Lifestyle and health status in a sample of Swedish women four years after pregnancy : a comparison of women with a history of normal pregnancy and women with a history of gestational diabetes mellitus

Background: Despite the recommendations to continue the regime of healthy food and physical activity (PA) postpartum for women with previous gestational diabetes mellitus (GDM), the scientific evidence reveals that these recommendations may not be complied to. This study compared lifestyle and health status in women whose pregnancy was complicated by GDM with women who had a normal pregnancy and delivery. Methods: The inclusion criteria were women with GDM (ICD-10: O24.4 A and O24.4B) and women with uncomplicated pregnancy and delivery in 2005 (ICD-10: O80.0). A random sample of women fulfilling the criteria (n = 882) were identified from the Swedish Medical Birth Register. A questionnaire was sent by mail to eligible women approximately four years after the pregnancy. A total of 444 women (50.8%) agreed to participate, 111 diagnosed with GDM in their pregnancy and 333 with normal pregnancy/ delivery. Results: Women with previous GDM were significantly older, reported higher body weight and less PA before the index pregnancy. No major differences between the groups were noticed regarding lifestyle at the follow-up. Overall, few participants fulfilled the national recommendations of PA and diet. At the follow-up, 19 participants had developed diabetes, all with previous GDM. Women with previous GDM reported significantly poorer self-rated health (SRH), higher level of sick-leave and more often using medication on regular basis. However, a history of GDM or having overt diabetes mellitus showed no association with poorer SRH in the multivariate analysis. Irregular eating habits, no regular PA, overweight/obesity, and regular use of medication were associated with poorer SRH in all participants. Conclusions: Suboptimal levels of PA, and fruit and vegetable consumption were found in a sample of women with a history of GDM as well as for women with normal pregnancy approximately four years after index pregnancy. Women with previous GDM seem to increase their PA after childbirth, but still they perform their PA at lower intensity than women with a history of normal pregnancy. Having GDM at index pregnancy or being diagnosed with overt diabetes mellitus at follow-up did not demonstrate associations with poorer SRH four years after delivery.

No consensus on gestational diabetes mellitus screening regimes in Sweden : pregnancy outcomes in relation to different screening regimes 2011 to 2012, a cross-sectional study

Background: Although associated adverse pregnancy outcomes, no international or Swedish consensus exists that identifies a cut-off value or what screening method to use for definition of gestational diabetes mellitus. This study investigates the following: i) guidelines for screening of GDM; ii) background and risk factors for GDM and selection to OGTT; and iii) pregnancy outcomes in relation to GDM, screening regimes and levels of OGTT 2 hour glucose values. Methods: This cross-sectional and population-based study uses data from the Swedish Maternal Health Care Register (MHCR) (2011 and 2012) combined with guidelines for GDM screening (2011-2012) from each Maternal Health Care Area (MHCA) in Sweden. The sample consisted of 184, 183 women: 88, 140 in 2011 and 96,043 in 2012. Chi-square and two independent samples t-tests were used. Univariate and multivariate logistic regression analyses were performed. Results: Four screening regimes of oral glucose tolerance test (OGTT) (75 g of glucose) were used: 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 (2.9%) was found with a 2-hour cut-off value of 8.9 mmol/L when selective screening was applied. Unemployment and low educational level were associated with an increased risk of GDM. The OR was 4.14 (CI 95%: 3.81-4.50) for GDM in obese women compared to women with BMI <30 kg/m(2). Women with non-Nordic origin presented a more than doubled risk for GDM compared to women with Nordic origin (OR = 2.24; CI 95%: 2.06-2.43). Increasing OGTT values were associated with increasing risks of adverse pregnancy outcomes. Conclusions: There was no consensus regarding screening regimes for GDM from 2011 through 2012 when four different regimes were applied in Sweden. Increasing levels of OGTT 2-hour glucose values were strongly associated with adverse pregnancy outcomes. Based on these findings, we suggest that Sweden adopts the recent recommendations of the International Association of Diabetes and Pregnancy Study Group (IADPSG) concerning the performance of OGTT and the diagnostic criteria for GDM.

Efeito do exercício aeróbio moderado em gestantes com sobrepeso avaliado através de teste de exercício submáximo : um ensaio clínico randomizado

Objetivo: Avaliar os efeitos de um programa de exercício aeróbio sobre o condicionamento cardiorrespiratório em gestantes hígidas, de baixo risco, com sobrepeso. Métodos: 92 mulheres gestantes com sobrepeso (índice de massa corporal 26-31kg/m2), idade ≥ 20 anos, idade gestacional ≤ 20 semanas, com ausência de diabetes e hipertensão, foram alocadas aleatoriamente para realizar exercício aeróbio três vezes por semana com uma hora de duração ou para realizar sessões de relaxamento no grupo controle. Foram realizados dois testes de exercício submáximo em esteira, utilizando protocolo de rampa na entrada do estudo e outro teste após 12 semanas. Resultados: Em teste de exercício submáximo 12 semanas após randomização, o consumo de oxigênio (VO2) no limiar anaeróbio aumentou 17% (± 3) no grupo intervenção enquanto reduziu 16% (± 3) no grupo controle, de modo que após 12 semanas de exercício ajustado através da análise de covariância pelo o VO2 no limiar na linha de base, idade gestacional e idade materna foi de 2,68ml/kg/min (IC 95% 1,32-4,03) maior, P = 0,002. Conclusão: Exercício aeróbio realizado em gestantes com sobrepeso produz um aumento no limiar anaeróbio, sobrepondo os efeitos negativos da gestação sobre o condicionamento cardiorrespiratório em mulheres com estilo de vida sedentário.

Hiperecogenicidade dos vasos talâmicos no recém-nascido prematuro internado no Hospital de Clínicas de Porto Alegre

O presente estudo procura avaliar as possíveis patologias que se manifestam como hiperecogenicidade dos vasos talâmicos (HEVT) à ultra-sonografia cerebral (USC) e observar a freqüência com que ocorrem. A amostra foi constituída de 206 recém-nascidos (RNs) prematuros nascidos no Hospital de Clínicas de Porto Alegre (HCPA) no período de julho de 1998 a maio de 1999. Todos os RNs realizaram a USC na primeira semana de vida. Foram incluídos no estudo aqueles prematuros que necessitaram de internação hospitalar e que tiveram o termo de consentimento informado assinado por um dos responsáveis. Foram excluídos aqueles cuja USC evidenciava sangramento cerebral e/ou malformações congênitas associadas e os que evoluíram para óbito antes da realização do exame. A USC levou à identificação de 65 RNs prematuros com HEVT e 141 RNs prematuros sem HEVT. A forma de apresentação do tipo pélvica ao nascimento, a maior idade gestacional, o maior peso do RN ao nascimento e a classificação grande para a idade gestacional foram fatores de risco para a ocorrência de HEVT. A presença de hipertensão materna durante o período de gestação tendeu a ser fator de proteção para HEVT. Os RNs que apresentaram crises convulsivas durante o período de internação hospitalar tiveram risco 3,2 vezes maior de ter HEVT quando comparados com os RNs que não apresentaram crises convulsivas.

Perfil epidemiológico dos distúrbios hipertensivos na gravidez

The preeclampsia is a disease that evolves to high death rate for the mother and for the fetus. The incidence of this disease in the world is variable and there are no data of this disturb in the Brazilian population. This paper had the objective to determine the incidence and risk factors for development of hypertensive disorders of pregnancy in a neighborhood in Natal, RN, Brazil, taking place a prospective study, cohort type, with the objective of evaluating the entire pregnancy of 242 women that got pregnant between 2004-2007. The incidence of hypertensive disorders was of 17%, while the incidence of preeclampsia was of 13.8%. The age average of women that developed the hypertensive disorders was of 27.4 years (SD±.9), whilst those that developed preeclampsia was of 26.6 (SD ±7.8) years and the normotensive was of 23.9 (SD±5.8) (p=0.002). It is noted a significant increase of the hypertensive disorder with age (p=0.0265). The gestational age for those who developed preeclampsia was lower than the women that developed normotensive pregnancy (p=0.0002). The body mass index (BMI) of the group of women that developed the hypertensive disorder was of 25.8 (SD±3.9), significantly higher than the group of normotensive women with 23.5 (SD±3.7) (p=0.02). The levels of triglycerides and cholesterol tended to be higher on women with preeclampsia than on normotensive, p=0.0502 and p=0.0566, respectively. Six (6) women presented with severe preeclampsia and one (1) developed HELLP Syndrome. The resolution of the pregnancy was performed by cesarean section in 70% of women that developed hypertensive disorders, whilst the normotensive was of 23.6% (p<0.0001). A subgroup of the studied subjects was reassessed one year after labor, revealing that 50% of the patients were still hypertensive. There were no larger complications nor mother death during labor. The incidence of hypertensive disorders are above the levels noted in other studies and 30% of the women were within the poles of greater risk for the hypertensive disorders; the elevated BMI in the beginning of the pregnancy is a risk factor for hypertensive disorder. The risk of severe complication in preeclampsia is high, with imminence of eclampsia occurring in 20.1% of women who developed hypertensive disorder of pregnancy. The adequate prenatal care and the opportune labor assistance may minimize the complications of the pregnancy hypertension and avoid mother death, although the risk of women remaining hypertensive is elevated

Glargine vs. NPH insulin therapy in pregnancies complicated by diabetes: An observational cohort study

Aims: The effects of glargine insulin therapy in pregnancies are not well established. We compared maternal and neonatal outcomes of women with pregestational and gestational diabetes treated with glargine or NPH insulin.Methods: A prospective cohort study was conducted analyzing outcomes from 56 women with pregestational and 82 with gestational diabetes treated with either insulin regimen.Results: Comparisons were performed among 138 women: 56 with pregestational and 82 with gestational diabetes. In relation to maternal complications, worsening of retinopathy and nephropathy, preeclampsia, micro and macroalbuminuria, and all kinds of hypoglycemia were found higher in women with pregestational diabetes NPH-treated vs. glargine-treated. In women with gestational diabetes NPH-treated, it was observed increased incidence of prepregnancy and new-onset pregnancy hypertension, micro and macroalbuminuria, as well as mild and frequent hypoglycemia, compared to glargine-treated. Among the neonatal outcomes, 1-min Apgar score <7, necessity of intensive care unit and fetal death in pregestational, while jaundice and congenital malformations in gestational diabetes, respectively, were more frequently observed in infants born to NPH-treated, compared to glargine-treated.Conclusions: Glargine use during pregnancy from preconception through delivery, showed to be safe since it is associated with decreased maternal and neonatal adverse outcomes compared with NPH insulin-treated patients. (C) 2010 Elsevier B.V. All rights reserved.

Primary non-gestational choriocarcinoma of the uterine cervix: A case report

Background. Primary non-gestational choriocarcinoma of the female genital tract has been described in the ovaries and is very unusual in other genital sites.Case. Primary non-gestational uterine cervical choriocarcinoma was diagnosed in a patient, 32, single, without previous sexual contact nor antecedent pregnancy, admitted to the hospital with irregular vaginal hemorrhaging. Pelvic examination realized under anesthetic revealed a tumor mass occupying the uterine cervix. Metastases investigation was realized and the patient was accepted as FIGO IV: risk factor of 13. She was submitted to intensive chemotherapy and hysterectomy, showing general recovery, but died from drug-resistant disease 12 months later. Histological, immunohistochemical, and molecular genetics studies confirmed non-gestational choriocarcinoma.Conclusion. Primary non-gestational uterine cervical choriocarcinoma may arise from germ cell tumor or epithelial tissue. (c) 2005 Elsevier B.V. All rights reserved.

Effects of hypertension on maternal adaptations to pregnancy: experimental study on spontaneously hypertensive rats

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Combined exercise training in asymptomatic elderly with controlled hypertension: Effects on functional capacity and cardiac diastolic function

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Effect of felodipine on myocardial and renal injury induced by aldosterone-high salt hypertension in uninephrectomized rats

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Morphometric study of placental villi and vessels in women with mild hyperglycemia or gestational or overt diabetes

In this study, morphometric measures of placental terminal villi and villous vessels were compared in overt, as well as gestational diabetes mellitus, and mild hyperglycemia diagnosed by oral 100 g glucose tolerance test (100 g-OGTT) and glucose profile (GP). At delivery (gestational age >= 34 weeks) a total of 207 placentas were assigned to a control group (n = 56) or to one of three groups complicated by mild hyperglycemia (n = 5 1), gestational diabetes (n = 59) and overt diabetes (n = 4 1). Placenta samples were randomly selected for blind morphometric assessment with an image analyser. Morphometric measures obtained included area and number of terminal villi and their respective villous vessels. Statistical analyses were performed using the chi-square test, ANOVA and stepwise regression (p <= 0.05). Glycemic means were 86.2 mg/dL in controls, 98.9 mg/dL in mild hyperglycemia, 114.1 mg/dL in gestational diabetes and 122.1 mg/dL in overt diabetes. Our results show that abnormal maternal glycemic levels may change the placental morphometric characteristics related to materno-fetal exchanges. (C) 2007 Elsevier B.V.. All rights reserved.