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, Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):697-702
, To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM).
A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes.
A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG)<90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235-0.815]; p=0.009], as well as primiparity (OR: 0.280 [0.111-0.704]; p=0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063-4,039]; p=0,032).
Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG<90 mg/dL and primiparity were protective factors.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):697-702
, To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM).
A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes.
A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG)<90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235-0.815]; p=0.009], as well as primiparity (OR: 0.280 [0.111-0.704]; p=0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063-4,039]; p=0,032).
Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG<90 mg/dL and primiparity were protective factors.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(4):180-187
To assess the effectiveness of metformin in the incidence of gestational diabetes mellitus (GDM) in obese pregnant women attending a public maternity hospital in Joinville, Santa Catarina, Brazil.
Randomized clinical trial including obese pregnant women with a body mass index (BMI) ≥ 30 kg/m2, divided into two groups (control and metformin). Both groups received guidance regarding diet and physical exercise. The participants were assessed at two moments, the first at enrollment (gestational age ≤ 20) and the second at gestational weeks 24-28. The outcomes assessed were BMI and gestational diabetes mellitus (GDM) diagnosis. The data distribution was assessed with the Friedman test. For all the analytical models, the p-values were considered significant when lower than 0.05. The absolute risk reduction was also estimated.
Overall, 164 pregnant women were assessed and further divided into 82 participants per group. No significant difference was observed in BMI variation between the control and metformin groups (0.9 ± 1.2 versus 1.0 ± 0.9, respectively, p = 0.63). Gestational diabetes mellitus was diagnosed in 15.9% (n = 13) of the patients allocated to the metformin group and 19.5% (n = 16) of those in the control group (p = 0.683). The absolute risk reduction was 3.6 (95% confidence interval 8.0- 15.32) in the group treated with metformin, which was not significant.
Metformin was not effective in reducing BMI and preventing GDM in obese pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(4):180-187
To assess the effectiveness of metformin in the incidence of gestational diabetes mellitus (GDM) in obese pregnant women attending a public maternity hospital in Joinville, Santa Catarina, Brazil.
Randomized clinical trial including obese pregnant women with a body mass index (BMI) ≥ 30 kg/m2, divided into two groups (control and metformin). Both groups received guidance regarding diet and physical exercise. The participants were assessed at two moments, the first at enrollment (gestational age ≤ 20) and the second at gestational weeks 24-28. The outcomes assessed were BMI and gestational diabetes mellitus (GDM) diagnosis. The data distribution was assessed with the Friedman test. For all the analytical models, the p-values were considered significant when lower than 0.05. The absolute risk reduction was also estimated.
Overall, 164 pregnant women were assessed and further divided into 82 participants per group. No significant difference was observed in BMI variation between the control and metformin groups (0.9 ± 1.2 versus 1.0 ± 0.9, respectively, p = 0.63). Gestational diabetes mellitus was diagnosed in 15.9% (n = 13) of the patients allocated to the metformin group and 19.5% (n = 16) of those in the control group (p = 0.683). The absolute risk reduction was 3.6 (95% confidence interval 8.0- 15.32) in the group treated with metformin, which was not significant.
Metformin was not effective in reducing BMI and preventing GDM in obese pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(2):60-65
The aim of this study was to evaluate which risk factors may lead patients with gestational diabetes mellitus to cesarean delivery.
This was a retrospective, descriptive study. The subjects of the study were pregnant women with gestational diabetes mellitus attending a public maternity hospital in the south of Brazil. The primary outcomes assessed were based on maternal and fetal characteristics. The data were correlated using an odds ratio (OR) with a 95% confidence interval (95%CI), calculated using multinomial logistic regression.
A total of 392 patients with gestational diabetes mellitus were analyzed, and 57.4% of them had cesarean deliveries. Among the maternal characteristics, the mean age of the patients and the pregestational body mass index were greater when a cesarean delivery was performed (p = 0.029 and p < 0.01 respectively). Gestational age at birth, newborn weight, weight class according to gestational age, and Apgar score were not significant. The analysis of the OR showed that the chance of cesarean delivery was 2.25 times (95%CI = 1.49-2.39) greater if the pregnant woman was obese, 4.6 times (95%CI = 3.017-7.150) greater if she was a primigravida, and 5.2 times (95% CI = 2.702-10.003) greater if she had a previous cesarean delivery. The other parameters analyzed showed no differences.
The factors that led to an increase in the occurrence of cesarean deliveries included history of a prior cesarean section, first pregnancy, and obesity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(2):60-65
The aim of this study was to evaluate which risk factors may lead patients with gestational diabetes mellitus to cesarean delivery.
This was a retrospective, descriptive study. The subjects of the study were pregnant women with gestational diabetes mellitus attending a public maternity hospital in the south of Brazil. The primary outcomes assessed were based on maternal and fetal characteristics. The data were correlated using an odds ratio (OR) with a 95% confidence interval (95%CI), calculated using multinomial logistic regression.
A total of 392 patients with gestational diabetes mellitus were analyzed, and 57.4% of them had cesarean deliveries. Among the maternal characteristics, the mean age of the patients and the pregestational body mass index were greater when a cesarean delivery was performed (p = 0.029 and p < 0.01 respectively). Gestational age at birth, newborn weight, weight class according to gestational age, and Apgar score were not significant. The analysis of the OR showed that the chance of cesarean delivery was 2.25 times (95%CI = 1.49-2.39) greater if the pregnant woman was obese, 4.6 times (95%CI = 3.017-7.150) greater if she was a primigravida, and 5.2 times (95% CI = 2.702-10.003) greater if she had a previous cesarean delivery. The other parameters analyzed showed no differences.
The factors that led to an increase in the occurrence of cesarean deliveries included history of a prior cesarean section, first pregnancy, and obesity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(1):9-13
To evaluate the prevalence of hypertrophic cardiomyopathy (HCM) in fetuses of pregnant women with gestational diabetes mellitus (GDM) in the beginning of the treatment.
A cross-sectional study was performed between July 1, 2013, and Decem-ber 20, 2013, in a public maternity clinic in southern Brazil. The subjects were 63 fetuses of mothers with gestational diabetes, with a single pregnancy and no other associated pathologies. We diagnosed HCM through a fetal echocardiography before treatment and evaluated the maternal and fetal characteristics.
The average age of the pregnant women was 32.32 (±6.2) years, and the average gestational age at the time of the evaluation was 30.59 (±2.27) weeks. The interventricular septum thickness showed a standard deviation of more than two in 50.8% of the fetuses (95% confidence interval [95%CI]: 38.1-63.5%). The left ventricular wall thickness showed a standard deviation of more than 2 in 13 (20.6%) fetuses (95%CI: 11.1-30.2%). The HCM was confirmed in 54% of the fetuses (95%CI: 41.3-65.1%). The fetal abdominal circumference was normal in 46 (73%) fetuses, and 50% of these fetuses had HCM.
The prevalence of hypertrophic cardiomyopathy in fetuses of pregnant women with GDM before treatment was of 54% (95%CI: 41.3-65.1%).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(1):9-13
To evaluate the prevalence of hypertrophic cardiomyopathy (HCM) in fetuses of pregnant women with gestational diabetes mellitus (GDM) in the beginning of the treatment.
A cross-sectional study was performed between July 1, 2013, and Decem-ber 20, 2013, in a public maternity clinic in southern Brazil. The subjects were 63 fetuses of mothers with gestational diabetes, with a single pregnancy and no other associated pathologies. We diagnosed HCM through a fetal echocardiography before treatment and evaluated the maternal and fetal characteristics.
The average age of the pregnant women was 32.32 (±6.2) years, and the average gestational age at the time of the evaluation was 30.59 (±2.27) weeks. The interventricular septum thickness showed a standard deviation of more than two in 50.8% of the fetuses (95% confidence interval [95%CI]: 38.1-63.5%). The left ventricular wall thickness showed a standard deviation of more than 2 in 13 (20.6%) fetuses (95%CI: 11.1-30.2%). The HCM was confirmed in 54% of the fetuses (95%CI: 41.3-65.1%). The fetal abdominal circumference was normal in 46 (73%) fetuses, and 50% of these fetuses had HCM.
The prevalence of hypertrophic cardiomyopathy in fetuses of pregnant women with GDM before treatment was of 54% (95%CI: 41.3-65.1%).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(8):353-358
DOI 10.1590/SO100-720320150005338
To investigate the association between genetic, behavioral, biological and medical risk factors and the occurrence of preterm birth.
A retrospective case-control study was conducted. The real-time polymerase chain reaction was used to analyze the influence of the rs12473815 polymorphism of the follicle stimulating hormone receptor gene (FSHR) and the rs1942836 polymorphism of the progesterone receptor gene (PGR). Other proposed risk factors were assessed using validated or specifically developed questionnaires and analysis of electronically recorded medical data. A total of 157 patients were included (45 cases who went into labor before 37 weeks of pregnancy and 112 controls who went into labor after 37 and before 42 weeks of pregnancy).
The genotypes CT of rs12473815 and CT and CC of rs1942836 were associated with a higher chance of premature delivery. There was an association between preterm birth and alcohol intake when consumption occurred 2 or more times per month. Low pre-pregnancy body mass index was a predictor of spontaneous preterm birth, while high body mass index reduced this likelihood.
The results suggest that excessive alcohol intake, a low level of pre-pregnancy body mass and the risk alleles of rs12473815 and rs1942836 polymorphisms of the FSHR and PGR genes, respectively, influence the occurrence of preterm birth.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(8):353-358
DOI 10.1590/SO100-720320150005338
To investigate the association between genetic, behavioral, biological and medical risk factors and the occurrence of preterm birth.
A retrospective case-control study was conducted. The real-time polymerase chain reaction was used to analyze the influence of the rs12473815 polymorphism of the follicle stimulating hormone receptor gene (FSHR) and the rs1942836 polymorphism of the progesterone receptor gene (PGR). Other proposed risk factors were assessed using validated or specifically developed questionnaires and analysis of electronically recorded medical data. A total of 157 patients were included (45 cases who went into labor before 37 weeks of pregnancy and 112 controls who went into labor after 37 and before 42 weeks of pregnancy).
The genotypes CT of rs12473815 and CT and CC of rs1942836 were associated with a higher chance of premature delivery. There was an association between preterm birth and alcohol intake when consumption occurred 2 or more times per month. Low pre-pregnancy body mass index was a predictor of spontaneous preterm birth, while high body mass index reduced this likelihood.
The results suggest that excessive alcohol intake, a low level of pre-pregnancy body mass and the risk alleles of rs12473815 and rs1942836 polymorphisms of the FSHR and PGR genes, respectively, influence the occurrence of preterm birth.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(11):509-513
DOI 10.1590/S0100-720320140005024
To evaluate the influence of maternal obesity on pregnancy, childbirth, and neonatal outcomes.
A cross-sectional study with 298 postpartum women. Information was obtained through interviews and access to patients' medical records. The patients were divided into three groups according to their pre-gestational body mass index: normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30.0 kg/m2). Data are reported as adjusted odds ratios with 95% confidence interval (95%CI) following multinomial logistic regression analysis to account for confounding variables.
Compared to pregnant women with normal body mass index, overweight women had greater chances of having cesarean delivery, odds ratio (OR) of 2.2 and 95%CI 1.3–3.9, and obese women even more (OR=4.2; 95%CI 2.1–8.1). The chances of gestational diabetes increased in the Overweight (OR=2.5; 95%CI 1.1–5.6) and Obese groups (OR=11.1; 95%CI 5.0–24.6). The occurrence of hypertensive syndrome was also higher in overweight (OR=3.2; 95%CI 1.2–8.1) and obese pregnant women (OR=7.5; 95%CI 2.9–19.1). Major postpartum hemorrhage only showed greater values in the obese women group (OR=4.1; 95%CI 1.1–15.8). Regarding the newborns, the probability of a low Apgar score at first minute was higher in the Obese Group (OR=5.5; 95%CI 1.2–23.7) and chances of macrosomia were higher in the Overweight Group (OR=2.9; 95%CI 1.3–6.3). Data regarding neonatal hypoglycemia were not conclusive.
Excessive weight (overweight and obesity) during pregnancy increases the chance of maternal complications (gestational diabetes, hypertensive syndrome, and major postpartum hemorrhage) and neonatal outcomes (cesarean delivery, macrosomia, and low Apgar score).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(11):509-513
DOI 10.1590/S0100-720320140005024
To evaluate the influence of maternal obesity on pregnancy, childbirth, and neonatal outcomes.
A cross-sectional study with 298 postpartum women. Information was obtained through interviews and access to patients' medical records. The patients were divided into three groups according to their pre-gestational body mass index: normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30.0 kg/m2). Data are reported as adjusted odds ratios with 95% confidence interval (95%CI) following multinomial logistic regression analysis to account for confounding variables.
Compared to pregnant women with normal body mass index, overweight women had greater chances of having cesarean delivery, odds ratio (OR) of 2.2 and 95%CI 1.3–3.9, and obese women even more (OR=4.2; 95%CI 2.1–8.1). The chances of gestational diabetes increased in the Overweight (OR=2.5; 95%CI 1.1–5.6) and Obese groups (OR=11.1; 95%CI 5.0–24.6). The occurrence of hypertensive syndrome was also higher in overweight (OR=3.2; 95%CI 1.2–8.1) and obese pregnant women (OR=7.5; 95%CI 2.9–19.1). Major postpartum hemorrhage only showed greater values in the obese women group (OR=4.1; 95%CI 1.1–15.8). Regarding the newborns, the probability of a low Apgar score at first minute was higher in the Obese Group (OR=5.5; 95%CI 1.2–23.7) and chances of macrosomia were higher in the Overweight Group (OR=2.9; 95%CI 1.3–6.3). Data regarding neonatal hypoglycemia were not conclusive.
Excessive weight (overweight and obesity) during pregnancy increases the chance of maternal complications (gestational diabetes, hypertensive syndrome, and major postpartum hemorrhage) and neonatal outcomes (cesarean delivery, macrosomia, and low Apgar score).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(1):5-9
DOI 10.1590/S0100-72032009000100002
PURPOSE: to evaluate factors related to the presence of neonatal macrosomia in pregnant women with gestational diabetes mellitus. METHODS: 157 pregnant women presenting gestational diabetes mellitus in follow-up were retrospectively selected from January 2004 to July 2006. This group has been divided into two subgroups: one with newborns with weight in accordance with the gestational age (n=136) and another with macrosomic newborns (n=21). Maternal characteristics have been compared between the groups. The t-Student test was used for the analysis of equality hypothesis between the averages of the two groups, and chi-square test, to check the groups' homogeneity concerning ratios. RESULTS: the groups did not show any significant difference concerning the gestational age, body mass index, weight gain along the gestation, number of previous pregnancies, fast glycemia in the oral glucose tolerance test after the ingestion of 75 g (TOTG 75 g), gestational age at delivery, glycemic values during the treatment, and the type of treatment used (p>0.05). In the group with neonatal macrosomia, there was a higher two-hour-glycemia in the TOTG 75 g (p=0.02), higher gestational age at the treatment onset (p=0.02), and a lower number of appointments at the health service (p<0.01). When adjusted to a logistic regression model, the most important factor (p<0.01) found to predict neonatal macrosomia was the two-hour-glycemia in the TOTG 75 g. CONCLUSIONS: the factors more frequently related to neonatal macrosomia were late treatment onset and, consequently, lower number of appointments and chiefly, high two-hour-glycemia in the TOTG 75 g.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(1):5-9
DOI 10.1590/S0100-72032009000100002
PURPOSE: to evaluate factors related to the presence of neonatal macrosomia in pregnant women with gestational diabetes mellitus. METHODS: 157 pregnant women presenting gestational diabetes mellitus in follow-up were retrospectively selected from January 2004 to July 2006. This group has been divided into two subgroups: one with newborns with weight in accordance with the gestational age (n=136) and another with macrosomic newborns (n=21). Maternal characteristics have been compared between the groups. The t-Student test was used for the analysis of equality hypothesis between the averages of the two groups, and chi-square test, to check the groups' homogeneity concerning ratios. RESULTS: the groups did not show any significant difference concerning the gestational age, body mass index, weight gain along the gestation, number of previous pregnancies, fast glycemia in the oral glucose tolerance test after the ingestion of 75 g (TOTG 75 g), gestational age at delivery, glycemic values during the treatment, and the type of treatment used (p>0.05). In the group with neonatal macrosomia, there was a higher two-hour-glycemia in the TOTG 75 g (p=0.02), higher gestational age at the treatment onset (p=0.02), and a lower number of appointments at the health service (p<0.01). When adjusted to a logistic regression model, the most important factor (p<0.01) found to predict neonatal macrosomia was the two-hour-glycemia in the TOTG 75 g. CONCLUSIONS: the factors more frequently related to neonatal macrosomia were late treatment onset and, consequently, lower number of appointments and chiefly, high two-hour-glycemia in the TOTG 75 g.
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.