Follow-up metabólico e biométrico de pacientes com hiperglicemia na gestação e seus conceptos
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Data
2018-03-06
Autores
Arantes, Mariana Alvarez
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução e objetivos: as mulheres com Diabetes mellitus gestacional (DMG) estão em maior risco de resultados adversos na gravidez, bem como, desenvolver o Diabete mellitus tipo 2 (DM2) e outras síndromes metabólicas no futuro, em comparação com mulheres sem DMG. A co-ocorrência de DMG com obesidade "diabesity", é provavelmente a maior epidemia da história humana. As alterações metabólicas no útero podem influenciar os padrões fisiológicos e estruturais que "programam" a saúde a longo prazo na idade adulta. A prole destas mães tem o risco aumentado ao longo da vida para doenças metabólicas e obesidade. Métodos: Este estudo descritivo deriva de uma coorte prospectiva de mulheres grávidas que foram seguidas no Centro de Pesquisa sobre Diabetes Perinatal - FMB-UNESP. Todos os pares de mulheres e recém-nascidos que realizaram a triagem para DMG durante a gravidez foram contatados e convidados a retornar para o estudo de acompanhamento de longo prazo com seus filhos. Resultados: Nossos resultados mostram que DMG anterior foi preditor significativo para DM2 isolado [2.56 (95% C.I. 1.73- 3.79)]. Quando avaliamos a "diabesidade" com sobrepeso pré-gestacional e DMG, houve significancia para a progressão para DM2 [6.00 (IC 95% 2.42- 14.84)], sobrepeso no futuro [2.37 (IC 95%: 1.56- 3.61)], resistência à insulina [3.14 (IC 95% 1.79- 5.49)] e dislipidemia [5.47 (IC 95% 2.17- 13.76)]. Conclusão: O DMG foi fortemente associado ao maior risco tanto materno quanto para os descendentes, esses achados sustentam a idéia da forte associação entre exposições ambientais durante o início da vida (pré e pós-natal) e o condicionamento das respostas biológicas que definem o risco de doença ao longo da vida da prole e da mãe. Além disso, os processos de adaptação fisiológica decorrentes da exposição à obesidade materna e diabetes “diabesidade” durante a gravidez afetam descendência fetal, resultando em adaptações nos níveis do sistema celular, tecido e órgão. Mudanças epigenéticas ao longo do curso de vida em conjunto com fatores como dieta e estilo de vida pós-natal levam ao desenvolvimento de distúrbios metabólicos na idade adulta jovem que continuam na idade adulta e na velhice.
Background and aims: Women with gestational Diabetes mellitus (GDM) are at increased risk of adverse pregnancy outcomes, as well as, developing type 2DM and other metabolic syndrom in the future compared to women non-GDM, and the co-occurrence of GDM with obesity “diabesity”, is probably the major epidemic in human history. The metabolic changes in utero may influence the physiological and structural patterns that “program” long-term health in adulthood, offspring of these mother have an increased lifetime risk of metabolic disease and obesity. Methods: This descriptive study derives from a prospective cohort of pregnant women that were followed at Perinatal Diabetes Research Center- FMB-UNESP. All women-newborns pairs who performed a screening for GDM during pregnancywere contacted and invited to return for the long-term follow-up study with their children. Results: Our findings show that previous GDM was significant predictor of type 2DM isolated [2.56 (95% C.I. 1.73-3.79)]. When we evaluated GDM plus pregestation overweight “diabesity”, were significantly for progression to type 2DM [6.00 (95% C.I. 2.42- 14.84)], overweight in the future [2.37 (95% C.I. 1.56- 3.61)], insulin-resistance [3.14 (95% C.I. 1.79- 5.49)], and dyslipidemia [5.47 (95% C.I. 2.17- 13.76)]. Conclusion: GDM was strongly associated with greater risk of both maternal and offspring, these findings support the idea of a strong association between environmental exposures during early life (pre and postnatal) and the conditioning of biological responses that define disease risk over the life course of the offspring and mother. Besides, the physiological adaptive processes upon exposure to maternal obesity and diabetes “diabesity” during pregnancy affect fetal offspring resulting in adaptations across the cellular, tissue, and organ system levels. Epigenetic changes throughout the life course in conjunction with postnatal diet and lifestyle factors lead to the development of metabolic disorders in young adulthood which continue into adulthood and old age.
Background and aims: Women with gestational Diabetes mellitus (GDM) are at increased risk of adverse pregnancy outcomes, as well as, developing type 2DM and other metabolic syndrom in the future compared to women non-GDM, and the co-occurrence of GDM with obesity “diabesity”, is probably the major epidemic in human history. The metabolic changes in utero may influence the physiological and structural patterns that “program” long-term health in adulthood, offspring of these mother have an increased lifetime risk of metabolic disease and obesity. Methods: This descriptive study derives from a prospective cohort of pregnant women that were followed at Perinatal Diabetes Research Center- FMB-UNESP. All women-newborns pairs who performed a screening for GDM during pregnancywere contacted and invited to return for the long-term follow-up study with their children. Results: Our findings show that previous GDM was significant predictor of type 2DM isolated [2.56 (95% C.I. 1.73-3.79)]. When we evaluated GDM plus pregestation overweight “diabesity”, were significantly for progression to type 2DM [6.00 (95% C.I. 2.42- 14.84)], overweight in the future [2.37 (95% C.I. 1.56- 3.61)], insulin-resistance [3.14 (95% C.I. 1.79- 5.49)], and dyslipidemia [5.47 (95% C.I. 2.17- 13.76)]. Conclusion: GDM was strongly associated with greater risk of both maternal and offspring, these findings support the idea of a strong association between environmental exposures during early life (pre and postnatal) and the conditioning of biological responses that define disease risk over the life course of the offspring and mother. Besides, the physiological adaptive processes upon exposure to maternal obesity and diabetes “diabesity” during pregnancy affect fetal offspring resulting in adaptations across the cellular, tissue, and organ system levels. Epigenetic changes throughout the life course in conjunction with postnatal diet and lifestyle factors lead to the development of metabolic disorders in young adulthood which continue into adulthood and old age.
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Palavras-chave
obesidade, diabesidade, obesidade infantil, type 2 Diabetes mellitus, diabesity, offspring obesity, obesity, diabetes mellitus tipo 2, diabetes mellitus gestacional