RESUMO
Objetivo: verificar os impactos do IMC, no tratamento e resultado perinatal, em pacientes com DMG. Material e métodos: foi realizado um estudo de coorte retrospectivo. Foram sujeitos deste estudo 258 gestantes portadoras de DMG e seus recém-nascidos, divididas em 4 grupos: baixo peso (IMC<18,5kg/m2), normopeso (IMC entre 18,5 e 24,9 kg/m2), sobrepeso (IMC25-29,9 kg/m2) e obesidade (IMC>ou=30 kg/m2). O estudo foi realizado no período de Janeiro de 2003 a março de 2008. Foram avaliados dados relacionados ao diabete e ao recém-nascido. Resultados: encontramos 10,1% de baixo peso, 63,9% normopeso, 12,4% sobrepeso e 13,6% obesas. Encontramos um aumento da média das glicemias em jejum coletadas em pacientes com IMC aumentado durante o tratamento (p=0,004), enquanto as pós-prandiais foram semelhantes (p=0,837). A necessidade do uso de insulina como terapia ocorreu independentemente do IMC da paciente (p=0,692), entretanto as doses de insulina aumentaram com o IMC (p=0,053). Referente às características do nascimento e do recém-nascido, não houve diferenças entre os 4 grupos. Conclusão: encontramos um aumento da média das glicemias em jejum coletadas durante o tratamento e da dose final de insulina conforme há aumento do IMC. Contudo, não observamos repercussões, relacionadas a esse índice, nos recém-nascidos.
Objective: to assess the impact of BMI in the treatment and perinatal outcome of patients with GDM. Methods: a retrospective cohort study was carried out. Participants of this study were 258 pregnant women suffering from GDM and their newborn infants. The women were divided into 4 groups: low (BMI <18.5 kg/m2), normal weight (BMI between 18.5 and 24.9 kg/m2), overweight (BMI 25-29, 9 kg/m2) and obesity (BMI> or = 30 kg/m2). The study was carried out from January 2003 to March 2008. Data related to diabetes and the newborn was evaluated. Results: patients were found to be 10.1% low weight, 63.9% normal weight, 12.4% overweight and 13.6% obese. According to the variables related to DMG, an increase in fasting blood glucose with TTOG and in fasting home glycemic control corresponded to an increase in BMI (p <0.05), but this has not occurred after 2hs TTOG or postprandial home glycemic control (p> 0.05). The need of using insulin as therapy occurred regardless of the patient?s BMI (p = 0692), however, insulin doses increased with BMI (p = 0053). Regarding characteristics of birth and the newborn, no differences between the 4 groups were found. Conclusion: as BMI increased, a rise in fasting blood glucose with TTOG, in fasting glycemia collected during treatment, and in the final dose of insulin was found. However, no effect in newborns was found in relation to this index.
RESUMO
OBJECTIVE: To assess blood glucose control and neonatal outcomes when women with gestational diabetes mellitus (GDM) were treated with metformin or glyburide. METHODS: When an appropriate diet was insufficient to control their blood glucose levels, women with GDM were randomized to a glyburide or a metformin treatment group. If the maximum dose was reached, the assessed drug was replaced by insulin. The primary outcome measures analyzed were maternal glucose levels during pregnancy, birth weight, and neonatal glucose levels. RESULTS: The only significant difference in outcome between the 2 treatment drugs was that maternal weight gain during pregnancy was less in the metformin (n=40) than in the glyburide group (n=32) (10.3 kg vs 7.6 kg; P=0.02). No differences were found in treatment failure, mean level of fasting or postprandial plasma glucose, rate of participants with glycated hemoglobin, birth weight, rate of large-for-gestational-age newborns, or newborns with hypoglycemia. CONCLUSION: The treatment of GDM with metformin or glyburide was found to be equivalent for both women and newborns.
Assuntos
Glicemia/efeitos dos fármacos , Diabetes Gestacional/tratamento farmacológico , Glibureto/uso terapêutico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Peso ao Nascer/efeitos dos fármacos , Jejum , Feminino , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemia/induzido quimicamente , Recém-Nascido , Insulina/uso terapêutico , Gravidez , Resultado do TratamentoRESUMO
O diabetes gestacional é uma patologia frequente durante a gestação e com graves repercussões perinatais. Seu tratamento visa bom controle glicêmico, por dieta e atividade física, quando ocorre falha nesta terapêutica inicial está indicada insulinoterapia. Atualmente, na literatura mundial, vários estudos apresentam uma alternativa, os hipoglicemiantes orais, que sempre foram contraindicados durante a gestação, devido ao aumento da incidência de malformações, hipoglicemia neonatal e óbito, resultados estes baseados em estudos com pequena casuística, em série de casos ou caso-controle. Revisando a literatura foram encontrados vários estudos randomizados, controlados, com um grande número de casos, comparando a glibenclamida e a metformina com a insulinoterapia, mostrando que estas drogas são eficazes no controle glicêmico e não diferem da insulinoterapia quanto às complicações perinatais.(AU)
Gestational diabetes is a common condition during pregnancy with serious perinatal outcomes. The management of this disease aims to achieve adequate blood glucose control, through diet and regular exercises, in its failure insulin therapy can be indicated. In current literature, several studies offer an alternative to insulin therapy: oral hypoglycemic agents. These have always been counter-indicated during pregnancy because of increased incidence of malformations, hypoglycemia and neonatal death. These results were based on small scale studies, series of cases or case-control studies. A review of literature has shown several randomized, controlled, large-scale studies comparing the use of glyburide and metformin with insulin therapy. These studies have shown that these drugs are effective in controlling blood glucose and do not differ from insulin therapy regarding perinatal complications.(AU)