Diabetes and Pregnancy: an Update of the Problem (original) (raw)
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Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics, 2020
Objective To assess the prevalence of gestational diabetes mellitus and the main associated risk factors in the population served by the Brazilian Unified Health System in the city of Caxias do Sul, state of Rio Grande do Sul. Materials and Methods A descriptive, cross-sectional and retrospective study was conducted. Maternal variables were collected from the medical records of all pregnant women treated at the basic health units in 2016. Hyperglycemia during pregnancy (pregestational diabetes, overt diabetes and gestational diabetes mellitus) was identified by analyzing the results of a 75-g oral glucose tolerance test, as recommended by the Brazilian Ministry of Health. Based on the data, the women were allocated into two groups: the gestational diabetes group and the no gestational diabetes group. Results The estimated prevalence of gestational diabetes among 2,313 pregnant women was of 5.4% (95% confidence interval [95%CI]: 4.56–6.45). Pregnant women with 3 or more pregnancies h...
2016
nization (WHO) diagnostic criteria for gestational diabetes mellitus (GDM) against pregnancy outcomes. RESEARCH DESIGN AND METHODS — This cohort study consecutively enrolled Brazilian adult women attending general prenatal clinics. All women were requested to under-take a standardized 2-h 75-g oral glucose tolerance test (OGTT) between their estimated 24th and 28th gestational weeks and were then followed to delivery. New ADA criteria for GDM require two plasma glucose values 5.3mmol/l(fasting),5.3 mmol/l (fasting), 5.3mmol/l(fasting),10 mmol/l (1 h), and 8.6mmol/l(2h).WHOcriteriarequireaplasmaglucose8.6 mmol/l (2 h). WHO criteria require a plasma glucose 8.6mmol/l(2h).WHOcriteriarequireaplasmaglucose7.0 mmol/l (fasting) or $7.8 mmol/l (2 h). Individuals with hyperglycemia indicative of diabetes outside of pregnancy were excluded. RESULTS — Among the 4,977 women studied, 2.4 % (95 % CI 2.0–2.9) presented with GDM by ADA criteria and 7.2 % (6.5–7.9) by WHO criteria. After adjustment for the effects of age, obesity, and other risk factors, GDM by ADA criteria predicted an increased risk of macrosomia (RR 1.2...
medRxiv (Cold Spring Harbor Laboratory), 2022
Objective: To analyze the maternal-fetal characteristics of patients with gestational diabetes mellitus (GDM) attended in a private service. Materials and Methods: This is a cross-sectional study. Data collection was carried out from the medical records of patients diagnosed with GDM at Centro Hospitalar UNIMED, in Joinville city, between 2011 and 2017. Maternal-fetal characteristics, therapeutics and complications of pregnant women diagnosed with GDM were analyzed. Results: 515 patients with GDM were reported. Of the maternal characteristics, the mean age was (31.77), BMI (27.82). The proportion of obese pregnant women was (55.6%), normal (42.4%) and low weight (2%). The preference for cesarean section was (81.4%) and Gestational Age (GA) of GDM diagnosis (26.85), with higher diagnosis in the third trimester (65.2%) than second (29.3%) and first (5.3%). Incidences of hypertension (7.4%), preeclampsia (0.6%) and pregnant women with previous abortions (16.5%) were found. The mean glycemic profile showed HbA1C (5.26), estimated glucose (104.30) and FPG fasting (86.38), in the first hour (144.46) and in the second hour (64.15). Treatment with diet and exercise (38.3%), metformin (40%), insulin (14.5%) and combined (7.8%). Regarding newborns, the mean weight was (3.123.46) and the GA at birth (37.46). Regarding the percentile, AGP (71.8%), SGP (28.2%) and no cases of LGP. In terms of adverse outcomes, hyperbilirubinemia was evidenced in (25.6%), prematurity (10.9%) and fetal hypoglycemia (9.9%). Conclusion: Pregnant women diagnosed with GDM had a higher GA at diagnosis in the third trimester and more cesarean sections. Among the adverse outcomes related to newborns, there were more cases of hyperbilirubinemia, prematurity and fetal hypoglycemia.
GESTATIONAL DIABETES MELLITUS: A SILENT AND GROWING PROBLEM IN BRAZIL'S HEALTH - A LITERATURE RESCUE (Atena Editora), 2022
INTRODUCTION: Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder in the pregnancy cycle. In recent years, the number of cases has increased, mainly due to the increase in obesity. GOAL: Discuss in the light of the literature on the topic of Gestational Diabetes in Brazilian women from 2019 to 2021. METHODOLOGY:The present study carries out an exploratory bibliographic research on Scielo platforms; Virtual Health Library and the Report on Screening and Diagnosis of Gestational Diabetes Mellitus in Brazil; in addition to databases such as Associação Brazileira de Diabetes in a period of 3 years, between 2019 and 2021. As inclusion criteria, articles in Portuguese, published between 2019 and 2021 were used. The exclusion criteria were English language, dissertations and TCCs. 16 articles were located, and after analysis, 13 were excluded, finally, the study consisted of 3 publications. RESULT: Of the studies surveyed, the largest number were those from the year 2019, totaling 10 (63%); followed by 2019, totaling 04 (25%). The others dated from 2020 and 2021, 01 (6%) in each year. However, only 3 (18.7%) referred to the importance of the topic addressed, therefore, used. GDM is understood as the inability of the maternal body to secrete insulin at levels necessary to meet the needs of the pregnancy-puerperal cycle. GDM is liable to develop in any woman, but it is common in those with risk factors such as advanced age, a history of gestational diabetes, polycystic ovary syndrome or obesity. It can cause complications such as preeclampsia, preterm birth, macrosomia, fetal malformations and fetal death. According to the class, DMG can be controlled only with lifestyle change (SEM). CONCLUSION: GDM, a relevant public health problem, is influenced by several factors. However, the cases can decrease when associating an adequate work of the multiprofessional team in the prenatal and SEM follow-up.
Diabetology & Metabolic Syndrome, 2020
Background While sufficient evidence supporting universal screening is not available, it is justifiable to look for specific risk factors for gestational diabetes mellitus (GDM) or hyperglycemia in pregnancy (HIP). The objective of this study is to identify independent risk factors for HIP and its adverse perinatal outcomes in a Brazilian public referral center. Methods We included 569 singleton pregnant women who were split into three groups by glucose status: GDM (n = 207), mild gestational hyperglycemia (MGH; n = 133), and control (n = 229). Women who used corticosteroids or had a history of DM were excluded. HIP comprised both GDM and MGH, diagnosed by a 100 g- or 75 g-oral glucose tolerance test (OGTT) and a glucose profile at 24–28 weeks. Maternal characteristics were tested for their ability to predict HIP and its outcomes. Bivariate analysis (RR; 95% CI) was used to identify potential associations. Logistic regression (RRadj; 95% CI) was used to confirm the independent risk ...
Sao Paulo medical journal = Revista paulista de medicina
The prevalence and characteristics of gestational diabetes mellitus (GDM) have changed over time, reflecting the nutritional transition and changes in diagnostic criteria. We aimed to evaluate characteristics of women with GDM over a 20-year interval. Comparison of two pregnancy cohorts enrolled in different periods, in university hospitals in Porto Alegre, Brazil: 1991 to 1993 (n = 216); and 2009 to 2013 (n = 375). We applied two diagnostic criteria to the cohorts: International Association of Diabetes and Pregnancy Study Groups (IADPSG)/World Health Organization (WHO); and National Institute for Health and Care Excellence (NICE). We compared maternal-fetal characteristics and outcomes between the cohorts and within each cohort. The women in the 2010s cohort were older (31 ± 7 versus 30 ± 6 years), more frequently obese (29.4% versus 15.2%), with more hypertensive disorders (14.1% versus 5.6%) and at increased risk of cesarean section (adjusted relative risk 1.8; 95% confidence int...
Dysglycemias in pregnancy: from diagnosis to treatment. Brazilian consensus statement
Diabetology & Metabolic Syndrome, 2010
There is an urgent need to find consensus on screening, diagnosing and treating all degrees of DYSGLYCEMIA that may occur during pregnancies in Brazil, considering that many cases of DYSGLYCEMIA in pregnant women are currently not diagnosed, leading to maternal and fetal complications. For this reason the Brazilian Diabetes Society (SBD) and the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASGO), got together to introduce this proposal. We present here a joint consensus regarding the standardization of clinical management for pregnant women with any degree of Dysglycemia, on the basis of current information, to improve medical assistance and to avoid related complications of Dysglycemia in pregnancy to the mother and the fetus. This consensus aims to standardize the diagnosis among general practitioners, endocrinologists and obstetricians allowing the dissemination of information in basic health units, public and private services, that are responsible for screening, diagnosing and treating disglycemic pregnant patients.
2022
BackgroundGestational Diabetes Mellitus (GDM) is a very prevalent disease and can cause several morbidities for women and their offspring. The literature demonstrates the necessity for a better approach during prenatal assistance to detect and treat the disease. We aimed to evaluate the model and efficacy of GDM screening and diagnosis in a referenced low-risk obstetrical center of the municipality of Assis, Sao Paulo state, Brazil. Moreover, the specific objective was to evaluate the prevalence of GDM.MethodsWe conducted a retrospective cross-sectional study of pregnant women, in which 257 prenatal cards and the clinical approaches used for GDM diagnosis and their results. We observed the consecutive patients admitted to the low-risk referenced obstetrical service of the “Santa Casa de Assis-SP” for childbirth from January to August 2021.ResultsThere were 257 pregnant women, 227 prenatal cards obtained. Of these, 24.6% of the cards were considered incomplete, 25 (9.72%) did not con...
2020
BACKGROUND – In Brazil, the prevalence of maternal hyperglycemia is among the highest, costs are elevated and there is no evidence to recommend universal screening. OBJECTIVE – To evaluate the performance of risk factors (RF) for predicting hyperglycemia in pregnancy – Mild Gestational Hyperglycemia (MGH) or gestational Diabetes Mellitus (GDM) in public primary-care centers in Brazil. METHODS – A cohort study, including 514 women with a single pregnancy and no hyperglycemia. Study participants were evaluated at GA (gestational age) < or ≥ 20 weeks, and underwent a 75g-OGTT along with glycemic profile (GP) testing between 24 and 28 weeks. Clinical, anthropometric and laboratory data – fasting glucose (FG), glycated hemoglobin (HbA1c), basal insulin and lipid profile were obtained. The most common RF associations (OR and 95% CI and p <0.05) and different cut-off points were tested for the prediction of MGH-GDM. Predictive performance was assessed by Sensitivity/Specificity, nega...