Perinatal Outcome of Pregnancies Complicated by Diabetes and by Maternal Daily Hyperglycemia Not Related to Diabetes

Abstract

We analyzed the perinatal outcome of 1,086 pregnancies classified according to the response to the 3-hour 100-gram glucose tolerance test and the diurnal glycemic profile into the Rudge groups corresponding to control pregnant women, class A gestational diabetic women, class A/B to FRH pregnant women and women with daily hyperglycemia. Despite treatment, the diabetic pregnant women and those with daily hyperglycemia presented higher mean blood glucose levels compared to controls (76.6 ± 10.2 mg/dl). The pregnancies complicated by diabetes and by daily hyperglycemia were characterized by a high incidence of prematurity, macrosomia, large for gestational age newborn infants, malformation and fetal and neonatal death, with consequent perinatal mortality. The perinatal mortality of women with daily hyperglycemia was 10 times higher than that of the controls and was similar to that of the diabetic patients. These adverse perinatal results emphasize the need for the diagnosis and control of intrauterine hyperglycemia both in diabetic pregnant women and in women with an altered diurnal glycemic profile.

Associação glicemia de jejum e fatores de risco como teste para rastreamento do diabete gestacional

“…A mãe é alertada sobre uma condição que pode afetar sua saúde no futuro e os riscos fetais, associados à tolerância diminuída à glicose, podem ser prevenidos ou minimizados com o tratamento adequado. 3,4 Não existe, contudo, consenso a respeito dos métodos de rastreamento e diagnóstico do diabete gestacional. Isso porque essa afecção específica aglutina uma série de distúrbios relacionados à ação e à secreção de insulina e seu simples reconhecimento, pela primeira vez na gravidez, não descarta a possibilidade de sua pré-existência.…”

Recomendações da 2ª. Reunião do Grupo de Trabalho em Diabetes e Gravidez

“…Se houver uma forte suspeita de diabetes na gestação atual -crescimento fetal exagerado, presença de polidrâmnio, ou a presença de vários fatores de risco -pode-se repetir algum dos testes para a detecção do diabetes gestacional: uma nova glicemia de jejum, o teste de tolerância de 75g ou o perfil glicêmico (7).…”

Evaluation of cell proliferation and apoptosis in placentas of rats with severe diabetes

“…This event is energy-dependent and detected by terminal transferase-mediated in situ end labeling (TUNEL) (Kim et al 2006). Investigations with animal models have also shown that in streptozotocin-induced diabetic rats, placental growth is markedly altered, exhibiting a notable decrease in apoptotic and proliferation indexes (Rudge et al 2000). Proliferating cell nuclear antigen (PCNA) protein is one of the central molecules responsible for decisions of life and death of the cell.…”