Résumé : Au Canada, un tiers des enfants souffrent d’embonpoint ou sont obèses. Les événements survenant au cours de la vie intra-utérine jouent un rôle important dans la détermination de la susceptibilité des enfants à développer des maladies liées au métabolisme énergétique comme l’obésité et le diabète. L’épigénétique pourrait expliquer en partie ce risque à long terme. Mon projet de maîtrise s’appuie sur les résultats d’une approche à l’échelle du génome qui a pour objectif d’identifier les changements épigénétiques (méthylation de l’ADN), chez les nouveau-nés, associés à une exposition fœtale à l’obésité maternelle ou au diabète gestationnel (DG). Cette stratégie a permis d’identifier le gène PRDM16 qui joue un rôle clé dans le développement du tissu adipeux brun (BAT). Un déficit dans la fonction du BAT résulte en une accumulation de lipides dans le tissu graisseux ce qui est associé au développement de maladies métaboliques. Notre hypothèse est que le profil de méthylation de l’ADN de PRDM16 et d’autres gènes centraux impliqués dans la genèse du BAT est perturbé par une exposition aux débalancements métaboliques associés à l’obésité maternelle et au DG. Cette étude inclut 133 femmes et leur nouveau-né recrutés dans la région du Saguenay-Lac-St-Jean. Les données anthropométriques et métaboliques des femmes ont été récoltées à la fin de chaque trimestre de grossesse. Une hyperglycémie orale provoquée (HGOP, 75g), entre la 24e et la 28e semaine de grossesse, a permis d’établir le diagnostic de DG selon les critères de l’OMS. À la naissance, des biopsies de placenta ont été recueillies ainsi que les données anthropométriques et métaboliques pour chaque enfant. Les niveaux de méthylation de l’ADN des gènes PRDM16, PPARGC1α, BMP7 et CTBP2 dans le placenta fœtal ont été mesurés par pyroséquençage de l’ADN traité au bisulfite de sodium. Les résultats ont montré que le DG était associé à une méthylation de l’ADN du gène BMP7 plus faible dans le placenta des nouveau-nés exposés au DG contrairement à ceux non exposés. Les niveaux de méthylation des gènes BMP7, PPARGC1α et PRDM16 étaient corrélés au statut glycémique maternel au 2e trimestre de grossesse et expliquaient une partie des niveaux de leptine dans le sang de cordon ombilical. Ces résultats suggèrent que la méthylation des gènes associés à la genèse du BAT est affectée par le DG. Ces résultats suggèrent également que le métabolisme énergétique des enfants exposés au DG est altéré ce qui pourrait mener au développement de troubles métaboliques plus tard dans la vie comme l’obésité et le diabète de type 2. // Abstract : In Canada, one third of children are overweight or obese. The events occurring during the intrauterine life play an important role in determining the susceptibility of children to develop diseases related to energy metabolism such as obesity and diabetes. Epigenetic changes can to explain this long-term risk. My project is build on the results of an epigenome-wide aiming to identify epigenetic changes (DNA methylation) in newborns associated with fetal exposure to maternal obesity and gestational diabetes (GD). This strategy has identified the PRDM16 gene which plays a key role in the development of brown adipose tissue (BAT). A deficiency in the function of BAT results in accumulation of lipids in the adipose tissue that is associated with the development of metabolic diseases. Our hypothesis is that the profile of DNA methylation at PRDM16 gene and other genes involved in BAT genesis are disrupted by exposure to metabolic dysregulation associated with maternal obesity and GD. This study included 133 women and their newborn recruited in the Saguenay-Lac-St-Jean region. Anthropometric and metabolic data of the women were collected at the end of each trimester of pregnancy. An oral glucose tolerance test (OGTT, 75g), between the 24th and 28th week of pregnancy, resulted in the diagnosis of GD according to the WHO criteria. At birth, the fetal placenta biopsies were collected and anthropometric and metabolic data for each newborn. DNA methylation levels of PRDM16, PPARGC1α, BMP7 and CTBP2 genes in fetal placenta were measured by pyrosequencing of sodium bisulfite treated DNA. The results showed that GD was associated with lower DNA methylation of BMP7 gene in the placenta of newborns exposed to GD in contrast to those not exposed. DNA methylation levels of BMP7, PPARGC1α and PRDM16 genes were correlated with maternal glycemic status in the 2nd trimester of pregnancy and partially explained leptin level variability in cord blood . These results suggest that DNA methylation of genes associated with BAT genesis is affected by GD. Therefore, energy metabolism of children exposed to GD could be altered and thus leading to the development of metabolic disorders such as obesity and type 2 diabetes later in life .

Résumé : Introduction : Le débat sur l’utilisation des hypoglycémiants oraux (HGO) dans le traitement du diabète gestationnel (DG) perdure. Plusieurs études ont montré que la metformine et le glyburide sont deux alternatives acceptables en grossesse. Malgré tout, l’insuline reste le choix de première intention pour le traitement du DG lorsque la diète et l’exercice physique ne suffisent plus. Les principaux arguments en faveur des HGO sont la possibilité d’une meilleure observance du traitement et une meilleure qualité de vie (QDV). Cependant, les études sur la QDV chez les femmes atteintes de DG sont rares et d’autres études sur le HGO sont nécessaires pour valider leur efficacité et innocuité dans le traitement du DG. Méthodes : Étude pilote; 73 patientes avec DG ont été randomisées au groupe HGO (metformine ± glyburide, et ajout d’insuline au besoin) ou au groupe insuline. L’objectif primaire est de comparer, entre les deux groupes, la préférence du traitement ainsi que plusieurs aspects de la QDV (état de santé général, bien-être général, satisfaction quant au traitement du diabète et dépression post-natale). Les objectifs secondaires étaient de comparer le contrôle glycémique maternel et les issues maternelles et néonatales. Résultats : Des 73 femmes recrutées, 68 ont été incluses pour analyses. Dans le groupe HGO (n=34), 35,3% des participantes ont reçu de l’insuline. Plus de femmes dans le groupe HGO ont mentionné préférer recevoir le même traitement pour une prochaine grossesse (72.7% vs. 42,4%, p=0.01) si un traitement s’avérait nécessaire. Aucune différence n’est ressortie pour l’état de santé général, le bien-être général, la satisfaction quant au traitement et la dépression post-natale. Le taux moyen d’hypoglycémies maternelles (glycémie < 3.3 mmol/L) était supérieur dans le groupe HGO (0.8 vs. 0.1, p=0.008). Il n’y a eu aucune différence dans les autres complications maternelles et néonatales. Conclusion : La QDV est similaire dans les deux groupes mais, si un traitement pharmacologique s’avérait nécessaire lors d’une prochaine grossesse, les femmes préfèreraient débuter par les HGO. L’utilisation des HGO n’était pas associée à une hausse cliniquement significative des complications maternelles et néonatales. / Abstract: Background: The use of oral hypoglycemic agents (OHA) in gestational diabetes mellitus (GDM) is still debated. Insulin remains the first line treatment after diet failure. We hypothesized that OHA allows for better quality of life (QOL) in women with GDM and that the y prefer OHA to insulin therapy. Methods: Pilot study; 73 women with GDM were randomly assigned to the OHA group (metformin ± glyburide ± supplementary insulin, as needed) or the insulin group. General health, well-being, and treatment satisfaction using established questionnaires (SF-36, Well-Being Questionnaire and Diabetes Treatment Satisfaction Questionnaire) were respectively assessed at randomization, 38 weeks, and postpartum. Treatment preference and depression were assessed 8 weeks postpartum using the MIG questionnaire and the Short-form Edinburgh Depression Scale. Our primary outcomes were 1) preference of treatment and 2) QOL. Secondary outcomes included maternal glycemic control (hypoglycemia defined as plasma glucose < 3.3 mmol/L), as well as gestational and neonatal complications. Results: Analyses were performed in 68 women. In the OHA group (n= 34), 35.3% women received insulin therapy. More women in the OHA group than in the insulin group preferred their assigned treatment for another pregnancy (72.7% vs. 42.4%, p < 0.01) if a treatment is needed. No statistical differences between groups were found for the 3 items of QOL, the depression score, and neonatal complications. The mean rate of maternal hypoglycemia was higher in the OHA group (0. 8 vs. 0.1, p < 0.008). No statistical differences were found for other maternal and neonatal issues. Conclusion: Women declared to prefer OHA to insulin for a subsequent pregnancy complicated by GDM. QOL was similar in both groups. Use of OHA was not associated to clinically significant differences in maternal and neonatal complications.

Background Overweight and obesity are global health problems with several adverse health effects that threaten public health. In Sweden, almost four of ten pregnant women are overweight or obese, conditions that are associated with adverse pregnancy outcomes, including gestational diabetes mellitus (GDM), a metabolic disorder that complicates pregnancy. Globally, physical inactivity is the fourth leading risk factor for mortality. The recommendation for physical activity (i.e., ≥150 minutes/week) issued by the Professional Associations for Physical Activity and the Swedish National Board of Health and Welfare is in line with the recommendations by the WHO. Physical activity during pregnancy is generally safe and beneficial for both the pregnant woman and her fetus and can maintain or improve fitness and may further improve pregnancy outcomes. However, pregnant women tend to lower their physical activity when entering pregnancy. Midwives working in antenatal care (ANC) in Sweden play a prominent role in promoting a healthy lifestyle through counselling pregnant women on lifestyle, including physical activity during pregnancy. Individual counselling on physical activity encourages pregnant women to maintain their pre-pregnant leisure time physical activity throughout their pregnancy. Aims This thesis has three main aims. First, this thesis investigated guidelines for screening of GDM, risk factors, and pregnancy outcomes in relation to GDM. Second, it investigated physical activity during pregnancy and pregnancy outcomes. Third, it explored midwives’ and pregnant women’s experiences with counselling that addressed physical activity during pregnancy. Methods Study I and III are cross-sectional studies using data from the Maternal Health Care Register and the Salut Register. A total of 184,183 pregnant women were included in Study I (2011-2012) and 3,868 in Study III (2011-2012). Several statistical analyses were used: two-independent samples t-test, Pearson’s Chi-Square test, and univariate and multivariate logistic regression analyses. Study II and IV are qualitative studies applying qualitative content analysis. Study II included 41 midwives who were interviewed in eight focus group discussions (FGD). Study IV included 14 pregnant women who participated in individual in-depth interviews. Main findings There was no consensus in Sweden regarding clinical guidelines for screening regimes or 2-hour cut-off value for diagnosis of GDM from 2011 through 2012. Four screening regimes were applied in Sweden during this time period: A) universal screening with a 2-hour cut-off value of 10.0 mmol/L; B) selective screening with a 2-hour cut-off value of
8.9 mmol/L; C) selective screening with a 2-hour cut-off value of 10.0 mmol/L; and D) selective screening with
a 2-hour cut-off value of 12.2 mmol/L. The highest prevalence of GDM was found where selective screening was applied with a 2-hour cut-off value of 8.9 mmol/L. Unemployment, low educational level, and non-Nordic origin were all risk factors for GDM, and a BMI ≥30 kg/m2 almost four-doubled the risk for GDM compared to pregnant women with BMI &lt;30 kg/m2. Increasing OGTT-values were associated with increasing risk of adverse pregnancy outcomes (Paper I). Midwives in antenatal care perceived counselling as both challenging and as an opportunity to promote a healthy lifestyle for pregnant women. As the theme “An on-going individual adjustment” revealed, the midwives tried to adjust their counselling to each pregnant woman’s individual needs. Counselling pregnant women on physical activity was seen as complex and ambiguous with a risk of being rejected by the women if the advice was delivered too straightforward. Instead, the midwives were “tiptoeing” around the sensitive topics (Paper II). Almost half of pregnant women reported that they achieved the recommended level of physical activity during pregnancy (i.e., ≥150 minutes/week). These pregnant women were characterized by lower BMI, higher educational level, and very good or good self-rated health (SRH) compared to the pregnant women who did not achieve the recommended level (Paper III). Pregnant women reported a desire for individual counselling on physical activity during pregnancy. The theme that emerged was “Longing for fulfilment of individual needs and expectations”, which reflected the wish that midwives’ counselling on physical activity should be based on pregnant women’s individual needs instead of merely providing general advice. Some participants reported receiving encouragement and support, but others believed they were provided insufficient counselling on physical activity and that the midwife had her own agenda focusing mostly on medical surveillance (Paper IV). Conclusions No consensus regarding clinical guidelines and diagnostic criterion for GDM existed in Sweden during 2011 to 2012. Obesity was a strong risk factor for development of GDM, and low socio-economic status and non-Nordic origin were also demonstrated as significant risk factors. Positively, almost half of the pregnant women reached the recommended level of physical activity during pregnancy. Participants fulfilling the recommendation were characterized by lower BMI, higher education, and very good or good self-rated health. Midwives strived to adjust and individualize their counselling on physical activity; however, some of the pregnant women could experience the counselling on physical activity being too general. Clearly, healthcare professionals should encourage fertile and pregnant women to be physically active, especially overweight and obese pregnant women who report low levels of physical activity, in order to improve overall health in this population. / Bakgrund Övervikt och fetma är ett stort hälsoproblem globalt med flera negativa hälsoeffekter som utgör ett hot mot folkhälsan. Nästan 40% av de gravida i Sverige har övervikt eller fetma vilket är associerat med flera negativa graviditetsutfall där graviditetsdiabetes (GDM) är en metabolisk sjukdom som komplicerar graviditeten. Fysisk inaktivitet är den fjärde ledande riskfaktorn för dödlighet i ett globalt perspektiv. Att vara fysiskt aktiv förbättrar välbefinnandet och livskvaliteten, främjar stabil vikt, insulinkänslighet och normalt blodtryck. Vidare sänker fysisk aktivitet risken för diabetes mellitus typ 2, fetma och hjärt-och kärlsjukdomar. Fysisk aktivitet under en okomplicerad graviditet är generellt att betrakta som utan risk och ökar välbefinnandet för både kvinnan och fostret. Fysisk aktivitet bidrar till att bibehålla eller förbättra fysisk kondition och kan förbättra graviditetsutfall. Trots dessa fördelar tenderar gravida att sänka sin fysiska aktivitet under graviditeten. De svenska rekommendationerna följer de internationella riktlinjerna som innebär ≥150 minuter/vecka av måttlig fysisk aktivitet alternativt 75 minuter/vecka av intensiv fysisk aktivitet eller en kombination av dessa. Svenska barnmorskor som arbetar inom mödrahälsovården i Sverige har en central, rådgivande roll gentemot gravida kvinnor när det gäller att verka för en hälsosam livsstil inkluderande fysisk aktivitet. Individuell rådgivning i fysisk aktivitet kan uppmuntra och stödja gravida kvinnor att fortsätta vara fysiskt aktiva under hela graviditeten. Syfte Att kartlägga riktlinjer för graviditetsdiabetes i Sverige samt riskfaktorer och graviditetsutfall i relation till GDM. Vidare att undersöka fysisk aktivitet under graviditeten samt associationer till graviditetsutfall och slutligen att utforska barnmorskor och gravida kvinnors upplevelser av rådgivning i fysisk aktivitet. Metod Studie I och III var tvärsnittsstudier där data från Mödrahälsovårds-registret och Salutregistret nyttjades. Totalt 184,183 gravida kvinnor inkluderades i Studie I och 3,868 inkluderades i Studie III (tidsperiod 2011-2012). Statistiska analyser som genomfördes var t-test, Pearson’s Chi-2-test och univariat samt multivariat logistisk regressionsanalys. Studie II och IV var kvalitativa studier där intervjuerna analyserades med manifest och latent kvalitativ innehållsanalys. Studie II inkluderade 41 barnmorskor i åtta fokusgrupper och 14 gravida omföderskor djupintervjuades individuellt i Studie IV. Resultat Under perioden 2011-2012 förelåg inte någon enighet gällande riktlinjer för screening och gränsvärde för diagnosen GDM i Sveriges 43 mödrahälsovårdsområden. Fyra olika screeningregimer identifierades; A) generell screening och 2-timmar gränsvärde på 10,0 mmol/L i plasmaglukos, B) selektiv screening och 2-timmar gränsvärde på 8,9 mmol/L i plasmaglukos, C) selektiv screening och 2-timmar gränsvärde på 10,0 mmol/L i plasmaglukos och D) selektiv screening och 2-timmar gränsvärde på 12,2 mmol/L i plasmaglukos. Den högsta prevalensen av GDM återfanns i det område som hade 8,9 mmol/L som gränsvärde och den lägsta där 12,2 mmol/L var gränsvärdet för GDM. Arbetslöshet, låg utbildningsnivå och ett utom-nordiskt ursprung utgjorde alla riskfaktorer för utveckling av GDM. Fetma, BMI ≥30 kg/m2, utgjorde den riskfaktor med högst risk för att utveckla GDM under graviditet med en nästan fyrdubblad risk jämfört med en kvinna med BMI &lt;30kg/m2. Ökande 2-timmarsvärden av blodglukos var associerat med ökande negativa graviditetsutfall såsom kejsarsnitt och instrumentell vaginal förlossning (Artikel I). Barnmorskorna i mödrahälsovården upplevde rådgivningen i fysisk aktivitet som å ena sidan utmanande men å andra sidan som en möjlighet att verka för en hälsosam livsstil hos de gravida kvinnorna. Temat ”En ständigt pågående anpassning” visar barnmorskornas försök att anpassa sin rådgivning efter varje enskild gravid kvinnas behov och situation. Rådgivningen i fysisk aktivitet till gravida upplevdes som komplex och mångfacetterad. Det uttrycktes en oro för att bli avvisad av den gravida kvinnan om de givna råden förmedlades för uppriktigt. Detta ledde ibland till att barnmorskorna ”trippade på tå” och försiktigt närmade sig känsliga ämnen såsom övervikt och råd om fysisk aktivitet. Barnmorskorna försökte även finna individuella lösningar och anpassa råden utifrån varje enskild gravid kvinnas möjligheter. Detta var särskilt tydligt i mötet med kvinnor som immigrerat till Sverige, där barnmorskorna upplevde att en del av rådgivningen bestod i att slå hål på myter om fysisk aktivitet såsom något riskfyllt samt att informera om de positiva hälsoeffekterna med fysisk aktivitet under graviditeten (Artikel II). Nästan hälften av de gravida kvinnorna uppnådde Socialstyrelsens rekommendationer avseende fysisk aktivitet under graviditet och dessa kvinnor karakteriserades av lägre BMI, högre utbildningsnivå samt mycket bra/bra självskattad hälsa jämfört med de gravida som inte uppnådde rekommendationerna Artikel III). Temat som framkom i Artikel IV var ”Längtan efter tillfredsställelse av individuella behov och förväntningar” och speglar de gravidas önskan att erhålla en individuellt anpassad rådgivning i fysisk aktivitet av barnmorskorna istället för en generell rådgivning avsedd för alla. Några gravida hade erfarenheter av barnmorskan som stöttande och uppmuntrande i sin rådgivning i fysisk aktivitet. Andra kunde uppleva rådgivningen som otillräcklig, att barnmorskan exempelvis inte hade tillräckligt med kunskap i fysisk aktivitet samt att barnmorskan hade en egen agenda för deras möten som i huvudsak fokuserade på den medicinska övervakningen av graviditeten. Slutsats Under perioden 2011-2012 förelåg ingen consensus angående de nationella riktlinjerna och diagnostiska värdet för GDM i Sverige. Fetma var den riskfaktor med högst risk för utvecklande av GDM och låg socio-ekonomi, maternell ålder &gt;35 år samt utom-nordiskt ursprung utgjorde även riskfaktorer för GDM. Positivt var att nästan hälften av de gravida uppnådde Socialstyrelsens rekommendationer för fysisk aktivitet under graviditeten och dessa karakteriserades av signifikant lägre BMI, högre utbildningsnivå samt mycket god/god självskattad hälsa. Trots att barnmorskorna beskrev hur de strävade efter att anpassa rådgivningen i fysisk aktivitet till varje enskild kvinna, kunde de gravida kvinnorna uppleva att rådgivningen var otillräcklig, för generell och främst fokuserad på den medicinska övervakningen. Det är av största vikt att hälso- och sjukvårdspersonal som möter fertila och gravida kvinnor verkar för en hälsosam livsstil, särskilt avseende kvinnor med en inaktiv livsstil och de som har övervikt eller fetma för att på så sätt förbättra hälsan hos denna del av befolkningen. För att uppnå detta krävs resurser gällande personal, tidsutrymme samt fortbildning inom hälsa och rådgivning för barnmorskor och annan hälso- och sjukvårdspersonal som möter dessa kvinnor. Slutligen, för att möjliggöra rådgivning som avser att stödja fysisk aktivitet för de kvinnor som immigrerat till Sverige behövs mer kunskap och utbildning i mötet med dessa kvinnor.

O diabetes mellitus gestacional (DMG) é o distúrbio metabólico mais comum da gravidez. A definição padrão do DMG consiste no metabolismo anormal da glicose diagnosticado pela primeira vez durante a gestação. Mulheres que têm história de DMG geralmente apresentam diabetes pós-parto, resistência à insulina, síndrome metabólica, hipertensão e dislipidemia. A detecção precoce deste estado metabólico anormal é importante para eventual intervenção na tentativa de impedir ou mesmo retardar o aparecimento dos outros tipos de diabetes. Alguns estudos têm apontado, em mulheres com DMG, indução de genes envolvidos com resposta imune, particularmente aqueles associados com inflamação. A identificação de genes de inflamação induzidos em gestantes com DMG tem fornecido a base para elucidar a ligação entre vias inflamatórias e DMG. Para testar esta hipótese foi realizada a comparação do perfil transcricional de células mononucleares de sangue periférico (PBMCs) de pacientes com DMG e controles. As amostras de RNA total foram hibridadas utilizando oligo microarrays Agilent ® 4 x 44 K englobando o genoma funcional humano total. Os mRNAs diferencialmente expressos foram identificados aplicando-se a análise de Rank Products, e posteriormente submetidos ao agrupamento hierárquico de Pearson por meio do software Cluster. Utilizando o programa TreeView, foi realizada a construção dos dendrogramas com as representações espaciais dos mRNAs, classificados de acordo com suas funções moleculares e vias biológicas. A partir do banco de dados DAVID, foram identificados 130 processos biológicos significantes (P<0.05) incluindo os de resposta imune e defesa, resposta inflamatória, regulação de citocinas, apoptose, desenvolvimento de vasos sanguíneos e proliferação celular. Entre as vias de maior relevância destacamos a via de interação entre receptores de citocinas e a de sinalização do receptor NOD-like, além das vias de câncer, lúpus e asma. Adicionalmente, encontramos os transcritos dos genes IGFBP2, TCF3, OLR1, TCF7L2, previamente associados a alterações metabólicas, diferencialmente expressos nas gestantes com DMG. Também observamos que genes do complexo principal de histocompatibilidade (MHC), HLA-DRB6, HLA-DQA2, HLA-DQB2, HLA-DQB1, HLA-DOA, apresentaram mRNAs induzidos nas pacientes com DMG. A partir deste estudo, constatamos que vias relacionadas ao sistema imunológico e categorias funcionais associadas à inflamação participam da patogenia do DMG. Além disso, evidenciamos que transcritos de genes que pertencem ao MHC e aqueles envolvidos em processos metabólicos, estiveram diferencialmente expressos no DMG. Estes resultados confirmam nossa hipótese inicial e contribuem para o melhor entendimento das bases genéticas desta doença. / Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder found during pregnancy. The standard definition of GDM is the abnormal glucose metabolism first diagnosed during pregnancy. Women who have a history of GDM usually present postpartum diabetes, insulin resistance, metabolic syndrome, hypertension and dyslipidemia. Early detection of this abnormal metabolic status may permit early intervention to prevent or even delay the development of other types of diabetes. The induction of genes involved in immune response in women with GDM has been reported, particularly those associated with inflammatory pathways, providing basis proposing that inflammation genes might be associated to GDM. To test this hypothesis, we compared the transcriptome profiling of peripheral blood mononuclear cells (PBMCs) of GDM patients and controls. The total RNA samples were hybridized to Agilent ® 4 x 44 K oligo microarrays covering the whole human functional genome. Differentially expressed mRNAs were obtained by Rank Product analysis and then submitted to hierarchical clustering using the Cluster software . Dendrograms and spatial representations of mRNAs were constructed through the TreeView software . These mRNAs were classified according to their molecular functions and biological pathways using the DAVID database. We observed 130 significant biological processes (P<0.05), including immune and defense response, inflammatory response, regulation of cytokines, apoptosis, blood vessels development and cell proliferation. Among the most relevant pathways, we highlighted the interaction between cytokine receptors, NOD-like receptor signaling and cancer, lupus and asthma pathways. Additionally, we found transcripts of the genes IGFBP2, TCF3, OLR1, TCF7L2, which were previously associated with metabolic abnormalities, differentially expressed in pregnant women with GDM. Some major histocompatibility complex (MHC) genes (HLA-DRB6, HLA-DQA2, HLA-DQB2, HLA-DQB1, HLA-DOA) also presented mRNAs induced in patients with GDM. In conclusion, we found that immunerelated pathways and functional categories associated with inflammation participate in the pathogenesis of DMG. Furthermore, we showed that transcripts of genes belonging to MHC and those involved in metabolic processes were differentially expressed in DMG. These results confirmed our initial hypothesis and contribute to a better understanding of the genetics basis of this disease.

Bakgrund: Graviditetsdiabetes är den vanligaste metabola sjukdomen hos gravida. Sjukdomen ökar drastiskt relaterat till ökat stillasittande. Åtgärder inkluderar kostråd, råd om fysisk aktivitet, stöd att förbättra levnadsvanor samt vid behov insulinbehandling. Trots att forskning visar att fysisk aktivitet har flera positiva effekter på graviditetsdiabetes är mindre än hälften av populationen så fysiskt aktiva som de rekommenderas vara. För att bättre kunna stötta dessa kvinnor i sitt fysiska aktivitetsbeteende behövs mer information om deras kunskap och utfallsförväntningar avseende fysisk aktivitet. Syfte: Att undersöka hur fysiskt aktiva gravida med graviditetsdiabetes är, vilken kunskap och vilka utfallsförväntningar de har avseende fysisk aktivitet vid graviditetsdiabetes samt undersöka eventuella samband mellan kunskap, utfallsförväntningar och fysisk aktivitetsnivå. Metod: Observationsstudie av icke experimentell design genomfördes med webbenkät skapad i Google Forms. Bekvämlighetsurval från specialistmödravården samt sluten Facebook-grupp. Resultat: Majoriteten ägnade mindre än 30 minuter åt fysisk träning en vanlig vecka, uppfyllde inte rekommendationerna för vardagsmotion samt var stillasittande hela dagen. Majoriteten av deltagarna hade mer än häften rätt på kunskapsfrågorna och var säkra på att fysisk aktivitet är hälsosamt. Korrelationsberäkningarna var inte statistiskt signifikanta. Slutsats: Deltagarna hade kunskaper och höga utfallsförväntningar avseende fysisk aktivitet men låg fysisk aktivitetsnivå. Ytterligare forskning krävs för att undersöka eventuell korrelation. / Background: Gestational diabetes mellitus (GDM) is the most common metabolic disease in pregnant women. GDM increases drastically related to sedentary behaviour. Treatment includes dietary advice, advice on physical activity and if necessary, insulin therapy. Objective: The purpose was to examine how physically active women with GDM are, their knowledge and outcome expectations on physical activity during GDM and whether there is any correlation between knowledge, outcome expectations and level of physical activity. Method: Observation study of non-experimental design was performed with a web-based questionnaire created in Google Forms. Study participants from Specialistmödravården at Akademiska sjukhuset Uppsala and a closed Facebook group. Results: The majority devoted less than 30 minutes to physical exercise a regular week, did not meet the recommendations for everyday exercise and were sedentary throughout the day. Most of the participants answered more than half of the questions correctly and were confident that physical activity is healthy. No significant correlations were found. Conclusion: The study participants had knowledge and high outcome expectations regarding physical activity, but their physical activity level was low. Further research on correlations is required.

A prática de atividade física durante a gestação está relacionada a controle de ganho de peso materno, redução de desenvolvimento de distúrbios metabólicos e síndromes hipertensivas. Está indicada também como intervenção importante no tratamento de Diabetes mellitus, distúrbio metabólico mais comum durante a gravidez. Para a orientação de um adequado programa de exercícios físicos durante o período gestacional, torna-se necessário o conhecimento do conjunto de atividades e do gasto energético de cada paciente durante este período da vida da mulher. O Objetivo do trabalho foi avaliar a taxa de atividade física durante o ciclo gravídico-puerperal e a influência do Índice de Massa Corporal (IMC) em mulheres com ou sem Diabetes Mellitus Gestacional (DMG). As pacientes foram estratificadas de acordo com presença ou ausência de diagnóstico de DMG e IMC pré- concepcional, resultando em quatro grupos com 66 participantes cada (grupo de gestação de risco habitual - GRH com IMC adequado, >=18,5 e <= 24,9 kg/m2, e IMC alterado, >= 25 kg/m e grupo com DMG com IMC adequado, >=18,5 e <= 24,9 kg/m2, e IMC alterado, >= 25 kg/m2). As pacientes selecionadas foram submetidas a análise socioeconômica e foi aplicada a versão validada para o português do Questionário de Atividade Física para Mulheres Grávidas-QAFMG (do inglês Pregnancy Physical Activity Questionnaire-PPAQ) para avaliação do nível de atividade física no período pré-gestacional, no terceiro trimestre da gestação e três meses após o parto, que foram expressos em Equivalente Metabólico da Tarefa (do inglês Metabolic Equivalent of Task-MET). Os resultados mostraram que classificaram-se como de etnia branca 54,55% das entrevistadas no grupo DMG - IMC 0; 63,10% no grupo DMG - IMC 1; 60,24% no grupo GRH- IMC 0; 53,25% no grupo GRH - IMC1; como donas de casa 49,35%; 54,76%; 62,65 e 53,25% nos respectivos grupos. Já em estado civil as porcentagens encontradas foram de 80,52%; 89,29%; 75,90% e 80,52%.A variável escolaridade mostrou que 63,03% das gestantes do grupo DMG de IMC 0, 65,48% das gestantes do grupo DMG - IMC 1, 75,90% das gestantes do 8 grupo GRH e IMC 0 e 72,73% das gestantes do grupo GRH e IMC 1 apresentava entre 8 e 11 anos de estudo. A classe econômica mais predominante em todos os grupos foi a C2 em que a renda familiar é de 1.446,24 reais. (DMG - IMC 0 = 40,26%; DMG - IMC 1 = 31,33%; GRH - IMC 0 = 43,90%; GRH - IMC 1 = 38,96%). Ao comparar as médias dos valores de MET´s encontrados na amostra, notou-se que os valores encontrados na avaliação três meses após o parto (representado pelo tempo 2) foram superiores a 1 (1,10 MET para grupo DMG de IMC adequado e 1,06 MET para IMC alterado e no grupo GRH 1,02 MET de IMC adequado e 1,07 MET de IMC alterado). Já nas análises pré-gestacional (tempo 0) e de terceiro trismestre (tempo 1), os valores foram inferiores a 1 MET. Concluiu-se que o nível de atividade física não foi influenciado pelo diagnóstico de DMG e nem pelo IMC pré- gestacional. No entanto, alterou-se de acordo com a evolução temporal, com aumento da atividade física no período pós-parto. / The practice of physical activity during pregnancy is related to the control of weight gain in the mother\'s part, and the reduced development of metabolic disorders and hypertensive syndromes. It is also indicated as an important intervention in the treatment of Diabetes mellitus, the most common metabolic disorder during pregnancy. In order to achieve an adequate program of physical exercises to be done during the gestational period, it becomes necessary the knowledge of a set of activities and the energy expenditure of each patient during this period of a woman\'s life. The goal of this study was to evaluate the rate of physical activity during the pregnancy- postpartum cycle and the influence of the Body Mass Index (BMI) in women with or without Gestational Diabetes Mellitus (GDM). Patients were stratified according to the presence or absence of the GDM diagnosis and their preconception BMI, resulting in four groups with 66 participants in each (group of gestational habitual risk - GHR with normal BMI >=18.5 and <= 24.9 kg/m², and with altered BMI, >= 25 kg/m² and group with GDM, with normal BMI, >=18.5 and <= 24.9 kg/m², and with altered BMI, >= 25 kg/m²). The selected patients were submitted to a socioeconomic analysis and to did the Portuguese-validated version of the Pregnancy Physical Activity Questionnaire (PPAQ) to assess the level of physical activity in the pregestational period, in the third trimester of gestation and three months postpartum, which were expressed in Metabolic Equivalent of Task (MET). The results showed that 54.55% of the interviewees in the GDM - BMI 0 group; 63.10% GDM - BMI 1 group; 60.24% in the GHR-BMI 0 group; 53.25% no GHR - BMI 1 group; as housewives 49.35%; 54.76%; 62.65 and 53.25% in the respective groups. Already in civil status as percentages found were of 80.52%; 89.29%; 75.90% and 80.52%. The educational variable showed that 63.03% of the pregnant women in the GDM - BMI 0 group, 65.48% of the pregnant women in the GDM - BMI 1 group, 75.90% of the pregnant women in the GRH - BMI 0 group and 72.73% of the pregnant women in the GHR - BMI 1 group had between 8 and 11 years of study. The most predominant economic class in all groups for a C2 in which the family income is 1.446,24 reais. (GDM - BMI 0 = 40.26%, DMG - BMI 1 = 31.33%, GHR - BMI 0 = 43.90%, GHR - 10 BMI 1 = 38.96%). When comparing as mean values of METs found in the sample, it was observed that the values found in the evaluation three months after childbirth (represented by time 2) were higher than 1 (1.10 MET for adequate BMI of GDM group 1.06 MET for altered BMI and no GHR 1.02 MET for adequate BMI and 1.07 MET for altered BMI). In the pre-gestational analyses (time 0) and the third trimester (time 1), the values lower than 1 MET.It was concluded that the level of physical activity was not influenced by the diagnosis of GDM neither by the pre-gestational BMI. However, it changed according to a temporal development, with increased physical activity in the postpartum period.

INTRODUÇÃO: O Diabetes Gestacional (DG) é qualquer grau de intolerância a carboidratos com início ou diagnóstico na gravidez, com prevalência de 1% a 14% de todas as gestações. Para que complicações provenientes da doença sejam minimizadas, faz-se necessário o adequado controle glicêmico da paciente portadora dessa doença. Modelos experimentais sugerem que reside na musculatura estriada esquelética o principal sítio de resistência à insulina ocorrida durante a gestação. A prática de exercícios resistidos (ER) durante a gestação, embora ainda pouco difundida, é considerada segura, tanto para o feto como para a gestante. A literatura científica, porém, é extremamente escassa em relação à utilização dessa forma de atividade física como coadjuvante no tratamento do DG. OBJETIVOS: O presente estudo teve como objetivo avaliar pacientes com diagnóstico de DG, incluídas em programa de ER realizados com corda elástica, comparando a freqüência de mulheres que usaram insulina no grupo que realizou o programa ao grupo que não se exercitou, e verificar o impacto do programa sobre a adequação do controle glicêmico capilar das gestantes. MÉTODOS: Foi realizado um ensaio clínico randomizado com 62 portadoras de DG que acompanharam o programa de pré-natal da Clínica Obstétrica do Hospital das Clínicas da FMUSP no período entre outubro de 2006 e novembro de 2008. Elas foram alocadas em dois grupos de estudo após o diagnóstico de DG: o grupo de exercícios (GE; n = 31), que praticou ER e o grupo controle (GC; n = 31). Os grupos eram semelhantes em todas as características aferidas no momento da inclusão no estudo. RESULTADOS: Verificou-se redução estatisticamente significativa (p = 0,009) no número de pacientes que necessitou de insulina no GE (n = 07) em comparação ao observado no GC (n= 17). Houve diferença significativa do controle glicêmico entre os grupos. Enquanto o GC atingiu a meta para monitoração glicêmica capilar durante, em média, 43% do período de acompanhamento, o GE o fez por 62% do período de estudo (p = 0,014). Foi verificada também maior freqüência de médias glicêmicas ideais no GE (67,7%) em comparação ao GC (25,8%) (p = 0,001). Não houve diferença significativa (p =0,836) no período (semanas ± DP) entre a inclusão no estudo e o início da terapia com insulina entre o GC (2,00 ± 1,62) e o GE (1,86 ± 1,21), bem como na quantidade de insulina (UI/kg ± DP) utilizada pelas gestantes na comparação entre os grupos (GC: 0,49 ± 0,12; GE: 0,45 ± 0,11; p = 0,398). CONCLUSÕES: A prática de ER por portadoras de DG foi eficiente em diminuir a utilização de insulina, além de melhorar o controle glicêmico dessa população. / INTRODUCTION: Gestational Diabetes (GD) is any degree of intolerance to carbohydrates that begins or is diagnosed in pregnancy, with a prevalence of 1% to 14% of all gestations. So that complications arising from the disease may be minimized, adequate blood sugar control of patients with this disease is necessary. Experimental models suggest that the main area of resistance to insulin occurring during gestation resides in the skeletal muscle. The practice of resistance exercises (RE) during pregnancy, although not widely disseminated, is considered safe for the fetus as well as for the pregnant woman. Scientific literature is extremely scarce with regard to the utilization of this form of physical activity in conjunction with treatment for GD. OBJECTIVES: The object of this study was to evaluate patients with a diagnosis of GD who were included in a program of RE carried out with rubber tubes, comparing the frequency of women who used insulin in the group who participated in the program with the group that did not do the exercises, and to verify the impact of the program on the adequacy of capillary glycemic control of the pregnant women. METHODS: A randomized clinical trial was performed with 62 GD patients who were following the prenatal program at the Obstetric Clinic of the Hospital of Clinics of FMUSP (Faculty of Medicine from University of Sao Paulo) from October, 2006 to November, 2008. They were divided into two study groups after the diagnosis of GD: the exercise group (EG), who practiced RE, and the control group (CG). The groups were similar in all characteristics assessed at the time of enrollment in the study. RESULTS: A statistically significant reduction (p = 0,009) was verified in the number of patients who needed insulin in the EG (n = 07) in comparison with what was observed in the CG (n = 17). There was a significant difference in glycemic control between the groups. While the CG reached the goal for capillary glycemic monitoring during, on the average, 43% of the follow-up period, the EG reached it for 62% of the study period (p = 0,014). A higher frequency of ideal glicemic mean levels was also verified in the EG (67.7%) in comparison with the CG (25.8%) (p = 0,001). There was no significant difference (p =0,836) in the period (weeks ± SD) between study enrollment and the start of insulin therapy between the CG (2,00 ± 1,62) and the EG (1,86 ± 1,21), nor was there in the amount of insulin (UI/kg ± SD) used by the pregnant women in the comparison between the groups. (CG: 0,49 ± 0,12; EG: 0,45 ± 0,11; p = 0,398). CONCLUSIONS: The practice of RE by pregnant women with GD was efficient to reduce the use of insulin, as well as to improve the glycemic control of this population.

Introdução: O exercício físico como parte do tratamento do diabetes mellitus gestacional (DMG) pode ajudar na manutenção das concentrações da glicemia de jejum. Objetivos: Conduzir uma revisão sistemática, com metanálise de ensaios clínicos randomizados, para avaliar o efeito do exercício supervisionado e estruturado ou o efeito do aconselhamento de atividade física, em mulheres com DMG, e comparar ao pré-natal usual para o controle da glicemia. Métodos: Os estudos elegíveis foram identificados a partir das bases de dados MEDLINE, EMBASE, Web of Science, Scopus e SportDiscus até 4 de Junho de 2015. Os dados foram extraídos de ensaios clínicos randomizados que compararam o pré-natal usual ao pré-natal usual somado ao exercício supervisionado e estruturado (pelo menos uma vez na semana) ou ao aconselhamento de atividade física, pelas quais os valores de glicemia de jejum pré e pós-intervenção estavam disponíveis. A metanálise de efeitos randômicos foi conduzida para a diferença entre as médias pós-intervenção da glicemia de jejum. Resultados: Foram encontradas 664 publicações, nas quais 82 foram avaliadas pela elegibilidade e oito foram incluídas na análise final. O efeito total do exercício nas concentrações absolutas da glicemia de jejum não foi significativamente diferente (P = 0,11) comparado ao pré-natal usual. Entretanto, o aconselhamento de atividade física comparado ao pré-natal usual demonstrou uma redução significativa nas concentrações da glicemia de jejum (diferença da média ponderada -3,88 mg/dL, 95% CI-7,33 a -0,42; I2, 48%; P para heterogeneidade < 0,15). Conclusão: O exercício supervisionado ou o aconselhamento de atividade física em mulheres com DMG não foi significativamente diferente comparado ao pré-natal usual nas concentrações de glicemia de jejum. Visto que o pré-natal usual inclui algum tipo de recomendação de atividade física, estes resultados não são surpreendentes. O aconselhamento de atividade física com o pré-natal usual inclui modificações da dieta que podem motivar as mulheres com DMG a serem mais ativas e aderentes ao aconselhamento nutricional, enquanto que o exercício estruturado pode ser mais difícil de atingir. / Background: Exercise as part of the treatment for gestational diabetes mellitus (GDM) may help maintain fasting glucose concentrations. Objective: A systematic review with meta-analysis was performed to evaluate the effect of weekly-supervised exercise or physical activity (PA) counseling in GDM women compared to standard care (SC) on glycemic control. Methods: Eligible trials were identified from MEDLINE, EMBASE, Web of Science, Scopus and SportDiscus up to 4 June 2015. Data were retrieved from randomized controlled trials comparing SC with SC plus weekly-supervised (at least once a week) prenatal exercise or PA counseling for which fasting blood glucose (FBG) values pre and post intervention were available. Random-effects meta-analysis was conducted for mean difference in FBG post exercise intervention. Results: Our search yielded 664 publications of which 82 were assessed for eligibility. Eight were analyzed and all were included in the meta-analysis. The overall effect of exercise on absolute FBG concentrations was not different (P=0.11) compared to SC. However, PA counseling versus SC showed a significant reduction in the absolute FBG concentrations (weighted mean difference -3.88 mg/dL, 95% CI-7.33 to -0.42; I2, 48%; P for heterogeneity<0.15). Conclusions: Supervised exercise or PA counseling in GDM women was not significantly different compared to SC on FBG concentrations. Since SC includes some type of PA recommendation, these results are not surprising. PA counseling with SC including dietary modifications may help motivate GDM women to be more active and adherent to nutrition advice, while structured exercise may be more difficult to achieve.

Diabetes mellitus gestacional (DMG) é uma condição cada vez mais frequente na população, uma vez que os novos critérios adotados consideram menores valores de glicemia para diagnóstico e cada vez mais mulheres iniciam a gestação com excesso de peso, fator de risco para DMG. Cerca de 50% das mulheres que tiveram DMG irão desenvolver diabetes mellitus tipo 2 (DM2) entre 5 e 10 anos após o parto. Uma das intervenções utilizada para prevenção do DM2 é o aleitamento materno (AM). Entretanto, são escassas as informações sobre AM em mulheres que tiveram DMG. Sendo assim, o objetivo deste estudo é avaliar o aleitamento materno em mulheres que tiveram diabetes gestacional e os fatores associados à não iniciação. Trata-se de um estudo de coorte, com dados da linha de base e seguimento de um estudo maior, LINDA-Brasil, realizado nas cidades de Porto Alegre (RS), Pelotas (RS) e Fortaleza (CE), de março de 2013 a dezembro de 2016. Gestantes com DMG foram arroladas em serviços de pré-natal de alto risco. Foram coletados dados demográficos, sócio-econômicos, de estilo de vida e contato. O seguimento foi realizado por ligações telefônicas e foram coletadas informações do parto, dados do recém-nascido e amamentação. Essas ligações foram realizadas um mês após o recrutamento e dois meses após o parto. A descrição dos dados foi apresentada através de frequências relativas e absolutas ou média e desvio padrão. Análise de Regressão de Poisson foi utilizada para estimar o risco relativo de não ter iniciado aleitamento materno. Todas as participantes assinaram termo de consentimento livre e esclarecido. Foram incluídas 2523 mulheres. A média de idade foi 31,3 (±6,3) anos, sendo a maioria branca (49,5%), com ensino médio completo (38,3%) e renda entre 1 e 2 salários mínimos (39,9%). Não ter amamentado o último bebê (RR = 3,82; IC95%: 1,86 – 7,84), fumo durante a gestação (RR = 2,09; IC95%: 1,17 – 3,75), bebê com problemas ao nascer (RR = 3,11; IC95%: 1,90 – 5,12), prematuridade (RR = 1,60; IC95%: 1,09 – 2,57), consumo de bebidas adoçadas (RR = 1,10; IC95%: 1,02 – 1,19) e não ter intenção de amamentar o bebê (RR = 4,75; IC95%: 1,92 – 11,72) foram relacionadas à não iniciação ao aleitamento materno. Experiências anteriores, problemas com o bebê e comportamento materno, como fumo na gestação, consumo de bebidas adoçadas e não ter intenção de amamentar são fatores associados à não iniciação ao aleitamento materno em mulheres que tiveram diabetes mellitus gestacional. / Gestational diabetes mellitus (GDM) is an increasingly frequent condition in the population, since the new criteria adopted consider lower values of glycemia for diagnosis, and more and more women are starting gestation with excess weight, a risk factor for GDM. About 50% of women who have GDM will develop type 2 diabetes mellitus (DM2) between 5 and 10 years after giving birth. One of the interventions used to prevent DM2 is breastfeeding. However, there is little information on AM in women who have GDM. Therefore, the objective of this study is to evaluate breastfeeding in women who had gestational diabetes and factors associated with non-initiation. This is a cohort study, with baseline data and follow-up of a larger study, LINDA-Brasil, conducted in the cities of Porto Alegre (RS), Pelotas (RS) and Fortaleza (CE), March 2013 To December 2016. Pregnant women with DMG were enrolled in high-risk prenatal services. Demographic, socio-economic, lifestyle and contact data were collected. Follow-up was performed by telephone calls and information was collected on birth, newborn data and breastfeeding. These calls were made one month after enrollment and 2 months after delivery. The data description was presented through relative and absolute frequencies or mean and standard deviation. Poisson regression analysis was used to estimate the relative risk of not having started breastfeeding. All participants signed a free and informed consent form. A total of 2523 women were included. The mean age was 31.3 (± 6.3) years, the majority of whom were white (49.5%), with a high school education (38.3%) and income between 1 and 2 minimum wages (39.9% ). Not having breastfed the last baby (RR = 3.82, 95% CI: 1.86 - 7.84), smoking during pregnancy (RR = 2.09, 95% CI: 1.17 - 3.75), baby with (RR = 3.11, 95% CI: 1.90 - 5.12), prematurity (RR = 1.60, 95% CI: 1.09 - 2.57), consumption of sweetened beverages (RR = 1 , 10; 95% CI: 1.02 - 1.19) and did not intend to breastfeed the baby (RR = 4.75, 95% CI: 1.92 - 11.72) were related to non - initiation to breastfeeding. Previous experiences, problems with the baby and maternal behavior, such as smoking during pregnancy, consumption of sweetened beverages and no intention to breastfeed are factors associated with not initiating breastfeeding in women who have had gestational diabetes mellitus.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2014-09-03T10:17:49Z No. of bitstreams: 2 Tese Hugo Campos Oliveira Santos.pdf: 2080957 bytes, checksum: 336f5cb1ae89058f6495b2a2af051029 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-09-03T10:17:49Z (GMT). No. of bitstreams: 2 Tese Hugo Campos Oliveira Santos.pdf: 2080957 bytes, checksum: 336f5cb1ae89058f6495b2a2af051029 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-12-18 / Caesarean section is a surgical technique utilized to deliver the fetus from the uterus and an increase in this surgical procedure can be noted around the world. In Brazil, approximately 40% of total deliveries occur in this way, it is estimated that caesarean section corresponds to 80% of deliveries in private assistance between 2008 and 2012. Diabetes complicates gestation and pregnancy complicates diabetes, this combination increases the possibility of flawed scarring process, which may cause esthetic, psychological and clinical problems. The Low-Level Laser Therapy (LLLT) is an ally for the treatment of a number of wounds – accelerating cell metabolism and reducing inflammatory and infectious processes. The objective of this study was to evaluate the effects of AlGaInP LASER (660nm) treatment regarding wound healing quality and hypertrophic scar prevention in patients with gestational diabetes undergone caesarean section. The clinical study was performed at Hospital das Clínicas of the Federal University of Goiás, after Ethics Committee approval (CEP/HC.053/11). In the period between November (2011) and May (2013) 90 patients divided into 3 groups were assessed: Group A: LASER (3 Joules/cm2), Group B: LASER (6 Joules/cm2) and Group C (Control – no treatment). Caesarean incision was photographed in the periods: T1 (1day), T2 (2days), T3 (3days), T4 (15days) and T5 (30days). Photos were used in order to calculate mean area and standard deviation. The area of the photographs was analyzed and calculated in pixels with specific software (Software Image J – NIH/USA), measuring, thus, the wound contraction in percentage (%). The calculation was performed by the caesarean scar area reduction and the increase of incision contraction percentage (recovery) throughout the periods for each group. Contraction results (%) with regard to wound area were significant (p<0.05) for all groups studied, according to Kruskal Wallis’, Mann-Whitney’s and Wilcoxon’s tests. Groups treated with LASER (A and B) presented higher edge contraction, being 89% the scar reduction of Group A (p<0.001) and 81% of Group B (p<0.05), when compared to control group (73%). However, Group A demonstrated higher wounded area reduction when compared to group B, especially in the period between the 3rd and the 15th day from the postoperative (p<0.001). It was verified that the better performance of Low-power LASER (AlGaInP) occurred in the time reported in the literature as scarring process inflammatory stage (≤7days). Inflammatory process reduction may have contributed to reducing scarring time, increasing wound contraction percentage, benefitting, thus, the incision esthetic aspect throughout 30 days of treatment. During the study, occurrence of hypertrophic scars was not observed in any of the experimental groups in the period of 60days from the postoperative. / A cesárea é uma técnica cirúrgica utilizada para retirar o feto do útero, nota-se atualmente um aumento dessa cirurgia em todo o mundo. No Brasil, aproximadamente 40% do total de partos são realizados por essa via, estima-se que a cesariana corresponda a 80% dos partos na assistência privada entre 2008 a 2012 . O diabetes complica a gestação, e, a gravidez complica o diabetes, essa combinação aumenta as chances de falhas no processo de cicatrização, o que pode acarretar problemas estéticos, psicológicos e clínicos. O LASER de baixa potência (LBP) é um aliado para o tratamento de uma variedade de ferimentos – acelerando o metabolismo celular, reduzindo os processos inflamatório e infeccioso. Esse estudo tem por objetivo avaliar os efeitos da terapia a LASER AlGaInP (660nm) quanto à qualidade da cicatrização e da prevenção de cicatrizes hipertróficas em pacientes com diabetes gestacional submetidas à cirurgia cesárea. A pesquisa clínica foi realizada no Hospital das Clínicas da Universidade Federal de Goiás - UFG, após aprovação do Comitê de Ética (CEP/HC.053/11). Entre novembro de 2011 e maio de 2013 foram avaliadas 90 pacientes divididas em 3 grupos: Grupo A: LASER (3 Joules/cm2), Grupo B: LASER (6 Joules/cm2) e Grupo C (Controle - sem tratamento). A incisão cesárea foi fotografada nos tempos: T1 (1dia), T2 (2dias), T3 (3dias), T4 (15dias) e T5 (30dias). As fotos foram utilizadas para calcular a área média e o desvio padrão. A área das fotografias foi analisada e calculada em pixels por meio de programa específico (Software Image J – NIH/USA). Mensurando, assim, a contração da ferida em percentagem (%). O cálculo foi realizado por meio da redução da área da cicatriz cesárea e a percentagem de contração da incisão em decorrer do tempo para cada grupo. Os resultados da contração (%) em relação à área da ferida foram significativos (p<0,05) para todos os grupos estudados, conforme testes de Kruskal Wallis, Mann-Whitney e Wilcoxon. Os grupos tratados com LASER (A e B) tiveram maior contração das bordas, sendo de 89% de redução da cicatriz para o grupo A (p<0,001) e de 81% para o grupo B (p<0,05), quando comparados ao grupo controle (73%). Porém, o grupo A demonstrou maior redução da área da ferida, quando comparado ao grupo B, principalmente no período entre o 3º e 15º dias do pós-operatório (p<0,001). Verificou-se que a melhor atuação do LASER de baixa potência (AlGaInP) ocorreu no tempo relacionado na literatura como fase inflamatória do processo de cicatrização (≤ 7dias). A redução do processo inflamatório pode contribuir para reduzir o tempo de cicatrização, aumentando a percentagem de contração da ferida, favorecendo assim, o aspecto estético da incisão no decorrer de 30 dias de tratamento. Durante o estudo, não foi observado ocorrência de cicatrizes hipertróficas em nenhum dos grupos experimentais no período de até 60dias do pós-operatório.