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2.
Einstein (Sao Paulo) ; 18: eAO4682, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31664330

RESUMO

OBJECTIVE: To investigate the epidemiological data of hypertension in pregnant women, as well as to identify its possible associated events. METHODS: Data collection was performed at the high-risk prenatal outpatient clinic and in the maternity ward at a public hospital in the São Paulo city, during the morning and afternoon periods, from October 2015 to July 2016. A questionnaire with 22 questions prepared by the researchers was used. The margin of error was 5% and the confidence level was 95%. For the calculation, the two-proportion equality, Pearson correlation and ANOVA tests were used. RESULTS: Among the interviewees, 43% had chronic hypertension, 33.3% presented with up to 20 weeks of gestation, 23.7% presented after the 20th week of gestation, 62.3% were between 18 and 35 years of age, 78.1% had a family history of hypertension, and among those aged 36 to 45 years, 11.4% were in the first gestation, and 26.3% in the second gestation. Considering the associated conditions, diabetes prevailed with 50%; obesity with 22.2%, and the most selected foods for consumption among pregnant women, 47.5% had high energy content (processed/ultraprocessed). CONCLUSION: After an epidemiological analysis of the prevalence of hypertension, pregnant women with chronic hypertension, preexisting hypertension diagnosed during pregnancy, and hypertensive disease of pregnancy were identified. Regarding the possible factors associated with arterial hypertension, higher age, family history of hypertension, preexistence of hypertension, late pregnancies, diabetes, obesity and frequent consumption of processed/ultraprocessed foods were found.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Feminino , Preferências Alimentares , Humanos , Idade Materna , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Gravidez , Gravidez em Diabéticas/epidemiologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
3.
Int J Gynaecol Obstet ; 147(3): 404-412, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479156

RESUMO

OBJECTIVE: To characterize the demographics, comorbidities, management, and outcomes of pregnant women with pre-gestational and gestational diabetes (GDM), including overt and true GDM, taking into account HIV infection and the influence of exposure to oral hypoglycemic agents (OHAs). METHODS: A review of medical records of 1071 diabetic pregnancies (between 2012 and 2018) at a tertiary hospital in South Africa. RESULTS: Of the women, 43% had GDM, 19% had type 1 diabetes (T1DM), and 38% had type 2 diabetes (T2DM). Each group had a mean initial body mass index (BMI) >25 kg/m2 . Despite poor initial HbA1c for pre-gestational groups, over 90% of the cohort achieved glycemic control by the time of delivery. The rate of prematurity was 30.9%. Perinatal mortality (PNM) was 5.1% for the pre-gestational group and 1.8% for GDM. Of the cohort, 23.9% was HIV infected. PNM was higher in the HIV-infected pregnancies (9.4%) than non-HIV exposed pregnancies (1.8%, P<0.001). The macrosomia rate was higher in the glibenclamide-exposed group than the insulin-alone group (12.2% vs 0%, P=0.025). CONCLUSION: Obesity is a significant predictor for macrosomia and was high in all groups. In a low-/middle-income country setting with a high prevalence of HIV and high usage of OHAs as an alternative to insulin therapy, HIV might be associated with higher PNM and glibenclamide with increased rates of macrosomia, which warrants further exploration.


Assuntos
Diabetes Gestacional/epidemiologia , Infecções por HIV/epidemiologia , Gravidez em Diabéticas/epidemiologia , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/etiologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Recém-Nascido Prematuro , Mortalidade Perinatal , Gravidez , Estudos Retrospectivos , África do Sul/epidemiologia , Adulto Jovem
4.
Chem Pharm Bull (Tokyo) ; 67(7): 648-653, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31257320

RESUMO

Diabetic embryopathy is a diabetic complication, in which maternal hyperglycemia in early pregnancy causes birth defects in newborn infants. Under maternal diabetic conditions, hyperglycemia disturbs intracellular molecular activities and organelles functions. These include protein misfolding in the endoplasmic reticulum (ER), overproduction of reactive oxygen species (ROS) in mitochondria, and high levels of nitric oxide (NO). The resultant ER, oxidative, and nitrosative stresses activate apoptotic machinery to cause cell death in the embryo, ultimately resulting in developmental malformations. Based on the basic research data, efforts have been made to develop interventional strategies to alleviate the stress conditions and to reduce embryonic malformations. One of the challenges in birth defect prevention is to identify effective and safe agents to be used in pregnancy. One approach is to search and characterize naturally occurring phytochemicals, including flavonoids, curcuminoids and stilbenoids, for use in prevention of diabetic embryopathy.


Assuntos
Anormalidades Congênitas/prevenção & controle , Compostos Fitoquímicos/uso terapêutico , Gravidez em Diabéticas/prevenção & controle , Curcumina/química , Curcumina/farmacologia , Curcumina/uso terapêutico , Estresse do Retículo Endoplasmático/efeitos dos fármacos , Feminino , Humanos , Estresse Oxidativo/efeitos dos fármacos , Compostos Fitoquímicos/química , Compostos Fitoquímicos/farmacologia , Gravidez , Estilbenos/química , Estilbenos/farmacologia , Estilbenos/uso terapêutico
5.
Dan Med J ; 66(6)2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31256772

RESUMO

INTRODUCTION: The risk of congenital heart defects in the offspring of women with Type 2 diabetes is only sparsely described. The aim of this review was to estimate the prevalence of congenital heart defects in offspring of women with Type 2 diabetes in comparison to offspring of women with Type 1 diabetes and to offspring of the background population. METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A literature search was performed in the PubMed, Embase and Cochrane databases. Studies were included if they were published from 2007 to 2018, comprised a minimum of 200 offspring of women with Type 2 diabetes and examined the prevalence of congenital heart defects. RESULTS: Five cohort studies with a total of 23,845 offspring of women with Type 2 diabetes were included. The studies were heterogeneous with respect to method of diagnosis and whether terminated pregnancies were included, and a meta-analysis could not be performed. The mean prevalence of congenital heart defects was 44 (range: 26-65) per 1,000 offspring. The mean relative risk was 0.82 (range: 0.53-1.01) compared with offspring of women with Type 1 diabetes, and 3.83 (range: 2.53-5.49) compared with the background population. A positive association was described between the prevalence of congenital heart defects and the maternal glycated haemoglobin level, but not with medical treatment. CONCLUSIONS: The risk of congenital heart defects among offspring of women with Type 2 diabetes was comparable to that of offspring of women with Type 1 diabetes and almost four times higher than in the background population.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Cardiopatias Congênitas/epidemiologia , Gravidez em Diabéticas , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Cardiopatias Congênitas/diagnóstico , Humanos , Gravidez , Prevalência , Fatores de Risco
6.
Int J Mol Sci ; 20(12)2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31242551

RESUMO

Infants born to diabetic or obese mothers are at greater risk of heart disease at birth and throughout life, but prevention is hindered because underlying mechanisms remain poorly understood. Using a rat model, we showed that prenatal exposure to maternal diabetes and a high-fat diet caused diastolic and systolic dysfunction, myocardial lipid accumulation, decreased respiratory capacity, and oxidative stress in newborn offspring hearts. This study aimed to determine whether mitochondrial dynamism played a role. Using confocal live-cell imaging, we examined mitochondrial dynamics in neonatal rat cardiomyocytes (NRCM) from four prenatally exposed groups: controls, diabetes, high-fat diet, and combination exposed. Cardiac expression of dynamism-related genes and proteins were compared, and gender-specific differences were evaluated. Findings show that normal NRCM have highly dynamic mitochondria with a well-balanced number of fusion and fission events. Prenatal exposure to diabetes or a high-fat diet impaired dynamism resulting in shorter, wider mitochondria. Mechanisms of impaired dynamism were gender-specific and protein regulated. Females had higher expression of fusion proteins which may confer a cardioprotective effect. Prenatally exposed male hearts had post-translational modifications known to impair dynamism and influence mitophagy-mediated cell death. This study identifies mitochondrial fusion and fission proteins as targetable, pathogenic regulators of heart health in offspring exposed to excess circulating maternal fuels.


Assuntos
Dieta Hiperlipídica/efeitos adversos , Desenvolvimento Fetal , Coração/embriologia , Dinâmica Mitocondrial , Organogênese , Gravidez em Diabéticas , Animais , Animais Recém-Nascidos , Biomarcadores , Feminino , Desenvolvimento Fetal/genética , Imunofluorescência , Regulação da Expressão Gênica , Masculino , Mitocôndrias Cardíacas/genética , Mitocôndrias Cardíacas/metabolismo , Mitocôndrias Cardíacas/ultraestrutura , Dinâmica Mitocondrial/genética , Proteínas Mitocondriais/genética , Proteínas Mitocondriais/metabolismo , Miócitos Cardíacos/metabolismo , Organogênese/genética , Gravidez , Processamento de Proteína Pós-Traducional , Ratos , Fatores Sexuais
7.
Rev Med Suisse ; 15(653): 1143-1146, 2019 May 29.
Artigo em Francês | MEDLINE | ID: mdl-31148426

RESUMO

In patients with diabetes, pregnancy is associated with high maternal and fetal risks, especially in unplanned pregnancies. Current evidence confirms that timely family planning and interdisciplinary care and management starting at the preconceptional period can optimize metabolic control and significantly reduce these risks. The purpose of this article is to summarize the different aspects to consider as well as provide tools to use when preparing patients with diabetes for a pregnancy.


Assuntos
Diabetes Mellitus , Cuidado Pré-Concepcional , Gravidez em Diabéticas , Serviços de Planejamento Familiar , Feminino , Humanos , Gravidez
8.
J Pak Med Assoc ; 69(6): 911-912, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31201405

RESUMO

This communication shares the challenges and concerns associated with marriage in persons living with diabetes. It classifies the challenges as psychosocial and biomedical, and lists counselling tips to tackle these. It dispels the various myths associated with marriage, andsuggests proactive steps to improve societal attitudes and practices.


Assuntos
Atitude Frente a Saúde , Diabetes Mellitus , Casamento , Gravidez em Diabéticas , Sexualidade , Aconselhamento , Feminino , Humanos , Masculino , Cuidado Pré-Concepcional , Gravidez , Autorrevelação , Estigma Social
9.
Diabetes Res Clin Pract ; 154: 1-8, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31220483

RESUMO

AIMS: Women with pre-existing diabetes should plan for optimal care of the disease before, during and after pregnancy. The aim of this study was to assess the quality of diabetes mellitus monitoring and care before, during and after pregnancy in a large cohort of women. METHODS: 1913 diabetic women resident in the Lombardy Region (Italy) who experienced at least a birth between 2011 and 2015 and exhibited signs of diabetes ≥2 years before delivery were identified using the healthcare utilization database. Antidiabetic care was defined via outpatient examinations (i.e., assessments of glycated haemoglobin, lipid profile, urine albumin excretion and serum creatinine, and dilated eye exams) and use of antidiabetic drugs. Differences in adherence to recommendations before, during and after pregnancy were assessed by the non-parametric McNemar's test among the whole cohort and among the subgroup with type 1 diabetes. RESULTS: Adherence to recommendations was very poor before pregnancy, ranging from 13% to 42% for dilated eye and serum creatinine exam, respectively. During pregnancy, a significant portion of women increased adherence to all recommendations (e.g., glycated haemoglobin from 20% to 47%, p-value < 0.001), with the exception of lipid profile control. After pregnancy, adherence dropped to pre-pregnancy levels. A similar trend was observed in the use of antidiabetic drugs. Although women with type 1 diabetes showed better adherence across all periods, the same patterns emerged. CONCLUSIONS: Besides an improvement in the indicators of clinical adherence during pregnancy, the management of diabetes among pregnant women remains sub-optimal both before and after the birth.


Assuntos
Biomarcadores/sangue , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Cooperação do Paciente/estatística & dados numéricos , Gravidez em Diabéticas/sangue , Adolescente , Adulto , Estudos de Coortes , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/prevenção & controle , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Humanos , Hipoglicemiantes , Itália/epidemiologia , Pessoa de Meia-Idade , Gravidez , Gravidez em Diabéticas/epidemiologia , Gravidez em Diabéticas/prevenção & controle , Prognóstico , Adulto Jovem
10.
PLoS One ; 14(5): e0216477, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141530

RESUMO

BACKGROUND: Maternal hypertension, type 2 diabetes (T2D) and obesity are associated with an increased risk of having offspring with conotruncal heart defects (CTDs). Prior studies have identified sets of single nucleotide polymorphisms (SNPs) that are associated with risk for each of these three adult phenotypes. We hypothesized that these same SNPs are associated with maternal risk of CTDs in offspring. METHODS AND RESULTS: We evaluated the parents of children with a CTD ascertained from the Children's Hospital of Philadelphia (n = 466) and by the Pediatric Cardiac Genomic Consortium (n = 255). We used a family-based design to assess the association between CTDs and the maternal genotype for individual hypertension, T2D, and obesity-related SNPs and found no association between CTDs and the maternal genotype for any individual SNP. In addition, we calculated genetic risk scores (GRS) for hypertension, T2D, and obesity using previously published GRS formulas. When comparing the GRS of mothers to fathers, there were no statistically significant differences in the mean for the combined GRS or the GRS for each individual condition. However, when we categorized the mothers and fathers of cases with CTDs as having high (>95th percentile) or low (≤95th percentile) scores, compared to fathers, mothers had almost two times the odds of having a high GRS for hypertension (OR 1.7, 95% CI 1.0, 2.8) and T2D (OR 1.8, 95% CI 1.1, 3.1). CONCLUSIONS: Our results support a link between maternal genetic risk for hypertension/T2D and CTDs in their offspring. These associations might be independent of maternal phenotype at conception.


Assuntos
Diabetes Mellitus Tipo 2/genética , Cardiopatias Congênitas/genética , Hipertensão/genética , Polimorfismo de Nucleotídeo Único , Complicações Cardiovasculares na Gravidez/genética , Gravidez em Diabéticas/genética , Adulto , Diabetes Mellitus Tipo 2/patologia , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Cardiopatias Congênitas/patologia , Cardiopatias Congênitas/fisiopatologia , Humanos , Hipertensão/patologia , Hipertensão/fisiopatologia , Masculino , /fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/patologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Gravidez em Diabéticas/patologia , Gravidez em Diabéticas/fisiopatologia , Fatores de Risco
11.
Indian Pediatr ; 56(4): 314-316, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-31064902

RESUMO

OBJECTIVE: To compare the frequency of asymmetric septal hypertrophy in appropriate for gestational age infants born to diabetic mothers with those born to non-diabetic mothers. METHODS: We compared 38 full term infants born to diabetic mothers with 85 full term infants of non-diabetic mothers. 2-D echocardiography was obtained in the first 24 hours after birth. RESULTS: Asymmetric septal hypertrophy was only present in infants born to diabetic mothers (50% vs. 0%; P<0.001). Intraventricular septum thickness and intraventricular septum/posterior wall of the left ventricle ratio was also significantly higher in the first group (P<0.001). We found no correlation between mother´s glycated hemoglobin levels and intraventricular septum thickness in newborns. CONCLUSION: Asymmetric septal hypertrophy is a common finding in infants born to diabetic mothers, even if they are appropriate for gestational age.


Assuntos
Idade Gestacional , Defeitos dos Septos Cardíacos , Gravidez em Diabéticas/epidemiologia , Diabetes Mellitus/epidemiologia , Ecocardiografia , Feminino , Hemoglobina A Glicada/análise , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Defeitos dos Septos Cardíacos/epidemiologia , Defeitos dos Septos Cardíacos/patologia , Humanos , Hipertrofia , Recém-Nascido , Masculino , Mães/estatística & dados numéricos , Gravidez
12.
JAMA ; 321(18): 1811-1819, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31087027

RESUMO

Importance: The presence of preexisting type 1 or type 2 diabetes in pregnancy increases the risk of adverse maternal and neonatal outcomes, such as preeclampsia, cesarean delivery, preterm delivery, macrosomia, and congenital defects. Approximately 0.9% of the 4 million births in the United States annually are complicated by preexisting diabetes. Observations: Women with diabetes have increased risk for adverse maternal and neonatal outcomes, and similar risks are present with type 1 and type 2 diabetes. Both forms of diabetes require similar intensity of diabetes care. Preconception planning is very important to avoid unintended pregnancies and to minimize risk of congenital defects. Hemoglobin A1c goals are less than 6.5% at conception and less than 6.0% during pregnancy. It is also critical to screen for and manage comorbid illnesses, such as retinopathy and nephropathy. Medications known to be unsafe in pregnancy, such as angiotensin-converting enzyme inhibitors and statins, should be discontinued. Women with obesity should be screened for obstructive sleep apnea, which is often undiagnosed and can result in poor outcomes. Blood pressure goals must be considered carefully because lower treatment thresholds may be required for women with nephropathy. During pregnancy, continuous glucose monitoring can improve glycemic control and neonatal outcomes in women with type 1 diabetes. Insulin is first-line therapy for all women with preexisting diabetes; injections and insulin pump therapy are both effective approaches. Rates of severe hypoglycemia are increased during pregnancy; therefore, glucagon should be available to the patient and close contacts should be trained in its use. Low-dose aspirin is recommended soon after 12 weeks' gestation to minimize the risk of preeclampsia. The importance of discussing long-acting reversible contraception before and after pregnancy, to allow for appropriate preconception planning, cannot be overstated. Conclusions and Relevance: Preexisting diabetes in pregnancy is complex and is associated with significant maternal and neonatal risk. Optimization of glycemic control, medication regimens, and careful attention to comorbid conditions can help mitigate these risks and ensure quality diabetes care before, during, and after pregnancy.


Assuntos
Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Gravidez em Diabéticas/terapia , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Feminino , Humanos , Hipoglicemia , Contracepção Reversível de Longo Prazo , Gravidez , Gravidez em Diabéticas/tratamento farmacológico
13.
Vnitr Lek ; 65(4): 256-263, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31091944

RESUMO

It is well known, that number of diabetics pregnancies is raising. It is due to growing amount of women with type 1 and type 2 diabetes, which can easily reach the right age for pregnancy. It allows new ways of diabetes treatment, new technologies and in general better health state of this women. Displacement the pregnancy to later age, leads to gestational diabetes increasing. Especially women with pregestational diabetes are in higher risk of perinatal and diabetic complications. More than half of all pregnancies are not planned and so that often not well controlled or used inappropriate medication. Preterm deliveries, acute sectiones cesarea, eclampsia, preeclampsia or higher risk of late diabetics complications are in consequencies. The article brings the current point of view to treatment diabetic pregnancies with respect to prevent all types of complications.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Pré-Eclâmpsia , Gravidez em Diabéticas , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Recém-Nascido , Pré-Eclâmpsia/etiologia , Pré-Eclâmpsia/prevenção & controle , Gravidez , Resultado da Gravidez , Gravidez em Diabéticas/tratamento farmacológico , Nascimento Prematuro
14.
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
15.
Diabetes Res Clin Pract ; 152: 58-64, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31102682

RESUMO

AIM: To report glycemic control and pregnancy outcome in pregnant women with type 1 diabetes on insulin degludec. METHODS: Twenty-two women with type 1 diabetes on degludec from conception to delivery between 2014 and 2018 were compared with 51 pregnant women with type 1 diabetes on glargine. RESULTS: Baseline characteristics were comparable, however HbA1c was higher at median 9 (range 5-19) weeks in women on degludec compared to women on glargine (6.9% (5.7-8.7); (52 (39-72) mmol/mol) versus 6.4% (5.1-10.1); (46 (32-87) mmol/mol), p = 0.04). HbA1c was similar in late pregnancy (6.3% (5.6-7.1); (45 (38-54) mmol/mol) versus 6.1% (5.2-9.0); (43 (33-75) mmol/mol), p = 0.28). The prevalence of severe hypoglycemia was 3 (14%) versus 6 (12%), p = 1.00 during pregnancy and 0 versus 1, p = 1.00 during hospital admittance after delivery. Most women on degludec used one daily injection in early (20 (91%) versus 25 (49%), p = 0.001) and late pregnancy (21 (96%) versus 19 (37%), p < 0.001). No significant differences in obstetrical and neonatal outcomes were found between the groups. Maternal hospital admittance after delivery was 2 (1-5) versus 3 (2-11) days (p = 0.004). CONCLUSIONS: Glycemic control in late pregnancy, severe hypoglycemia during and immediately after pregnancy as well as pregnancy outcome were comparable in women on degludec or glargine. Degludec initiated preconceptionally may be continued in pregnancy.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Insulina de Ação Prolongada/administração & dosagem , Gravidez em Diabéticas/tratamento farmacológico , Adulto , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Hemoglobina A Glicada/análise , Hemoglobina A Glicada/metabolismo , Hospitalização/estatística & dados numéricos , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Insulina Glargina/administração & dosagem , Insulina Glargina/efeitos adversos , Insulina de Ação Prolongada/efeitos adversos , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez/epidemiologia , Gravidez em Diabéticas/sangue , Gravidez em Diabéticas/epidemiologia , Prevalência , Resultado do Tratamento , Adulto Jovem
16.
Diabetes Res Clin Pract ; 152: 88-95, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31121274

RESUMO

AIMS: To secure adequate carbohydrate supply in pregnancy, the Institute of Medicine (IOM) recommends a minimum amount of carbohydrates of 175 g daily. Currently a low carbohydrate diet is a popular health trend in the general population and this might also be common among overweight and obese pregnant women with type 2 diabetes (T2D). Thus, we explored carbohydrate consumption among pregnant women with T2D including women with type 1 diabetes (T1D) for comparison. METHODS: A retrospective cohort study of consecutive women with T2D (N = 96) and T1D (N = 108), where dietary records were collected at the first antenatal visit. RESULTS: Among women with T2D and T1D, bodyweight at the first visit was 90.8 ±â€¯22 (mean ±â€¯SD) and 75.5 ±â€¯15 kg (P < 0.001) while HbA1c was 6.6 ±â€¯1.2% (49 ±â€¯13 mmol/mol) and 6.6 ±â€¯0.8% (48 ±â€¯8 mmol/mol), P = 0.8, respectively. The average daily carbohydrate consumption from the major carbohydrate sources was similar in the two groups (159 ±â€¯56 and 167 ±â€¯48 g, P = 0.3), as was the level of total daily physical activity (median (interquartile range)): 215 (174-289) and 210 (178-267) metabolic equivalent of task-hour/week (P = 0.9). A high proportion of women with T2D and T1D (52% and 40%, P = 0.08) consumed fewer carbohydrates than recommended by the IOM. The prevalence of ketonuria (≥4 mmol/L) was 1% in both groups. CONCLUSIONS: In early pregnancy, a lower daily carbohydrate consumption than recommended by the IOM was common among women with T2D. The results were quite similar to women with T1D, despite a markedly higher bodyweight in women with T2D. Reassuringly, ketonuria was rare in both groups.


Assuntos
Diabetes Mellitus Tipo 2/dietoterapia , Carboidratos da Dieta/administração & dosagem , Ingestão de Alimentos/fisiologia , Gravidez em Diabéticas/dietoterapia , Gravidez em Diabéticas/epidemiologia , Cuidado Pré-Natal/normas , Recomendações Nutricionais , Adulto , Glicemia/metabolismo , Dinamarca/epidemiologia , Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Dieta com Restrição de Carboidratos/normas , Carboidratos da Dieta/normas , Feminino , Idade Gestacional , Humanos , Obesidade/dietoterapia , Obesidade/prevenção & controle , Gravidez , Cuidado Pré-Natal/métodos , Prevalência , Estudos Retrospectivos , Estados Unidos
17.
Clin Perinatol ; 46(2): 257-272, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31010559

RESUMO

Diabetes is a common complication of pregnancy associated with both short- and long-term adverse maternal and offspring effects. All types of diabetes in pregnancy are increasing in prevalence. Treatment of diabetes in pregnancy, targeting glycemic control, improves both maternal and offspring outcomes, albeit imperfectly for many women. Pharmacologic treatment recommendations differ between pregestational and gestational diabetes. Improved treatment of diabetes in pregnancy will need to consider maternal disease heterogeneity and comorbidities as well as long-term offspring outcomes. In this review, the authors summarize recent clinical studies to highlight established pharmacologic treatments for diabetes in pregnancy and provide suggestions for further research.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Gestacional/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Gravidez em Diabéticas/tratamento farmacológico , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Gestacional/metabolismo , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Insulina/uso terapêutico , Metformina/uso terapêutico , Planejamento de Assistência ao Paciente , Gravidez , Gravidez em Diabéticas/metabolismo
18.
Nat Rev Endocrinol ; 15(7): 406-416, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30948803

RESUMO

Women with pre-existing (type 1 or type 2) diabetes mellitus are at increased risk of pregnancy complications, such as congenital malformations, preeclampsia and preterm delivery, compared with women who do not have diabetes mellitus. Approximately half of pregnancies in women with pre-existing diabetes mellitus are complicated by fetal overgrowth, which results in infants who are overweight at birth and at risk of birth trauma and, later in life, the metabolic syndrome, cardiovascular disease and type 2 diabetes mellitus. Strict glycaemic control with appropriate diet, use of insulin and, if necessary, antihypertensive treatment is the cornerstone of diabetes mellitus management to prevent pregnancy complications. New technology for managing diabetes mellitus is evolving and is changing the management of these conditions in pregnancy. For instance, in Europe, most women with pre-existing diabetes mellitus are treated with insulin analogues before and during pregnancy. Furthermore, many women are on insulin pumps during pregnancy, and the use of continuous glucose monitoring is becoming more frequent. In addition, smartphone application technology is a promising educational tool for pregnant women with diabetes mellitus and their caregivers. This Review covers how modern diabetes mellitus management with appropriate diet, insulin and antihypertensive treatment in patients with pre-existing diabetes mellitus can contribute to reducing the risk of pregnancy complications such as congenital malformations, fetal overgrowth, preeclampsia and preterm delivery.


Assuntos
Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Insulina/uso terapêutico , Resultado da Gravidez , Gravidez em Diabéticas/terapia , Gravidez de Alto Risco , Automonitorização da Glicemia/métodos , Terapia Combinada/métodos , Diabetes Mellitus/epidemiologia , Dieta para Diabéticos , Feminino , Humanos , Saúde do Lactente , Recém-Nascido , Gravidez , Gravidez em Diabéticas/diagnóstico , Melhoria de Qualidade , Medição de Risco , Índice de Gravidade de Doença
19.
Rev Bras Ginecol Obstet ; 41(4): 220-229, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30939606

RESUMO

OBJECTIVE: Different intrauterine environments may influence the maternal prepregnancy body weight (BW) variation up to 6 months postpartum. The objective of the present study was to verify the association of sociodemographic, obstetric, nutritional, and behavioral factors with weight variation in women divided into four groups: hypertensive (HM), diabetic (DM), smokers (SM), and control mothers (CM). METHODS: It was a convenience sample of 124 postpartum women recruited from 3 public hospitals in the city of Porto Alegre, state of Rio Grande do Sul, Brazil, between 2011 and 2016. Multiple linear regressions and generalized estimating equations (GEE) were conducted to identify the factors associated with maternal weight variation. For all GEE, the maternal weight measurements were adjusted for maternal height, parity, educational level, and the type of delivery, and 3 weight measurements (prepregnancy, preceding delivery, and 15 days postpartum) were fixed. RESULTS: A hierarchical model closely associated the maternal diagnosis of hypertension and a prepregnancy body mass index (BMI) classified as overweight with maternal weight gain measured up to the 6th month postpartum (the difference between the maternal weight at 6 months postpartum and the prepregnancy weight). These results showed that the BW of the HM group and of overweight women increased ∼ 5.2 kg 6 months postpartum, compared with the other groups. Additionally, women classified as overweight had a greater BW variation of 3.150 kg. CONCLUSION: This evidence supports the need for specific nutritional guidelines for gestational hypertensive disorders, as well as great public attention for overweight women in the fertile age.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Sobrepeso , Gravidez em Diabéticas/epidemiologia , Fumar , Adulto , Brasil/epidemiologia , Estudos de Coortes , Dieta , Feminino , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Entrevistas como Assunto , Modelos Lineares , Estudos Longitudinais , Modelos Teóricos , Gravidez , Gravidez em Diabéticas/etiologia , Inquéritos e Questionários , Ganho de Peso , Adulto Jovem
20.
Cardiol Young ; 29(4): 467-474, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30940265

RESUMO

OBJECTIVE: The objective of this study was to assess differences in myocardial systolic and diastolic function and vascular function in children 2-5 years of age born to diabetic as compared to non-diabetic mothers. METHODS: This study was a retrospective cohort conducted in 2016 at The Aga Khan University Hospital, Karachi, Pakistan. It included children between 2 and 5 years of age born to mothers with and without exposure to diabetes in utero (n = 68 in each group) and who were appropriate for gestational age. Myocardial morphology and function using echocardiogram and carotid intima media thickness (cIMT) and pulse wave velocity was performed to evaluate cardiac function as well as macrovascular remodelling in these children. Multiple linear regression was used to compare the groups. RESULTS: There was no significant difference in cardiac morphology, myocardial systolic and diastolic function, and macrovascular assessment between the exposed and unexposed groups of AGA children. Subgroup analysis demonstrated a significantly decreased mitral E/A ratio in children whose mothers were on medications as compared to those on dietary control (median [IQR] = 1.7 [1.6-1.9] and 1.56 [1.4-1.7], respectively, p = 0.02), and a higher cIMT in children whose mothers were on medication as compared to controls (0.48 [0.44-0.52] and 0.46 [0.44-0.50], respectively, p = 0.03). CONCLUSION: In utero exposure to uncontrolled maternal diabetes has an effect on the cardiovascular structure and function in children aged 2-5 years. However, future work requires long-term follow-up from fetal to adult life to assess these changes over the life course.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/etiologia , Hiperglicemia/complicações , Gravidez em Diabéticas , Efeitos Tardios da Exposição Pré-Natal , Remodelação Vascular , Adulto , Sistema Cardiovascular/patologia , Espessura Intima-Media Carotídea , Pré-Escolar , Diástole , Ecocardiografia , Feminino , Humanos , Modelos Lineares , Masculino , Mães , Paquistão , Gravidez , Análise de Onda de Pulso , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sístole , Adulto Jovem
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