RESUMO
OBJECTIVES: To determine the prevalence of hypothyroidism during pregnancy in a group of pregnant patients attending antenatal care at the National Institute of Perinatology and to meet cases not detected by universal screening. MATERIALS AND METHODS: Was conducted from October 2012 to March 2013, in a group of pregnant patients attending to National Institute of Perinatology, thyroid profile was performed according to the recom- mendations of the American Thyroid Association. Patients were referred to endocrinology consultation and treatment was started in case of abnormal thyroid profile. We used central tendency and non-parametric measures for description of the sample. RESULTS: The prevalence of thyroid disease in pregnancy was 33.9% (n = 37), 12.8% (n = 14) with clinical hypothyroidism and 21.1% (n = 23) subclinical hypothyroidism. The 87.1% (n = 95) of patients reported at least one symptom or risk factor history for thyroid disease, only 12.8% (n = 14), had no history or symptoms related to thyroid disease. There is no relationship between a history or symptoms reported and the presence of thyroid disease. CONCLUSIONS: The prevalence of thyroid clinical and subclinical disease is greater than that reported in the literature. There is not relationship with each risk factor for thyroid disease. Perform universal screening detects almost twice thyroid disease during pregnancy.
Assuntos
Hipotireoidismo/epidemiologia , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Prevalência , Registros , Adulto JovemRESUMO
BACKGROUND: Gestational diabetes is one of the most common diseases during pregnancy. Despite this situation, there is still no consensus on methods for screening and diagnosis of this disease. OBJECTIVE: To assess perinatal outcomes of patients with gestational diabetes diagnosed using three different methods. PATIENTS AND METHODS: Clinical observational, longitudinal, randomized trial at the National Institute of Perinatology Isidro Espinosa de los Reyes. We included all patients admitted to the Institute for a period of three months without pregestational diabetes. Patients were screened for gestational diabetes with an oral load of 50 g of glucose. Patients with a positive screen were randomized by a computer program that randomly chose patients and made a curve according to the criteria of the American Diabetes Association 75 g or 100 g and another group with 75 g according to the criteria of the World Health Organization. Patients with gestational diabetes were followed throughout pregnancy until its reclassification in the puerperium. RESULTS: Screening was performed in 863 patients and 87 were diagnosed with gestational diabetes. Perinatal outcomes were similar in patients with gestational diabetes diagnosed using different methods, but there was a higher frequency of pregnancy-induced hypertension in patients diagnosed with the curves of the American Diabetes Association 75 and 100 g compared with the curve of the World Health Organization. CONCLUSIONS: The American Diabetes Association diagnostic method as the World Health Organization are acceptable forms to diagnose gestational diabetes.
Assuntos
Diabetes Gestacional/diagnóstico , Teste de Tolerância a Glucose/normas , Resultado da Gravidez , Glicemia/análise , Anormalidades Congênitas/epidemiologia , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/terapia , Feminino , Morte Fetal/epidemiologia , Macrossomia Fetal/epidemiologia , Seguimentos , Teste de Tolerância a Glucose/estatística & dados numéricos , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Programas de Rastreamento , México , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Gravidez Múltipla , Estudos Prospectivos , Natimorto/epidemiologia , Estados Unidos , Instituições Filantrópicas de Saúde , Organização Mundial da SaúdeRESUMO
BACKGROUND: Metabolic disturbance commonly occurs during pregnancy and perinatal outcome harms, with increased maternal-fetal morbidity. The prevalence of diabetes during pregnancy in Mexico is 7%. OBJECTIVE: To develop a guideline available to the staff of the first, second and third level of care, that includes recommendations based on the best available evidence. METHODS: Clinical questions were formulated and structured. Standardized sequence was established to search for practice guidelines from the clinical questions raised on diagnosis and treatment of diabetes and pregnancy. The working group selected clinical practice guidelines. We found eleven guidelines which took many of the recommendations. For recommendations not included in the reference guides the search process was conducted in PubMed and Cochrane Library. The results were expressed as levels of evidence and grade of recommendation. CONCLUSIONS: Diabetes mellitus during pregnancy increases perinatal morbidity and mortality. The recommendations in this evidence-based guide will help to make diagnosis and treatment standardized to reduce the consequences of disease.
Assuntos
Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Algoritmos , Feminino , Humanos , Guias de Prática Clínica como Assunto , GravidezRESUMO
UNLABELLED: Diabetes in pregnancy is a major public health problem in Mexico. Nutrition therapy is an important component of treatment. Intensive nutrition intervention has not been implemented for Mexican pregnant women with diabetes. Its effect on different types of diabetes mellitus has not been studied. PURPOSE: The authors assessed the effect of a medical nutrition therapy (MNT) program on perinatal complications in Mexico City. METHODS: Quasi-experimental design with a historical control. Women were assigned to a MNT program (n = 88) and were followed up with every 2 weeks until delivery (2004-2007). The control group (n = 86) was selected from medical charts (2001-2003) and the same inclusion criteria were used. In each group, 55% of women had type 2 diabetes mellitus and 45% had gestational diabetes. The MNT program included a moderate intake of carbohydrate (40%-45% of total energy) and reduction in energy intake, capillary glucose self-monitoring, and education. The control group received usual hospital routine care. Statistical analysis included descriptive statistics, chi-square, and multivariate logistic regression (OR, 95% CI) as indicated. RESULTS: Women in the MNT program had a lower risk of preeclampsia, fewer maternal hospitalization, and neonatal deaths in both types of diabetes. Low birth weight was less frequent only in women with gestational diabetes receiving MNT, while neonatal intensive care unit admissions were lower only in women with type 2 diabetes. CONCLUSIONS: An intensive MNT program, including counseling, education, and capillary glucose self-monitoring, has a positive effect over preeclampsia, maternal hospitalization, and neonatal death in women with diabetes in pregnancy. MNT guidelines should be implemented in Mexican health care facilities treating diabetes in pregnancy.
Assuntos
Diabetes Mellitus Tipo 2/reabilitação , Diabetes Gestacional/dietoterapia , Diabetes Gestacional/reabilitação , Glicemia/análise , Automonitorização da Glicemia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Gestacional/sangue , Diabetes Gestacional/tratamento farmacológico , Jejum , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , México , Terapia Nutricional , Obesidade/reabilitação , Sobrepeso/reabilitação , Período Pós-Prandial , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/reabilitação , Resultado do TratamentoRESUMO
Introducción. La enfermedad de Graves-Basedow es una enfermedad autoinmune con producción de anticuerpos antitiroideos que son inmunoglobulinas del tipo IgG; éstas, durante la gestación pueden atravesar la placenta y producir estimulación anormal de la tiroides fetal ocasionando hipertiroidismo. Presentación del caso clínico. Se presenta el caso de un recién nacido femenino, producto de madre con enfermedad de Graves-Basedow que presentó datos clínicos (peso bajo para la edad gestacional, exoftalmos, taquicardia) y de laboratorio de hipertiroidismo en el periodo neonatal, ameritando tratamiento con metamizol, propanolol y prednisona. Conclusiones. Se analizan las características clínicas del hipertiroidismo transitorio neonatal secundario a paso de anticuerpos antitiroideos durante la gestación