Diabetes, gestational Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(11):555-560
DOI 10.1590/S0100-72032007001100002
PURPOSE: to identify the factors related to successful gestational diabetes mellitus (GDM) management with glyburide and to evaluate perinatal outcomes. METHODS: prospective longitudinal study including 50 pregnant women with GDM who required complementary treatment to diet and physical activity, whose fetus presented normal abdominal circumference (AC) to ultrasound (pct<75). Study period was August 2005 to July 2006. Ultrasonography was carried out monthly. Glyburide was used until delivery, as long as glucose control was obtained and fetal AC was normal, being thus considered therapeutically successful. In case there was no glucose control or alteration in AC, management was switched to insulin therapy, being thus considered therapeutically unsuccessful. Pregnant women were divided into two groups: one therapeutically successful (n=29) and another therapeutically unsuccessful (n=21). The results evaluated were: therapeutic success, maternal characteristics and perinatal outcome. RESULTS: fifty-eight percent of the cases were successfully managed with glyburide. No difference was found (p>0.05) in either group, with regards to maternal age, glucose values at OGTT75g, maternal body mass index (BMI), number of pre-natal consultations, number of previous pregnancies. According to the logistic model of regression used, therapeutically successful pregnant patients had had a later diagnosis (p=0.02) and lower weight gain during gestation (p<0.01). Perinatal outcome did not differ in either group. CONCLUSIONS: patients with later diagnosis and lower weight gain are more likely to have successful GDM management with glyburide. Unsuccessful management with glyburide did not alter the perinatal outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(11):555-560
DOI 10.1590/S0100-72032007001100002
PURPOSE: to identify the factors related to successful gestational diabetes mellitus (GDM) management with glyburide and to evaluate perinatal outcomes. METHODS: prospective longitudinal study including 50 pregnant women with GDM who required complementary treatment to diet and physical activity, whose fetus presented normal abdominal circumference (AC) to ultrasound (pct<75). Study period was August 2005 to July 2006. Ultrasonography was carried out monthly. Glyburide was used until delivery, as long as glucose control was obtained and fetal AC was normal, being thus considered therapeutically successful. In case there was no glucose control or alteration in AC, management was switched to insulin therapy, being thus considered therapeutically unsuccessful. Pregnant women were divided into two groups: one therapeutically successful (n=29) and another therapeutically unsuccessful (n=21). The results evaluated were: therapeutic success, maternal characteristics and perinatal outcome. RESULTS: fifty-eight percent of the cases were successfully managed with glyburide. No difference was found (p>0.05) in either group, with regards to maternal age, glucose values at OGTT75g, maternal body mass index (BMI), number of pre-natal consultations, number of previous pregnancies. According to the logistic model of regression used, therapeutically successful pregnant patients had had a later diagnosis (p=0.02) and lower weight gain during gestation (p<0.01). Perinatal outcome did not differ in either group. CONCLUSIONS: patients with later diagnosis and lower weight gain are more likely to have successful GDM management with glyburide. Unsuccessful management with glyburide did not alter the perinatal outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):253-259
DOI 10.1590/S0100-72032007000500006
PURPOSE: to evaluate the insulin therapy protocol and its maternal and perinatal outcome in patients with clinical or gestational diabetes in a high risk reference service. METHODS: descriptive and prospective study including 103 pregnant women with gestational or clinical diabetes treated with insulin and attended by the reference service from October 2003 to December 2005. Gemellarity, miscarriages, unfinished prenatal care and deliveries not attended by the service were excluded. The gestational age at the beginning of the treatment, dosage, doses/day, increment of insulin (UI/kg), glycemic index (GI) and perinatal outcomes were compared. ANOVA, Fisher’s exact test and Goodman’s test considering p<0.05 were used. RESULTS: multiparity (92 versus 67.9%), pre-gestational body mass index (BMI) >25 kg/m² (88 versus 58.5%), weight gain (WG) <8 kg (36 versus 17%) and a high increment of insulin characterized the gestational diabetes. For the patients with clinical diabetes, despite the highest GI (120 mg/dL (39.2 versus 24%)) at the end of the gestational period, insulin therapy started earlier (47.2 versus 4%), lasted longer (56.6 versus 6%) and higher doses of insulin (92 versus 43 UI/day) were administered up to three times a day (54.7 versus 16%). Macrosomia was higher among newborns from the cohort of patients with gestational diabetes (16 versus 3.8%), being the only significant neonatal outcome. There were no neonatal deaths, except for one fetal death in the cohort of patients with clinical diabetes. There were no differences in the other neonatal complications in both cohorts, and most of the newborns were discharged from hospital up to seven days after delivery (46% versus 55.8%). CONCLUSIONS: the analysis of these two cohorts has shown differences in the insulin therapy protocol in quantity (UI/day), dosage (UI/kg weight) and number of doses/day, higher for the clinical diabetes cohort, and in the increment of insulin, higher for the gestational diabetes cohort. Indirectly, the quality of maternal glycemic control and the satisfactory perinatal outcome have proven that the treatment protocol was adequate and did not depend on the type of diabetes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):253-259
DOI 10.1590/S0100-72032007000500006
PURPOSE: to evaluate the insulin therapy protocol and its maternal and perinatal outcome in patients with clinical or gestational diabetes in a high risk reference service. METHODS: descriptive and prospective study including 103 pregnant women with gestational or clinical diabetes treated with insulin and attended by the reference service from October 2003 to December 2005. Gemellarity, miscarriages, unfinished prenatal care and deliveries not attended by the service were excluded. The gestational age at the beginning of the treatment, dosage, doses/day, increment of insulin (UI/kg), glycemic index (GI) and perinatal outcomes were compared. ANOVA, Fisher’s exact test and Goodman’s test considering p<0.05 were used. RESULTS: multiparity (92 versus 67.9%), pre-gestational body mass index (BMI) >25 kg/m² (88 versus 58.5%), weight gain (WG) <8 kg (36 versus 17%) and a high increment of insulin characterized the gestational diabetes. For the patients with clinical diabetes, despite the highest GI (120 mg/dL (39.2 versus 24%)) at the end of the gestational period, insulin therapy started earlier (47.2 versus 4%), lasted longer (56.6 versus 6%) and higher doses of insulin (92 versus 43 UI/day) were administered up to three times a day (54.7 versus 16%). Macrosomia was higher among newborns from the cohort of patients with gestational diabetes (16 versus 3.8%), being the only significant neonatal outcome. There were no neonatal deaths, except for one fetal death in the cohort of patients with clinical diabetes. There were no differences in the other neonatal complications in both cohorts, and most of the newborns were discharged from hospital up to seven days after delivery (46% versus 55.8%). CONCLUSIONS: the analysis of these two cohorts has shown differences in the insulin therapy protocol in quantity (UI/day), dosage (UI/kg weight) and number of doses/day, higher for the clinical diabetes cohort, and in the increment of insulin, higher for the gestational diabetes cohort. Indirectly, the quality of maternal glycemic control and the satisfactory perinatal outcome have proven that the treatment protocol was adequate and did not depend on the type of diabetes.