RESUMO
OBJECTIVE: Gestational diabetes can cause maternal and neonatal morbidity. Psychological factors, especially stress, play a meaningful role in diabetes management. Therefore, the present study aimed to investigate the effect of Mindfulness-Based Stress Reduction counseling on blood sugar and perceived stress in women with gestational diabetes. METHODS: The present quasi-experimental interventional study was performed on 78 women with gestational diabetes. In the intervention group, a Mindfulness-Based Stress Reduction counseling program was conducted by the researcher in 8 sessions of 90 minutes twice a week. The Cohen stress questionnaire was filled in both groups. Also, fasting blood sugar and 2-hour blood sugar levels were measured in both groups. Statistical analysis was performed using the independent T-Test, the paired T-Test, the Mann-Whitney and Wilcoxon Tests using IBM SPSS Statistics for Windows version 20 version (IBM Corp., Armonk, NY, USA). RESULTS: The mean age of pregnant women in the intervention group was 28.84 ± 6.20 years old and 29.03 ± 5.42 years old in the control group. There was a significant mean difference between the fasting blood sugar score (p = 0.02; - 6.01; and - 11.46) and the 2-hour fasting blood sugar score (p < 0.001;12.35; and - 5.3) and the perceived stress score (p < 0.001; 35.57; and - 49.19) existed between the intervention and control groups after the intervention. CONCLUSION: The results of the present study showed that mindfulness-based stress reduction counseling is effective in reducing blood sugar levels and reducing perceived stress in women with gestational diabetes treated with diet.
Assuntos
Diabetes Gestacional , Atenção Plena , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Adulto Jovem , Glicemia , Aconselhamento , Diabetes Gestacional/prevenção & controle , Diabetes Gestacional/psicologia , Estresse Psicológico/prevenção & controleRESUMO
La diabetes mellitus gestacional DMG es una enfermedad con consecuencias mortales, incapacitantes y costosas para las personas, las familias, las comunidades y los países. Con el fin de establecer de manera sistemática los factores de riesgo psicosocial asociados con la DMG que deberían ser monitoreados durante y después del embarazo se realizó una revisión sistemática en las bases de datos PubMed/Medline y Cochrane. Se encontraron 1188 artículos y se seleccionaron 41. Algunos temas principales fueron conflictos con prácticas culturales, estigma social, influencia de la etnia/raza, bajo nivel educativo, calidad del sueño, problemas con la lactancia materna, preocupación por la propia salud o la del bebé, baja percepción de riesgo de DMG o de diabetes mellitus tipo 2 en el futuro, estrés, ansiedad y depresión, conocimiento limitado, falta de apoyo de la pareja, de la familia o social y de los profesionales de la salud, bajos niveles de autocuidado/autoeficacia y dificultades con cambios en el estilo de vida. Estos factores deberían monitorearse en las embarazadas durante y después del parto. Los tratamientos deberían considerar el impacto psicológico y el riesgo de desarrollar diabetes mellitus tipo 2 después del parto, y deberían ser incluidos en las guías de práctica clínica. Las poblaciones multiétnicas y los grupos más vulnerables demográficamente y socioeconómicamente son más susceptibles de desarrollar DMG.
Gestational diabetes mellitus (GDM) is a disease with fatal, disabling, and costly consequences for individuals, families, communities and countries. To systematically establish the psychosocial risk factors associated with GDM that should be monitored during and after pregnancy. Systematic review in PubMed/Medline and Cochrane databases. 1188 articles were found and 41 were selected. Some main themes were conflicts with cultural practices, social stigma, ethnicity/race influence, low educational level, sleep quality, breastfeeding problems, concern for ones own health/baby, low perception of the risk of GDM/DM2 in the future, stress, anxiety and depression, limited knowledge, lack of support from the partner/family/social and health professionals, low levels of self-care/self-efficacy and difficulties with changes in the lifestyle. These factors should be monitored in pregnant women during and after delivery. Treatments should consider the psychological impact and the risk of developing DM2 after childbirth and should be included in clinical practice guidelines. Multi-ethnic populations and the most demographically and socioeconomically vulnerable groups are more susceptible to developing GDM.
Assuntos
Humanos , Feminino , Gravidez , Diabetes Gestacional/psicologia , Diabetes Gestacional/epidemiologia , Apoio Social , Fatores de RiscoRESUMO
OBJECTIVE: The study was conducted to determine the quality of life and depression of women with gestational diabetes during pregnancy and the postpartum period. METHODS: 100 pregnant women with gestational diabetes and 100 healthy pregnant women were included in the present study. Data were obtained from pregnant women in their third trimester who agreed to take part in the study. The data was collected during the third trimester and six to eight weeks after the baby was born. The data were obtained by socio-demographic characteristics form, postpartum data collection form, the MOS 36 Item Short Form Health Survey and Center for Epidemiologic Studies Depression Scale (CESD). RESULTS: The mean age of pregnant women with gestational diabetes in the study was the same as the average age of healthy pregnant women. The CESD score of pregnant women with gestational diabetes was 26,77 ± 4,85 while the corresponding score was 25,19 ± 4,43 for healthy women. Additionally, the score in the postpartum period was 32.47 ± 5.94 for pregnant women with gestational diabetes and 35.47 ± 8.33 for healthy pregnant women. CESD scores were found to be higher than the cut-off score of 16 in both groups, and the mean scores increased during the postpartum period. CONCLUSION: During the postpartum period, the quality of life of pregnant women with gestational diabetes was affected more negatively than healthy pregnant women. Depressive symptoms of women with both gestational diabetes and healthy pregnancy were found to be high in pregnancy and postpartum periods.
OBJETIVO: O estudo foi realizado para determinar a qualidade de vida e depressão de mulheres com diabetes gestacional durante a gravidez e período pós-parto. MéTODOS: 100 gestantes com diabetes gestacional e 100 gestantes saudáveis incluídas no presente estudo. Os dados foram obtidos de mulheres grávidas no terceiro trimestre que concordaram em participar do estudo. Os dados foram coletados durante o terceiro trimestre e seis a oito semanas após o nascimento do bebê. Os dados foram obtidos por meio do formulário de características sociodemográficas formulário de coleta de dados pós-parto MOS 36 Item Short Form Health Survey e Center for Epidemiologic Studies Depression Scale (CESD). RESULTADOS: A idade média das gestantes com diabetes gestacional no estudo foi igual à idade média das gestantes saudáveis. O escore CESD de gestantes com diabetes gestacional foi de 26 77 ± 4 85 enquanto o escore correspondente foi de 25 19 ± 4 43 para mulheres saudáveis. Além disso o escore no pós-parto foi de 32 47 ± 5 94 para gestantes com diabetes gestacional e 35 47 ± 8 33 para gestantes saudáveis. Os escores do CESD foram maiores do que o ponto de corte de 16 em ambos os grupos e os escores médios aumentaram durante o período pós-parto. CONCLUSãO: Durante o período pós-parto a qualidade de vida de gestantes com diabetes gestacional foi mais afetada negativamente do que gestantes saudáveis. Os sintomas depressivos de mulheres com diabetes gestacional e gravidez saudável foram elevados na gravidez e nos períodos pós-parto.
Assuntos
Depressão Pós-Parto , Depressão , Diabetes Gestacional , Gestantes , Feminino , Humanos , Gravidez , Diabetes Gestacional/psicologia , Parto , Período Pós-Parto , Gestantes/psicologia , Qualidade de Vida , Complicações na Gravidez/psicologiaRESUMO
Gestational diabetes (GD) has a negative impact on neurodevelopment, resulting in cognitive and neurological deficiencies. Oxidative stress (OS) has been reported in the brain of the first-generation offspring of GD rats. OS has been strongly associated with neurodegenerative diseases. In this work, we determined the effect of GD on the cognitive behavior, oxidative stress and metabolism of second-generation offspring. GD was induced with streptozotocin (STZ) in pregnant rats to obtain first-generation offspring (F1), next female F1 rats were mated with control males to obtain second-generation offspring (F2). Two and six-month-old F2 males and females were employed. Anxious-type behavior, spatial learning and spatial working memory were evaluated. In cerebral cortex and hippocampus, the oxidative stress and serum biochemical parameters were measured. Male F2 GD offspring presented the highest level of anxiety-type behavior, whilst females had the lowest level of anxiety-type behavior at juvenile age. In short-term memory, adult females presented deficiencies. The offspring F2 GD females presented modifications in oxidative stress biomarkers in the cerebral cortex as lipid-peroxidation, oxidized glutathione and catalase activity. We also observed metabolic disturbances, particularly in the lipid and insulin levels of male and female F2 GD offspring. Our results suggest a transgenerational effect of GD on metabolism, anxiety-like behavior, and spatial working memory.
Assuntos
Ansiedade/etiologia , Comportamento Animal/fisiologia , Fenômenos Fisiológicos da Nutrição Materna , Estresse Oxidativo/fisiologia , Efeitos Tardios da Exposição Pré-Natal/etiologia , Animais , Biomarcadores , Córtex Cerebral/metabolismo , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/psicologia , Diabetes Gestacional/metabolismo , Diabetes Gestacional/psicologia , Modelos Animais de Doenças , Feminino , Hipocampo/metabolismo , Peroxidação de Lipídeos/fisiologia , Masculino , Memória de Curto Prazo/fisiologia , Gravidez , Ratos , Aprendizagem Espacial/fisiologia , EstreptozocinaRESUMO
BACKGROUND: Breastfeeding offers benefits to mother and child but is frequently not practiced among women whose pregnancy is complicated by gestational diabetes mellitus. Factors associated with not initiating or not maintaining breastfeeding among these women have been little investigated. RESEARCH AIMS: (1) To evaluate the frequency of breastfeeding for 30 days among women with a recent pregnancy complicated by gestational diabetes and (2) to determine factors associated with not initiating or not maintaining breastfeeding. METHODS: Between January 2014 and July 2017 we enrolled women with gestational diabetes at high-risk prenatal services in three Brazilian cities. We collected baseline sociodemographic and health data and followed up with participants by telephone. Using Kaplan-Meier curves, we calculated the proportions of participants not initiating breastfeeding or not maintaining it for at least 30 days. We used Poisson regression with robust variance to identify factors related to this outcome. RESULTS: Of the 2328 participants with complete information, 2236 (96.1%) initiated breastfeeding, and 2166 (93.1%) maintained breastfeeding for 30 days. Not having breastfed the previous infant (relative risk [RR] = 5.02, 95% CI [3.39, 7.45]), smoking during pregnancy (RR = 2.37, 95% CI [1.48, 3.80]), infant with health problems (RR = 2.25, 95% CI [1.27, 3.99]), early preterm birth (RR = 2.49, 95% CI [1.07, 5.77]), and not intending to breastfeed (RR = 3.73, 95% CI [1.89, 7.33]) were related to not maintaining breastfeeding for at least 30 days. CONCLUSIONS: Breastfeeding initiation was nearly universal among participants, and most maintained breastfeeding for 30 days. Factors relating to not breastfeeding at 30 days were easily identifiable.
Assuntos
Aleitamento Materno/métodos , Diabetes Gestacional/fisiopatologia , Adulto , Brasil , Aleitamento Materno/efeitos adversos , Complicações do Diabetes/prevenção & controle , Complicações do Diabetes/terapia , Diabetes Gestacional/psicologia , Feminino , Humanos , Intenção , Estimativa de Kaplan-Meier , Estudos Longitudinais , Distribuição de Poisson , Gravidez , Estudos ProspectivosRESUMO
This study aimed to assess the frequency and severity of depressive symptoms and their relationship with sociodemographic characteristics in women with gestational diabetes mellitus (GDM) who participated in the LINDA-Brazil study. We conducted cross-sectional analyses of 820 women with GDM who were receiving prenatal care in the public health system. We conducted structured interviews to obtain clinical and sociodemographic information and applied the Edinburgh Postnatal Depression Scale (EPDS) to assess depressive symptoms. We classified the presence and severity of depressive symptoms using scores of ≥12 and ≥18, respectively. We used Poisson regression to estimate prevalence ratios (PR). Most of the women lived with a partner (88%), 50% were between 30 and 39 years old, 39% had finished high school, 39% had a family income of 1-2 minimum wages, and 47% were obese before their pregnancies. The presence of depressive symptoms was observed in 31% of the women, and severe depressive symptoms were observed in 10%; 8.3% reported self-harm intent. Lower parity and higher educational levels were associated with lower EPDS score. Depressive symptoms were common and frequently severe among women with GDM, indicating the need to consider this situation when treating such women, especially those who are more socially vulnerable. This trial is registered with NCT02327286, registered on 23 December 2014.
Assuntos
Depressão/diagnóstico , Diabetes Gestacional/psicologia , Complicações na Gravidez/diagnóstico , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/psicologia , Prevalência , Índice de Gravidade de Doença , Adulto JovemRESUMO
The aim of this study is to prospectively examine the association between maternal depressive symptoms in early pregnancy and risk of abnormal glucose tolerance (AGT) and impaired glucose tolerance (IGT) in mid-pregnancy. We evaluated this association among 934 participants in Proyecto Buena Salud, a prospective cohort study of Hispanic (predominantly Puerto Rican) women in Western Massachusetts. Depressive symptoms were assessed in early pregnancy using the 10-item Edinburgh Postnatal Depression Scale. Scores ≥13 indicated at least probable minor depression and scores ≥15 indicated probable major depression. AGT and IGT were diagnosed using American Diabetes Association criteria. In early pregnancy, 247 (26.5 %) participants experienced at least minor depression and 163 (17.4 %) experienced major depression. A total of 123 (13.2 %) were classified with AGT and 56 (6.0 %) were classified with IGT. In fully-adjusted models, the odds ratio for AGT associated with minor depression was 1.20 (95 % CI 0.77-1.89) and for major depression was 1.34 (95 % CI 0.81-2.23). The odds ratio for IGT associated with minor depression was 1.22 (95 % CI 0.62-2.40) and for major depression was 1.53 (95 % CI 0.73-3.22). We did not observe an association with continuous screening glucose measures. Findings in this prospective cohort of Hispanic women did not indicate a statistically significant association between minor or major depression in early pregnancy and AGT or screening glucose values in mid-pregnancy. Due to the small number of cases of IGT, our ability to evaluate the association between depression and IGT risk was constrained.
Assuntos
Glicemia/metabolismo , Depressão/etnologia , Diabetes Gestacional/etnologia , Intolerância à Glucose/etiologia , Hispânico ou Latino/psicologia , Adulto , Depressão/diagnóstico , Depressão/psicologia , Diabetes Gestacional/psicologia , República Dominicana/etnologia , Feminino , Teste de Tolerância a Glucose/métodos , Hispânico ou Latino/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Modelos Logísticos , Massachusetts/epidemiologia , Gravidez , Primeiro Trimestre da Gravidez , Estudos Prospectivos , Porto Rico/etnologia , Fatores de Risco , Estresse Psicológico/epidemiologia , Estresse Psicológico/etnologia , Inquéritos e QuestionáriosRESUMO
This phenomenological qualitative study aimed to understand the meaning of the experiences lived by women with gestational diabetes mellitus. The sample consisted of 12 patients hospitalized at a maternity hospital in the city of Fortaleza, state of Ceará, Brazil, which expressed their feelings and perceptions through open interviews and drawings. The empirical material was fully transcribed and then organized and analyzed by the phenomenological method. The results revealed two themes: (1) Living experiences that bring happiness and well-being, and (2) Living experiences that cause suffering. This phenomenological study showed the experience of women with gestational diabetes mellitus, thus enabling to plan and to implement intervention programs based on a participatory model of health in order to prioritize the subjective aspects involved in high-risk pregnancy.
Assuntos
Atitude Frente a Saúde , Diabetes Gestacional/psicologia , Adulto , Feminino , Hospitalização , Humanos , Gravidez , Adulto JovemRESUMO
Estudo qualitativo fenomenológico, que teve como objetivo compreender o significado das experiências vivenciadas por mulheres com diabetes mellitus gestacional. Participaram 12 pacientes internadas em uma maternidade de Fortaleza-CE, Brasil, que manifestaram seus sentimentos e percepções por meio de entrevista aberta e desenhos. O material empírico foi transcrito na íntegra e, posteriormente, organizado e analisado pelo método fenomenológico. Os resultados evidenciaram dois temas: (1) Vivenciando experiências que trazem felicidade e bem-estar e (2) Vivenciando experiências que provocam sofrimento. Este estudo fenomenológico, ao possibilitar apreender a experiência das mulheres com diabetes mellitus gestacional, contribui para o planejamento e a implementação de programas de intervenção baseados em um modelo de saúde participativo, com vistas a priorizar os aspectos subjetivos envolvidos na gravidez de risco.
This phenomenological qualitative study aimed to understand the meaning of the experiences lived by women with gestational diabetes mellitus. The sample consisted of 12 patients hospitalized at a maternity hospital in the city of Fortaleza, state of Ceará, Brazil, which expressed their feelings and perceptions through open interviews and drawings. The empirical material was fully transcribed and then organized and analyzed by the phenomenological method. The results revealed two themes: (1) Living experiences that bring happiness and well-being, and (2) Living experiences that cause suffering. This phenomenological study showed the experience of women with gestational diabetes mellitus, thus enabling to plan and to implement intervention programs based on a participatory model of health in order to prioritize the subjective aspects involved in high-risk pregnancy.
Estudio fenomenológico cualitativo que objetivó comprender el significado de las experiencias vividas por las mujeres con diabetes mellitus gestacional. Los participantes fueron 12 pacientes ingresadas en un hospital de maternidad en la ciudad de Fortaleza, estado del Ceará, Brasil, que expresaran sus sentimientos y percepciones a través de entrevistas abiertas y dibujos. El material empírico fue transcrito completamente y luego organizado y analizado por el método fenomenológico. Los resultados revelaron dos temas: (1) Viviendo experiencias que traen felicidad y bienestar y (2) Viviendo experiencias que causan sufrimiento. Este estudio fenomenológico, que mostró la experiencia de las mujeres con diabetes mellitus gestacional, contribuye a la planificación y ejecución de programas de intervención basados en un modelo participativo de la salud, con el fin de dar prioridad a los aspectos subjetivos que intervienen en embarazos de riesgo.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Adulto Jovem , Atitude Frente a Saúde , Diabetes Gestacional/psicologia , HospitalizaçãoRESUMO
PURPOSE: To evaluate the frequency of fear of needles and the impact of a multidisciplinary educational program in women with pre-gestational and gestational diabetes taking insulin during pregnancy. METHODS: The short Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ), composed by two subscales that access fear of self injection (FSI) and fear of self testing (FST), was administered twice during pregnancy to 65 pregnant women with pre-gestational and gestational diabetes: at the first endocrine consult and within the last two weeks of pregnancy or postpartum. An organized multidisciplinary program provided diabetes education during pregnancy. Statistical analysis was carried out by Wilcoxon and McNemar tests and Spearman correlation. A p<0.05 was considered to be significant. RESULTS: Data from the short D-FISQ questionnaire shows that 43.1% of pregnant women were afraid of needles in the first evaluation. There was a significant reduction in scores for FSI and FST subscales between the first and second assessments (first FSI 38.5% compared with second 12.7%, p=0.001; first FST 27.7% compared with second FST 14.3%, p=0.012). CONCLUSIONS: The fear of needles is common in pregnant women on insulin therapy and an organized multidisciplinary educational diabetes program applied during pregnancy reduces scores of such fear.