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1.
Pan Afr Med J ; 34: 18, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762887

RESUMO

Introduction: The purpose of this study was to describe the diagnostic, prognostic and therapeutic features of gestational diabetes at the Sylvanus Olympio University Hospital Center. Methods: We conducted a retrospective descriptive study over a period of 5 years from 1st January 2013 to 31st December 2017. It involved 125 pregnant women who had given birth in the Department of Internal Medicine and in the Gyneco-Obstetric Department. Results: The average age of patients was 30.84±4.17 years. The most common risk factors were overweight and obesity (57.7%), a family history of diabetes (33.3%), a history of spontaneous miscarriage (26.6%), a history of fetal death in utero (15.5%) and a history of gestational diabetes (8.8%). Gestational diabetes screening was performed using fasting blood glucose test and 75g oral glucose-tolerance test. Diagnosis was made in the first quarter in 55.6% of cases, in the second quarter in 33.3% and in the third quarter in 11.1%. Insulin therapy was necessary in 24.4% of cases and a healthy meal-plan alone in 66.6%. Sixty-six point seven percent (66.7%) of women had given birth by cesarean section and 33.3% vaginally. Maternal complications at birth included: arterial hypertension (22.2%), preeclampsia (17.7%) and premature ruptured membranes (2.2%). Newborn complications included macrosomia (48.9%), prematurity (11.1%), hypoglycaemia (11.1%), malformations (4.4%) and stillborn child (4.4%). Eighty-eight point nine percent (88.9%) of newborns had Apgar score greater than 7 and more than 48% were macrosomes. Conclusion: Gestational diabetes leads to maternofetal complications. Systematic screening is essential even in the absence of risk factors for optimal patient management.


Assuntos
Cesárea/estatística & dados numéricos , Diabetes Gestacional/diagnóstico , Resultado da Gravidez , Adulto , Índice de Apgar , Diabetes Gestacional/terapia , Feminino , Teste de Tolerância a Glucose , Hospitais Universitários , Humanos , Recém-Nascido , Programas de Rastreamento/métodos , Obesidade/epidemiologia , Gravidez , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
2.
BMC Health Serv Res ; 19(1): 662, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31514743

RESUMO

BACKGROUND: Pre-gestational and gestational diabetes mellitus are common complications in pregnancy affecting one in six pregnancies. The maternity services are under significant strain managing the increasing number of complex pregnancies. This has an impact on patients' experience of antenatal care. Therefore, there is a clear need to address pregnancy care. One possible solution is to use home-based digital technology to reduce clinic visits and improve clinical monitoring. METHODS: The aim of this study was to evaluate the antenatal services provided to pregnant women with diabetes who were monitored at the joint metabolic and obstetric clinic at the Southern Health and Social Care Trust in Northern Ireland. RESULTS: The questionnaires were completed by sixty-three women, most of whom had gestational diabetes mellitus. Most of the participants were between 25 and 35 years of age (69.8%), had one or more children (65.1%) and spent over 2 h attending the clinics (63.9%); 78% of women indicated that their travel time to and from the clinic appointment was over 15 min. Over 70% of women used smartphones for health-related purposes. However, only 8.8% used smartphones to manage their health or diabetes. Less than 25% of the women surveyed expressed concerns about using digital technology from home to monitor various aspects of their health in pregnancy. CONCLUSIONS: Overall, pregnant women who had or developed diabetes in pregnancy experience frequent hospital visits and long waiting times in the maternity clinics. Most of these pregnant women are willing to self-manage their condition from home and to be monitored remotely by the healthcare staff.


Assuntos
Diabetes Gestacional/terapia , Maternidades , Monitorização Fisiológica/métodos , Complicações na Gravidez/terapia , Autogestão , Telemedicina , Adulto , Diabetes Gestacional/fisiopatologia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Irlanda do Norte , Gravidez , Complicações na Gravidez/fisiopatologia , Autogestão/estatística & dados numéricos
3.
Cochrane Database Syst Rev ; 9: CD012544, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31476798

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) is a common medical condition that complicates pregnancy and causes adverse maternal and fetal outcomes. At present, most treatment strategies focus on normalisation of maternal blood glucose values with use of diet, lifestyle modification, exercise, oral anti-hyperglycaemics and insulin. This has been shown to reduce the incidence of adverse outcomes, such as birth trauma and macrosomia. However, this involves intensive monitoring and treatment of all women with GDM. We propose that using medical imaging to identify pregnancies displaying signs of being affected by GDM could help to target management, allowing low-risk women to be spared excessive intervention, and facilitating better resource allocation. OBJECTIVES: We wanted to address the following question: in women with gestational diabetes, does the use of fetal imaging plus maternal blood glucose concentration to indicate the need for medical management compared with glucose concentration alone reduce the risk of adverse perinatal outcomes? SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (29 January 2019), ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) (both on 29 January 2019), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials, including those published in abstract form only. Studies using a cluster-randomised design and quasi-randomised controlled trials were both eligible for inclusion, but we didn't identify any. Cross-over trials were not eligible for inclusion in our review.We included women carrying singleton pregnancies who were diagnosed with GDM, as defined by the trials' authors. The intervention of interest was the use of fetal biometry on imaging methods in addition to maternal glycaemic values for indicating the use of medical therapy for GDM. The control group was the use of maternal glycaemic values alone for indicating the use of such therapy. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and assessed risk of bias. Two review authors extracted data and checked them for accuracy. MAIN RESULTS: Three randomised controlled trials met the inclusion criteria for our systematic review - the studies randomised a total of 524 women.We assessed the three included studies as being at a low to moderate risk of bias; the nature of the intervention made it difficult to achieve blinding of participants and personnel and none of the trial reports contained information about methods of allocation concealment (and were therefore assessed as being at an unclear risk of selection bias).In all studies, the intervention was the use of fetal biometry on ultrasound to identify fetuses displaying signs of fetal macrosomia, and the use of this information to indicate the use of medical anti-hyperglycaemic treatments. Those pregnancies were subject to more stringent blood glucose targets than those without signs of fetal macrosomia.Maternal outcomesThe use of fetal biometry in addition to maternal blood glucose concentration (compared with maternal blood glucose concentration alone) may make little or no difference to the incidence of caesarean delivery (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.59 to 1.10; 2 trials, 428 women; low-certainty evidence). We are unclear about the results for hypertensive disorders of pregnancy (RR 0.80, 95% CI 0.34 to 1.89; 2 trials, 325 women) due to very low-certainty evidence. The included trials did not report on development of type 2 diabetes in the mother or maternal hypoglycaemia.Fetal and neonatal outcomesThe use of fetal biometry may make little or no difference to the incidence of neonatal hypoglycaemia (RR 0.90, 95% CI 0.57 to 1.42; 3 trials, 524 women; low-certainty evidence). Very low-certainty evidence means that we are unclear about the results for large-for-gestational age (RR 0.81, 95% CI 0.38 to 1.74; 3 trials, 524 women); shoulder dystocia (RR 0.33, 95% CI 0.01 to 7.98; 1 trial, 96 women); a composite measure of perinatal morbidity or mortality (RR 1.00, 95% CI 0.21 to 4.71; 1 study, 96 women); or perinatal mortality (RR 0.33, 95% CI 0.01 to 7.98; 1 trial, 96 women). AUTHORS' CONCLUSIONS: This review is based on evidence from three trials involving 524 women. The trials did not report some important outcomes of interest to this review, and the majority of our secondary outcomes were also unreported. The available evidence ranged from low- to very low-certainty, with downgrading decisions based on limitations in study design, imprecision and inconsistency.There is insufficient evidence to evaluate the use of fetal biometry (in addition to maternal blood glucose concentration values) to assist in guiding the medical management of GDM, on either maternal or perinatal health outcomes, or the associated costs.More research is required, ideally larger randomised studies which report the maternal and infant short- and long-term outcomes listed in this review, as well as those outcomes relating to financial and resource implications.


Assuntos
Biometria/métodos , Diabetes Gestacional/terapia , Macrossomia Fetal/prevenção & controle , Complicações na Gravidez/prevenção & controle , Feminino , Humanos , Insulina/uso terapêutico , Gravidez , Resultado da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Diabetes Metab Syndr ; 13(4): 2775-2784, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405707

RESUMO

Gestational diabetes mellitus (GDM) is one of the most common complication of pregnancy and can lead to significant perinatal mortalities as well as long term risk of comorbidities for both mother and her offspring. This systematic review aimed to explore whether combined diet and exercise interventions are associated with improved glycemic control and/or improved maternal and newborn outcomes in women with GDM when compared to dietary interventions. A search on combined diet and exercise interventions during pregnancy in women with GDM was performed in 3 electronic databases: PubMed (NCBI), ScienceDierct, and the Cochrane Library. Evaluated outcomes were fasting blood glucose levels, postprandial blood glucose levels, glycated hemoglobin percentages, total weight gain during pregnancy, proportion of caesarean delivery, proportion of patients needing insulin, neonatal birth weight, proportion of macrosomia, neonatal hypoglycemia, and preterm birth. This systematic review identified eight randomized, controlled trials involving 592 pregnant women and 350 infants. The risk of bias of the included trials ranged from high to low. The combined diet and exercise interventions reduced fasting and postprandial blood glucose levels when compared to dietary interventions. No significant differences were reported in the selected trials regarding total weight gain during pregnancy, cesarean section, neonatal birth weight, macrosomia, neonatal hypoglycemia, and preterm birth between diet plus exercise and diet groups. The combination of diet and exercise interventions help to control postprandial blood glucose concentration in women diagnosed with GDM, but did not change either maternal or newborn outcomes. REGISTRATION: PROSPERO CRD42018109896.


Assuntos
Diabetes Gestacional/terapia , Dieta , Exercício , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Glicemia/análise , Diabetes Gestacional/diagnóstico , Feminino , Humanos , Hiperglicemia/sangue , Hipoglicemia/sangue , Recém-Nascido , Gravidez , Prognóstico
5.
Stud Health Technol Inform ; 262: 39-42, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349260

RESUMO

Gestational Diabetes Mellitus (GDM) has been associated with a plethora of maternal and neonatal comorbidities as well as adverse pregnancy outcomes. Evidence supports that identifying women with GDM and tight controlling of blood glucose (BG) levels are the fundamental steps for an effective management and prevention of risks associated with GDM. Recent advances in mobile phone applications have shown that they may offer personalized health care services, improve patient's care, independence and self-management as well as enhance patient's compliance to BG monitoring and treatment. Our aim was to identify and appraise main mobile phone applications that were evaluated by published clinical studies. Therefore, mobile applications that were accepted and deployed by healthcare providers, mainly hospitals, such as MobiGuide (Spain), Pregnant+ (Norway) and GDm-Health (UK) were reviewed herein.


Assuntos
Telefone Celular , Diabetes Gestacional , Aplicativos Móveis , Diabetes Gestacional/terapia , Feminino , Humanos , Noruega , Gravidez , Espanha
6.
Fertil Steril ; 111(6): 1076-1091, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31155115

RESUMO

Fetal programming may influence childhood and adult life, determining the risk of specific diseases. During earlier stages of pregnancy, the transfer of maternal thyroid hormones to the fetus is vital for adequate neurologic development. The presence of severe maternal thyroid dysfunction, particularly severe iodine deficiency, is devastating, leading to irreversible neurologic sequelae. Moreover, mild maternal thyroid conditions, such as a mild-to-moderate iodine deficiency, may also lead to milder neurologic and behavioral conditions later during the life of the offspring. Maternal dysglycemia due to pregestational or gestational diabetes mellitus is another common situation in which fetal development encounters a hostile environment. Hyperglycemia in utero may trigger metabolic conditions in the offspring, including abnormalities of glucose tolerance and weight excess. Physicians assisting pregnant women have to be aware about these conditions, because they may go unnoticed if not properly screened. Because an early diagnosis and appropriate management may prevent most of the possible negative consequences for the progeny, the prevention, early diagnosis, and proper management of these endocrine conditions should be offered to all women undergoing pregnancy. Here, we comprehensively review the current evidence about the effects of maternal thyroid dysfunction and maternal dysglycemia on the cognitive function and carbohydrate metabolism in the offspring, two prevalent conditions of utmost importance for the child's health and development.


Assuntos
Saúde da Criança , Filho de Pais Incapacitados , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Diabetes Gestacional , Sistema Endócrino/fisiopatologia , Efeitos Tardios da Exposição Pré-Natal , Doenças da Glândula Tireoide/complicações , Fatores Etários , Criança , Comportamento Infantil , Desenvolvimento Infantil , Pré-Escolar , Cognição , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/fisiopatologia , Diabetes Gestacional/terapia , Suscetibilidade a Doenças , Metabolismo Energético , Feminino , Nível de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Saúde Materna , Sistema Nervoso/crescimento & desenvolvimento , Gravidez , Medição de Risco , Fatores de Risco , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/fisiopatologia , Doenças da Glândula Tireoide/terapia
7.
Folia Med (Plovdiv) ; 61(1): 127-133, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31237851

RESUMO

BACKGROUND: Written health educational materials are an integral part of the treatment process. Because of the constantly increasing gestational diabetes mellitus (GDM) global rate, pregnant women require accessible, easy-to-understand and evidence-based medical information about this pregnancy complication. AIM: To adapt and elaborate printed educational materials on GDM and to evaluate the usefulness of the produced training materials and pregnant women's satisfaction. MATERIALS AND METHODS: The present study implemented a methodological approach covering three phases: (1) systematic literature review; (2) compilation of printed educational materials for pregnant women with GDM; (3) evaluation of the usefulness and satisfaction with the produced educational materials through a focus group consisting of pregnant women. A seven-item self-administered feedback questionnaire was adopted for evaluation of patient satisfaction after the use of educational materials. RESULTS: An educational manual was developed in compliance with the main requirements for effectiveness of educational materials referring to content, structure, language, layout and illustrations. The usefulness of the educational manual and patient satisfaction were evaluated by a sample group of 20 women with GDM. Approximately 95% agreed or strongly agreed that the information in the educational manual was useful. The patients' assessment of the understanding and readability of the written materials showed a satisfaction rate of 85%. The overall assessment for the educational materials was very high - excellent (65%), very good (30%) and good (5%). CONCLUSION: The provision of educational materials on GDM can enhance pregnant women's health literacy as well as their responsibility, motivation and attitude to their personal health.


Assuntos
Diabetes Gestacional/terapia , Educação em Saúde , Satisfação do Paciente , Adulto , Feminino , Humanos , Gravidez , Inquéritos e Questionários
8.
Diabetes Metab Syndr ; 13(3): 1827-1831, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235101

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) complicates the health of mother and child not only in the short term but also in the long term basis. Addressing GDM through early detection and proper management is vital to improve maternal and child health. Identifying existing barriers for detection and management is important for policy improvement. This study aims to explore barriers for detection and management of GDM in Wolaita Zone, Southern Ethiopia. METHODS: A qualitative study was conducted. Health professionals working in antenatal clinic, delivery, and other maternal health services were selected purposively. A total of 18 in-depth interviews were done. The transcripts were imported into NVIVO version 12 software packages. A qualitative thematic analysis approach was used to analyze the data. RESULTS: Screening of women for GDM was done based on the risk factor assessment within 24-28 weeks of gestational age. The participants mentioned that they made diagnosis of GDM based on the World Health organization criteria. Barriers for detection and management of GDM include; lack of standard guidelines and protocols, lack of awareness among mid-level health care providers on GDM, inadequate trained health care providers, shortage of supplies and equipment and late antenatal care visits. CONCLUSIONS: Policy makers and health care leadership need to address challenges by availing standard guidelines and protocols, providing on job training for health care providers, fulfilling supplies and consumables and working on early antenatal visits of pregnant mothers.


Assuntos
Competência Clínica , Diabetes Gestacional/diagnóstico , Programas de Rastreamento/psicologia , Cooperação do Paciente , Guias de Prática Clínica como Assunto/normas , Adulto , Comportamento Cooperativo , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/psicologia , Diabetes Gestacional/terapia , Gerenciamento Clínico , Etiópia/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Gravidez , Prognóstico , Pesquisa Qualitativa , Inquéritos e Questionários
9.
BMC Pregnancy Childbirth ; 19(1): 200, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196116

RESUMO

BACKGROUND: Despite many guidelines for the management of gestational diabetes available internationally, little work has been done to summarize and assess the content of existing guidelines. A paucity of analysis guidelines within in a unified system may be one explanatory factor. So this study aims to analyze and evaluate the contents of all available guidelines for the management of gestational diabetes. METHOD: Relevant clinical guidelines were collected through a search of relevant guideline websites and databases (PubMed, Web of Science, Embase, etc.). Fourteen guidelines were identified, and each guideline was assessed for quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Two independent reviewers extracted guideline recommendations using a "recommendation matrix" through which basic guideline information and consistency between search strategy and selection of evidence, between selected evidence and interpretation, and between interpretation and resulting recommendations were analyzed. RESULTS: Fourteen documents were analyzed, and a total of 361 original recommendations for gestational diabetes mellitus (GDM) management were assessed. In all guidelines included, the recommendations were developed in five domains, namely, diagnosis of GDM, prenatal care, intrapartum care, neonatal care and postpartum care. Different guidelines appeared to have significant discrepancy in consistency of guideline content, but overall, there was consistency between search strategy and selection of evidence, between selected evidence and interpretation, and between interpretation and resulting recommendations (scilicet 49.31, 57.20 and 58.17%, respectively). CONCLUSION: Although commonality in most recommendations existed, there were still some discrepancies between guidelines. Consistency of guidelines on the management of GDM in pregnancy is highly variable and needs to be improved.


Assuntos
Diabetes Gestacional/terapia , Administração dos Cuidados ao Paciente , Feminino , Humanos , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Guias de Prática Clínica como Assunto , Gravidez
10.
Medicine (Baltimore) ; 98(25): e16038, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232936

RESUMO

INTRODUCTION: The purpose of this protocol is to provide a network meta-analysis methodology that compares the effects of metformin and physical exercise in the prevention and treatment of gestational diabetes mellitus (GDM) and its associated fetal and maternal morbidity. METHODS AND ANALYSIS: This protocol conforms to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the recommendations of the Cochrane Collaboration Handbook. An electronic search will be conducted in MEDLINE, EMBASE, Web of Science and the Cochrane Library, from the inception until July 2019. There will be no language restrictions. The Cochrane Collaboration tool for assessing risk of bias (RoB2) and the quality assessment tool for quantitative studies will be used. The Grading of Recommendations, Assessment, Development and Evaluation scale will be used to evaluate the strength of the evidence. A Bayesian network meta-analysis will be carried out, which allows direct and indirect comparison of the interventions, for the risk of GDM, prematurity, caesarean section, macrosomia, hypertensive disorders, insulin requirement, and differences in basal glucose, maternal weight, and weight of the newborn. DISCUSSION: With this protocol, a methodology is established that resolves the limitations of previous meta-analysis. It will be possible to determine the difference of effect between physical exercise and metformin in the main outcomes of the GDM, as well as the type and intensity of the exercise, and the dose of metformin, more effective. ETHICS AND DISSEMINATION: The data included in the network meta-analysis will be obtained from trials that meet accepted ethical standards and the Declaration of Helsinki. The results will be published in a peer-reviewed journal. The evidence obtained could be included in the guidelines of clinical practice in pregnancy. STRENGTHS AND LIMITATIONS: A comprehensive methodology is established for the analysis, through network meta-analysis, of the comparative efficacy of metformin and physical exercise in gestational diabetes mellitus. The results obtained could help medical professionals by establishing the best evidence-based interventions which may be recommended for these population groups. REGISTRATION NUMBER: PROSPERO CRD42019121715.


Assuntos
Diabetes Gestacional/terapia , Exercício , Hipoglicemiantes/uso terapêutico , Metanálise como Assunto , Metformina/uso terapêutico , Revisão Sistemática como Assunto , Feminino , Macrossomia Fetal , Humanos , Meta-Análise em Rede , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal
11.
Sultan Qaboos Univ Med J ; 19(1): e4-e10, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31198588

RESUMO

This review aimed to examine the literature related to non-medical strategies used to improve pregnancy outcomes of women with gestational diabetes mellitus (GDM) and to determine the risk of bias of the selected studies. Treatment for GDM is changing due to the increased prevalence of GDM-related maternal and neonatal complications. A growing body of evidence suggests that early detection, aggressive monitoring and management of GDM using non-medical strategies can greatly improve outcomes for pregnant women and their babies. PubMed® (National Library of Medicine, Bethesda, Maryland, USA), Cumulative Index to Nursing and Allied Health Literature® (EBSCO Information Services, Ipswich, Massachusetts, USA), SCOPUS® (Elsevier, Amsterdam, Netherlands) and other electronic databases were searched for relevant literature published between 2005-2015. A total of 15 studies on women with GDM that met the inclusion criteria were included in this review and assessment of risk of bias was performed for each study. The results of the studies were consistent with findings of significant improvement in maternal and neonatal outcomes when diet was combined with moderate exercise, self-monitoring of blood glucose and individualised health education. Future intervention studies in this area should be focussed on identifying and implementing factors that enhance and encourage adherence to the healthy behaviours mentioned above.


Assuntos
Diabetes Gestacional/terapia , Complicações na Gravidez/prevenção & controle , Resultado da Gravidez , Diabetes Gestacional/psicologia , Dietoterapia/psicologia , Exercício/psicologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/psicologia , Complicações na Gravidez/terapia
12.
Obstet Gynecol Surv ; 74(5): 289-297, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31098642

RESUMO

Importance: Diabetes affects 6% to 9% of pregnancies, with gestational diabetes mellitus accounting for more than 90% of cases. Pregestational and gestational diabetes are associated with significant maternal and fetal risks; therefore, screening and treatment during pregnancy are recommended. Recommendations regarding the preferred treatment of diabetes in pregnancy have recently changed, with slight differences between American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) recommendations. Objective: Our review discusses the diagnosis, management, and treatment of pregestational and gestational diabetes with the oral hypoglycemic agents metformin and glyburide as well as insulin. We also review the evidence for the safety and efficacy of these medications in pregnancy. Evidence Acquisition: Articles were obtained from PubMed, the ACOG Practice Bulletin on Gestational Diabetes Mellitus, and the SMFM statement on the pharmacological treatment of gestational diabetes. Results: Insulin does not cross the placenta and has an established safety profile in pregnancy and is therefore considered a first-line treatment for gestational diabetes. Metformin and glyburide have also been shown to be relatively safe in pregnancy but with more limited long-term data. Regarding maternal and fetal outcomes, metformin is superior to glyburide and similar to insulin. Conclusions and Relevance: Insulin is the preferred pharmacologic treatment according to ACOG. However, SMFM has stated that outcomes with metformin are similar, and it may also be considered as first-line therapy. Both agree that the available data show that metformin is safer and superior to glyburide, and glyburide is no longer recommended as a first-line therapy for the treatment of gestational diabetes.


Assuntos
Diabetes Gestacional/terapia , Gravidez em Diabéticas/terapia , Diabetes Gestacional/diagnóstico , Exercício , Feminino , Glibureto/administração & dosagem , Glibureto/farmacologia , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/farmacologia , Insulina/administração & dosagem , Insulina/farmacologia , Metformina/administração & dosagem , Metformina/farmacologia , Gravidez , Gravidez em Diabéticas/diagnóstico , Cuidado Pré-Natal
13.
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
14.
Wien Klin Wochenschr ; 131(Suppl 1): 103-109, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-30980163

RESUMO

In 1989 the St. Vincent Declaration aimed to achieve comparable pregnancy outcomes in diabetic and non-diabetic women. However, currently women with pre-gestational diabetes still feature a higher risk of perinatal morbidity and even increased mortality. This fact is mostly ascribed to a persistently low rate of pregnancy planning and pre-pregnancy care with optimization of metabolic control prior to conception. All women should be experienced in the management of their therapy and on stable glycemic control prior to the conception. In addition, thyroid dysfunction, hypertension as well as the presence of diabetic complications should be excluded before pregnancy or treated adequately in order to decrease the risk for a progression of complications during pregnancy as well as maternal and fetal morbidity. Especially in women with type 1 diabetes mellitus in early pregnancy the risk of hypoglycemia is highest and decreases with the progression of pregnancy due to hormonal changes causing steady increase of insulin resistance. In addition, obesity increases worldwide and contributes to increasing numbers of women at childbearing age with type 2 diabetes mellitus and further deterioration of pregnancy outcomes in diabetic women. Maternal glycemic control should aim to achieve normoglycemia and normal HbA1c levels, possibly without hypoglycemia, but is associated with the development of diabetic embryopathy and fetopathy if dysglycemia occurs. Intensified insulin therapy with multiple daily insulin injections and pump treatment are effective in reaching good metabolic control during pregnancy. Oral glucose lowering drugs (Metformin) may be considered in obese women with type 2 diabetes mellitus to increase insulin sensitivity but should be also prescribed cautiously due to crossing the placenta and lack of long-time follow up data of the offspring.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Resultado da Gravidez , Glicemia/análise , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/prevenção & controle , Diabetes Gestacional/terapia , Feminino , Humanos , Hipoglicemia , Insulina , Guias de Prática Clínica como Assunto , Gravidez
15.
J Perinat Med ; 47(5): 553-557, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-30982004

RESUMO

Objectives To evaluate whether gestational diabetes mellitus (GDM) diagnosed by different criteria impacts perinatal outcome. Methods This was a retrospective study of deliveries with a diagnosis of GDM (2014-2016). Perinatal outcomes were compared between patients with: (1) GDM diagnosed according to a single abnormal value on the 100-g oral glucose tolerance test (OGTT); (2) two or more abnormal OGTT values; and (3) a 50-g glucose challenge test (GCT) value ≥200 mg/dL. Results A total of 1163 women met the inclusion criteria, of whom 441 (37.9%) were diagnosed according to a single abnormal OGTT value, 627 (53.9%) had two or more abnormal OGTT values and 95 (8.17%) had a GCT value ≥200 mg/dL. Diet-only treatment was significantly higher in the single abnormal value group (70.3% vs. 65.1% vs. 50.5%) and rates of medical treatment were significantly higher in the GCT ≥ 200 mg/dL group (P < 0.05). Women in the GCT ≥ 200 mg/dL group had higher rates of neonatal intensive care unit (NICU) admission (10.5% vs. 2.7% vs. 2.8%, P < 0.001) and neonatal hypoglycemia (5.3% vs. 0.5% vs. 0.8%, P < 0.001). On multivariate logistic regression, GCT ≥ 200 mg/dL was no longer associated with higher rates of NICU admission and neonatal hypoglycemia (P > 0.05). Conclusion No difference was noted in the perinatal outcome amongst the different methods used for diagnosing GDM.


Assuntos
Diabetes Gestacional/diagnóstico , Resultado da Gravidez , Adulto , Diabetes Gestacional/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Adulto Jovem
16.
BMC Pregnancy Childbirth ; 19(1): 107, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30922259

RESUMO

BACKGROUND: Diabetes is the most common medical condition in pregnant women and its complications affect both mother and fetus. The beneficial effects of vitamin D on gestational diabetes have been shown, though data on the effects of co-administration of vitamin D with other nutrients on pregnancy outcomes in gestational diabetes (GDM) are scarce. This study was aimed to determine the effects of magnesium-zinc-calcium-vitamin D co-supplementation on parameters of inflammation and oxidative stress, and pregnancy outcomes among women with GDM. METHODS: This randomized, double-blinded, placebo-controlled trial was conducted on 60 women with GDM not taking oral hypoglycemic agents. Patients were randomly assigned to take magnesium-zinc-calcium-vitamin D supplements (n = 30) or placebo (n = 30) for 6 weeks. Fasting blood samples were collected from participants at baseline and after the 6-week intervention to measure related biomarkers. RESULTS: Magnesium-zinc-calcium-vitamin D co-supplementation resulted in a significant reduction in serum high-sensitivity C-reactive protein (- 1.2 ± 3.5 vs. + 0.8 ± 2.0 mg/L, P = 0.01) and plasma malondialdehyde concentrations (- 0.3 ± 0.3 vs. + 0.3 ± 1.1 µmol/L, P = 0.003), as well as a significant increase in total antioxidant capacity levels (+ 38.2 ± 76.5 vs. -16.3 ± 93.5 mmol/L, P = 0.01), compared to placebo. We found a decreasing trend in newborns' weight (3089.8 ± 519.9 vs. 3346.3 ± 411.1 g, P = 0.05) and the rate of macrosomia (3.3% vs. 16.7%, P = 0.08) in the magnesium-zinc-calcium-vitamin D supplemented women. CONCLUSIONS: Overall, the findings of this study have demonstrated that magnesium-zinc-calcium-vitamin D co-supplementation for 6 weeks to women with GDM may reduce biomarkers of inflammation and oxidative stress. This study was retrospectively registered on 25 April 2017 in the Iranian website ( www.irct.ir ) for clinical trials registration ( http://www.irct.ir : IRCT201704225623N109).


Assuntos
Cálcio/uso terapêutico , Diabetes Gestacional/terapia , Suplementos Nutricionais , Magnésio/uso terapêutico , Vitamina D/uso terapêutico , Zinco/uso terapêutico , Adulto , Antioxidantes/metabolismo , Biomarcadores/sangue , Peso ao Nascer , Proteína C-Reativa/metabolismo , Diabetes Gestacional/sangue , Método Duplo-Cego , Feminino , Humanos , Recém-Nascido , Inflamação , Malondialdeído/sangue , Estresse Oxidativo , Gravidez , Resultado da Gravidez , Resultado do Tratamento , Adulto Jovem
17.
Gynecol Endocrinol ; 35(9): 752-755, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30905204

RESUMO

Silver-Russell syndrome (SRS) is a heterogeneous disorder characterized by severe intrauterine and postnatal growth retardation and typical dysmorphic features including body asymmetry, relative macrocephaly, protruding forehead, and feeding difficulties. Previous descriptions of SRS focus on the management of specific issues in children. Herein, we present clinical and metabolic characteristics of an adult woman with SRS accompanied by gestational diabetes mellitus (GDM). Given the rare circumstances presented in our case, the emerging questions concerning the management of metabolic issues and fertility potential in adult SRS patient deserve more attention. Further, long-term follow up is essential to gain future insights into the natural history and optimal management in adulthood.


Assuntos
Diabetes Gestacional , Nascimento Vivo , Síndrome de Silver-Russell , Adulto , Grupo com Ancestrais do Continente Asiático , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/genética , Diabetes Gestacional/terapia , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/genética , Complicações na Gravidez/terapia , Resultado da Gravidez , Síndrome de Silver-Russell/complicações , Síndrome de Silver-Russell/diagnóstico , Síndrome de Silver-Russell/genética , Síndrome de Silver-Russell/terapia , Nascimento a Termo
18.
Pregnancy Hypertens ; 15: 98-107, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30825935

RESUMO

OBJECTIVES: To evaluate the feasibility and effectiveness of a postpartum lifestyle intervention after pregnancies complicated by preeclampsia, fetal growth restriction (FGR) and/or gestational diabetes mellitus (GDM) to improve maternal risk factors for future cardiometabolic disease. METHODS: Women following a complicated pregnancy were included six months postpartum in this specific pre-post controlled designed study. It has been conducted in one tertiary and three secondary care hospitals (intervention group) and one secondary care hospital (control group). The program consisted of a computer-tailored health education program combined with three individual counselling sessions during seven months. Primary outcome measures were the proportion of eligible women and weight change during the intervention. RESULTS: Two hundred and six women were willing to participate. The proportion of eligible women who complied with the intervention was 23%. Major barrier was lack of time. Adjusted weight change attributed to lifestyle intervention was -1.9 kg (95%-CI -4.3 to -0.3). Further changes were BMI (-0.9 kg/m2 (95%-CI -1.4 to -0.3)), waist-to-hip ratio (-0.04 cm/cm (95%-CI -0.06 to -0.03)), blood pressure medication use (19% (95%-CI 9% to 28%)), HOMA2-score (59 %S (95%-CI 18 to 99)) and total fat intake (-2.9 gr (95%-CI -4.6 to -1.2)). CONCLUSIONS: The results support feasibility and effectiveness of a lifestyle intervention after complicated pregnancies to improve maternal cardiometabolic risk factors. Further randomized controlled studies are needed with longer follow-up to evaluate durability. In the meantime, we suggest health care professionals to offer lifestyle interventions to women after complicated pregnancies.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/prevenção & controle , Estilo de Vida Saudável , Período Pós-Parto , Diabetes Gestacional/terapia , Estudos de Viabilidade , Feminino , Retardo do Crescimento Fetal/terapia , Humanos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Cuidado Pós-Natal/métodos , Pré-Eclâmpsia/terapia , Gravidez , Fatores de Risco
19.
Diabetes Care ; 42(5): 810-815, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30765428

RESUMO

OBJECTIVE: Continuous glucose monitoring (CGM) provides far greater detail about fetal exposure to maternal glucose across the 24-h day. Our aim was to examine the role of temporal glucose variation on the development of large for gestational age (LGA) infants in women with treated gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: We performed a prospective observational study of 162 pregnant women with GDM in specialist multidisciplinary antenatal diabetes clinics. Participants undertook 7-day masked CGM at 30-32 weeks' gestation. Standard summary indices and glycemic variability measures of CGM were calculated. Functional data analysis was applied to determine differences in temporal glucose profiles. LGA was defined as birth weight ≥90th percentile adjusted for infant sex, gestational age, maternal BMI, ethnicity, and parity. RESULTS: Mean glucose was significantly higher in women who delivered an LGA infant (6.2 vs. 5.8 mmol/L, P = 0.025, or 111.6 mg/dL vs. 104.4 mg/dL). There were no significant differences in percentage time in, above, or below the target glucose range or in glucose variability measures (all P > 0.05). Functional data analysis revealed that the higher mean glucose was driven by a significantly higher glucose for 6 h overnight (0030-0630 h) in mothers of LGA infants (6.0 ± 1.0 mmol/L vs. 5.5 ± 0.8 mmol/L, P = 0.005, and 108.0 ± 18.0 mg/dL vs. 99.0 ± 14.4 mg/dL). CONCLUSIONS: Mothers of LGA infants run significantly higher glucose overnight compared with mothers without LGA infants. Detecting and addressing nocturnal glucose control may help to further reduce rates of LGA in women with GDM.


Assuntos
Glicemia/metabolismo , Ritmo Circadiano/fisiologia , Diabetes Gestacional/sangue , Diabetes Gestacional/terapia , Macrossomia Fetal/etiologia , Adolescente , Adulto , Peso ao Nascer/fisiologia , Automonitorização da Glicemia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/sangue , Macrossomia Fetal/epidemiologia , Idade Gestacional , Teste de Tolerância a Glucose , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Adulto Jovem
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