


Assuntos
Hipertensão/mortalidade , Complicações Cardiovasculares na Gravidez/mortalidade , Descolamento Prematuro da Placenta/mortalidade , Adolescente , Adulto , Doença Crônica , Diabetes Gestacional/mortalidade , Métodos Epidemiológicos , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Mortalidade Perinatal , Pré-Eclâmpsia/mortalidade , Gravidez , Fatores Sexuais , Natimorto/epidemiologia , Suécia/epidemiologia , Adulto Jovem
15.
Rev. centroam. obstet. ginecol ; 13(1): 19-23, ene.-mar. 2008. ilus
Artigo em Espanhol | LILACS | ID: lil-644046

RESUMO

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


Assuntos
Adolescente , Adolescente/fisiologia , Diabetes Gestacional/mortalidade , Diabetes Gestacional/prevenção & controle , Gravidez/fisiologia
16.
Am J Obstet Gynecol ; 198(2): 186.e1-7, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17905178

RESUMO

OBJECTIVE: The objective of the study was a comparison of insulin aspart (IAsp) with human insulin (HI) in basal-bolus therapy with neutral protamine Hagedorn for fetal and perinatal outcomes of type 1 diabetes in pregnancy. STUDY DESIGN: This was a randomized, parallel, open-label, controlled, multicenter, multinational study. Subjects were pregnant (gestational age; <10 weeks) or planning pregnancy at enrollment. Three hundred twenty-two women with type 1 diabetes received IAsp (n = 157) or HI (n = 165). RESULTS: For IAsp and HI, respectively, there were 137 and 131 live births and 14 and 21 fetal losses. Perinatal mortality was 14 and 22 per 1000 births; number of congenital malformations were 6 and 9; mean (SEM) birthweight corrected for gestational age was 3438 g (71.5) and 3555 g (72.9; P = .091). Mean gestational age was 37.6 vs 37.4 weeks. Preterm delivery occurred in 20.3% (IAsp) and 30.6% (HI) of pregnancies (P = .053). CONCLUSION: The fetal outcome using IAsp was comparable with HI with a tendency toward fewer fetal losses and preterm deliveries.


Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Gestacional/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/análogos & derivados , Insulina/uso terapêutico , Adulto , Dinamarca , Diabetes Gestacional/sangue , Diabetes Gestacional/mortalidade , Feminino , Hemoglobina A Glicada , Humanos , Hipoglicemiantes/administração & dosagem , Recém-Nascido , Insulina/administração & dosagem , Insulina Aspart , Masculino , Gravidez , Resultado da Gravidez , Natimorto , Resultado do Tratamento
17.
Eur J Obstet Gynecol Reprod Biol ; 137(2): 178-84, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17681419

RESUMO

OBJECTIVE: To evaluate the prevalence of metabolic syndrome and its components in normal and complicated pregnancies. SETTING: university hospital, tertiary referral centre. SUBJECTS: 90 pregnant women in four groups: 20 women with preeclampsia, 20 women with gestational hypertension, 30 women with late-onset gestational diabetes and 20 healthy pregnant women as a control group. INTERVENTION: peripheral insulin resistance was measured by using the insulin tolerance test. Glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure and body mass index were analysed. Comparisons were done by Chi-squared test, one-way analysis of variance and the Bonferroni's test. Prevalence of the metabolic syndrome was calculated by adapting both the WHO and the NCEP definitions of the metabolic syndrome to pregnancy. RESULTS: There were no cases of metabolic syndrome in the control group according to any of the adapted definitions. The prevalence of this syndrome was 3.3% and 10% in the late-onset gestational diabetes group, 35% and 20% in the gestational hypertension group and 30% and 30% in the preeclampsia group for the WHO and the NCEP definitions, respectively. CONCLUSIONS: Metabolic syndrome is present in about one-third of women with pregnancy-induced hypertension but only in 10% of women with late-onset gestational diabetes.


Assuntos
Diabetes Gestacional/diagnóstico , Hipertensão Induzida pela Gravidez/diagnóstico , Síndrome Metabólica/diagnóstico , Complicações na Gravidez/diagnóstico , Adulto , Glicemia/metabolismo , Pressão Sanguínea/fisiologia , HDL-Colesterol/sangue , Diabetes Gestacional/mortalidade , Diabetes Gestacional/fisiopatologia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão Induzida pela Gravidez/fisiopatologia , Resistência à Insulina/fisiologia , Síndrome Metabólica/metabolismo , Síndrome Metabólica/fisiopatologia , Gravidez , Complicações na Gravidez/metabolismo , Complicações na Gravidez/fisiopatologia , Prevalência , Triglicerídeos/sangue , Organização Mundial da Saúde
18.
Z Geburtshilfe Neonatol ; 210(6): 193-9, 2006 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-17206553

RESUMO

OBJECT: The prevalence of intrauterine fetal death as well as the relevant risk factors in pregnancies of women with preconceptional and gestational diabetes mellitus and non-diabetic women were investigated. METHODS: The data of the Perinatal Registry of Lower Saxony between 1987 and 1999 for pregnancies of women with preconceptional diabetes mellitus (PDM, n = 3351), gestational diabetes mellitus (GDM, n = 3954) and women without diabetes mellitus (non-diabetic pregnancies, NDM, n = 887,779) were retrospectively analysed. RESULTS: Intrauterine fetal death occurred in 46 women with PDM (1.35 %), 32 women with GDM (0.79 %) and 2756 non-diabetic women (0.31 %). The odds ratio (OR, 95 % CI) for PDM vs. NDM was 4.468 (3.332 - 5.992; p < 0.01) and for GDM vs. NDM it was 2.595 (1.829 - 3.682; p < 0.01). The percentage of death, which occurs before the 32nd week of gestation, was 13 % in pregnancies with PDM, 12.5 % in pregnancies with GDM and 27.7 % in non-diabetic pregnancies. 50 % of fetal deaths in the PDM group, 43.8 % of those in the GDM group and 39.3 % of those in the NDM group occurred after the 36th week of gestation. The percentages of dead fetuses who were under the 10th percentile of growth (small for gestational age, SGA), in pregnancies with PDM, GDM and NDM were 15.2 %, 6.3 %, and 28.7 %, respectively. The percentages of dead fetuses above the 90th percentile of growth (large for gestational age, LGA) were 41.3 % (PDM), 37.5 % (GDM), and 8.7 % (NDM), (p < 0.01 for PDM vs. NDM and for GDM vs. NDM). CONCLUSION: The risk of intrauterine fetal death in pregnancies of diabetic women is still increased. It seems that especially the LGA fetuses of diabetic mothers and SGA fetuses of non-diabetic mothers are at greater risk of intrauterine death.


Assuntos
Diabetes Gestacional/mortalidade , Morte Fetal/epidemiologia , Mortalidade Fetal , Gravidez em Diabéticas/mortalidade , Sistema de Registros , Medição de Risco/métodos , Adulto , Feminino , Alemanha/epidemiologia , Teste de Tolerância a Glucose/estatística & dados numéricos , Humanos , Gravidez , Prevalência , Fatores de Risco
19.
Z Geburtshilfe Neonatol ; 210(6): 200-7, 2006 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-17206554

RESUMO

OBJECTIVE: Pregnancies of women with glucose tolerance disorders are still associated with high maternal and perinatal morbidity. In the present population-based study, we investigated the fetal and neonatal risks and complications in pregnancies of women with preconceptional and gestational diabetes in comparison with pregnancies of non-diabetic women. METHODS: A total of 913,255 pregnancies with 926,685 newborns documented by the Perinatal Registry of Lower Saxony, Germany, between 1987 and 1999 was retrospectively evaluated. In particular, the obstetric parameters of 3439 women with preconceptional diabetes mellitus (PDM, n = 3485 neonates), 4051 women with gestational diabetes mellitus (GDM, n = 4155 neonates) and 905,765 non-diabetic women (NDM, n = 919.053 neonates) were analysed. RESULTS: The diabetes groups had a higher rate of preterm birth < 31st week of gestation (PDM vs. NDM odds ratio [OR] 2.341; GDM vs. NDM OR 1.483) and between the 32nd and 37th weeks of gestation (OR 3.688 and 2.418, respectively). The incidences of pathological cardiotocograms (OR 1.519 and 1.258, respectively) and acidosis as indication for operative delivery (OR 5,015 and 2,102, respectively) were increased in the diabetes groups. There was a higher prevalence of birth weight > 4500 g (OR 2.775 and 2.742, respectively) and >95. percentile (OR 4.268 and 3.610, respectively) in newborns of diabetic women. The higher rate of umbilical arterial pH < 7.00 (OR 2.481 and 1.195, respectively) as well as Apgar score at 1 minute <7 (OR 2.971 and 1.897, respectively) indicated a poorer neonatal outcome in pregnancies of women with diabetes mellitus. The frequency of necessary intubation of the infants was significantly higher in the diabetes group (OR 3.384 and 1.317, respectively). There also was an increased prevalence of intrauterine fetal death in pregnancies of diabetic women (OR 4.197 and 2.511, respectively). CONCLUSION: Pregnancies of women with diabetes mellitus are still correlated with higher perinatal risks and complications. The neonatal morbidity in pregnancies with gestational diabetes mellitus was more similar to that of pregnancies with preconceptional diabetes mellitus than to the morbidity in the group of non-diabetic women. Changes of the parameters within the observation period were the same in all three groups and therefore cannot be attributed to a primary more intensive prenatal care of diabetic women.


Assuntos
Diabetes Gestacional/mortalidade , Mortalidade Infantil , Gravidez em Diabéticas/mortalidade , Sistema de Registros , Medição de Risco/métodos , Adulto , Feminino , Alemanha/epidemiologia , Teste de Tolerância a Glucose/estatística & dados numéricos , Humanos , Recém-Nascido , Gravidez , Prevalência , Fatores de Risco
20.
Semin Fetal Neonatal Med ; 10(4): 317-23, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15935748

RESUMO

The term 'gestational diabetes mellitus' is unsatisfactory as it refers to a heterogeneous group of women, including those with minimal abnormality of carbohydrate metabolism and those with undiagnosed type II diabetes. However, perinatal morbidity is increased even in the group of women who have only impaired glucose tolerance; the mothers are at increased risk of subsequent development of diabetes, and there may also be long-term implications for the offspring. Current research is aiming to define the blood glucose levels at which risks increase so that clinical management can be appropriately directed. When available, the criteria required to justify population screening in pregnancy should be satisfied. The glucose challenge and fasting glucose tests are the leading contenders as appropriate screening tests to determine who should have the diagnostic glucose tolerance test. However, until this is reviewed, the widely used scheme of risk factors as a screening method should continue, as it detects at least 50% of women with gestational diabetes.


Assuntos
Diabetes Gestacional/diagnóstico , Programas de Rastreamento/métodos , Diabetes Gestacional/complicações , Diabetes Gestacional/mortalidade , Feminino , Intolerância à Glucose , Humanos , Gravidez , Resultado da Gravidez , Fatores de Risco
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