Navegando por Palavras-chave "Diabetes, gestational"

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    Avaliação quantitativa e qualitativa de monócitos em pacientes com diabetes mellitus gestacional
    (Universidade Federal de São Paulo (UNIFESP), 2017-10-26) Angelo, Ana Geisa Santos de [UNIFESP]; Daher, Silvia [UNIFESP]; Neves, Carla Taddei de Castro; http://lattes.cnpq.br/2153017362476065; http://lattes.cnpq.br/5938358901097469; http://lattes.cnpq.br/2950551810923855; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Immunological changes leading to a predominantly inflammatory profile seem to be involved in the pathophysiology of Gestational Diabetes Mellitus (GDM). The role of monocytes and their mediators in this process remains unclear. Objective: The aim of this study was to evaluate the profile of peripheral blood monocytes of patients with GDM and compare it with the observed in healthy pregnant and nonpregnant women. We quantified and evaluated the expression of TLR-4, chemokine CCR2 and cytokines (TNF-A, IL-6 and IL-10) in circulating monocytes of pregnant women with and without DMG and healthy nonpregnant women. Methods: This was a cross-sectional analytical study. Patients were enrolled in the 3 rd trimester of pregnancy, healthy and with GDM, and a group of healthy non-pregnant women. Peripheral blood was collected for quantitative evaluation of total monocytes and their subclasses, and also to characterize their spontaneous and post-stimulation by lipopolysaccharide (LPS) expression of TLR-4, CCR2 and cytokines. All participants underwent oral glucose tolerance test with 75g (TTOG) by the 20th week of gestation, and the diagnosis of GDM was established according to the IADPSG criteria. The percentages of total (CD14+ ), classic (CD14+CD16- ), intermediate (CD14+CD16+ ) and non-classical (CD14+CD16++) monocytes were assessed by flow cytometry. The same technique was used to evaluate the spontaneous and post-stimulation by LPS expression of TLR-4, CCR2, TNF-A + , IL-6 + and IL-10+ in all subclasses. Student t tests, One-Way ANOVA, Kruskal-Wallis, χ2, Pearson's correlation were used for statistical analysis. The level of significance was set at p<0.05. Results: Thirty-eight patients in the third trimester of pregnancy, 20 healthy and 18 patients with GDM, in addition to 18 non-pregnant women of reproductive age were included. The control xviii and DMG groups presented lower number of total CD14+ monocytes when compared to the non-pregnant group, both spontaneous (6,30 +/- 2,37 x 6,67 +/- 1,81 X 11,95 +/- 4,07, respectively, p <0,0001 - One-way ANOVA test) and after stimulation with LPS (Med: 5,37 x 5,24 x 9,74, Iq: 4,33 - 6,29 x 3,88 - 7,15 x 6,38 - 11,78 respectively, p=0,0005 - Kruskal-Wallis test). We did not observe statistically significant difference between the study groups when we analyzed the subsets of monocytes (classic, intermediate and nonclassical) in both situations: spontaneous production or stimulation with LPS. We observed lower expression of TLR-4 by classic monocytes of DMG patients, in comparison to the control and nonpregnant groups (Med: 39,40 x 71,65 x 63,30, Iq: 11,33 - 69,83 x 61,80 - 76,78 x 21,50 - 74,23 respectively, p=0,01 - Kruskal-Wallis test). The same occurred in the intermediate monocytes (Med: 84,25 x 100,00 x 100,00, Iq: 56,10 - 100,00 x 87,00 - 100,00 x 87,50 - 100,00 respectively, p = 0,04 - Kruskal-Wallis test) and, although it was not statistically significant in nonclassical monocytes, we also observed a tendency to lower expression of TLR-4 in the diabetic group (Med: 88,70 x 100,00 x 100,00, Iq: 55,55 - 100,00 x 88,03 - 100,00 x 86,10 - 100,00 respectively, p = 0,08 - KruskalWallis test). We also identified lower levels of sCD14 + in the control group when compared to DMG and non - pregnant groups (Med: 225,50 x 779,20 x 1383,00, Iq: 152,90 - 274,90 x 229,80 - 1623, 00 x 836,70 - 1658,00, respectively, p <0,0001 - Kruskal-Wallis test). As expected, we detected altered laboratory parameters in diabetic pregnant women (glycated hemoglobin: 5,72 +/- 0,33 x 5,32 +/- 0,41 x 5,33 +/- 0,31, respectively, p <0 , 0001 - One-way ANOVA test; fasting glycemia 89,60 +/- 5,55 x 81,52 +/- 8,64, p = 0,001 - Student's t-test). There was no correlation between percentages of CD14 + cells and levels of glycated hemoglobin and fasting glycemia. Conclusion: Patients with DMG had xix lower percentage of monocytes that spontaneously expressed TLR-4. Pregnant women with and without DMG had a lower percentage of total monocytes (CD14+ ) and of monocytes expressing IL-10+ than non-pregnant women.
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    Fatores relacionados à presença de recém-nascidos grandes para a idade gestacional em gestantes com diabetes mellitus gestacional
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2009-01-01) Silva, Jean Carl; Bertini, Anna Maria [UNIFESP]; Ribeiro, Thaís Engel [UNIFESP]; Carvalho, Leonardo Souza De; Melo, Muriel Matias; Barreto Neto, Lauro; Universidade da Região de Joinville; Hospital Dona Helena; Universidade Federal de São Paulo (UNIFESP)
    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.
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    Risco de diabetes gestacional conforme o índice de massa corporal: revisão sistemática da literatura com metanálise
    (Universidade Federal de São Paulo (UNIFESP), 2009-10-28) Torloni, Maria Regina [UNIFESP]; Valente, Orsine [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: Assess and quantify the risk for gestational diabetes (GDM) according to pre-pregnancy maternal body mass index (BMI). Design: Systematic review of observational studies published in the last 30 years. Methods: Four electronic databases were searched for publications (1977- 2007).BMI was elected as the only measure of obesity and all diagnostic criteria for GDM were accepted. Studies with selective screening for GDM were excluded. There were no language restrictions. The methodological quality of primary studies was assessed. Results: 1745 citations were screened and 70 studies (2 unpublished) involving 671,945 women were included (59 cohorts and 11 case-controls). Most studies (81.4%) were of medium or high quality. Compared to women with a normal BMI, the unadjusted pooled OR of an underweight woman developing GDM was 0.75 (95% CI 0.69 to 0.82). The OR for women with overweight, class I and class II to III obesity were 1.97 (95% CI 1.77 to 2.19), 3.01 (95% CI 2.34 to 3.87) and 5.55 (95% CI 4.27 to 7.21), respectively. For every 1 kg/m2 increase in BMI, the prevalence of GDM increased by 0.92% (95% CI 0.73 to 1.10). Conclusions: The risk of GDM is directly associated with pre-pregnancy BMI. This information is important when counseling women planning a pregnancy.
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    Tratamento do diabetes mellitus gestacional com glibenclamida: fatores de sucesso e resultados perinatais
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2007-11-01) Silva, Jean Carl; Heinen, Amanda; Scheidt, Mariana Benedet; Marcondes, Marina Abreu De Oliveira; Bertini, Anna Maria [UNIFESP]; Universidade da Região de Joinville Departamento de Ginecologia e Obstetrícia; Maternidade Darcy Vargas; Universidade da Região de Joinville; Universidade Federal de São Paulo (UNIFESP)
    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.