Dysglycemias in pregnancy: from diagnosis to treatment. Brazilian consensus statement

There is an urgent need to find consensus on screening, diagnosing and treating all degrees of DYSGLYCEMIA that may occur during pregnancies in Brazil, considering that many cases of DYSGLYCEMIA in pregnant women are currently not diagnosed, leading to maternal and fetal complications. For this reason the Brazilian Diabetes Society (SBD) and the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASGO), got together to introduce this proposal. We present here a joint consensus regarding the standardization of clinical management for pregnant women with any degree of Dysglycemia, on the basis of current information, to improve medical assistance and to avoid related complications of Dysglycemia in pregnancy to the mother and the fetus. This consensus aims to standardize the diagnosis among general practitioners, endocrinologists and obstetricians allowing the dissemination of information in basic health units, public and private services, that are responsible for screening, diagnosing and treating disglycemic pregnant patients.

Mola Completa em Gravidez Gemelar: relato de Caso

A gravidez gemelar na qual coexistem um feto normal e uma mola completa é um evento raro. Complicações clínicas e aumento de risco de malignização são de importância nesta patologia. Este trabalho descreve um caso de diagnóstico tardio em decorrência da presença do feto. Este diagnóstico foi feito no momento da resolução da gestação e confirmado por estudo histopatológico e citometria de fluxo. A resolução da gestação foi por via transpélvica em decorrência de hemorragia uterina maciça. O seguimento pós-molar evidenciou a persistência de níveis elevados de bhCG, obtendo-se remissão completa da doença com o uso do metotrexato. À luz deste caso, discutem-se o diagnóstico, a história natural e a conduta desta rara intercorrência na clínica obstétrica.

Vascular endothelial growth factor (VEGF) and VEGF-receptor expression in placenta of hyperglycemic pregnant women

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of exercise on the reproductive outcome and fetal development of diabetic rats

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Maternal-Fetal Outcome, Lipid Profile and Oxidative Stress of Diabetic Rats Neonatally Exposed to Streptozotocin

Background: There is no evidence about the integrated issue on glycemia, lipid profile, oxidative stress, and anomaly frequency of pregnant diabetic rats neonatally exposed to streptozotocin.Objective: Evaluating the impact of hyperglycemia in diabetic rats neonatally exposed to streptozotocin on maternal reproductive and fetal outcomes and the relationship with lipid profile and maternal oxidative stress.Material and Methods: Ten 90-day-old female Wistar rats were mated to obtain offspring. Some of these newborns received streptozotocin (70 mg/kg, i.p. - n5-STZ group) and the remainder given only citrate buffer (control group) on their day 5 of life. At adult life, these rats (n =13 animals/group) were mated and, at day 21 of pregnancy, they were killed to obtain a maternal blood samples for biochemical determinations. The gravid uterus was weighed with its contents and fetuses were analyzed.Results: At day 0 of pregnancy, glycemic means of n5-STZ rats were significantly greater compared to those of control rats, but presented fetuses classified as small for pregnancy age. The n5-STZ rats showed increased total cholesterol, triglycerides, MDA concentrations, lower SOD activity and increased frequency fetal visceral anomalies as compared to the control group.Conclusion: This study showed that the experimental model used led to mild hyperglycemia during pregnancy, although it did not lead to increased macrosomic fetus rates. The hyperglycemic maternal environment caused metabolic alterations, including increased triglyceride and total cholesterol concentrations, and elevated oxidative stress, contributing to increase fetal visceral anomalies.

Genotoxicity and Fetal Abnormality in Streptozotocin-Induced Diabetic Rats Exposed to Cigarette Smoke Prior to and during Pregnancy

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of cigarette smoke exposure on pregnancy outcome and offspring of diabetic rats

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Animal models for clinical and gestational diabetes: maternal and fetal outcomes

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Histopathological placental lesions in mild gestational hyperglycemic and diabetic women

Objective: To investigate and compare the incidence of histopathological placental lesions in mild gestational hyperglycemia, gestational diabetes and overt diabetes at term and preterm gestation.Research design and methods: One-hundred-and-thirty-one placental samples were collected from Diabetes mellitus (DM) positive screened patients. Two diagnostic tests, glycemic profile and 100 g oral glucose tolerance test (OGTT) in parallel identified 4 groups normoglycemic, mild gestational hyperglycemia (MGH), gestational DM (GDM) or overt DM (DM). Placental tissue specimens and sections from 4 groups were obtained by uniform random sampling and stained with hematoxylin-eosin.Results: Placentas from MGH group presented 17 types of histopathological change and higher rates of syncytial nodes and endarteritis. GDM placentas presented only nine types of histopathological change, high rates of dysmaturity, low rates of calcification and no syncytial nodes. Overt DM placentas showed 22 types of histopathological change, 21 of which were present in the preterm period. There were histopathological similarities between MGH and DM placentas, but the former exhibited a higher incidence of endarteritis, which has been described as a post-mortem phenomenon.Conclusion: Our results confirmed that the distinct placental changes associated with DM and MGH depend on gestational period during which the diabetic insult occurs. It may reasonably be inferred that subclinical maternal hyperglycemia during pregnancy, as showed in MGH group, is responsible for increased placental endarteritis, a postmortem lesion in the live fetus.

Blood galactose and glucose levels in mothers, cord blood, and 48-hour-old breast-fed full-term infants

Background: Although galactose is an important component in human lactose, there are few reports of its role in the newborn metabolism. Objective: To determine the relationship of blood galactose and glucose levels in mothers, cord blood, and breast-fed full-term newborn infants. Methods: Maternal and cord vein blood samples were obtained from 27 pregnant women at delivery, and from their breastfed, full-term newborns 48 h later. Galactose and glucose were determined by HPLC. Statistical analysis used ANOVA and Pearson correlation with p < 0.05. Results: Maternal galactose concentrations (0.08 +/- 0.03 mmol/l) were similar to cord blood galactose (0.07 +/- 0.03 mmol/l; p = 0.129). However, newborn blood galactose (0.05 +/- 0.02 mmol/l) was significantly lower than both cord (p = 0.042) and maternal blood (p = 0.002). Maternal blood glucose levels (4.72 +/- 0.86 mmol/l) were higher than cord blood (3.98 +/- 0.57 mmol/l; p < 0.001), and cord blood concentrations were higher than newborn blood levels (3.00 +/- 0.56 mmol/l; p < 0.001); all values expressed as mean +/- SD. Significant correlation was only seen between maternal and cord blood galactose levels (r = 0.67; p < 0.001) and glucose levels (r = 0.38; p = 0.047). Conclusion: the association and similarity between maternal and cord blood galactose levels suggest that the fetus is dependent on maternal galactose. In contrast, the lower galactose levels in newborn infants and a lack of association between both suggest self-regulation and a dependence on galactose ingestion. Copyright (c) 2007 S. Karger AG, Basel.

Fructose in fetal cord blood and its relationship with maternal and 48-hour-newborn blood concentrations

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Ureteroscopy in Pregnant Women for Ureteral Stone

Introduction: The occurrence of urolithiasis in pregnancy represents a challenge in both diagnosis and treatment of this condition, because it presents risks not only to the mother but also to the fetus. Surgical treatment may be indicated for patients with infection, persistent pain, and obstruction of a solitary kidney. We present our experience on the management of pregnant patients with ureteral calculi and a review of the literature.Materials and Methods: The charts of 19 pregnant patients with obstructive ureteral calculi were retrospectively reviewed. Gestational age ranged from 13 to 33 weeks. In all patients, ureteral stone was diagnosed on abdominal ultrasound. In regard to localization, 15 calculi were in the distal ureter, 3 in the proximal ureter, and 1 in the interior of an ureterocele. Calculi size ranged from 6 to 10 mm (mean, 8 mm). The following criteria were used to indicate ureteroscopy: persistent pain with no improvement after clinical treatment, increase in renal dilation, or presence of uterine contractions. Nine patients (47.3%) were submitted to ureteroscopy. All calculi (100%) were removed with a stone basket extractor under continuous endoscopic vision. None of the calculi demanded the use of a lithotriptor.Results: Nine patients (47.3%) treated with clinical measurements presented no obstetric complications and spontaneous elimination of the calculi. Nine patients (47.3%) submitted to ureteroscopy had no surgical complications. There was remission of pain in all cases after ureteroscopy and ureteral catheter placement.Conclusion: The diagnosis and treatment of ureteral lithiasis in pregnant women present potential risks for the fetus and the mother. Conservative management is the first option, but ureteroscopy may be performed with safety and high success rates.

Haematic Mummification in a Mare With Twin Pregnancy

Mummification occurs when the fetus dies during the second or third trimester of gestation and remains in the uterine cavity because of the persistence of the corpus luteum or existence of another live fetus. Generally, the mummified fetus and fetal membranes undergo desiccation. The hematic process is similar, but the fetus appears like melted chocolate and becomes lodged between the uterus and chorion. This report describes the treatment of dystocia in a mare with twin pregnancy, with one fetus having undergone hematic mummification. Although difficult to diagnose, the possibility of a second fetus should be investigated in mares with dystocia. (C) 2012 Elsevier B.V. All rights reserved.

Evaluation of Toxoplasma gondii placental transmission in BALB/c mice model

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)