Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

Thesis (MSc(Genetics))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: The hypertensive conditions of pregnancy (including pre-eclampsia (PE)) is the leading cause of primary obstetric death in South Africa and affects at least five percent of pregnancies in the Western Cape province. Reduced levels of placental protein 13 (PP13) early in pregnancy are associated with a higher incidence of PE in later gestation. PP13 and annexin II have been co-localised to the brush border membrane of syncytiotrophoblasts, and form a complex that is transported to the maternal circulation. It is speculated that genetic variation in the gene encoding annexin II (ANXA2) could underlie the reduced PP13 levels. The aim of this study was to screen the ANXA2 gene, including the proximal promoter region, in two South African population groups, (Mixed Ancestry and Black) from the Western Cape, to identify whether variants in the ANXA2 gene confer susceptibility to PE. The study cohort comprised of 120 pre-eclamptic maternal, 94 pre-eclamptic fetal and 54 healthy control individuals. Genomic DNA of patient and control individuals was extracted for PCR amplification of ANXA2 and Multiphor SSCP/HD analysis was performed for mutation detection. The conformational variants identified were subjected to automated DNA sequencing and subsequently to RFLP analysis, to confirm the genotypes in the remainder of the cohort. Nine previously identified variants (c.-31 T>C, c.292 G>T; p.Val98Leu, c.975 C>T;p.Gly325Gly, c.-12+75 C>A, c.-11-43 G>A, c.-11-13 A>T, c.48+67 C>T, c.449-17 G>A, c.683-56 G>A) and 16 novel variants (c.-442 C>G, c.-191 G>C, c.-189_-188insGCCGG, c.-135 C>G, c.-92 A>T, c.222 C>T; p.Ala74Ala, c.600 C>T; p.Asp110Asp, c.934 G>A; p.Gly312Ser, c.244-42 G>C, c.244-76 C>G, c.528+38 C>T, c.589-5 C>T, c.682+49 C>T, c.961-30 A>G, c.961-24 C>G, c.*1057 A>G) were identified upon screening the ANXA2 gene. Statistical analysis identified significant association at five loci: SNP c.-92 A>T located within the ANXA2 5‟UTR, exonic SNP c.222 C>T; p.Ala74Ala and three intronic SNPs c.244-76 C>G, c.449-17 G>A and c.589-5 C>T. Three of the five variants (c.-92 A>T, c.244-76 C>G, c.589-5 C>T) were significantly associated with PE (P<0.05) and could contribute to PE susceptibility in these two SA iv populations, whereas the other two variants (c.222 C>T; p.Ala74Ala, c.449-17 G>A) revealed a possible protective effect, suggesting a reduced risk of developing PE. In silico analysis predicted the disruption and creation of several putative transcription factor binding sites by three SNPs in the ANXA2 gene, which could subsequently affect ANXA2 functioning. This study provides evidence for genetic variation in the ANXA2 gene, which warrants functional experimental validation in an attempt to investigate the function of these SNPs in molecular, cellular and physiological processes underlying PE. Identifying an association between variants in the ANXA2 gene and PE could contribute to the development of an additional early biomarker. The early identification of PE would promote the South African health system by providing the appropriate health care support and monitoring of high risk pregnancies, which could ultimately result in improved pregnancy outcome. / AFRIKAANSE OPSOMMING: Die hipertensiewe siektes van swangerskap (insluitende pre-eklampsie (PE)) is die belangrikste direkte oorsaak van moedersterftes in Suid-Afrika en dit kom voor by ongeveer 5% van swangerskape in die Wes-Kaap provinsie. Verlaagde plasentale proteïen 13 (PP13) vlakke tydens vroeë swangerskap word verbind met „n hoër voorkoms van PE in latere swangerskap. PP13 en anneksin II kom albei op die borselgrens membraan van synsitiotrofoblaste voor waar hulle „n kompleks vorm wat na die moederlike sirkulasie vervoer word. Daar word gespekuleer dat die onderliggende oorsaak vir laer PP13 vlakke as gevolg van genetiese variasie in die geen wat anneksin II kodeer (ANXA2) kan wees. Die doel van hierdie studie was om die ANXA2 geen, insluitende die proksimale promoter area, in twee Suid-Afrikaanse populasie groepe, (Kleurling en Swart) van die Wes-Kaap, te skandeer met die doel om variante in die ANXA2 geen te identifiseer en ‟n moontlike assosiasie met die vatbaarheid vir PE te bepaal. Hierdie studie populasie het bestaan uit 120 pre-eklamptiese vroue, 94 neonate van pre-eklamptiese ma‟s en 54 gesonde kontrole individue. Genomiese DNS van die pasiënte en kontrole individue is geëkstraeer vir polimerase kettingreaksie amplifikasie van die ANXA2 geen, waarna Multiphor enkelstring konformasie polimorfisme heterodupleks analise uitgevoer is met die doel om DNS variante te identifiseer. Die verskillende konformasies waargeneem is onderwerp aan semi-geoutomatiseerde DNS volgorde bepalingsanalise en gevolglik restriksie fragment lengte polimorfisme analise om genotipes in die res van die studiegroep te bevestig. Vyf-en-twintig variante is geïdentifiseer met die skandering van die ANXA2 geen, waarvan nege voorheen geïdentifiseer is (c.-31 T>C, c.292 G>T; p.Val98Leu, c.975 C>T;p.Gly325Gly, c.-12+75 C>A, c.-11-43 G>A, c.-11-13 A>T, c.48+67 C>T, c.449-17 G>A, c.683-56 G>A) en 16 nuwe variante is (c.-442 C>G, c.-191 G>C, c.-189_-188insGCCGG, c.-135 C>G, c.-92 A>T, c.222 C>T; p.Ala74Ala, c.600 C>T; p.Asp110Asp, c.934 G>A; p.Gly312Ser, c.244-42 G>C, c.244-76 C>G, c.528+38 C>T, c.589-5 C>T, c.682+49 C>T, c.961-30 A>G, c.961-24 C>G, c.*1057 A>G). Statistiese analise het „n statisties beduidende assosiasie met vyf SNPs geïdentifiseer: SNP c.-92 A>T geleë in die ANXA2 5‟UTR, die koderende SNP c.222 C>T; p.Ala74Ala en drie SNPs c.244-76 C>G, c.449-17 G>A and c.589-5 C>T geleë in die nie-koderende areas. Drie van hierdie vyf SNPs (c.-92 A>T, c.244-76 C>G, c.589-5 C>T) het statisties beduidende assosiasie met PE (P<0.05) getoon en kan bedra tot die vatbaarheid vir PE in hierdie twee Suid-Afrikaanse populasies, terwyl die ander twee SNPs (c.222 C>T; p.Ala74Ala, c.449-17 G>A) „n moontlike beskermende effek gedui het, wat „n verlaagde risiko vir die ontwikkeling van PE voorstel. In silico analise het voorspel dat verskeie voorgestelde transkripsiefaktor bindingsetels onderbreek of geskep sal word in die teenwoordigheid van drie SNPs in die ANXA2 geen, wat gevolglik die funksionering van ANXA2 kan affekteer. Hierdie studie verskaf bewyse vir genetiese variasie in die ANXA2 geen, wat verdere funksionele eksperimentele ondersoeke vereis om die funksie van hierdie SNPs in molekulêre, sellulêre en fisiologiese prosesse onderliggend aan PE te bepaal. Die identifisering van ‟n assosiasie tussen variante in die ANXA2 geen en PE kan bydra tot die ontwikkeling van ‟n addisionele vroeë genetiese merker. Die vroeë identifisering van PE kan die Suid-Afrikaanse gesondheidsisteem geweldig baat deurdat die geskikte gesondheidsorg en ondersteuning asook deurgaanse monitering van hoë risiko swangerskappe verskaf sal kan word. Dit kan uiteindelik lei tot ‟n verbeterde uitkoms vir swangerskappe in Suid-Afrika.

Thesis (MSc (Genetics))--University of Stellenbosch, 2006. / Pre-eclampsia is a multisystemic disorder with an incidence of ~6-8% in non-Caucasian women in the Western Cape. Trophoblast invasion is vital for adequate anchorage of the placenta to the uterine wall as well as for the optimisation of utero-placental blood flow in uncomplicated pregnancies. This process is facilitated by the fetal trophoblast cells that digest the extracellular matrix of the uterus by secreting various molecules, including the metalloproteinases (MMP), of which MMP-9 has an increased production during the first trimester. Leptin, an autocrine regulator of MMP-9 secretion, functions via the leptin receptor to prevent over-invasion of maternal tissues. The aim of this study was to investigate the role of the leptin (ob) and leptin receptor (obR) genes in predisposition to pre-eclampsia and involved screening the genes in South African non-Caucasian cohorts and performing statistical analysis to determine whether any variants contributed to the disease profile.

Orientador: Lígia Maria Suppo de Souza Rugolo / Banca: Maria Regina Bentlin / Banca: Paulo Roberto Pachi / Resumo: A síndrome hipertensiva gestacional está associada com prematuridade e restrição de crescimento fetal. Estudos sobre o crescimento dos recém-nascidos de mães hipertensas são escassos e inconclusivos. Avaliar o perfil de crescimento de prematuros de baixo peso ao nascer, filhos de mães hipertensas nos primeiros dois anos de vida e investigar a ocorrência de distúrbios no crescimento. Estudo de coorte de prematuros de baixo peso, acompanhados até os 24 meses de idade corrigida, no ambulatório de seguimento de um centro Universitário, entre agosto de 2008 a dezembro de 2010. Peso, comprimento e perímetro cefálico foram aferidos a cada 3 meses no 1º ano e por semestres no 2º ano. As medidas antropométricas foram analisadas conforme as curvas-padrão da OMS. Desfechos: falha de crescimento e risco de sobrepeso. Associações entre grupos foram investigadas por análise univariada. 80 prematuros de mães hipertensas e 101 de mães normotensas foram estudados. Não houve diferença no perfil de crescimento entre os 2 grupos. As medidas das crianças foram próximas ao padrão da OMS, principalmente peso e perímetro cefálico. Crianças de mães hipertensas mostraram aumento do risco de sobrepeso (RR=2,20;IC95%:1,07-4,57) com 24 meses de idade corrigida. Prematuros adequados para idade gestacional apresentaram maior crescimento ponderal que os pequenos para idade gestacional. O perfil de crescimento de prematuros de baixo peso de mães hipertensas e normotensas é semelhante nos primeiros anos de vida, mas ao final do segundo ano as crianças de mães hipertensas apresentam maior risco de sobrepeso / Abstract: Hypertensive disorders of pregnancy are associated with prematurity and fetal growth restriction. Studies on the growth of infants born to hypertensive mothers are scarce and inconclusive. To assess the growth profile of preterm low birth weight infants, born to hypertensive mothers in the first two years of life and to evaluate the occurrence of growth disorders. A cohort study of low birth weight preterm infants followed up to 24 months corrected age (CA) at a University follow up clinic, between August 2008 to December 2010. Weight, length and head circumference were measured every 3 months during the first year and by semesters in the second year. Anthropometric measurements were plotted on WHO growth reference charts. Outcomes: failure to thrive and risk of overweight. Associations between groups were investigated by univariate analysis. 80 premature infants born to hypertensive mothers and 101of normotensive were studied. There was no difference in the growth profile between the 2 groups. The measurements of the infants were close to the standard of WHO, especially weight and head circumference. Children of hypertensive mothers showed increased risk for overweight (RR = 2.20, 95% :1,07-4, 57) at 24 months CA. Appropriate for gestational age infants had higher weight growth than small for gestational age. The growth profile of preterm low birth weight born to hypertensive and normotensive mothers is similar in the first years of life, but at the end of the second year the infants of hypertensive mothers are at increased risk of overweight / Mestre

Orientador: Cristina Maria Garcia de Lima Parada / Coorientador: Márcia Guimarães da Silva / Banca: Maria Antonieta de Barros Leite Carvalhaes / Banca: Marli Terezinha Cassamassimo Duarte / Banca: Sandra Marisa Pelloso / Banca: Flávia Gomes-Sponhoz / Resumo: O objetivo geral deste estudo foi analisar o resultado perinatal de gestantes submetidas a busca ativa de infecção genital inferior. Para alcance deste objetivo foram realizados três subprojetos, apresentados em capítulos. Capítulo I- Infecção do trato genital inferior e repercussões perinatais: revisão integrativa da literatura, teve por objetivo identificar, na produção científica dos últimos 10 anos, evidências sobre as condições dos neonatos ao nascimento, quando a mãe apresentou infecção do trato genital inferior na gravidez. Os resultados foram variados, sendo que os estudos apontaram associação de determinado tipo de infecção a alguns desfechos e não a outros. A associação mais frequentemente buscada foi entre vaginose bacteriana e prematuridade, tendo sido apontada associação em seis estudos e ausência em três. Capítulo II - Resultado perinatal de gestantes submetidas à busca ativa de infecção do trato genital inferior: estudo observacional e analítico, teve por objetivo analisar o resultado perinatal de gestantes de baixo risco submetidas à busca ativa de infecção genital. Observou-se que a chance do índice de Apgar de primeiro minuto ser inferior a sete pontos foi significativamente menor entre as gestantes que passaram pela busca ativa e esse grupo teve recém-nascidos com peso ao nascer em média 350 gramas maior. Capítulo III: Resultado perinatal de mulheres com história de trabalho de parto prematuro e submetidas à busca ativa de infecção do trato genital inferior, objetivou comparar a frequência de prematuridade e de índice de Apgar de primeiro minuto de vida inferior a sete em gestantes submetidas ou não a busca ativa de infecções do trato genital inferior e tratamento etiológico. Estudo controlado, não randomizado, não encontrou relação significativa entre busca ativa e menores taxas de prematuridade e melhores índices de Apgar. Conclui-se que, pela relevância do tema para ... / Abstract: This paper aimed at evaluate perinatal results of pregnant women who were submitted to an active search of inferior genital infection. Three sub-projects were developed in chapters in order to reach this objective. Chapter 1 - Infection of the lower genital tract and perinatal outcomes: a literature review. The purpose was to identify in 10 years scientific production, evidences of neonatal conditions at birth when the mother presented genital tract infection during pregnancy. The results differed. The studies showed an association of certain types of infection in some outcomes and not in others. The most frequently searched association was among bacterial vaginitis and prematurity, present in six cases and absent in three of them. Chapter II - Perinatal outcome of pregnant women submitted to an active search of the lower genital tract infection; observational and analytical study. The purpose was to evaluate the perinatal result of low risk pregnant women submitted to an active search of genital infection. In this case, the chance of first minute Agpar score to be less than 7 points was significantly smaller among pregnant women who underwent an active search. Newborns in this group weighed 350 grams more. Chapter III - Perinatal results of women who experienced premature labor and were submitted to an active search of inferior genital tract infection. The purpose was to compare prematurity frequency and first minute Apgar score, inferior to seven, in pregnant women submitted or not to an active search of the inferior genital tract and etiological treatment. The study was controlled and non randomized. A significative relationship between an active search and lower prematurity indexes and better Agpar scores was found. The study leads to the conclusion that considering the relevance of the subject for public health, the results should be seen as a first approach. Further investigations on special controlled studies with larger ... / Doutor

Made available in DSpace on 2015-05-14T16:53:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-05-29Bitstream added on 2015-05-14T16:59:05Z : No. of bitstreams: 1 000816181.pdf: 1313890 bytes, checksum: 785f61dc5b28f498e5dd5476b29eaed5 (MD5) / O objetivo geral deste estudo foi analisar o resultado perinatal de gestantes submetidas a busca ativa de infecção genital inferior. Para alcance deste objetivo foram realizados três subprojetos, apresentados em capítulos. Capítulo I- Infecção do trato genital inferior e repercussões perinatais: revisão integrativa da literatura, teve por objetivo identificar, na produção científica dos últimos 10 anos, evidências sobre as condições dos neonatos ao nascimento, quando a mãe apresentou infecção do trato genital inferior na gravidez. Os resultados foram variados, sendo que os estudos apontaram associação de determinado tipo de infecção a alguns desfechos e não a outros. A associação mais frequentemente buscada foi entre vaginose bacteriana e prematuridade, tendo sido apontada associação em seis estudos e ausência em três. Capítulo II - Resultado perinatal de gestantes submetidas à busca ativa de infecção do trato genital inferior: estudo observacional e analítico, teve por objetivo analisar o resultado perinatal de gestantes de baixo risco submetidas à busca ativa de infecção genital. Observou-se que a chance do índice de Apgar de primeiro minuto ser inferior a sete pontos foi significativamente menor entre as gestantes que passaram pela busca ativa e esse grupo teve recém-nascidos com peso ao nascer em média 350 gramas maior. Capítulo III: Resultado perinatal de mulheres com história de trabalho de parto prematuro e submetidas à busca ativa de infecção do trato genital inferior, objetivou comparar a frequência de prematuridade e de índice de Apgar de primeiro minuto de vida inferior a sete em gestantes submetidas ou não a busca ativa de infecções do trato genital inferior e tratamento etiológico. Estudo controlado, não randomizado, não encontrou relação significativa entre busca ativa e menores taxas de prematuridade e melhores índices de Apgar. Conclui-se que, pela relevância do tema para ... / This paper aimed at evaluate perinatal results of pregnant women who were submitted to an active search of inferior genital infection. Three sub-projects were developed in chapters in order to reach this objective. Chapter 1 - Infection of the lower genital tract and perinatal outcomes: a literature review. The purpose was to identify in 10 years scientific production, evidences of neonatal conditions at birth when the mother presented genital tract infection during pregnancy. The results differed. The studies showed an association of certain types of infection in some outcomes and not in others. The most frequently searched association was among bacterial vaginitis and prematurity, present in six cases and absent in three of them. Chapter II - Perinatal outcome of pregnant women submitted to an active search of the lower genital tract infection; observational and analytical study. The purpose was to evaluate the perinatal result of low risk pregnant women submitted to an active search of genital infection. In this case, the chance of first minute Agpar score to be less than 7 points was significantly smaller among pregnant women who underwent an active search. Newborns in this group weighed 350 grams more. Chapter III - Perinatal results of women who experienced premature labor and were submitted to an active search of inferior genital tract infection. The purpose was to compare prematurity frequency and first minute Apgar score, inferior to seven, in pregnant women submitted or not to an active search of the inferior genital tract and etiological treatment. The study was controlled and non randomized. A significative relationship between an active search and lower prematurity indexes and better Agpar scores was found. The study leads to the conclusion that considering the relevance of the subject for public health, the results should be seen as a first approach. Further investigations on special controlled studies with larger ...

Made available in DSpace on 2014-06-11T19:29:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-02-28Bitstream added on 2014-06-13T20:20:22Z : No. of bitstreams: 1 kiy_am_me_botfm.pdf: 671369 bytes, checksum: 631d15c2eb13910d4bbd22e725169c09 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A síndrome hipertensiva gestacional está associada com prematuridade e restrição de crescimento fetal. Estudos sobre o crescimento dos recém-nascidos de mães hipertensas são escassos e inconclusivos. Avaliar o perfil de crescimento de prematuros de baixo peso ao nascer, filhos de mães hipertensas nos primeiros dois anos de vida e investigar a ocorrência de distúrbios no crescimento. Estudo de coorte de prematuros de baixo peso, acompanhados até os 24 meses de idade corrigida, no ambulatório de seguimento de um centro Universitário, entre agosto de 2008 a dezembro de 2010. Peso, comprimento e perímetro cefálico foram aferidos a cada 3 meses no 1º ano e por semestres no 2º ano. As medidas antropométricas foram analisadas conforme as curvas-padrão da OMS. Desfechos: falha de crescimento e risco de sobrepeso. Associações entre grupos foram investigadas por análise univariada. 80 prematuros de mães hipertensas e 101 de mães normotensas foram estudados. Não houve diferença no perfil de crescimento entre os 2 grupos. As medidas das crianças foram próximas ao padrão da OMS, principalmente peso e perímetro cefálico. Crianças de mães hipertensas mostraram aumento do risco de sobrepeso (RR=2,20;IC95%:1,07-4,57) com 24 meses de idade corrigida. Prematuros adequados para idade gestacional apresentaram maior crescimento ponderal que os pequenos para idade gestacional. O perfil de crescimento de prematuros de baixo peso de mães hipertensas e normotensas é semelhante nos primeiros anos de vida, mas ao final do segundo ano as crianças de mães hipertensas apresentam maior risco de sobrepeso / Hypertensive disorders of pregnancy are associated with prematurity and fetal growth restriction. Studies on the growth of infants born to hypertensive mothers are scarce and inconclusive. To assess the growth profile of preterm low birth weight infants, born to hypertensive mothers in the first two years of life and to evaluate the occurrence of growth disorders. A cohort study of low birth weight preterm infants followed up to 24 months corrected age (CA) at a University follow up clinic, between August 2008 to December 2010. Weight, length and head circumference were measured every 3 months during the first year and by semesters in the second year. Anthropometric measurements were plotted on WHO growth reference charts. Outcomes: failure to thrive and risk of overweight. Associations between groups were investigated by univariate analysis. 80 premature infants born to hypertensive mothers and 101of normotensive were studied. There was no difference in the growth profile between the 2 groups. The measurements of the infants were close to the standard of WHO, especially weight and head circumference. Children of hypertensive mothers showed increased risk for overweight (RR = 2.20, 95% :1,07-4, 57) at 24 months CA. Appropriate for gestational age infants had higher weight growth than small for gestational age. The growth profile of preterm low birth weight born to hypertensive and normotensive mothers is similar in the first years of life, but at the end of the second year the infants of hypertensive mothers are at increased risk of overweight

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / As SÃndromes Hipertensivas Gestacionais (SHG) respondem por elevados Ãndices de morbimortalidade materna e neonatal, tendo estudos mostrado que seus efeitos nÃo resumem-se ao perÃodo da gestaÃÃo, acarretando em um perfil clÃnico e metabÃlico diferenciado conferindo maior risco para a ocorrÃncia de eventos cardiovasculares em mulheres com histÃria destas patologias. Objetivou-se neste estudo analisar o perfil de risco cardiovascular em mulheres com histÃria obstÃtrica de SHG. Tratou-se de uma coorte retrospectiva na qual foram avaliadas 60 mulheres (30 com histÃria de SHG e 30 com histÃria de gestaÃÃes sem complicaÃÃes) cujos partos ocorreram no perÃodo entre 1992 e 2002 em uma Maternidade TerciÃria de Fortaleza-Ce. As pacientes que aceitaram participar do estudo realizaram avaliaÃÃo antropomÃtrica, laboratorial e da funÃÃo endotelial atravÃs da dilataÃÃo fluxo-mediada da artÃria braquial. As variÃveis contÃnuas foram analisadas utilizando os testes de Kolmogorov-Smirnov para verificaÃÃo da normalidade destas, sendo utilizados os testes t-Student e Mann-Whitney para comparaÃÃo das mÃdias. As medidas clÃnicas e metabÃlicas foram categorizadas segundo os pontos de corte determinados por consensos nacionais segundo o risco cardiovascular, sendo utilizado o teste do qui-quadrado e Exato de Fisher para comparaÃÃo entre os grupos. Calculou-se a OR para as variÃveis que se mostraram estatisticamente significantes considerando p<0,05. O perÃodo de seguimento mÃdio dos grupos foi de 15,2Â3,5 anos. O estudo mostrou que mulheres com histÃria de SHG apresentam maiores valores de IMC, PAS, LDL-C e glicemia em jejum (p=0,03; 0,03; 0,02 e 0,02, respectivamente). Mostrou-se estatisticamente significante o uso de anti-hipertensivos (p=0,03) e tendÃncia ao uso de hipoglicemiantes (p=0,05). Encontrou-se uma frequÃncia de disfunÃÃo endotelial de 60% entre as expostas, demonstrando diferenÃa estatisticamente significante entre os grupos (p=0,01). Foi identificada SÃndrome MetabÃlica em 80% das expostas, com diferenÃa entre os grupos quanto ao diagnÃstico e o nÃmero de componentes da sÃndrome (p=0,01). As pacientes do grupo exposto apresentaram maiores pontuaÃÃes no Escore de Risco de Framingham e no Escore Global de RCV (p=0,03; 0,01). O estudo apresenta um perfil de risco cardiovascular desfavorÃvel em pacientes com histÃria de SHG corroborando com dados da literatura e contribuindo para embasar a necessidade de um melhor acompanhamento no pÃs-parto em longo prazo de mulheres com histÃria desta complicaÃÃo obstÃtrica.

Abstract The aim of this study was to evaluate the treatment, course and outcome of pregnancy in Finland using two cohorts of diabetic women. The clinical cohort consisted of data from all 210 women with Type 1 diabetes and their 296 pregnancies managed between 1986 and 1995 in the two northernmost provinces of Finland. The register-based study population included all 1442 mothers with a singleton birth who had insulin treatment during pregnancy in 1991-1995 according to the Medical Birth Register. Of these mothers, 954 (66%) had pre-existing diabetes. Insulin-treated diabetes complicated 4.5/1000 births in Finland in 1991-1995, the prevalence of Type 1 diabetes being 2.9/1000 in the whole country and 3.3/1000 in Northern Finland. In the 1990's the care of these women shifted from tertiary level only to include the secondary level hospitals as well, and was more often carried out on an out-patient basis. This care policy in association with the self-monitoring of blood glucose levels contributed to an obvious improvement in glycaemic control during pregnancy. Despite that, the high proportion (73%) of women entering pregnancy with unsatisfactory glycaemic control did not decrease during the study period. Retinopathy complicated 134 (45.3%) diabetic pregnancies, while clinical nephropathy was found in 23 (7.8%) cases. Although retinopathy was more often aggravated during the first pregnancy, the occurrence of retinopathy or its severe form was not increased at the beginning of consecutive pregnancies. Of the mothers, 50 (16.9%) had pre-eclampsia during pregnancy, and in 28% of these cases it was classified as superimposed. It was found more often among primiparous than multiparous (25.6% vs. 11.0%, respectively), and its occurrence rose with the severity of diabetes. In both cohorts, the rates of preterm deliveries, Caesarean sections and large for gestational age (LGA) infants were significantly (p &lt; 0.001) higher in Type 1 diabetic pregnancies than in the background population. The rates of congenital anomalies (CA) were 540-629/10000 in two study populations, both being 2-3-fold as compared to the background population. Cardiac malformations were most common, with anomalies in the genitourinary tract and the musculoskeletal organs being next in frequency. Sixty-three percent of malformed infants were boys. Though pregnancy itself was not found to worsen the prognosis of diabetes, at least in the short term, pregnancy in diabetic women still remains a high risk state with an increased rate of prematurity, operative deliveries, CAs and peri- and neonatal mortality. In order to decrease the mortality rate in diabetic births, attention should be directed at both the prevention of CA and at identifying the foetuses at risk for intrauterine death. The postneonatal mortality rate is also high, reflecting a shift in the deaths from the early neonatal period to a later age. Therefore, a combined mortality, including induced abortions, stillborns and infant deaths, would give a more realistic idea of the outcomes in diabetic pregnancies.