The objectives of this research were to determine the prevalence of gestational diabetes mellitus (GDM) among the Cree of James Bay, identify independent risk factors for GDM and infant macrosomia in this population and compare the risk for GDM and infant macrosomia among Cree women with Canadian non-Native women. The prevalence of GDM using the National Diabetes Data Group criteria among the Cree was 12.8% (95% CI: 10.1--15.5), among the highest ever reported for an Aboriginal group. Independent risk factors for GDM among the Cree were advanced age, pregravid overweight and previous GDM. A comparison of risk of GDM between Cree and non-Native women revealed a significant interaction between ethnicity and pregravid weight. Overweight Cree women were at an elevated risk for GDM compared with overweight non-Native women (OR: 2.3, 95% CI: 1.3--3.8), whereas the risk for GDM was not statistically different between normal weight Cree and non-Native women (OR: 1.4, 95% CI: 0.7--2.7) after adjusting for age, parity, and smoking status. Mean birth weight among Cree infants was 3859 +/- 519 g, the highest reported for any ethnic group in the world. Macrosomia prevalence was also high at 34.3%. Independent risk factors for macrosomia among the Cree were advanced age, pregravid overweight and GDM. A significant interaction was noted between ethnicity and GDM on risk for macrosomia. GDM increased the risk for macrosomia 4.5-fold among the Cree but had no significant effect among non-Natives. After adjusting for age, parity, pregravid weight, gestational weight gain, GDM, gestational duration and smoking status, Cree infants remained heavier than non-Native infants by 235 g. The results of this research indicate the need to control pregravid obesity through culturally acceptable dietary modifications and exercise in order to minimize the risk for GDM among Cree women. The significant impact of GDM on risk for macrosomia among the Cree calls for the re-evaluation of the existi

Made available in DSpace on 2014-06-11T19:27:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2004Bitstream added on 2014-06-13T20:36:11Z : No. of bitstreams: 1 kerche_ltrl_me_botfm.pdf: 560618 bytes, checksum: 73e382097a4197d2e252b34f5a64a0f0 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Identificar fatores de risco para a macrossomia fetal na população de gestantes portadoras de diabete ou hiperglicemia diária. Método - Estudo retrospectivo, tipo caso-controle, incluindo 803 pares de mães e recém-nascidos desta população específica, distribuídos em dois grupos - macrossômicos (casos, n = 242) e não-macrossômicos (controles, n = 561). Foram comparadas variáveis relativas à idade, paridade, peso e índice de massa corporal (IMC), ganho de peso (GP), antecedentes de diabete, hipertensão arterial e tabagismo, tipo e classificação do diabete e indicadores do controle glicêmico no terceiro trimestre. As médias foram avaliadas pelo teste F e as variáveis categorizadas foram submetidas à análise univariada, utilizando-se o teste do qui-quadrado (c²). Os resultados significativos foram incluídos no modelo de regressão múltipla, para identificação do risco independente de macrossomia, considerando-se OR, IC95% e valor de p. Para todas as análises foi estabelecido o limite de significância estatística de 5% (p < 0,05). Resultados - Observou-se associação significativa entre macrossomia e GP > 16kg, IMC = 25kg/m2, antecedentes pessoais, obstétricos e, especificamente, o de macrossomia, classificação nos grupos de Rudge (IB e IIA + IIB), média glicêmica (MG) ³120mg/dL e média de glicemia pósprandial (MPP) ³ 130mg/dL no terceiro trimestre. Na análise de regressão múltipla, o GP > 16kg (OR = 1,79; IC95% = 1,23 ¾ 1,60), o IMC = 25kg/m² (OR = 1,83; IC95% = 1,27 ¾ 2,64), o antecedente pessoal de diabete (OR = 1,56; IC95% = 1,05 ¾ 2,31) e de macrossomia (OR = 2,37; IC95% = 1,60 ¾ 3,50) e a MG ³120mg/dL no terceiro trimestre (OR = 1,78; IC95% = 1,13 ¾ 2,80) confirmaram risco independente para macrossomia nestas gestações de risco. Conclusão - O GP > 16Kg, o IMC ³ 25Kg/m2, a MG ³ 120mg/dL no terceiro trimestre e a presença... / To identify risk factors for fetal macrosomia in pregnant women having diabetes or daily hyperglycemia. Method – Retrospective study, control-case, including 803 pairs of mothers and newborns belonging to this specific population, distributed in two groups- macrosomic (cases, n = 242) and non-macrosomic (controls, n = 561). Variables related to age, parity, weight and body mass index (BMI), weight gain (WG), diabetes history, high blood pressure and tabagism, diabetes type and classification and glycemic control indicators in the third trimester were compared. The means were evaluated by the F test and the categorized variables were submitted to univariate analysis using the chi square test (c²). The significative results were included in the multiple regression model for the identification of macrosomia independent risk considering OR, 95% CI and p value. The statistical significance limit of 5% was established for all the analysis. Results – There was significative association between macrosomia and WG > 16kg, BMI = 25kg/m², personal, obstetric and macrosomic history, classification in the Rudge groups (IB and IIA + IIB), glycemic mean (GM) = 120mg/dL and postprandial glycemic mean (PPGM) = 130mg/dL in the third trimester. In the multiple regression analysis, the WG > 16kg (OR= 1,79; 95%CI= 1,23 - 1,60), the BMI ³ 25kg/m² (OR = 1,83; 95% CI = 1,27 - 2,64), the diabetes personal history (OR = 1,56; 95%CI = 1,05 - 2,31), and of macrossomia (OR = 2,37; 95%CI= 1,60- 3,50) and the GM ³ 120mg/dL in the third trimester (OR = 1,78; 95%= 1,13 - 2,80) confirmed independent risk for macrossomia in these risk pregnancies. Conclusion – The WG > 16kg, the BMI ³ 25kg/m², the GM = 120mg/dL in the third trimester and macrosomia and diabetes personal history were identified as risk factors for fetal macrosomia in pregnant women having diabetes or daily hyperglycemia.

Orientador: João Luiz de Carvalho Pinto e Silva / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T23:07:09Z (GMT). No. of bitstreams: 1 Rehder_PatriciaMoretti_D.pdf: 1866616 bytes, checksum: 49b75f5f19ec3fe077d8154a0e8696e3 (MD5) Previous issue date: 2011 / Resumo: O Diabetes mellitus quando associado à gestação resulta em complicações gestacionais e perinatais, portanto recomenda-se a pesquisa do diabetes a todas as gestantes através da identificação dos fatores de risco para a doença e glicemia de jejum. Quando houver pelo menos um fator de risco presente ou glicemia de jejum alterada, isto é, rastreamento positivo, deve-se realizar a curva glicêmica gestacional (CGG) com sobrecarga de glicose para confirmação diagnóstica. Os pontos de corte para diagnóstico de diabetes são elevados de tal forma que algumas gestantes com curvas glicêmicas normais, mas com o rastreamento positivo, apresentam os resultados similares aos de mães diabéticas. Assim, começaram a surgir trabalhos analisando resultados de gestantes com essas características. Objetivo: Avaliar os resultados gestacionais e perinatais de mulheres com rastreamento positivo para diabetes mellitus e curvas glicêmicas normais. Pacientes e Método: Trata-se de estudo longitudinal retrospectivo e descritivo com componente de validação de testes de diagnóstico. Foram incluídas 409 gestantes, atendidas no Hospital da Mulher Prof. Dr. José A. Pinotti Centro de Atenção Integral à Saúde da Mulher - CAISM\UNICAMP, no período de 2000 a 2009, com rastreamento positivo e diagnóstico negativo para DMG. Foram analisadas as prevalências das variáveis demográficas, gestacionais e neonatais e calculadas a sensibilidade e a especificidade da CGG para predizer macrossomia e recém-nascido grande para idade gestacional e com esses valores desenhadas as curvas "ROC" tendo a curva glicêmica como teste diagnóstico. Resultados: Os fatores de risco que foram mais prevalentes para realização da CGG foram obesidade ou sobrepeso, hipertensão arterial crônica, idade materna avançada e antecedente familiar de DM. Os resultados neonatais e gestacionais com maior prevalência foram maior taxa de cesárea, recém-nascidos grandes para idade gestacional e prematuridade. Na curva ROC, a glicemia de jejum da CGG foi menor que a da literatura em predição de RN GIG. Já a glicemia de jejum de início do pré-natal sem associação a fatores de risco teve baixa prevalência a resultados adversos gestacionais e perinatais. Conclusões: A prevalência de recém-nascido grande para idade gestacional, taxa de cesárea e prematuridade foi alta em gestantes com rastreamento positivo para DM e CGG normal. O ponto da curva glicêmica que melhor se associou a esses resultados foi a glicemia de jejum com valor entre 87mg/dL, pela curva ROC / Abstract: Diabetes mellitus when associated with pregnancy, results in high frequency gestational and perinatal complications. Recommended search of gestational diabetes to all pregnant women through the identification of risk factors for disease and fasting plasma glucose and in case there is at least one risk factor or plasma glucose value over than 90mg%, must be the confirmation of the diagnosis by oral glucose challenge test (OGCT). The cut-off points for diagnosis are high so that some pregnant women have normal OGCT and positive screening with results similar to those of diabetic. Thus began to appear work analyzing results of pregnant women with these characteristics. Objective: to evaluate the accuracy of the OGCT in predicting adverse perinatal outcomes in women screened positive for diabetes mellitus and to estimate cut-off thresholds related to these outcomes. Patients and methods: retrospective study and longitudinal prevalence with component validation of diagnostic tests. The sample was constituted of 409 women, in Women's Hospital Prof. Dr. José A. Pinotti Center for Integral Women's Health of State University of Campinas - CAISM\UNICAMP, in the period of 2000 to 2009, with screening positive and negative diagnosis for DMG. Were analysed the prevalence of gestational demographic variables, and neonatal diseases and sensitivity and specificity were calculated for each of the OGCT to predict macrossomia and newborn large for gestational age and with these values drawn on curves "ROC" having the OGCT as diagnostic testes. Results: the risk factors that were more prevalent for realization of OGCT were overweight or obesity, chronic hypertension, advanced maternal age and family antecedent of DM. the results of neonatal and gestational with higher prevalence were higher rate of c-section, newborn large for gestational age (LGA) and prematurity. In the ROC curve, the GCT fasting which best joined the ability of predicting newborn LGA was smaller than the literature. Already the fasting of early prenatal without association with risk factors had low Association regarding adverse perinatal and gestational outcomes. Conclusion: the pregnant women with positive screening for DM and CGG normal higher prevalence of newborns large for gestational age, Cesarean sections and premature and the point of the curve which best joined this fact was the fasting plasma glucose value of 87 mg% / Doutorado / Saúde Materna e Perinatal / Doutor em Ciências da Saúde

Objetivo: Determinar potenciales factores de riesgo para diabetes mellitus gestacional (DMG). Métodos: Estudio de casos y controles realizado en el Hospital Alberto Sabogal mediante recolección de historias clínicas del 2009 a 2014. Se define como caso las gestantes con diagnóstico de DMG mediante una prueba de tolerancia oral a la glucosa (PTOG), previa glucosa en ayunas anormal y control a la gestante sin valores indicativos de DMG. Las variables de interés fueron paridad, antecedente de cesáreas, abortos y recién nacido con mayor peso. Modelos de regresión logística fueron calculados para estimar odd ratios (OR) e intervalos de confianza al 95% (IC95%). Resultados: Se incluyeron 84 casos y 336 controles. En el modelo multivariado, la multiparidad incrementó el riesgo de DMG (OR= 3,54; IC95% 1,55 – 8,14). También, antecedente de abortos, a partir del segundo aborto (OR= 3,40, IC95% 1,55 – 7,44) y cesáreas previas (1 cesárea OR= 3,5 IC95% 1,89 – 6,47 y 2+ cesáreas OR=8,35 IC95% 3,50 – 19,95). La multiparidad, dos o más abortos y mayor número de cesáreas son factores de riesgo para DMG. / Objectives: To identify risk factors for gestational diabetes mellitus (GDM). Methods: A case-control study was performed in Alberto Sabogal Hospital, collecting medical records from 2009 to 2014. A case was defined as a pregnant women diagnosed with GDM by an oral glucose tolerance test (OGTT) after an abnormal fasting glucose and control was defined as a pregnant women without GDM indicative values. The study outcome was GDM. The variables of interest were multiparity, previous cesarean section, abortions, newborn with the greatest weight. Logistic regression were used to calculate the odds ratio (OR) and a confidence interval of 95% (IC95%). Results: 84 cases and 336 controls were included. In the multivariate model, multiparity increased risk of GDM (OR= 3.54, 95% CI 1.55 to 8.14). As well history of abortions, from the second abortion (OR= 3.40, 95% CI 1.55 to 7.44) and previous cesarean section are also related (cesarean section 1 OR= 3.5 95% CI 1.89 to 6.47 and 2+ cesarean OR= 8.35 95% CI 3.50 to 19.95). Multiparity, two or more abortions, a biggest number of cesarean sections are GDM risk factors.

No description available.

University of Bradford through the International Development Fund / The full text will be available at the end of the embargo: 21st June 2025

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-09-04T19:38:44Z No. of bitstreams: 1 MariaGloriaTavares.pdf: 1578457 bytes, checksum: d6ddc32a3c245b3f67f5abd4e4158ad0 (MD5) / Made available in DSpace on 2017-09-04T19:38:44Z (GMT). No. of bitstreams: 1 MariaGloriaTavares.pdf: 1578457 bytes, checksum: d6ddc32a3c245b3f67f5abd4e4158ad0 (MD5) Previous issue date: 2017-07-07 / Gestational Diabetes Mellitus (GDM) is classified as glucose intolerance, whose onset or detection occurs during pregnancy. One of the ways to identify GDM is 75g oral glucose tolerance test. According to the International Diabetes and Pregnancy Association Study Group(IADPSG), GDM is diagnosed when at least 1 of the three curve points are greater than or equal to 92, 180 and 153 mg / dl at time 0 , 1 and 2 hours respectively. A characteristic of this criterion is the diagnosis based on a single altered value. However, the mechanisms involved in impaired fasting glucose (IFG) are different from those found in impaired glucose tolerance (IGT) after oral glucose tolerance test (OGTT). So, differences in pregnancy outcomes are possible according to OGTT behavior. This work had as general objective to categorize pregnant women diagnosed with GDM, using the IADPSG criteria, according to the type of glycemic alteration found in the OGTT results, and to correlate with fetal weight birth. In order to do so, the cases of DMG treated at the University Hospital of the Federal University of Maranhão, from December 2013 to December 2015, were divided into 3 groups, according to the alterations found in the glycemic curve of the OGTT (Group 1: IFG isolated, Group 2: IGT only, Group 3: IFG and IGT). A total of 89 patients were studied, the majority belonging to groups 3 (54%). This same group had the highest glycemic averages at diagnosis and during follow-up, being the group with the highest occurrence of newborns large for gestational age (LGA), with 39.6%. Then group 1 with an occurrence of 27.3% of newborns LGAs. It was concluded that, as pregnant women with DMG with altered fasting glycemia in the OGTT, especially those with associated glucose intolerance, presented a higher risk for newborns large for gestational age. / Diabetes Mellitus Gestacional (DMG) é classicamente definido como intolerância à glicose de gravidade variável, cujo início ou detecção ocorre durante a gravidez. Uma das formas de rastreá-la é através da curva glicêmica após sobrecarga oral de glicose, com 75g de dextrosol. Segundo o critério do International Association of Diabetes and Pregnancy Study Group (IADPSG), considera-se diagnóstico de DMG quando pelo menos um dos três pontos da curva encontra-se maior ou igual a 92, 180 e 153 mg/dl, nos tempos 0, 1, 2 horas respectivamente. Uma característica deste critério, é o diagnóstico baseado em apenas um único valor alterado, seja ele em jejum ou após a sobrecarga. No entanto, os mecanismos que levam à alteração da glicemia jejum (GJA) são diferentes daqueles encontrados na intolerância à glicose (ITG) após sobrecarga de glicose. Sendo assim, acredita-se poder haver diferenças, em relação aos desfechos fetais, a depender do perfil encontrado na curva glicêmica das gestantes com diagnóstico de DMG. Este trabalho teve como objetivo geral categorizar as gestantes diagnosticadas com DMG pelo teste de tolerância oral à glicose (TTOG), utilizando o critério do IADPSG, de acordo com o tipo de alteração glicêmica encontrada na curva de sobrecarga, e correlacionar com o peso fetal ao nascimento. Para isso, foram revisados os casos de DMG atendidos no Hospital Universitário da Universidade Federal do Maranhão (HUUFMA), no período de dezembro de 2013 a dezembro de 2015, estes foram divididos em 3 grupos, de acordo com as alterações encontradas na curva glicêmica do TOTG (Grupo 1: GJA isoladamente; Grupo 2: ITG isoladamente, Grupo 3: GJA e ITG). Foram estudadas 89 pacientes, a maioria pertencente ao grupo 3 (54%). Este mesmo grupo apresentou as médias glicêmicas mais elevadas ao diagnóstico e durante o seguimento, sendo o grupo com maior ocorrência de recém-nascidos grandes para idade gestacional (GIG), com 39,6%. Em seguida o grupo 1 com uma ocorrência de 27,3% de recém nascidos GIGs. Concluiu-se que as gestantes com DMG com alteração na glicemia de jejum no TTOG, principalmente aquelas com intolerância à glicose associada, apresentaram maior risco para recém-nascidos grandes para idade gestacional.

Gestational diabetes mellitus (GDM) and infant macrosomia are important obstetric health concerns for Aboriginal populations in Canada. Previous research in non-Aboriginal populations has established that GDM and macrosomia are associated with increased risk of fetal morbidity. Specifically, GDM is a risk factor for infant macrosomia, hypoglycemia, polycythemia, hypocalcemia, and hyperbilirubinemia. Furthermore, macrosomia is an independent risk factor for shoulder dystocia, clavicular fracture, brachial plexus injury, birth asphyxia and operative delivery. The main objectives of this study were to determine prevalence rates of GDM and macrosomia related neonatal complications for the James Bay Cree population of northern Quebec, and to identify risk factors for specific birth trauma injuries and metabolic complications in the population. The prevalence of macrosomia (≥4500 g) was 10.4%, and the estimated prevalence of GDM was 16.6% (95% CI 14.6-18.6) (n = 229/1379). Shoulder dystocia was the most common birth trauma event among the Cree, affecting 2.5% (n = 42/1650) of all Cree births, and 9.3% (n = 16/172) of macrosomic deliveries ≥4500 g. The prevalence of neonatal hypoglycemia was also high, affecting 8.8% (n = 144/1650) of all Cree newborns, and 18.1% (n = 34/192) of GDM deliveries. Macrosomia (BW ≥ 4500 g) was a significant risk factor for shoulder dystocia, clavicular fracture, hypoglycemia, and caesarean section delivery. After adjusting for maternal age, parity, and gestational age, GDM was identified as a significant risk factor for macrosomia (≥4500 g), hypoglycemia, polycythemia, and hypocalcemia. In summary, this study identified a high incidence of neonatal complications among the James Bay Cree compared with rates in the general North American population. These outcomes can be explained, in part, by high prevalence rates of gestational diabetes and infant macrosomia. Further studies to investigate the long-term consequences of GDM and

Le diabète gestationnel (DG) est un trouble de la tolérance glucidique de gravité variable, survenant ou diagnostiqué pour la première fois pendant la grossesse, quel que soit le traitement nécessaire et son évolution après l’accouchement. Il est associé, à court et à long terme, à un ensemble de complications ou pathologies tant chez la mère que chez l’enfant. Nous avons étudié le rôle des cytokines, des adipokines, du statut anti-oxydant et des facteurs de croissance au cours du diabète gestationnel et de la macrosomie. Notre étude a montré que le diabète gestationnel et la macrosomie sont associés à une perturbation du métabolisme lipidique et une altération des statuts antioxydant et immunitaire. Le DG était lié à une diminution de l’adiponectine et des cytokines Th1 et une augmentation de la leptine et des cytokines inflammatoires alors que la macrosomie est associée à une augmentation des cytokines Th1 et une diminution de toutes ces hormones relatives à l’obésité (IL-6, TNF-α, leptine et adiponectine). Plusieurs altérations observées à la naissance dans le métabolisme des carbohydrates et des lipides chez les enfants issus de mères diabétiques persistent encore à l’âge adulte. Il semble que la programmation in utero au cours du diabète gestationnel crée une ‘‘mémoire métabolique’’ qui est responsable de l’obésité et des altérations chez les nouveau-nés macrosomiques. Selon les régressions linéaires multiples incrémentielles que nous avons établies, il semble que les facteurs de croissance qui influencent l’augmentation du poids fœtal sont : PDGF du côté maternel et FGF2 des deux côté maternel et fœtal. / Gestational diabetes mellitus (GDM) is defined as ‘carbohydrate intolerance of variable severity with onset or first recognition during pregnancy’, irrespective to necessary treatment and its evolution in the post partum. GDM is associated with a number of complications/ pathologies both in mother and in their newborns, with short and long-term. In this study, we investigated the role of cytokines, adipokines and antioxidant status during GDM and macrosomia. Our study has demonstrated that these pathologies are associated with a perturbation in lipid metabolism, and antioxidant and immune status. GDM is linked to the down-regulation of adiponectin along with Th1 cytokines and upregulation of leptin and inflammatory cytokines whereas macrosomia was associated with the up-regulation of Th1 cytokines and the down-regulation of the obesity-related agents (IL-6, TNF-α, leptin and adiponectin). Several alterations observed at birth in carbohydrates and lipids metabolism in the children born to diabetic mothers, still persist at the adulthood. It seems that in utero programming during diabetic pregnancy creates a ‘‘metabolic memory’’ which is responsible for the development of obesity and physiological anomalies in macrosomic offspring. According to multiple linear regressions incremental that we established, it appears that growth factors that influence the increase of foetal weight are: PDGF in mother's side and FGF2 in maternal and foetal side.

<p><strong>Objectives: </strong>To examine associations between macrosomia, maternal body mass index (BMI) during pregnancy, and psychopathology in youth, and to determine if these are due to prenatal environmental exposures or confounding variables.</p> <p><strong>Methods: </strong>Study 1 reviewed studies examining associations between macrosomia and mental health. Data from the Ontario Child Health Study (OCHS) were then used to explore these links in youth (Study 2). A second review summarized studies assessing associations between maternal pregnancy BMI and psychopathology in offspring (Study 3). Data from the Western Australia Pregnancy Cohort were then used to quantify associations between maternal pre-pregnancy BMI and child behaviour at age 1 and 2 (Study 4), and from 5-17 years of age (Study 5).</p> <p><strong>Results: </strong>Seven of the 15 studies that had examined associations between macrosomia and psychopathology supported a link. In the OCHS, youth born macrosomic had elevated externalizing scores compared those born at appropriate birth weights. Eight of 12 studies suggested that links exist between elevated maternal BMI during pregnancy and psychopathology in offspring. Maternal pre-pregnancy BMI was positively associated with offspring externalizing problems from age 2 to 17 and linked to less favourable trajectories of internalizing symptoms from 5-17. These findings persisted despite adjustment for confounders.</p> <p><strong>Conclusions: </strong>Youth born macrosomic have elevated levels of externalizing symptoms, though a more robust association was noted with maternal pre-pregnancy BMI. The data comprising this thesis suggest that associations between macrosomia/maternal BMI and externalizing and internalizing problems in youth may be due to intrauterine exposures rather than confounding variables.</p> / Doctor of Philosophy (PhD)