BACKGROUND: Women with a history of gestational diabetes mellitus (GDM) are at an increased risk of developing type 2 diabetes mellitus (T2DM). Lifestyle interventions aimed at postpartum weight loss to reduce T2DM risk have been reported, but poor compliance remains a barrier. Smartphone-based interventions may improve compliance, but data on its use in women with recent GDM are limited. OBJECTIVE: This trial aimed to investigate the efficacy of a smartphone app in restoring optimal weight following delivery in women with GDM, in the setting of a population with high rates of GDM and type 2 diabetes. METHODS: In this unblinded randomized controlled trial, 200 women with GDM were randomized to receive the intervention or standard care following delivery. The intervention enabled logging of weight, meals, and activity, with web-based interaction with a team comprising dieticians, a physiotherapist, and an occupational therapist. The primary outcome was an achievement of optimal weight (defined as the restoration of first trimester weight if first trimester BMI≤23 kg/m2 or weight loss of at least 5% from first trimester weight if first trimester BMI>23 kg/m2) at 4 months post partum. Secondary outcome measures included absolute weight loss, serum metabolic markers, self-reported nutritional intake, health education, and quality of life via questionnaires and user engagement in the intervention group. RESULTS: In total, 40% (38/96) of women in the intervention group achieved optimal weight at 4 months post delivery compared with 32% (28/93) in the control group (P=.27). Compared with the control group, women in the intervention group reported significantly reduced caloric intake at 4 months after delivery (P<.001) and higher health-directed behavior scores (P=.045). The intervention group also reported increased emotional distress scores (P=.01). At 4 months, participant engagement with the intervention was maintained at 60.8% (SD 33.9%). CONCLUSIONS: Although a statistically significant increase in women achieving healthy weight was not observed, this app remains promising, as women in the intervention group reported improved health behaviors and lower caloric intake. Importantly, the high retention rates suggest that a larger study with a longer follow-up period might confirm the effectiveness of this app for weight management. TRIAL REGISTRATION: ClinicalTrials.gov NCT03324737; https://clinicaltrials.gov/ct2/show/NCT03324737. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-019-7691-3.
AssuntosDiabetes Mellitus Tipo 2 , Diabetes Gestacional , Aplicativos Móveis , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/terapia , Feminino , Humanos , Gravidez , Qualidade de Vida , Smartphone
Maternal metabolism and intrauterine conditions influence development of health and disease in offspring, leading to metabolic, physiologic, and/or epigenetic adaptation of the fetus. Maternal gestational diabetes (GDM) leads to higher incidence of obesity and type 2 diabetes in offspring. We have previously shown that fetuses of insulin-resistant mothers with GDM have a delayed reaction to auditory stimuli in the postprandial state, indicating a fetal central insulin resistance. We tested whether this effect could be influenced by a lifestyle intervention in mothers with GDM, including diet counselling and regular blood glucose measurements. We measured fetal brain activity over the course of a maternal glucose challenge, at two measurement time points (baseline at an average of 29 weeks of gestation and follow-up after 4 weeks) in mothers with GDM and mothers with normal glucose tolerance (NGT). Data from eight mothers were able to be included. Fetuses of GDM mothers showed longer latencies than those of NGT mothers postprandially at both measurement time points during the third trimester and did not show a difference in response patterns between baseline and after 4 weeks. Maternal postprandial blood glucose and insulin values did not change from baseline to follow-up either. While the overall intervention seems to have been effective, it does not appear to have influenced the fetal postprandial brain responses. This might have been because interventions for GDM take place relatively late in pregnancy. Future research should focus on maternal lifestyle interventions as early as possible during gestation, or even prenatally.
AssuntosEncéfalo/embriologia , Diabetes Gestacional/terapia , Feto/fisiopatologia , Terceiro Trimestre da Gravidez , Cuidado Pré-Natal/métodos , Adulto , Glicemia/metabolismo , Estudos de Coortes , Diabetes Gestacional/sangue , Feminino , Feto/embriologia , Idade Gestacional , Ganho de Peso na Gestação , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Resistência à Insulina/fisiologia , Estilo de Vida , Período Pós-Prandial/fisiologia , Gravidez
AssuntosHipertensão Induzida pela Gravidez/terapia , Manejo da Obesidade/métodos , Obesidade Materna/terapia , Obesidade/terapia , Adulto , Cirurgia Bariátrica , Diabetes Gestacional/terapia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Obesidade/complicações , Gravidez , Perda de Peso
AIMS: This population-based cross-sectional study aimed to investigate recent trends in the prevalence and treatment of gestational diabetes mellitus (GDM) in Korea. We also investigated trends in annual prevalence rate of pregnancy-induced hypertension (PIH) and cesarean section (C-section) in GDM patients. METHODS: We used data from the Health Insurance Review and Assessment-National Patient Sample (HIRA-NPS) database, 2012-2016. Non-GDM (n = 53,698) and GDM (n = 7956) patient data were analyzed for each year. RESULTS: The annual increase in the prevalence of GDM was 11.1% over 2012-2016, with a significant continuously increasing trend (p < 0.0001). Age-stratified analysis showed that the annual prevalence of GDM significantly increased in patients below 40 years of age, but was not statistically significant as an increasing trend in patients above 40 years of age. Annual PIH prevalence rate among GDM women showed decreasing trend but was not statistically significant. An annual increase in C-section rate above 5% in GDM patients was statistically significant in both unadjusted and adjusted for age and PIH models. CONCLUSIONS: The prevalence of GDM in Korean women and C-section rates in women with GDM showed a significantly increasing trend, 2012-2016. There is a need for further efforts to monitor this trend and to identify associated risk factors for GDM in Korean women.
AssuntosCesárea/efeitos adversos , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/terapia , Programas Nacionais de Saúde/normas , Adulto , Estudos Transversais , Bases de Dados Factuais , Feminino , História do Século XXI , Humanos , Gravidez , Prevalência , República da Coreia/epidemiologia , Fatores de Risco
ABSTRACT: To compare pregnancy outcomes between patients with gestational diabetes mellitus (GDM) with and without their own blood glucose meter.We conducted a retrospective-cohort study of 835 women with GDM at the Second Hospital of Tianjin Medical University, Tianjin, China from 1 January 2016 to 31 December 2018. Perinatal outcomes of these patients were monitored and collected in the Tianjin Maternal and Child Health System. Each patient was advised by a certified clinical nutritionist regarding dietary analysis and lifestyle recommendations. All pregnant women with GDM were divided into the following 2 groups according to whether they had their own blood glucose meter: women with self-measured blood glucose levels with a routine obstetric examination in the study group (nâ=â424); and those with non-self-measured blood glucose levels with a double obstetric examination in the control group (nâ=â411). Maternal and fetal pregnancy outcomes were compared between these 2 groups. According to different self-management modes, the women were also divided into eight subgroups to compare blood sugar control and compliance with recommended insulin therapy.The cesarean section rate was significantly lower in the study group than in the control group (Pâ<â.05). The prevalence of large-for-gestational age (Pâ<â.05) and macrosomia was significantly lower in the study group than in the control group (both Pâ<â.05). The prevalence of appropriate-for-gestational age was significantly higher in the study group than in the control group (Pâ<â.05). Birth weight was significantly lower in the study group than in the control group (Pâ<â.05). The mean times for blood sugar control and from the doctor recommendation for insulin treatment to the patient compliance in the study group were significantly shorter than those in the control group (both Pâ<â.05). The proportion of insulin required in the study group was significantly lower than that in the control group (Pâ<â.05). There were no significant differences in the time of controlling blood sugar and compliance among the 4 subgroups of the study group. However, subgroups with a dietary diary in the control group were better.Self-monitoring blood sugar plus a routine obstetric examination can help patients with GDM control blood sugar, even without dietary diaries and treadmills. In addition to increasing the number of obstetric examinations, recording dietary diaries is helpful for controlling blood sugar in patients with GDM who are unwilling to measure blood sugar by themselves.
AssuntosAutomonitorização da Glicemia/instrumentação , Diabetes Gestacional/terapia , Resultado da Gravidez/psicologia , Adulto , Glicemia/análise , Automonitorização da Glicemia/psicologia , Automonitorização da Glicemia/normas , China , Estudos de Coortes , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Estudos Retrospectivos
AssuntosInfecções por Coronavirus , Diabetes Gestacional , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/terapia , Feminino , Humanos , Gravidez
AssuntosPeso ao Nascer , Glicemia/metabolismo , Complicações do Diabetes/complicações , Diabetes Gestacional , Gravidez em Diabéticas , Composição Corporal , Cesárea , Anormalidades Congênitas/etiologia , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Feminino , Macrossomia Fetal/etiologia , Humanos , Hiperinsulinismo/etiologia , Recém-Nascido , Obesidade/complicações , Policitemia/etiologia , Gravidez , Gravidez em Diabéticas/sangue
Gestational diabetes, the most common medical disorder in pregnancy, is defined as glucose intolerance resulting in hyperglycaemia that begins or is first diagnosed in pregnancy. Gestational diabetes is associated with increased pregnancy complications and long-term metabolic risks for the woman and the offspring. However, the current diagnostic and management strategies recommended by national and international guidelines are mainly focused on short-term risks during pregnancy and delivery, except the Carpenter-Coustan criteria, which were based on the risk of future incidence of type 2 diabetes post-gestational diabetes. In this Personal View, first, we summarise the evidence for long-term risk in women with gestational diabetes and their offspring. Second, we suggest that a shift is needed in the thinking about gestational diabetes; moving from the perception of a short-term condition that confers increased risks of large babies to a potentially modifiable long-term condition that contributes to the growing burden of childhood obesity and cardiometabolic disorders in women and the future generation. Third, we propose how the current clinical practice might be improved. Finally, we outline and justify priorities for future research.
AssuntosSaúde da Criança/tendências , Diabetes Gestacional/terapia , Saúde Materna/tendências , Criança , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Hiperglicemia/terapia , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Gravidez
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.
AssuntosDiabetes Gestacional , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/terapia , Feminino , Humanos , Gravidez , Risco
Las enfermedades cardiovasculares representan la mayor causa de morbimortalidad a nivel mundial. Si bien presenta un descenso en la población general, en las mujeres tiende a mantenerse estable la prevalencia de enfermedad coronaria. Varios factores propios de la mujer predisponen a que esto ocurra, incluyendo el embarazo, mediado tanto por los cambios hematológicos y cardiovasculares característicos de la gestación; como por patologías asociadas, principalmente trastornos hipertensivos del embarazo y diabetes gestacional. Su presencia se ha asociado fuertemente a la aparición a futuro de otras patologías de alto riesgo cardiovascular como hipertensión crónica, dislipidemia y diabetes mellitus. Dado el impacto que esto representa, se hace imperante la identificación de grupos de alto riesgo y la implementación de medidas preventivas, así como de diagnóstico precoz y tratamientos adecuados con el fin de disminuir complicaciones materno-fetales en las etapas perinatal y posparto.
Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Although there is a decrease in general population, the prevalence of coronary heart disease remains stable in women. Several factors typical of womenkind predispose to cardiovascular disease, including pregnancy, mediated by hematological and cardiovascular changes characteristic of it; and by associated pathologies, mainly hypertensive disorders and diabetes. The presence of these diseases has been strongly associated with future presence of other conditions of high cardiovascular risk such as chronic hypertension, dyslipidemia and diabetes mellitus. Given this impact, the identification of high-risk groups and the implementation of preventive measures, as well as early diagnosis and adequate treatment in order to reduce both maternal and fetal complications in perinatal and postpartum stages becomes imperative.
AssuntosHumanos , Feminino , Gravidez , Pré-Eclâmpsia , Complicações Cardiovasculares na Gravidez/etiologia , Doenças Cardiovasculares/complicações , Diabetes Gestacional , Hipertensão/complicações , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/terapia , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Sistema Cardiovascular/fisiopatologia , Fatores de Risco , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Doenças Metabólicas
AIM: This study explores the General Practice (GP) experience of Gestational Diabetes Mellitus (GDM). Much has been written about patient perspectives, yet little is known about the GP perspective at initial diagnosis and management. GDM is increasingly managed in the secondary and tertiary sector, the confidence of GPs and their role in ongoing care has not been examined. Given GDM's poor follow up rates, all aspects of the patient journey warrant close examination. METHODS: Through purposive and snowball sampling, we conducted semi-structured interviews with GPs in Brisbane, Australia between April and October 2018. Data collection, until saturation, and analysis were concurrent, and the Leximancer analysis tool assisted with content analysis and suggestion of themes. RESULTS: Dominant themes include uncertainty/urgency and feeling under-utilised. GPs have a pragmatic approach in the face of uncertainty, and adopt one of several strategies to meet patient needs. A key issue that may impact on long term follow up and high quality GP-patient relationships is concern about the patient being 'taken away' by the hospital. Communication with the hospital is generally perceived as poor. CONCLUSIONS: The experience of GPs in the initial diagnosis and management of GDM may assist in improving GDM follow up.
AssuntosDiabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Clínicos Gerais , Padrões de Prática Médica , Atenção Primária à Saúde , Adulto , Austrália/epidemiologia , Continuidade da Assistência ao Paciente/normas , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Diabetes Gestacional/epidemiologia , Feminino , Seguimentos , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/normas , Clínicos Gerais/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Parto , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Encaminhamento e Consulta/estatística & dados numéricos
AIMS: To assess the impact of a culturally modified, motivationally targeted, individually-tailored intervention on postpartum physical activity (PA) and PA self-efficacy among Hispanic women. METHODS: Estudio PARTO was a randomized controlled trial conducted in Western Massachusetts from 2013-17. Hispanic women who screened positive for gestational diabetes mellitus were randomized to a Lifestyle Intervention (LI, n = 100) or to a comparison Health and Wellness (HW, n = 104) group during late pregnancy. Exercise goals in LI were to meet American College of Obstetrician & Gynecologists guidelines for postpartum PA. The Pregnancy Physical Activity Questionnaire (PPAQ) and the Self-Efficacy for Physical Activity Questionnaire were administered at 6 weeks, 6 months, and 1 year postpartum. RESULTS: Compared to baseline levels, both groups had significant increases in moderate-to-vigorous PA at 6 months and one year postpartum (i.e., LI: mean change = 30.9 MET-hrs/wk, p = 0.05; HW: 27.6 MET-hrs/wk, p = 0.01), with only LI group experiencing significant increases in vigorous PA (mean change = 1.3 MET-hrs/wk, p = 0.03). Based on an intent-to-treat analysis using mixed effects models, we observed no differences in pattern of change in PA intensity and type over time between intervention groups (all p > 0.10). However, there was the suggestion of a greater decrease in sedentary activity in the LI group compared to the HW group (ß = -3.56, p = 0.09). CONCLUSIONS: In this randomized trial among high-risk Hispanic women, both groups benefitted from participation in a postpartum intervention.
AssuntosDiabetes Gestacional/terapia , Exercício Físico , Estilo de Vida Saudável , Período Pós-Parto , Feminino , Hispano-Americanos , Humanos , Massachusetts , Gravidez
BACKGROUND: Gestational diabetes mellitus (GDM) is carbohydrate intolerance first recognised during pregnancy and associated with complications for mothers and babies. Probiotics are naturally occurring micro-organisms, which when ingested in adequate amounts, may confer health benefits. Evidence of the role of probiotics as treatment for GDM is limited. OBJECTIVES: To evaluate the safety and effectiveness of probiotics in treating women with GDM on maternal and infant outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth's Trials Register ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) (24 July 2019), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the use of probiotics versus placebo/standard care for the treatment of GDM. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data, checked data accuracy, and assessed risk of bias of included trials. The certainty of evidence for selected maternal and infant/child outcomes was assessed using GRADE. MAIN RESULTS: Nine RCTs (695 pregnant women with GDM) comparing probiotics versus placebo were identified. The overall risk of bias in the nine RCTs was low to unclear and the evidence was downgraded for imprecision due to the small numbers of women participating in the trials. The trials were carried out in hospitals and universities in Iran (seven trials), Thailand (one trial) and Ireland (one trial). All trials compared probiotics with placebo. Maternal outcomes We are uncertain if probiotics have any effect compared with placebo on hypertensive disorders of pregnancy, (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.64 to 3.53; participants = 256; studies = 3; low-certainty evidence) and mode of birth as caesareans (average RR 0.64, 95% CI 0.30 to 1.35; participants = 267; studies = 3; low-certainty evidence) because the certainty of evidence is low and the 95% CIs span possible benefit and possible harm. No trials reported primary outcomes of: mode of birth as vaginal/assisted and subsequent development of type 2 diabetes. We are uncertain if probiotics have any effect compared with placebo on induction of labour (RR 1.33, 95% CI 0.74 to 2.37; participants = 127; studies = 1; very low-certainty evidence). For other secondary maternal outcomes, we are uncertain if there are differences between probiotics and placebo for: postpartum haemorrhage; weight gain during pregnancy intervention and total gestational weight gain; fasting plasma glucose and need for extra pharmacotherapy (insulin). Probiotics may be associated with a slight reduction in triglycerides and total cholesterol. In probiotics compared with placebo, there was evidence of reduction in markers for insulin resistance (HOMA-IR) and HOMA-B; and insulin secretion. There was also an increase in quantitative insulin sensitivity check index (QUICKI). Probiotics were associated with minor benefits in relevant bio-markers with evidence of a reduction in inflammatory markers high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and marker of oxidative stress malondialdehyde; and an increase in antioxidant total glutathione, but we are uncertain if there is any difference in total antioxidant capacity. No trials reported secondary outcomes: perineal trauma, postnatal weight retention or return to pre-pregnancy weight and postnatal depression. Infant/child/adult outcomes We are uncertain if probiotics have any effect, compared with placebo, on the risk of large-for-gestational-age babies (RR 0.73, 95% CI 0.35 to 1.52; participants = 174; studies = 2; low-certainty evidence) or infant hypoglycaemia (RR 0.85, 95% CI 0.39 to 1.84; participants = 177; studies = 3; low-certainty evidence) because the certainty of evidence is low and the 95% CIs span possible benefit and possible harm. No trials reported primary outcomes of: perinatal (fetal/neonatal) mortality; or neurosensory disability. For other secondary outcomes, we are uncertain if there is any difference between probiotics and placebo in gestational age at birth, preterm birth, macrosomia, birthweight, head circumference, length, infant hypoglycaemia, and neonatal intensive care unit (NICU) admissions. There was evidence of a reduction in infant hyperbilirubinaemia with probiotics compared with placebo. No trials reported secondary outcomes: infant adiposity, and later childhood adiposity. There were no adverse events reported by any of the trials. AUTHORS' CONCLUSIONS: Low-certainty evidence means we are not certain if there is any difference between probiotic and placebo groups in maternal hypertensive disorders of pregnancy, caesareans; and large-for-gestational-age babies. There were no adverse events reported by the trials. Due to the variability of probiotics used and small sample sizes of trials, evidence from this review has limited ability to inform practice. Well-designed adequately-powered trials are needed to identify whether probiotics may improve maternal blood glucose levels and/or infant/child/adult outcomes; and whether they can be used to treat GDM.
AssuntosDiabetes Gestacional/terapia , Probióticos/uso terapêutico , Adulto , Criança , Intervalos de Confiança , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Recém-Nascido , Criança Pós-Termo , Trabalho de Parto Induzido/estatística & dados numéricos , Razão de Chances , Placebos/uso terapêutico , Gravidez , Probióticos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
BACKGROUND AND AIMS: New clinical approaches are needed to minimize complications of gestational diabetes during the COVID-19 outbreak with timely screening and proper management. The present study aims to highlight changes in the clinical guideline for gestational diabetes during the pandemic. METHODS: In a narrative review, multiple databases were searched. Furthermore, online searches were conducted to identify guidelines or support documents provided by NGOs, local health authorities, and societies and organizations in the field of diabetes and obstetrics. RESULTS: We included five national guidelines that were published in English from Canada, the United Kingdom, Australia, New Zealand, and Australia health agencies. FBG, A1C, RPG were recommended as alternative tests instead of a 2-h oral glucose tolerance test (OGGT) for GDM screening at 24-28 weeks of gestation. Recommendations also included a deferral of postpartum screening till the end of the pandemic, or postponement of testing to 6-12 months after delivery, use telemedicine and telecare. CONCLUSIONS: Updated temporary changes in clinical guidelines are sensible and accommodates social distancing and minimizes risk of exposure to COVID-19. Despite many unsolved controversies in screening, treatment, and follow-up of gestational diabetes, it seems involvement with novel coronavirus have made a reach to a global agreement simpler.
AssuntosBetacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Complicações Infecciosas na Gravidez/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Gestacional/virologia , Gerenciamento Clínico , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Gravidez , Prognóstico
AssuntosBetacoronavirus , Infecções por Coronavirus/epidemiologia , Diabetes Gestacional/diagnóstico , Hiperglicemia/diagnóstico , Pneumonia Viral/epidemiologia , Cuidado Pré-Natal/normas , Infecções por Coronavirus/prevenção & controle , Diabetes Gestacional/terapia , Feminino , Humanos , Hiperglicemia/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cuidado Pós-Natal/normas , Cuidado Pré-Concepcional/normas , Gravidez , Trimestres da Gravidez
Cardiovascular disease complicates 1-4% of pregnancies - with a higher prevalence when including hypertensive disorders - and is the leading cause of maternal death. In women with known cardiovascular pathology, such as congenital heart disease, timely counselling is possible and the outcome is fairly good. By contrast, maternal mortality is high in women with acquired heart disease that presents during pregnancy (such as acute coronary syndrome or aortic dissection). Worryingly, the prevalence of acquired cardiovascular disease during pregnancy is rising as older maternal age, obesity, diabetes mellitus and hypertension become more common in the pregnant population. Management of cardiovascular disease in pregnancy is challenging owing to the unique maternal physiology, characterized by profound changes to multiple organ systems. The presence of the fetus compounds the situation because both the cardiometabolic disease and its management might adversely affect the fetus. Equally, avoiding essential treatment because of potential fetal harm risks a poor outcome for both mother and child. In this Review, we examine how the physiological adaptations during pregnancy can provoke cardiometabolic complications or exacerbate existing cardiometabolic disease and, conversely, how cardiometabolic disease can compromise the adaptations to pregnancy and their intended purpose: the development and growth of the fetus.
AssuntosFenômenos Fisiológicos Cardiovasculares , Diabetes Gestacional/metabolismo , Hipertensão Induzida pela Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Gravidez/fisiologia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/terapia , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/fisiopatologia , Aneurisma Dissecante/terapia , Anti-Hipertensivos/uso terapêutico , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Aspirina/uso terapêutico , Débito Cardíaco , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Progressão da Doença , Endocardite/diagnóstico , Endocardite/fisiopatologia , Endocardite/terapia , Feminino , Humanos , Hipertensão/fisiopatologia , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Idade Materna , Obesidade Materna/metabolismo , Obesidade Materna/fisiopatologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Pré-Eclâmpsia/fisiopatologia , Pré-Eclâmpsia/prevenção & controle , Pré-Eclâmpsia/terapia , Gravidez/metabolismo , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Gravidez em Diabéticas/metabolismo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/fisiopatologia
Gestational diabetes mellitus (GDM) increases the risk of adverse events in pregnancy and jeopardizes long-term health of the mother and offspring. There is currently no consensus as to what screening strategies improve the efficiency of GDM diagnosis. Which criteria should be used? Is the one-step or two-step procedure better? There is no agreement as to what the best dietary approach in the treatment of GDM is. In addition, different nutritional interventions have been studied in the prevention of GDM. The Mediterranean diet seems to be effective in preventing GDM and other maternofoetal outcomes. We review herein our experience using the one-step criteria for GDM screening; the treatment and prevention strategies used; and the overall impact of nutrition on maternofoetal health
La diabetes gestacional (DG) incrementa el riesgo de tener eventos adversos durante el embarazo, y también afecta a la salud materna y de la descendencia a largo plazo. En la actualidad no existe un consenso sobre qué estrategia de cribado es más eficaz para el diagnóstico de la DG. ¿Qué criterios se deberían utilizar? ¿Es mejor hacerlo en un solo paso o en 2? Tampoco existe un acuerdo universal sobre cuál es el mejor tratamiento nutricional ni qué intervención nutricional es la más adecuada para su prevención. La dieta mediterránea parece ser las más efectiva en la prevención no solo de la DG, sino que también de otros eventos adversos materno-fetales. En este artículo revisamos la experiencia de nuestro grupo en la aplicación de los criterios diagnósticos de un solo paso para la DG; las estrategias empleadas en el tratamiento y prevención de la DG, y del impacto global que tiene la alimentación sobre la salud materno-fetal
AssuntosHumanos , Feminino , Gravidez , Adulto , Diabetes Gestacional/prevenção & controle , Diabetes Gestacional/terapia , Programas de Nutrição , Técnicas de Diagnóstico Endócrino/normas , Vigilância Nutricional , Dieta Mediterrânea , Estilo de Vida , Sobrepeso
PURPOSE OF REVIEW: Lifestyle interventions (such as diet and physical activity) successfully limit excessive gestational weight gain and can reduce some adverse maternal events; however, benefit is variable and cost-effectiveness remains unclear. We aimed to review published cost-effectiveness analyses of lifestyle interventions compared with usual care on clinically relevant outcome measures. Five international and six grey-literature databases were searched from 2007 to 2018. Articles were assessed for quality of reporting. Data were extracted from healthcare and societal perspectives. Costs were adapted to the common currencies of Australia and the United Kingdom by adjusting for resource utilization, healthcare purchase price and changes in costs over time. Included studies were economic analyses of lifestyle interventions aiming to limit weight-gain during pregnancy and/or reduce risk of gestational diabetes, for women with a BMI of 25 or greater in pre- or early-pregnancy. RECENT FINDINGS: Of the 538 articles identified, six were retained for review: one modelling study and five studies in which an economic analysis was performed alongside a randomized-controlled trial. Outcome measures included infant birth-weight, fasting glucose, insulin resistance, gestational weight-gain, infant respiratory distress syndrome, perceived health, cost per case of adverse outcome avoided and quality-adjusted life years (QALYs). Interventions were cost-effective in only one study. Although many studies have investigated the efficacy of lifestyle interventions in pregnancy, few have included cost-effectiveness analyses. Where cost-effectiveness studies were undertaken, results were inconsistent. Secondary meta-analysis, taxonomy and framework research is now required to determine the effective components of lifestyle interventions and to guide future cost-effectiveness analyses.
AssuntosDiabetes Gestacional/terapia , Ganho de Peso na Gestação , Comportamentos Relacionados com a Saúde , Sobrepeso/terapia , Análise Custo-Benefício , Diabetes Gestacional/economia , Diabetes Gestacional/etiologia , Diabetes Gestacional/prevenção & controle , Dieta Saudável , Exercício Físico , Feminino , Humanos , Recém-Nascido , Estilo de Vida , Sobrepeso/complicações , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia , Resultado da Gravidez , Qualidade de Vida , Medição de Risco , Fatores de Risco
Gestational diabetes (GDM) has deleterious effects on the offspring. Maternal obesity and excessive gestational weight gain (GWG), often associated with diabetes, also contribute to these adverse outcomes. OBJECTIVES: To assess the benefit for the offspring of maternal lifestyle interventions, including diets and physical activity, to prevent or to improve GDM and to limit excessive GWG. METHOD: Systematic review of meta-analyses published in English between December 2014 and November 2019. RESULTS: Lifestyle interventions to reduce the risk of GDM reported a decreased risk of 15% to 40%, with a greater effect of exercise compared to diet. Combined lifestyle interventions specifically designed to limit GWG reduced GWG by 1.6 kg in overweight and obese women, and on average by 0.7 to 1 kg in all pregnant women. In these trials, adverse neonatal outcomes were poorly studied. Combined lifestyle interventions in women with GDM significantly reduced fetal growth. Altogether, lifestyle interventions reduced the risk of preterm birth and shoulder dystocia, but individually, diets or exercise alone had no effect on neonatal adverse outcomes. CONCLUSION: Specific maternal, neonatal and offspring benefits of lifestyle interventions during pregnancy to prevent or improve GDM control or to limit GWG still require clarification.
AssuntosDiabetes Gestacional/terapia , Estilo de Vida , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Ganho de Peso
BACKGROUND: Hyperglycaemia in pregnancy contributes to adverse outcomes for women and their children. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. AIMS: To identify strengths and gaps in current care for Aboriginal women after a pregnancy complicated by hyperglycaemia. METHODS: A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013-2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)). RESULTS: Only 80 women (54%) with GDM had postpartum glycaemic checks. Of these, 32 women were diagnosed with prediabetes (n = 24) or diabetes (n = 8). Compared to women with GDM, women with T2D were more likely to have their weight measured (75% vs. 52%, p <0.01), and smoking status documented as "discussed" (65% vs. 34%, p < 0.01). Most women (97%) accessed the health centre at least once in the 12 month postpartum period but, during these visits, only 52% of women had service provision, either structured or opportunistic, related to diabetes. CONCLUSION: High rates of dysglycaemia among women screened for T2D after GDM in the 12 month postpartum period highlight the need for increased screening and early intervention to prevent the development of T2D and its complications. Whilst a clear strength was high postpartum attendance, many women did not attend health services for diabetes screening or management.