Prognóstico obstétrico de pacientes portadoras de diabetes mellitus pré-gestacional

Abstract

Sílvia maRgaRida duaRte teixeiRa gueRRa aRagüéS 3 njila Yakalage baRReiRa amaRal 3 Resumo OBJETIVO: Avaliar as alterações epidemiológicas, de perfil clínico e de prognóstico obstétrico em pacientes portadoras de diabetes mellitus pré-gestacional. MÉTODOS: Estudo retrospetivo (coorte) de todas as gestações simples, com diagnóstico de diabetes prévio que foram seguidas num centro com apoio perinatal diferenciado entre 2004 e 2011 (n=194). Analisaram-se tendências relacionadas com dados demográficos e variáveis clínicas maternas, dados de indicadores de cuidados pre-concepcionais e durante a gravidez, e de controle metabólico. Dados do parto como a idade gestacional (IG) do parto, via do parto e peso do neonato foram variáveis também estudadas. RESULTADOS: A frequência global de diabetes prévia, durante o período estudado, foi de 4,4 por mil, não se verificando variações significativas durante o período de estudo. Os casos de diabetes tipo 2 permaneceram constantes. Em 67% dos casos o parto foi de termo (máximo de 80% em 2010-2011), registrou-se uma redução significativa dos partos por cesárea eletiva (p=0,03) e na incidência de neonatos considerados grandes para a IG (p=0,04) ao longo dos anos em estudo. Apesar dos bons resultados relacionados com o controle metabólico ao longo da vigilância da gravidez não foi registrada nenhuma melhora ao longo do tempo. Da mesma forma a proporção de gestantes diabéticas com avaliação pre-concepcional permaneceu pouco animadora. CONCLUSÕES: O seguimento de gestantes portadoras de diabetes mellitus em unidades multidisciplinares parece permitir um ajuste metabólico tão precoce quanto possível, de forma a conseguir melhorar o prognóstico obstétrico. A melhora nos cuidados pré-concepcionais continua sendo um desafio. Abstract PURPOSE:To describe trends in prevalence, indicators of care and pregnancy outcomes for women with pre-existing type I or type II diabetes. METHODS: Cohort study of all consecutive singleton pregnancies complicated by pre-existing type I or type II diabetes followed from 2004 to 2011 at a tertiary perinatal care centre (n=194). We collected data from the medical records and described trends in demographics, clinical history, indicators of care before or during pregnancy and glycaemic control. We also studied perinatal outcomes, including gestational age at delivery, mode of delivery, and birthweight. RESULTS: The overall incidence of pregestational diabetes was 4.4 per 1000, with no significant changes throughout the study period. The number of type 2 diabetes cases also remained constant. In 67% of cases delivery occurred after 37 weeks (maximum 80% in 2010-11). During this period there was a significant reduction in rates of elective caesarean section (p=0.03) and in the incidence of large infants for gestational age (p=0.04). Indicators of glycaemic control were favorable throughout pregnancy, with no significant trends detected during the study period. However, preconceptional care indicators were substandard, with no significant improvement. CONCLUSIONS: ...

Trigonelline Inhibits Inflammation and Protects β Cells to Prevent Fetal Growth Restriction during Pregnancy in a Mouse Model of Diabetes

“…Diabetic pregnancy, defined as either maternal preexisting diabetes (types 1 and 2 diabetes) or gestational diabetes (which occurs only during pregnancy), is related with fetal growth restriction [1]. Offspring of diabetic mothers show a higher rate of diabetes and characteristics of the metabolic syndrome, both strongly associated with premature death [2].…”

Review of profile and prenatal care for women with gestational diabetes mellitus

“…Values over 6.5% of glycated hemoglobin are directly associated with foetal loss. A study with diabetic pregnant women at a maternity hospital in Portugal, showed significant occurrence of foetal loss before 24 weeks gestation whose women had elevated levels of glycated hemoglobin (14) .…”

“…Several studies have found an association between hyperglycemia and maternal and foetal risks, and increase the value of glycemic is the most important determinant for complications. The most prevalent pregnancy/foetal complications are congenital malformations, miscarriage and macrosomia (2,8,(14)(15) .…”

“…The glucose monitoring is an essential care to improve the obstetric prognosis of diabetes pregnancies, since hyperglycemia is considered the most important determinant of obstetrical risks (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) .…”

Maternal and Child Care Assessment Focused on Prenatal Care and Birth

“…Prevention undertaken by a multidisciplinary team and a good metabolic control before and during pregnancy, provide control of inadequate weight gain and contribute decisively to the improvement of high-risk pregnancies obstetric prognosis [5].…”