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

No description available.

Population health data suggests that the development of metabolic disease is influenced by early life events. Gestational diabetes (GDM) is a common complication of pregnancy, but its effects on the offspring are poorly understood. It is hypothesized that a diet high in fat and sucrose will cause excessive weight gain and obesity during pregnancy accompanied by hyperglycemia and hyperinsulinemia that are characteristic of GDM. It is also hypothesized that gestational exposure to GDM will cause obesity, hepatic steatosis and insulin resistance in the offspring when compared to the offspring from metabolically healthy, lean mothers.

Gestational diabetes mellitus (GDM), a pregnancy-induced metabolic disorder that affects 2-10% of pregnancies poses future risk for diabetes mellitus (DM) and cardiovascular disease in mother and child. However, few prospective studies have examined the effect of GDM on altered maternal and cord blood lipids, specifically HDL, LDL, triglycerides, and total cholesterol, both during and after pregnancy. We have evaluated the association between GDM and lipid metabolism in pregnant mothers and their infants using data from a prospective cohort study conducted at Baystate Medical Center’s Wesson Women and Infant’s Unit. GDM was assessed prenatally by 3-hr GTT blood samples and was confirmed by obstetrician review. Lipids were assessed via fasting and non-fasting blood samples obtained during 3-hr GTTs performed at 24-28 weeks of gestation and 6-8 weeks post-partum. Data for covariates were collected via an interview form administered at the time of recruitment. We used multivariable linear regression to evaluate the association between GDM status and maternal lipids during and after pregnancy as well as cord lipids. These study results inform future research on GDM as a risk factor for future metabolic disorders in mother and child.

Background: Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance diagnosed for the first time during pregnancy. Up to 60% of women who had a prior GDM will develop type II diabetes mellitus in the next 5 to 15 years after delivery. Our study aimed to examine perinatal factors associated with later development of impaired glucose metabolism in women with a recent history of GDM. Methods: We conducted a retrospective cohort study based on a 2-year follow-up of women with or without prior GDM. We recruited 39 women from the previous case-control study, including 19 women with prior GDM and 20 women without prior GDM. All the subjects were taken a 75-g oral glucose tolerance test (OGTT) and were interviewed with a questionnaire by research nurses. Chi-square tests were used to examine differences in proportions. Multiple log-linear regression models were used to determine whether there was an association between the prenatal potential risk factors and glucose metabolic abnormalities, after adjustment of various potential confounding variables. Results: Compared to women without a history of GDM, prior GDM women had significantly higher glucose and insulin concentration, increased insulin resistance and decreased β-cell function. Pre-pregnancy body mass index (BMI) and family history of diabetes were significantly reduced in early phase insulin responsiveness (IGI/HOMA-IR) and insulin secretion-sensitivity index (IS-SI) among women without prior GDM. Women’s parity was statistically significant decreased in Matsuda insulin sensitivity index (ISOGTT). Conclusion: Women with history of GDM have a significant higher risk of developing glucose metabolic abnormalities about two years after delivery. Pre-pregnancy BMI may have an association with later developing abnormal glucose metabolism in women without history of GDM. / acase@tulane.edu

Gestational diabetes Mellitus (GDM), a condition involving abnormal levels of glucose in the blood plasma has seen a rapid surge amongst the gestating mothers belonging to different regions and ethnicities around the world. Cur- rent method of screening and diagnosing GDM is restricted to Oral Glucose Tolerance Test (OGTT). With the advent of machine learning algorithms, the healthcare has seen a surge of machine learning methods for disease diag- nosis which are increasingly being employed in a clinical setup. Yet in the area of GDM, there has not been wide spread utilization of these algorithms to generate multi-parametric diagnostic models to aid the clinicians for the aforementioned condition diagnosis.In literature, there is an evident scarcity of application of machine learn- ing algorithms for the GDM diagnosis. It has been limited to the proposed use of some very simple algorithms like logistic regression. Hence, we have attempted to address this research gap by employing a wide-array of machine learning algorithms, known to be effective for binary classification, for GDM classification early on amongst gestating mother. This can aid the clinicians for early diagnosis of GDM and will offer chances to mitigate the adverse out- comes related to GDM among the gestating mother and their progeny.We set up an empirical study to look into the performance of different ma- chine learning algorithms used specifically for the task of GDM classification. These algorithms were trained on a set of chosen predictor variables by the ex- perts. Then compared the results with the existing machine learning methods in the literature for GDM classification based on a set of performance metrics. Our model couldn’t outperform the already proposed machine learning mod- els for GDM classification. We could attribute it to our chosen set of predictor variable and the under reporting of various performance metrics like precision in the existing literature leading to a lack of informed comparison. / Graviditetsdiabetes Mellitus (GDM), ett tillstånd som involverar onormala ni- våer av glukos i blodplasma har haft en snabb kraftig ökning bland de drab- bade mammorna som tillhör olika regioner och etniciteter runt om i världen. Den nuvarande metoden för screening och diagnos av GDM är begränsad till Oralt glukosetoleranstest (OGTT). Med tillkomsten av maskininlärningsalgo- ritmer har hälso- och sjukvården sett en ökning av maskininlärningsmetoder för sjukdomsdiagnos som alltmer används i en klinisk installation. Ändå inom GDM-området har det inte använts stor spridning av dessa algoritmer för att generera multiparametriska diagnostiska modeller för att hjälpa klinikerna för ovannämnda tillståndsdiagnos.I litteraturen finns det en uppenbar brist på tillämpning av maskininlär- ningsalgoritmer för GDM-diagnosen. Det har begränsats till den föreslagna användningen av några mycket enkla algoritmer som logistisk regression. Där- för har vi försökt att ta itu med detta forskningsgap genom att använda ett brett spektrum av maskininlärningsalgoritmer, kända för att vara effektiva för binär klassificering, för GDM-klassificering tidigt bland gesterande mamma. Det- ta kan hjälpa klinikerna för tidig diagnos av GDM och kommer att erbjuda chanser att mildra de negativa utfallen relaterade till GDM bland de dödande mamma och deras avkommor.Vi inrättade en empirisk studie för att undersöka prestandan för olika ma- skininlärningsalgoritmer som används specifikt för uppgiften att klassificera GDM. Dessa algoritmer tränades på en uppsättning valda prediktorvariabler av experterna. Jämfört sedan resultaten med de befintliga maskininlärnings- metoderna i litteraturen för GDM-klassificering baserat på en uppsättning pre- standametriker. Vår modell kunde inte överträffa de redan föreslagna maskininlärningsmodellerna för GDM-klassificering. Vi kunde tillskriva den valda uppsättningen prediktorvariabler och underrapportering av olika prestanda- metriker som precision i befintlig litteratur vilket leder till brist på informerad jämförelse.

Made available in DSpace on 2014-06-11T19:27:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2003Bitstream added on 2014-06-13T18:48:03Z : No. of bitstreams: 1 goncalves_lc_me_botfm.pdf: 549878 bytes, checksum: e39f24a75a657abf0621e0b892311a25 (MD5) / 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... / 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)

Résumé : L’aggravation de certaines caractéristiques cliniques des femmes enceintes (âge, poids) et l’augmentation de la prévalence du diabète gestationnel (DG) poussent à dépister le DG le plus tôt possible pour éviter chez la mère et le fœtus les complications à court et à long terme. Le dépistage du DG est recommandé à 24-28 semaines de grossesse, et le plus souvent un test de tolérance à 50g de glucose (TTG) est réalisé. Pour les femmes qui ont des facteurs de risque, ce test doit être effectué plus précocement, habituellement pendant le premier trimestre de la grossesse. Cette dernière recommandation est peu suivie, d’autant qu’il n’y a pas de consensus international sur le dépistage du DG pendant le premier trimestre de la grossesse. Objectifs. 1) Définir au premier trimestre de la grossesse la valeur de la glycémie du TTG qui prédit le diagnostic de DG à 24-28 semaines avec une sensibilité et une spécificité optimales à l’aide d’une courbe ROC. 2) Déterminer si la glycémie du TTG au premier trimestre est un facteur prédictif indépendant du DG. Méthodes. Étude prospective de cohorte. Les facteurs d'inclusion étaient : âge ≥ 18 ans et âge gestationnel entre 6 et 13 semaines après la dernière menstruation. Les TTG ont été effectués à la première visite prénatale. Une deuxième visite était programmée à 24-28 semaines pour faire une hyperglycémie provoquée par voie orale (HGPO) et donc un éventuel diagnostic de DG. Les critères utilisés pour ce diagnostic étaient ceux de l’Association américaine du diabète. Résultats. Les TTG ont été faits à 9,1±2,0 semaines et les HGPO à 26.5±1.1semaines chez 1180 femmes (28,2±4,4 ans, IMC : 25,2±5,5 kg/m[indice supérieur 2]). Un DG a été diagnostiqué chez 100 (8,4%) participantes. La valeur de glycémie du TTG à 5,6 mmol/L a prédit le DG avec une sensibilité de 84,1% et une spécificité de 62,3%, tandis que la valeur prédictive positive était de 0,121 et la valeur prédictive négative de 0,985. Cette valeur de 5,6 était indépendamment associée au DG (OR=2,806, IC 95%: 1,98 à 3,97, p <0,001). Comparé à d'autres facteurs de risque, le TTG était le plus puissant prédicteur indépendant du DG (OR=1,767, IC 95%: 1,52 à 2,05, p <0,001). Conclusions. Au premier trimestre, la valeur glycémie de 5.6 mmol/L du TTG prédit avec une bonne sensibilité et spécificité l’apparition d’un DG à 24-28 semaines. La glycémie du TTG au premier trimestre est le plus puissant prédicteur indépendant de DG. / Abstract : The changes in clinical characteristics of pregnant women and an increase in the prevalence of gestational diabetes mellitus (GDM) warrant the importance of screening as early as possible in order to possibly prevent short and long-term complications in both the mother and fetus. GDM screening is recommended at 24-28 weeks of pregnancy, using a 50g glucose challenge test (GCT) although women with multiple risk factors are expected to be assessed “early” in pregnancy, a recommendation poorly followed. Most importantly, there is no universal agreement currently in place for GDM screening, particularly during the first trimester of pregnancy. Objectives. 1) To define the cut-off value of GCT during the first trimester in order to predict GDM diagnosed at 24-28 weeks of gestation with optimal sensitivity and specificity using ROC curve. 2) To determine if GCT during the first trimester of pregnancy is an independent predictor of GDM diagnosed at 24-28 weeks gestation. Methods. This is a prospective cohort study. Women were recruited at their first prenatal visit. Inclusion factors were: age ≥ 18 years and gestational age between 6 and 13 weeks from their last menstrual period. GCT were performed at the first prenatal visit. The second visit was scheduled at 24-28 weeks for the diagnostic 75g oral glucose tolerance test (OGTT). GDM diagnosis was made in accordance with the American Diabetes Association guidelines. A variety of statistical analysis including multivariate logistic regression models and ROC curve were used to address the aims of the study. Results. Participants (n=1180, age: 28.2±4.4 years, BMI: 25.2±5.5 kg/m[superscript 2]) underwent GCT at 9.1±2.0 weeks and OGTT at 26.5±1.1 weeks of gestation. GDM was diagnosed in 100 (8.4%) women. The cut-off value of 5.6 mmol/L predicted GDM with 84.1% (75.4-92.7) sensitivity, 62.3% (59.5-65.1) specificity, while the positive predictive value was 0.121 (0.091-0.150) and the negative predictive value was 0.985 (0.975-0.994). This 5.6 value was independently associated with GDM (OR=2.806, 95% CI: 1.98-3.97, p<0.001). Compared to other risk factors, GCT was the strongest independent predictor of GDM (OR=1.767, 95% CI: 1.52-2.05, p<0.001). Conclusions. The cut-off value of 5.6 mmol/L has the optimal sensitivity and specificity for the GCT during the first trimester to predict GDM at 24-28 weeks of gestation according to ADA guidelines. GCT during the first trimester is the strongest independent predictor of GDM at 24-28 weeks of gestation.