Orientador: Walkyria de Paula Pimenta / Resumo: Está estabelecida a associação entre diabetes mellitus (DM) tipo 2 e hipertensão arterial sistêmica (HAS). É conhecida a maior ocorrência de distúrbios hipertensivos no diabetes mellitus gestacional (DMG). No Serviço de Obstetrícia da Faculdade de Medicina de Botucatu, as gestantes são avaliadas quanto ao metabolismo da glicose por meio do teste oral de tolerância à glicose (TOTG) e o perfil glicêmico (PG), sendo classificadas em 4 grupos: IA - com ambos os testes normais, têm tolerância à glicose normal; IB - com apenas o PG alterado, têm hiperglicemia diária; IIA - com apenas o TOTG alterado, têm DMG; IIB - com ambos os testes alterados, têm DMG e hiperglicemia diária. Anteriormente, observamos maior risco de desenvolvimento de DM tipo 2 nos três grupos com distúrbios hiperglicêmicos em relação ao grupo IA. O objetivo deste estudo foi avaliar a freqüência de ocorrência de HAS nos quatro grupos gestacionais após três a 12 anos do parto. De 3113 gestantes acompanhadas pelo Serviço de Obstetrícia, foram selecionadas 551 por meio de processo aleatório e proporcional ao número de gestantes de cada grupo. Destas, puderam participar do estudo 535, assim distribuídas nos grupos: IA - 250 (100,0%); IB - 120 (100,0%); IIA - 77 (87,5%) e IIB - 88 (94,6%). As participantes eram avaliadas clinicamente e quanto à tolerância à glicose, com medição da glicemia de jejum e realização do TOTG quando a glicemia estava alterada (110 a 125 mg/dL). O estudo da associação entre a freqüência de ocorrência das variáveis e os grupos gestacionais foi feito pelo teste de Goodman. Para as variáveis quantitativas, utilizou-se a análise de variância não paramétrica na comparação entre os quatro grupos. Na análise da associação entre a pressão arterial atual e as variáveis... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: High blood pressure is associated with type 2 diabetes mellitus (T2DM). There is an increased prevalence of hypertensive disorders in gestational diabetes mellitus (GDM). Glucose intolerance is evaluated at the Obstetrics Unit of Botucatu School of Medicine using the oral glucose tolerance test (OGTT) and glucose profile (GP). Pregnant women are classified into 4 groups: IA, both tests are normal - they have normal glucose tolerance; IB, only the GP is abnormal - they have habitual gestational hyperglycemia; IIA, only the OGTT is abnormal - they have GDM; and IIB, both tests are abnormal - they have GDM and habitual gestational hyperglycemia. Previously, we have observed higher risk of developing T2DM in the 3 above groups with hyperglycemic disorders in relation to the IA group. The aim of this study was to compare hypertension frequency in women among the 4 groups of glucose tolerance, 3 to 12 years after index-pregnancy. From 3,113 pregnant women followed at our Obstetrics Unit, we selected 551 by a process that was randomized and proportional to the number of pregnant women in each group. Of these, 535 could participate in this study and were distributed into the following groups: 250 (100.0%) - IA, 120 (100.0%) - IB, 77 (87.5%) - IIA, and 88 (94.6%) - IIB. The women were evaluated clinically and in relation to glucose tolerance. This was done by measuring fasting plasma glucose and performing the OGTT when plasma glucose was between 110 and 125 mg/dL. Analysis of association between frequency of the variables and the 4 groups was by Goodman's test. Comparison between the groups in relation to quantitative variables was performed by the non-parametric analysis of variance. The c2 test analyzed the association between normal or high... (Complete abstract click electronic address below) / Mestre

Orientador: Iracema Mattos Paranhos / Coorientador: Sulani Silva de Souza / Banca: José Guilherme Cecatti / Banca: Maria Aparecida Mourão Brasil / Resumo: As alterações no metabolismo materno são importantes para suprir as demandas do feto. Entretanto, mulheres que engravidam com algum grau de resistência à insulina, como nos casos de sobrepeso/obesidade, obesidade central e síndrome dos ovários policísticos, associado à ação dos hormônios placentários anti-insulínicos favorece o quadro de hiperglicemia de intensidade variada, caracterizando o diabetes mellitus gestacional (DMG) e levando a efeitos adversos maternos e fetais. Diante da ausência de um consenso universal para o rastreamento e diagnóstico do DMG, esta revisão teve como objetivos, elencar os variados protocolos que foram propostos, bem como ressaltar os fatores de risco associados ao DMG e suas complicações. O mais recente protocolo é o da Associação Americana de Diabetes, com mudanças que se justifi cariam pelo aumento alarmante da obesidade mundial e, em decorrência, o potencial incremento na ocorrência do diabetes mellitus tipo 2, nem sempre diagnosticado antes do período gestacional. A intenção deste protocolo é identifi car as gestantes que se benefi ciariam do controle da hiperglicemia, melhorando o prognóstico destas gestações e prevenindo complicações futuras para as mães e seus filhos / Abstract: Alterations in maternal metabolism are important in order to supply the demands of the fetus. However, pregnant women with some degree of insulin resistance, such as in cases of overweight/obesity, central obesity and polycystic ovaries syndrome, associated to the action of anti-insulin placental hormones, contribute to a case of hyperglycemia of varied intensity, characterizing gestational diabetes mellitus (GDM) and leading to adverse effects both maternal and fetal. At the absence of a universal consensus to the tracking and diagnosis of GDM, this review had the purpose of listing the various protocols that have been proposed, as well as highlighting the risk factors associated with GDM and its complications. The most recent protocol is the one from the American Diabetes Association, with changes that would be justifi ed by the alarming raise in worldwide obesity and, consequently, the potential increase to the occurrence of type 2 diabetes mellitus, not always diagnosed before the gestational period. The intention of this protocol is to identify the gestating women that could benefi t from hyperglycemia control, improving the prognostic of these pregnancies and preventing future complications for mothers and their children / Mestre

Made available in DSpace on 2014-06-11T19:29:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-26Bitstream added on 2014-06-13T20:39:44Z : No. of bitstreams: 1 bolognani_cv_me_botfm.pdf: 441282 bytes, checksum: 82f05cd6dba4ecfca5d19ced1146d059 (MD5) / Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS) / As alterações no metabolismo materno são importantes para suprir as demandas do feto. Entretanto, mulheres que engravidam com algum grau de resistência à insulina, como nos casos de sobrepeso/obesidade, obesidade central e síndrome dos ovários policísticos, associado à ação dos hormônios placentários anti-insulínicos favorece o quadro de hiperglicemia de intensidade variada, caracterizando o diabetes mellitus gestacional (DMG) e levando a efeitos adversos maternos e fetais. Diante da ausência de um consenso universal para o rastreamento e diagnóstico do DMG, esta revisão teve como objetivos, elencar os variados protocolos que foram propostos, bem como ressaltar os fatores de risco associados ao DMG e suas complicações. O mais recente protocolo é o da Associação Americana de Diabetes, com mudanças que se justifi cariam pelo aumento alarmante da obesidade mundial e, em decorrência, o potencial incremento na ocorrência do diabetes mellitus tipo 2, nem sempre diagnosticado antes do período gestacional. A intenção deste protocolo é identifi car as gestantes que se benefi ciariam do controle da hiperglicemia, melhorando o prognóstico destas gestações e prevenindo complicações futuras para as mães e seus filhos / Alterations in maternal metabolism are important in order to supply the demands of the fetus. However, pregnant women with some degree of insulin resistance, such as in cases of overweight/obesity, central obesity and polycystic ovaries syndrome, associated to the action of anti-insulin placental hormones, contribute to a case of hyperglycemia of varied intensity, characterizing gestational diabetes mellitus (GDM) and leading to adverse effects both maternal and fetal. At the absence of a universal consensus to the tracking and diagnosis of GDM, this review had the purpose of listing the various protocols that have been proposed, as well as highlighting the risk factors associated with GDM and its complications. The most recent protocol is the one from the American Diabetes Association, with changes that would be justifi ed by the alarming raise in worldwide obesity and, consequently, the potential increase to the occurrence of type 2 diabetes mellitus, not always diagnosed before the gestational period. The intention of this protocol is to identify the gestating women that could benefi t from hyperglycemia control, improving the prognostic of these pregnancies and preventing future complications for mothers and their children

Introduction: Adequate calcium and vitamin D are needed for maternal and fetal health. Many pregnant women are not consuming enough calcium and are at high risk for vitamin D deficiency. Objectives: To 1) investigate the nutrition-related knowledge, opinions, and clinical practices of family physicians (FPs) towards prenatal calcium and vitamin D; and 2) determine the prevalence of meeting a predefined cut-off serum 25-hydroxyvitamin D concentration ([25-OHD]) for vitamin D sufficiency (≥ 75 nmol/L) in a cohort of pregnant women with gestational diabetes mellitus (GDM). Methods: Part 1: 500 surveys were mailed out to randomly selected FPs across Manitoba. Part 2: data were collected via retrospective chart review of 35 pregnant women with GDM attending a teaching hospital in Winnipeg, Manitoba between January 1, 2010 and December 31, 2013 and having one serum [25-OHD] measurement during their pregnancy. Results: Approximately one-third of FPs are discussing calcium and vitamin D requirements and supplements with their prenatal patients. The top three perceived barriers to delivery of calcium and vitamin D advice were more urgent issues, lack of time, and forgetting to do so. The mean serum [25-OHD] was 52.5 ± 24.1 nmol/L (range 14-109 nmol/L). Over half of women (51.4%) were vitamin D deficient ([25-OHD] < 50 nmol/L), and 28.6% of women were insufficient ([25-OHD] 50-74 nmol/L). Conclusions: Physicians would benefit from more training in nutrition. Multiple barriers exist that prevent FPs from providing calcium and vitamin D advice. Women with GDM have a high prevalence of vitamin D deficiency in our study. / February 2016

Gestational diabetes mellitus (GDM) is the most common metabolic complication in pregnancy and is associated with substantial maternal and neonatal morbidity. The standard of care for GDM in most developed countries is universal mid- to late- pregnancy (24-28 weeks gestation) glucose testing. While earlier diagnosis and treatment could improve pregnancy outcomes, tools for early identification of risk for GDM are not commonly used in practice. Existing models for predicting GDM risk within the first trimester of pregnancy based on maternal risk factors perform only modestly in the clinical setting. Heavy reliance on history of GDM to predict GDM development in the current pregnancy prevents these tools from being applicable to nulliparous women (i.e., women who have never given birth). In order to offer timely preventive intervention and enhanced antenatal care to nulliparous women, we need to be able to accurately identify those at high risk for GDM early in pregnancy. Data from the California Office of Statewide Health Planning and Development Linked Birth File was used to address three aims: 1) improve early pregnancy prediction of GDM risk in nulliparous women through development of a risk factor-based model, 2) conduct a systematic review and meta-analysis assessing the relationship between first trimester prenatal screening biomarker levels and development of GDM, and 3) determine if the addition of first and second trimester prenatal screening biomarkers to risk factor-based models will improve early prediction of GDM in nulliparous women. We developed a clinical prediction model including five well-established risk factors for GDM (race/ethnicity, age at delivery, pre-pregnancy body mass index, family history of diabetes, and pre-existing hypertension). Our model had moderate predictive performance among all nulliparous women, and performed particularly well among Hispanic and Black women when assessed within specific racial/ethnic groups. Our risk prediction model also showed superior performance over the commonly used American College of Obstetricians and Gynecologists (ACOG) screening guidelines, encouraging the prompt incorporation of this tool into preconception and prenatal care. Biomarkers commonly assessed in prenatal screening have been associated with a number of adverse perinatal and birth outcomes. However, reports on the relationship between first trimester measurements of prenatal screening biomarkers and GDM development are inconsistent. Our meta-analysis demonstrated that women who are diagnosed with GDM have lower first trimester multiple of the median (MoM) levels of both pregnancy associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin (free β-hCG) than women who remain normoglycemic throughout pregnancy. Findings from our meta-analysis suggested that incorporation of prenatal screening biomarkers in clinical risk prediction models could aid in earlier identification of women at risk of developing GDM. Upon linkage of California Office of Statewide Health Planning and Development Linked Birth File and California Prenatal Screening Program records, we found that decreased levels of first trimester PAPP-A, increased second trimester unconjugated estriol, and increased second trimester dimeric inhibin A were associated with GDM development in nulliparous women. However, the addition of these biomarkers in clinical models did not offer improvements to the clinical utility (i.e., risk stratification) of models including maternal risk factors alone. Our findings demonstrate that incorporation of maternal risk factors in a clinical risk prediction model can more accurately identify nulliparous women at high risk for GDM early in pregnancy compared to current standard practice. The maternal characteristics model we developed is based on clinical history and demographic variables that are already routinely collected by clinicians in the United States so that it may be easily adapted into existing prenatal care practice and screening programs. Future work should focus on evaluating the clinical impact of model implementation on maternal and infant outcomes as well as financial costs to the health care system.

The purpose of this biobehavioral study was to explore relationships between psychosocial stressors of acculturation, acculturative stress, and metabolic markers of leptin and adiponectin in Mexican American women with and without gestational diabetes mellitus (GDM). A case control design was used for this secondary analysis which included a sample of 38 pregnant women with GDM and 38 healthy controls without GDM, who were matched on age and BMI status. Subjects completed two surveys—the Multidimensional Acculturation Scale II (MASII) and the Multidimensional Acculturative Stress Inventory (MASI)—which measured acculturation and acculturative stress. Descriptive statistics, Pearson r correlations, and independent sample t-tests were used to analyze the data. The results from this study indicated that significant relationships do exist between some of the variables of interest; however, there were no overall significant differences found between women with and without gestational diabetes. These mixed results may be an indicator of a need to further explore these concepts. / text

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy that affects 1-14% of all pregnancies. If not properly managed, GDM can be a devastating disease, leading to birth complications such as shoulder dystocia and neonatal hypoglycemia. GDM has many long-term implications as well, such as increased risk of obesity and type 2 diabetes mellitus (T2DM) in both the mother and the offspring. Additionally, women with a history of GDM are at increased risk of recurrent GDM in a subsequent pregnancy and multiple episodes of GDM further increases a woman’s risk for these short and long-term consequences. For this reason, a diagnosis of GDM provides an opportunity to target GDM and T2DM risk factors to prevent recurrence of GDM and halt the diabetes disease course. Research has shown that diet and physical activity interventions provided after a pregnancy complicated by GDM can delay or prevent the onset of T2DM yet literature on prevention of recurrent GDM is lacking. This thesis will propose a new intervention applied to the inter-pregnancy interval (IPI), designed to reduce incidence of recurrent GDM. The study will examine the effect of a diet and physical activity intervention for women with a recent pregnancy complicated by GDM on recurrence in a subsequent pregnancy and weight gain in the IPI. We hypothesize that our intervention will reduce incidence of GDM recurrence compared to the control group and that women in the intervention group will lose more weight compared to women in the control group. The results of this study will provide a background for further study on the prevention of GDM recurrence with the hope that prevention of recurrent GDM will prevent the short and long-term sequela of GDM.

Magister Pharmaceuticae - MPharm / Gestational diabetes mellitus (GDM) is a condition that affects pregnant women and is one of the most common complications related to pregnancy. According to the World health organisation (WHO), the usual window for diagnosing GDM is between 24 and 28 weeks of gestation and the primary aim of diagnosing gestational diabetes is to identify women and infants at risk of short- or longer-term adverse outcomes. Recent results from the hyperglycaemia and adverse pregnancy outcome (HAPO) study have suggested that even mild levels of hyperglycaemia can have adverse effects on foetal outcomes but there are uncertainties about the prevalence of these outcomes in GDM diagnosed according to the latest WHO 2013 guideline and/or IADPSG 2010 criteria in diverse populations. GDM prevalence has been studied by different researchers, but the prevalence of adverse foetal outcomes in GDM diagnosed based on the latest WHO 2013 guideline and/or IADPSG 2010 criteria have not yet been explored except for the data published by the HAPO study. Due to the lack of sufficient knowledge on foetal outcomes in GDM, this study was conducted to review the evidence on the prevalence of adverse foetal outcomes in GDM diagnosed according to WHO 2013 guideline and/or the IADPSG 2010 criteria. Different databases including PubMed, Science Direct, Google Scholar and CINAHL as well as bibliographic citations were searched using a well-formulated search strategy to find the relevant observational studies (prospective/retrospective cohort and case-control) using explicit inclusion and exclusion criteria. The following search terms were used, “gestational diabetes”, “pregnancy”, “adverse fetal outcomes” and “adverse foetal outcomes”. The findings of this study were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the obtained data analysed using MetaXL ® version 5.3. This review was registered online on PROSPERO, the International prospective register of systematic reviews (registration number: CRD42020155061). Fifteen studies with 88,831 pregnant women (range: 83-25,543 participants) from 12 countries around the world were identified, with a wide variation in the prevalence of foetal outcomes in GDM using the stipulated criteria. These studies were unevenly distributed geographically as six of them were conducted in Asia, four in Europe, four in North America, one in Australia and none in Africa, Antarctica and South America. A meta-analysis found that the overall prevalence of foetal outcomes ranged from 1% (perinatal mortality) to 11% ( large for gestational age). The finding is limited due to the paucity of data on the prevalence of foetal outcomes in GDM. However, more studies using these criteria in low- and middle- income countries (LMICs) are needed by health care providers, to inform practice and allocate resources for control of GDM and its adverse foetal outcomes in diverse settings and ethnic groups, especially in LMICs.

Thesis (MPH.) -- University of Limpopo, 2020 / The purpose of this study was to determine the prevalence of gestational diabetes mellitus (GDM) and the associated risk factors in the Greater Giyani Area, Mopani District. Quantitative cross-sectional descriptive study was conducted to determine the prevalence rate and risk factors of GDM. Data was collected using questionnaire and data entry form. One hundred and one (101) pregnant women who were attending antenatal clinic visits at Nkhensani Hospital, Nkhensani Gateway Clinic and Giyani Healthcare Centre participated in the study. The SPSS programme was used and p-value of <0.05 was considered significant. The study found that the prevalence of GDM in the area was 1.9%. Pregnant women above 30 years with secondary education, employed, obese and at gestational age of 31-35 weeks were more likely to present with GDM. A family history of diabetes was significantly associated with development of GDM. In conclusion, the universal screening approach for GDM needs to be adopted by all health institutions.

Gestational diabetes mellitus (GDM ) is a disease that appears during pregnancy due to an insulin resistance. GDM is associated with increased risks for complications both to the mother and the child during pregnancy. These risks include conditions such as neonatal macrosomi and hypoglycemia for the child. This leads to increased risk for cesarean section and birth injuries. GDM can be treated with a changed diet supported with exercise. If the blood glucose levels still remain high, insulin or metformin medication can be introduced to treat the patient. Metformin is a safe and effective anti-diabetic drug and it is used as a treatment for GDM. Since the treatment during GDM varies, the effect of insulin versus metformin was examined. The aim of this litterature study was to compare the treatment with metformin versus insulin and to investigate the differences between the two drugs in the treatment of GDM. The medical databases PubMed and Google Scholar were used to search for clinical studies that compare the effects of the two treatments. Four studies were selected for this litterature study. The results in this study indicated that both insulin and metformin are effective as  glucose lowering drugs in the treatment of GDM. All patients do not respond to metformin and therefore insulin may be preferable in the treatment of some patient. Both insulin and metformin lead to better glycemic control in GDM patients. Both drugs are safe and effective but metformin has several advantages. The cost is low, it is easier to use and leads to fewer cases of hypoglycemia compared to insulin, even though all patients do not respond to metformin, it is considered a good alternative.