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Original Article
Assessıng the predıctıve accuracy of blood-based bıomarkers ın neonatal outcomes for pregestatıonal dıabetes mellıtus
- Ayse Cigdem Bayrak
, - Erdem Fadiloglu ,
- Haticegul Tuncer ,
- Edip Alptug Kir ,
- Umutcan Kayikci , [ ... ],
- Ozgur Deren
04-30-2025
Summary
Original ArticleAssessıng the predıctıve accuracy of blood-based bıomarkers ın neonatal outcomes for pregestatıonal dıabetes mellıtus
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo17
04-30-2025- Ayse Cigdem Bayrak ,
- Erdem Fadiloglu ,
- Haticegul Tuncer ,
- Edip Alptug Kir ,
- Umutcan Kayikci ,
- Ozgur Deren
Views41Abstract
Objective:
This retrospective study aimed to investigate blood-based immune-inflammatory biomarkers (IIBs) in predicting neonatal outcomes in pregnancies with pregestational diabetes mellitus (PGDM).PIV[(neutrophil×platelet×monocyte)/lymphocyte)], SII (neutrophil×platelet/lymphocyte), and NLR neutrophil/lymphocyte) values were evaluated in all three trimesters, and their correlation with neonatal outcomes was examined.
Methods:
We included 82 cases of PGDM pregnancies delivered after 32 weeks. Maternal age, gravidity, parity, types of diabetes, and route of delivery were noted. For neonatal outcomes, we recorded gestational age at birth, birth weight percentile, existence of fetal growth restriction, LGA, neonatal intensive care unit (NICU) requirement, Apgar Score <7 at 1, 5, or 10 minutes, need for positive pressure ventilation (PPV), need for mechanical ventilation, hypoglycaemia, hyperbilirubinemia and the need for phototherapy. PIV, SII and NLR values were calculated in each trimester and their association with adverse neonatal outcomes was analyzed.
Results:
We could not detect any consistent and significant correlation between SII and PIV values and adverse neonatal outcomes for each trimester. There was a correlation between 3rd trimester NLR and adverse neonatal outcomes, including APGAR <7, the requirement for PPV and mechanical ventilation (p=0.056, 0.013 and 0.060, respectively).
Conclusion:
While SII and PIV values did not consistently correlate with adverse neonatal outcomes throughout each trimester in PGDM pregnancies, 3rd-trimester NLR showed a notable association with the requirement for PPV with statistical significance and with Apgar Score <7 and the requirement for mechanical ventilation without statistical significance. NLR in the third trimester may hold potential as a predictive marker for specific adverse neonatal outcomes in PGDM pregnancies, warranting further investigation.
Key-words biomarkersDiabetes mellitusGestational ageHypoglycemiaInfant, newbornIntensive care units, neonatalLymphocytesMaternal ageMonocytesNeuthrophilsPregancyPregnancy in diabetesRespiration, artificialSee moreViews41
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleAssessıng the predıctıve accuracy of blood-based bıomarkers ın neonatal outcomes for pregestatıonal dıabetes mellıtus
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo17
04-30-2025- Ayse Cigdem Bayrak ,
- Erdem Fadiloglu ,
- Haticegul Tuncer ,
- Edip Alptug Kir ,
- Umutcan Kayikci ,
- Ozgur Deren
Views41Abstract
Objective:
This retrospective study aimed to investigate blood-based immune-inflammatory biomarkers (IIBs) in predicting neonatal outcomes in pregnancies with pregestational diabetes mellitus (PGDM).PIV[(neutrophil×platelet×monocyte)/lymphocyte)], SII (neutrophil×platelet/lymphocyte), and NLR neutrophil/lymphocyte) values were evaluated in all three trimesters, and their correlation with neonatal outcomes was examined.
Methods:
We included 82 cases of PGDM pregnancies delivered after 32 weeks. Maternal age, gravidity, parity, types of diabetes, and route of delivery were noted. For neonatal outcomes, we recorded gestational age at birth, birth weight percentile, existence of fetal growth restriction, LGA, neonatal intensive care unit (NICU) requirement, Apgar Score <7 at 1, 5, or 10 minutes, need for positive pressure ventilation (PPV), need for mechanical ventilation, hypoglycaemia, hyperbilirubinemia and the need for phototherapy. PIV, SII and NLR values were calculated in each trimester and their association with adverse neonatal outcomes was analyzed.
Results:
We could not detect any consistent and significant correlation between SII and PIV values and adverse neonatal outcomes for each trimester. There was a correlation between 3rd trimester NLR and adverse neonatal outcomes, including APGAR <7, the requirement for PPV and mechanical ventilation (p=0.056, 0.013 and 0.060, respectively).
Conclusion:
While SII and PIV values did not consistently correlate with adverse neonatal outcomes throughout each trimester in PGDM pregnancies, 3rd-trimester NLR showed a notable association with the requirement for PPV with statistical significance and with Apgar Score <7 and the requirement for mechanical ventilation without statistical significance. NLR in the third trimester may hold potential as a predictive marker for specific adverse neonatal outcomes in PGDM pregnancies, warranting further investigation.
Key-words biomarkersDiabetes mellitusGestational ageHypoglycemiaInfant, newbornIntensive care units, neonatalLymphocytesMaternal ageMonocytesNeuthrophilsPregancyPregnancy in diabetesRespiration, artificialSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Ayse Cigdem Bayrak
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Original Article
Impact of Obesity and Hyperglycemia on Pregnancy-specific Urinary Incontinence
- Giovana Vesentini ,
- Fernanda Piculo ,
- Gabriela Marini ,
- Angélica Mércia Pascon Barbosa ,
- José Eduardo Corrente , [ ... ],
- Marilza Vieira Cunha Rudge
08-04-2023
Summary
Original ArticleImpact of Obesity and Hyperglycemia on Pregnancy-specific Urinary Incontinence
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(6):303-311
08-04-2023- Giovana Vesentini ,
- Fernanda Piculo ,
- Gabriela Marini ,
- Angélica Mércia Pascon Barbosa ,
- José Eduardo Corrente ,
- Marilza Vieira Cunha Rudge
Views151See moreAbstract
Objective
The lack of data on the impact of hyperglycemia and obesity on the prevalence of pregnancy-specific urinary incontinence (PSUI) led us to conduct a cross-sectional study on the prevalence and characteristics of PSUI using validated questionnaires and clinical data.
Methods
This cross-sectional study included 539 women with a gestational age of 34 weeks who visited a tertiary university hospital between 2015 and 2018. The main outcome measures were the prevalence of PSUI, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Incontinence Severity Index (ISI) questionnaires. The women were classified into four groups: normoglycemic lean, normoglycemic obese, hyperglycemic lean, and hyperglycemic obese. The differences between groups were tested using descriptive statistics. Associations were estimated using logistic regression analysis and presented as unadjusted and adjusted odds ratios.
Results
Prevalence rates of PSUI were no different between groups. However, significant difference in hyperglycemic groups worse scores for severe and very severe PSUI. When adjusted data for confound factors was compared with normoglycemic lean group, the hyperglycemic obese group had significantly higher odds for severe and very severe forms of UI using ICIQ-SF (aOR 3.157; 95% CI 1.308 to 7.263) and ISI (aOR 20.324; 95% CI 2.265 to 182.329) questionnaires and highest perceived impact of PSUI (aOR 4.449; 95% CI 1.591 to 12.442).
Conclusion
Our data indicate that obesity and hyperglycemia during pregnancy significantly increase the odds of severe forms and perceived impact of PSUI. Therefore, further effective preventive and curative treatments are greatly needed.
Views151This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleImpact of Obesity and Hyperglycemia on Pregnancy-specific Urinary Incontinence
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(6):303-311
08-04-2023- Giovana Vesentini ,
- Fernanda Piculo ,
- Gabriela Marini ,
- Angélica Mércia Pascon Barbosa ,
- José Eduardo Corrente ,
- Marilza Vieira Cunha Rudge
Views151See moreAbstract
Objective
The lack of data on the impact of hyperglycemia and obesity on the prevalence of pregnancy-specific urinary incontinence (PSUI) led us to conduct a cross-sectional study on the prevalence and characteristics of PSUI using validated questionnaires and clinical data.
Methods
This cross-sectional study included 539 women with a gestational age of 34 weeks who visited a tertiary university hospital between 2015 and 2018. The main outcome measures were the prevalence of PSUI, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Incontinence Severity Index (ISI) questionnaires. The women were classified into four groups: normoglycemic lean, normoglycemic obese, hyperglycemic lean, and hyperglycemic obese. The differences between groups were tested using descriptive statistics. Associations were estimated using logistic regression analysis and presented as unadjusted and adjusted odds ratios.
Results
Prevalence rates of PSUI were no different between groups. However, significant difference in hyperglycemic groups worse scores for severe and very severe PSUI. When adjusted data for confound factors was compared with normoglycemic lean group, the hyperglycemic obese group had significantly higher odds for severe and very severe forms of UI using ICIQ-SF (aOR 3.157; 95% CI 1.308 to 7.263) and ISI (aOR 20.324; 95% CI 2.265 to 182.329) questionnaires and highest perceived impact of PSUI (aOR 4.449; 95% CI 1.591 to 12.442).
Conclusion
Our data indicate that obesity and hyperglycemia during pregnancy significantly increase the odds of severe forms and perceived impact of PSUI. Therefore, further effective preventive and curative treatments are greatly needed.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Giovana Vesentini
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Original Article
Prevalence of Screening for Diabetes Mellitus in Patients Previously Diagnosed with Gestational Diabetes: Factors Related to its Performance
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(11):1032-1039
02-03-2022
Summary
Original ArticlePrevalence of Screening for Diabetes Mellitus in Patients Previously Diagnosed with Gestational Diabetes: Factors Related to its Performance
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(11):1032-1039
02-03-2022Views125See moreAbstract
Objective
To determine how many patients underwent screening for diabetes mellitus (DM) in the puerperium after a diagnosis of gestational DM (GDM) and which factors were related to its performance.
Methods
The present is a prospective cohort study with 175 women with a diagnosis of GDM. Sociodemographic and clinico-obstetric data were collected through a questionnaire and a screening test for DM was requested six weeks postpartum. After ten weeks, the researchers contacted the patients by telephone with questions about the performance of the screening. The categorical variables were expressed as absolute and relative frequencies. The measure of association was the relative risk with a 95% confidence interval (95%CI), and values of p ≤ 0.05 were considered statistically significant and tested through logistic regression.
Results
The survey was completed by 159 patients, 32 (20.1%) of whom underwent puerperal screening. The mean age of the sample was of 30.7 years, and most patients were white (57.9%), married (56.6%), and had had 8 or more years of schooling (72.3%). About 22.6% of the patients used medications to treat GDM, 30.8% had other comorbidities, and 76.7% attended the postnatal appointment. Attendance at the postpartum appointment, the use of medication, and the presence of comorbidities showed an association with the performance of the oral glucose tolerance test in the puerperium.
Conclusion
The prevalence of screening for DM six weeks postpartum is low in women previously diagnosed with GDM. Patients who attended the postpartum consultation, used medications to treat GDM, and had comorbidities were the most adherent to the puerperal screening. We need strategies to increase the rate of performance of this exam.
Views125This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticlePrevalence of Screening for Diabetes Mellitus in Patients Previously Diagnosed with Gestational Diabetes: Factors Related to its Performance
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(11):1032-1039
02-03-2022Views125See moreAbstract
Objective
To determine how many patients underwent screening for diabetes mellitus (DM) in the puerperium after a diagnosis of gestational DM (GDM) and which factors were related to its performance.
Methods
The present is a prospective cohort study with 175 women with a diagnosis of GDM. Sociodemographic and clinico-obstetric data were collected through a questionnaire and a screening test for DM was requested six weeks postpartum. After ten weeks, the researchers contacted the patients by telephone with questions about the performance of the screening. The categorical variables were expressed as absolute and relative frequencies. The measure of association was the relative risk with a 95% confidence interval (95%CI), and values of p ≤ 0.05 were considered statistically significant and tested through logistic regression.
Results
The survey was completed by 159 patients, 32 (20.1%) of whom underwent puerperal screening. The mean age of the sample was of 30.7 years, and most patients were white (57.9%), married (56.6%), and had had 8 or more years of schooling (72.3%). About 22.6% of the patients used medications to treat GDM, 30.8% had other comorbidities, and 76.7% attended the postnatal appointment. Attendance at the postpartum appointment, the use of medication, and the presence of comorbidities showed an association with the performance of the oral glucose tolerance test in the puerperium.
Conclusion
The prevalence of screening for DM six weeks postpartum is low in women previously diagnosed with GDM. Patients who attended the postpartum consultation, used medications to treat GDM, and had comorbidities were the most adherent to the puerperal screening. We need strategies to increase the rate of performance of this exam.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Review Article
Pregestational Diabetes and Congenital Heart Defects
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(10):953-961
01-23-2022
Summary
Review ArticlePregestational Diabetes and Congenital Heart Defects
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(10):953-961
01-23-2022Views271See moreAbstract
Studies have consistently shown a significant increase in the risk of congenital heart defects in the offspring of diabetic mothers compared with those of nondiabetic pregnancies. Evidence points that all types of pregestational diabetes have the capacity of generating cardiac malformations in a more accentuated manner than in gestational diabetes, and there seems to be an increased risk for all congenital heart defects phenotypes in the presence of maternal diabetes. Currently, the application of some therapies is under study in an attempt to reduce the risks inherent to diabetic pregnancies; however, it has not yet been possible to fully prove their effectiveness. The present review aims to better understand the mechanisms that govern the association between pregestational diabetes and congenital heart defects and how maternal diabetes interferes with fetal cardiac development, as there is still a long way to go in the investigation of this complex process.
Views271This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticlePregestational Diabetes and Congenital Heart Defects
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(10):953-961
01-23-2022Views271See moreAbstract
Studies have consistently shown a significant increase in the risk of congenital heart defects in the offspring of diabetic mothers compared with those of nondiabetic pregnancies. Evidence points that all types of pregestational diabetes have the capacity of generating cardiac malformations in a more accentuated manner than in gestational diabetes, and there seems to be an increased risk for all congenital heart defects phenotypes in the presence of maternal diabetes. Currently, the application of some therapies is under study in an attempt to reduce the risks inherent to diabetic pregnancies; however, it has not yet been possible to fully prove their effectiveness. The present review aims to better understand the mechanisms that govern the association between pregestational diabetes and congenital heart defects and how maternal diabetes interferes with fetal cardiac development, as there is still a long way to go in the investigation of this complex process.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article
Impact of Carbohydrate Counting Method during Pregnancy in Women with Pregestational Diabetes Mellitus: A Controlled Clinical Trial
- Larissa Mello de Oliveira ,
- Gabriella Pinto Belfort ,
- Patricia de Carvalho Padilha ,
- Eliane Lopes Rosado ,
- Letícia Barbosa Gabriel da Silva , [ ... ],
- Claudia Saunders
02-09-2022
Summary
Original ArticleImpact of Carbohydrate Counting Method during Pregnancy in Women with Pregestational Diabetes Mellitus: A Controlled Clinical Trial
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(3):220-230
02-09-2022- Larissa Mello de Oliveira ,
- Gabriella Pinto Belfort ,
- Patricia de Carvalho Padilha ,
- Eliane Lopes Rosado ,
- Letícia Barbosa Gabriel da Silva ,
- Sanmira Fagherazzi ,
- Lenita Zajdenverg ,
- Roberto Luís Zagury ,
- Claudia Saunders
Views189See moreAbstract
Objective
To evaluate the effect of the carbohydrate counting method (CCM) on glycemic control,maternal, and perinatal outcomes of pregnant women with pregestational diabetes mellitus (DM).
Methods
Nonrandomized controlled clinical trial performed with 89 pregnant women who had pregestational DMand received prenatal care in a public hospital in Rio de Janeiro, state of Rio de Janeiro, Brazil, between 2009 and 2014, subdivided into historic control group and intervention group, not simultaneous. The intervention group (n=51) received nutritional guidance from the carbohydrate counting method (CCM), and the historical control group (n=38), was guided by the traditionalmethod (TM). The Mann-Whitney test or the Wilcoxon test were used to compare intra- and intergroup outcomes andanalysis of variance (ANOVA) for repeated measures, corrected by the Bonferroni post-hoc test,was used to assess postprandial blood glucose.
Results
Only the CCM group showed a reduction in fasting blood glucose. Postprandial blood glucose decreased in the 2nd (p=0.00) and 3rd (p=0.00) gestational trimester in the CCM group, while in the TM group the reduction occurred only in the 2nd trimester (p=0.015). For perinatal outcomes and hypertensive disorders of pregnancy, there were no differences between groups. Cesarean delivery was performed in 82% of the pregnant women and was associated with hypertensive disorders (gestational hypertension or pre-eclampsia; p=0.047).
Conclusion
Both methods of nutritional guidance contributed to the reduction of postprandial glycemia of women and no differences were observed for maternal and perinatal outcomes. However, CCM had a better effect on postprandial glycemia and only this method contributed to reducing fasting blood glucose throughout the intervention. ReBEC Clinical Trials Database The present study was registered in the ReBEC Clinical Trials Database (Registro Brasileiro de Ensaios Clínicos, number RBR-524z9n).
Views189This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleImpact of Carbohydrate Counting Method during Pregnancy in Women with Pregestational Diabetes Mellitus: A Controlled Clinical Trial
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(3):220-230
02-09-2022- Larissa Mello de Oliveira ,
- Gabriella Pinto Belfort ,
- Patricia de Carvalho Padilha ,
- Eliane Lopes Rosado ,
- Letícia Barbosa Gabriel da Silva ,
- Sanmira Fagherazzi ,
- Lenita Zajdenverg ,
- Roberto Luís Zagury ,
- Claudia Saunders
Views189See moreAbstract
Objective
To evaluate the effect of the carbohydrate counting method (CCM) on glycemic control,maternal, and perinatal outcomes of pregnant women with pregestational diabetes mellitus (DM).
Methods
Nonrandomized controlled clinical trial performed with 89 pregnant women who had pregestational DMand received prenatal care in a public hospital in Rio de Janeiro, state of Rio de Janeiro, Brazil, between 2009 and 2014, subdivided into historic control group and intervention group, not simultaneous. The intervention group (n=51) received nutritional guidance from the carbohydrate counting method (CCM), and the historical control group (n=38), was guided by the traditionalmethod (TM). The Mann-Whitney test or the Wilcoxon test were used to compare intra- and intergroup outcomes andanalysis of variance (ANOVA) for repeated measures, corrected by the Bonferroni post-hoc test,was used to assess postprandial blood glucose.
Results
Only the CCM group showed a reduction in fasting blood glucose. Postprandial blood glucose decreased in the 2nd (p=0.00) and 3rd (p=0.00) gestational trimester in the CCM group, while in the TM group the reduction occurred only in the 2nd trimester (p=0.015). For perinatal outcomes and hypertensive disorders of pregnancy, there were no differences between groups. Cesarean delivery was performed in 82% of the pregnant women and was associated with hypertensive disorders (gestational hypertension or pre-eclampsia; p=0.047).
Conclusion
Both methods of nutritional guidance contributed to the reduction of postprandial glycemia of women and no differences were observed for maternal and perinatal outcomes. However, CCM had a better effect on postprandial glycemia and only this method contributed to reducing fasting blood glucose throughout the intervention. ReBEC Clinical Trials Database The present study was registered in the ReBEC Clinical Trials Database (Registro Brasileiro de Ensaios Clínicos, number RBR-524z9n).
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Larissa Mello de Oliveira
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Review Article
Effectiveness of Insulin Analogs Compared with Human Insulins in Pregnant Women with Diabetes Mellitus: Systematic Review and Meta-analysis
- Leyna Leite Santos ,
- Jamilly Leite Santos,
- Luciano Timbó Barbosa,
- Ivan do Nascimento da Silva,
- Célio Fernando de Sousa-Rodrigues, [ ... ],
- Fabiano Timbó Barbosa
02-01-2019
Summary
Review ArticleEffectiveness of Insulin Analogs Compared with Human Insulins in Pregnant Women with Diabetes Mellitus: Systematic Review and Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(2):104-115
02-01-2019- Leyna Leite Santos ,
- Jamilly Leite Santos,
- Luciano Timbó Barbosa,
- Ivan do Nascimento da Silva,
- Célio Fernando de Sousa-Rodrigues,
- Fabiano Timbó Barbosa
Views132See moreAbstract
Diabetes during pregnancy has been linked to unfavorable maternal-fetal outcomes. Human insulins are the first drug of choice because of the proven safety in their use. However, there are still questions about the use of insulin analogs during pregnancy. The objective of the present study was to determine the effectiveness of insulin analogs compared withhuman insulin in the treatment of pregnant women with diabetes througha systematic review withmeta-analysis. The search comprised the period since the inception of each database until July 2017, and the following databases were used:MEDLINE, CINAHL, EMBASE, ISIWeb of Science, LILACS, Scopus, SIGLE andGoogle Scholar.We have selected 29 original articles: 11 were randomized clinical trials and 18 were observational studies.We have explored data from 6,382 participants. All of the articles were classified as having an intermediate to high risk of bias. The variable that showed favorable results for the use of insulin analogs was gestational age, with a mean difference of - 0.26 (95 % confidence interval [CI]: 0.03-0.49; p = 0.02), but with significant heterogeneity (Higgins test [I2] = 38%; chi-squared test [χ2] = 16.24; degree of freedom [DF] = 10; p = 0.09). This result, in the clinical practice, does not compromise the fetal well-being, since all babies were born at term. There was publication bias in the gestational age and neonatal weight variables. To date, the evidence analyzed has a moderate-to-high risk of bias and does not allow the conclusion that insulin analogs are more effective when compared with human insulin to treat diabetic pregnant women.
Views132This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticleEffectiveness of Insulin Analogs Compared with Human Insulins in Pregnant Women with Diabetes Mellitus: Systematic Review and Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(2):104-115
02-01-2019- Leyna Leite Santos ,
- Jamilly Leite Santos,
- Luciano Timbó Barbosa,
- Ivan do Nascimento da Silva,
- Célio Fernando de Sousa-Rodrigues,
- Fabiano Timbó Barbosa
Views132See moreAbstract
Diabetes during pregnancy has been linked to unfavorable maternal-fetal outcomes. Human insulins are the first drug of choice because of the proven safety in their use. However, there are still questions about the use of insulin analogs during pregnancy. The objective of the present study was to determine the effectiveness of insulin analogs compared withhuman insulin in the treatment of pregnant women with diabetes througha systematic review withmeta-analysis. The search comprised the period since the inception of each database until July 2017, and the following databases were used:MEDLINE, CINAHL, EMBASE, ISIWeb of Science, LILACS, Scopus, SIGLE andGoogle Scholar.We have selected 29 original articles: 11 were randomized clinical trials and 18 were observational studies.We have explored data from 6,382 participants. All of the articles were classified as having an intermediate to high risk of bias. The variable that showed favorable results for the use of insulin analogs was gestational age, with a mean difference of - 0.26 (95 % confidence interval [CI]: 0.03-0.49; p = 0.02), but with significant heterogeneity (Higgins test [I2] = 38%; chi-squared test [χ2] = 16.24; degree of freedom [DF] = 10; p = 0.09). This result, in the clinical practice, does not compromise the fetal well-being, since all babies were born at term. There was publication bias in the gestational age and neonatal weight variables. To date, the evidence analyzed has a moderate-to-high risk of bias and does not allow the conclusion that insulin analogs are more effective when compared with human insulin to treat diabetic pregnant women.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Leyna Leite Santos
-
Original Articles
Electronic Medical Record for Prenatal Care of Diabetic Women
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(1):9-19
01-01-2016
Summary
Original ArticlesElectronic Medical Record for Prenatal Care of Diabetic Women
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(1):9-19
01-01-2016Views101Objective
To present and validate a multifunctional electronic medical record (EMR) for outpatient care to women with endocrine disorders in pregnancy and to compare health information data fill rate to conventional medical records.
Methods
We developed an EMR named Ambulatory of Endocrine Diseases in Pregnancy (AMBEG) for systematic registration of health information The AMBEG was used for obstetric and endocrine care in a sample of pregnant women admitted to the maternity reference in high-risk pregnancies in Bahia from January 2010 to December 2013. We randomly selected 100 patients accompanied with AMBEG and 100 patients monitored with conventional consultation and compared the health information data fill rate of the electronic consultation to that performed using conventional medical records.
Results
1461 consultations were held, of which 253, 963 and 245 were first, follow-up and puerperium consultations, respectively. Most patients were pregnant women with diabetes (77.2%) and 60.1% were women with pre-gestational diabetes. The AMBEG satisfactorily replaced the conventional medical record. The percentage of registered information was significantly higher in the AMBEG: clinical symptoms (87% versus 100, p < 0.01), uterine height (89 versus 75%, p = 0.01), total weight gain (91 versus 40%, p < 0.01) and specific diabetes data (diet, insulin regimen, glycemic control and management of hypoglycemia) revealed a significant difference (p < 0.01). The ability to export data to worksheets greatly facilitated and accelerated the statistical analysis of the data.
Conclusions
AMBEG is a useful tool in clinical care for women with endocrine diseases during pregnancy. The fill rate of clinical information was superior to that registered in conventional medical records.
Key-words computerizedDiabetes mellitusendocrine system diseasesGestational diabetesmedical records systemsPregnancy in diabeticsSee moreViews101This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticlesElectronic Medical Record for Prenatal Care of Diabetic Women
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(1):9-19
01-01-2016Views101Objective
To present and validate a multifunctional electronic medical record (EMR) for outpatient care to women with endocrine disorders in pregnancy and to compare health information data fill rate to conventional medical records.
Methods
We developed an EMR named Ambulatory of Endocrine Diseases in Pregnancy (AMBEG) for systematic registration of health information The AMBEG was used for obstetric and endocrine care in a sample of pregnant women admitted to the maternity reference in high-risk pregnancies in Bahia from January 2010 to December 2013. We randomly selected 100 patients accompanied with AMBEG and 100 patients monitored with conventional consultation and compared the health information data fill rate of the electronic consultation to that performed using conventional medical records.
Results
1461 consultations were held, of which 253, 963 and 245 were first, follow-up and puerperium consultations, respectively. Most patients were pregnant women with diabetes (77.2%) and 60.1% were women with pre-gestational diabetes. The AMBEG satisfactorily replaced the conventional medical record. The percentage of registered information was significantly higher in the AMBEG: clinical symptoms (87% versus 100, p < 0.01), uterine height (89 versus 75%, p = 0.01), total weight gain (91 versus 40%, p < 0.01) and specific diabetes data (diet, insulin regimen, glycemic control and management of hypoglycemia) revealed a significant difference (p < 0.01). The ability to export data to worksheets greatly facilitated and accelerated the statistical analysis of the data.
Conclusions
AMBEG is a useful tool in clinical care for women with endocrine diseases during pregnancy. The fill rate of clinical information was superior to that registered in conventional medical records.
Key-words computerizedDiabetes mellitusendocrine system diseasesGestational diabetesmedical records systemsPregnancy in diabeticsSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Articles
Correlation of the Levels of Fructosamine and Glycated Hemoglobin with the Blood Glucose Profile in Pregnant Women with Diabetes Mellitus
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(1):20-26
01-01-2016
Summary
Original ArticlesCorrelation of the Levels of Fructosamine and Glycated Hemoglobin with the Blood Glucose Profile in Pregnant Women with Diabetes Mellitus
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(1):20-26
01-01-2016Views92Objective
To evaluate the correlation of the levels of fructosamine and of glycated hemoglobin (HbA1c) with the frequency of blood glucose self-monitoring values out of the treatment target range in pregnant women with diabetes mellitus.
Methods
We performed an observational, retrospective, cross-sectional study, including all pregnant women with diabetes who attended prenatal care visits at a tertiary teaching hospital during the year of 2014 and who presented at least 20 days of blood glucose self-monitoring prior to assessment of serum levels of fructosamine and HbA1c. Capillary blood glucose values out of the treatment target range were considered "hypoglycemia" when lower than 70 mg/dL and "hyperglycemia" when above the glycemic therapeutic target. We evaluated the correlation of the levels of fructosamine and of HbA1c with the frequencies of hyperglycemia and hypoglycemia recorded in the glucometer device by performing Tau-b of Kendall correlation tests. Next, linear regression tests were performed between the levels of HbA1c and of fructosamine and the frequencies of hypoglycemia and hyperglycemia.
Results
We included 158 pregnant women, from whom 266 blood samples were obtained for assessing fructosamine and HbA1c levels. Measurements of fructosamine and of HbA1c presented, respectively, Kendall's τ coefficient of 0.29 (p < 0.001) and 0.50 (p < 0.001) regarding the frequency of hyperglycemia, and of 0.09 (p = 0.046) and 0.25 (p < 0.001) regarding the frequency of hypoglycemia. In the linear regression model, levels of fructosamine and of HbA1c respectively presented determination coefficients R2 = 0.265 (p < 0.001) and R2 = 0.513 (p < 0.001) for the prediction of hyperglycemia, and R2 = 0.033 (p = 0.003) and R2 = 0.059 (p < 0.001) for the prediction of hypoglycemia.
Conclusion
Levels of fructosamine and of HbA1c presented a weak to moderate correlation with the frequencies of hyperglycemia and hypoglycemia at blood glucose self-monitoring and were not able to accurately translate the deviations from the glycemic goals in pregnant women with diabetes.
Key-words blood glucose selfmonitoringDiabetes mellitusFructosamineglycosylated hemoglobin APregnancySee moreViews92This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticlesCorrelation of the Levels of Fructosamine and Glycated Hemoglobin with the Blood Glucose Profile in Pregnant Women with Diabetes Mellitus
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(1):20-26
01-01-2016Views92Objective
To evaluate the correlation of the levels of fructosamine and of glycated hemoglobin (HbA1c) with the frequency of blood glucose self-monitoring values out of the treatment target range in pregnant women with diabetes mellitus.
Methods
We performed an observational, retrospective, cross-sectional study, including all pregnant women with diabetes who attended prenatal care visits at a tertiary teaching hospital during the year of 2014 and who presented at least 20 days of blood glucose self-monitoring prior to assessment of serum levels of fructosamine and HbA1c. Capillary blood glucose values out of the treatment target range were considered "hypoglycemia" when lower than 70 mg/dL and "hyperglycemia" when above the glycemic therapeutic target. We evaluated the correlation of the levels of fructosamine and of HbA1c with the frequencies of hyperglycemia and hypoglycemia recorded in the glucometer device by performing Tau-b of Kendall correlation tests. Next, linear regression tests were performed between the levels of HbA1c and of fructosamine and the frequencies of hypoglycemia and hyperglycemia.
Results
We included 158 pregnant women, from whom 266 blood samples were obtained for assessing fructosamine and HbA1c levels. Measurements of fructosamine and of HbA1c presented, respectively, Kendall's τ coefficient of 0.29 (p < 0.001) and 0.50 (p < 0.001) regarding the frequency of hyperglycemia, and of 0.09 (p = 0.046) and 0.25 (p < 0.001) regarding the frequency of hypoglycemia. In the linear regression model, levels of fructosamine and of HbA1c respectively presented determination coefficients R2 = 0.265 (p < 0.001) and R2 = 0.513 (p < 0.001) for the prediction of hyperglycemia, and R2 = 0.033 (p = 0.003) and R2 = 0.059 (p < 0.001) for the prediction of hypoglycemia.
Conclusion
Levels of fructosamine and of HbA1c presented a weak to moderate correlation with the frequencies of hyperglycemia and hypoglycemia at blood glucose self-monitoring and were not able to accurately translate the deviations from the glycemic goals in pregnant women with diabetes.
Key-words blood glucose selfmonitoringDiabetes mellitusFructosamineglycosylated hemoglobin APregnancySee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Diabetes mellitus Archives - Revista Brasileira de Ginecologia e Obstetrícia
