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OBJECTIVE: To discuss the correlation between serum progesterone, glycosylated Hemoglobin (HbA1c), and insulin levels in pregnant women with Gestational Diabetes Mellitus (GDM) and the risk of Premature Rupture of Membranes (PROM). METHODS: A retrospective analysis was conducted on 52 patients diagnosed with GDM who also presented with PROM (Observation group) and compared with 89 patients diagnosed with GDM but not complicated with PROM (Control group). Progesterone, insulin, and HbA1c were detected. Risk factors for PROM in GDM patients were analyzed. RESULTS: The observation group had higher HbA1c and fasting blood glucose levels. Poor blood glucose control and GWG are risk factors for PROM in GDM patients. PROM increases adverse pregnancy outcomes in GDM. HbA1c, insulin, and HOMA-IR can predict the risk of PROM in GDM. CONCLUSIONS: The effective prediction of preterm PROM can be achieved through the monitoring of serum HbA1c, insulin levels, and insulin resistance in patients with GDM.
Assuntos
Glicemia , Diabetes Gestacional , Ruptura Prematura de Membranas Fetais , Hemoglobinas Glicadas , Insulina , Progesterona , Humanos , Feminino , Gravidez , Diabetes Gestacional/sangue , Ruptura Prematura de Membranas Fetais/sangue , Estudos Retrospectivos , Hemoglobinas Glicadas/análise , Adulto , Progesterona/sangue , Insulina/sangue , Fatores de Risco , Glicemia/análise , Resistência à Insulina/fisiologia , Estudos de Casos e Controles , Adulto JovemRESUMO
Abstract Objective: To discuss the correlation between serum progesterone, glycosylated Hemoglobin (HbA1c), and insulin levels in pregnant women with Gestational Diabetes Mellitus (GDM) and the risk of Premature Rupture of Membranes (PROM). Methods: A retrospective analysis was conducted on 52 patients diagnosed with GDM who also presented with PROM (Observation group) and compared with 89 patients diagnosed with GDM but not complicated with PROM (Control group). Progesterone, insulin, and HbA1c were detected. Risk factors for PROM in GDM patients were analyzed. Results: The observation group had higher HbA1c and fasting blood glucose levels. Poor blood glucose control and GWG are risk factors for PROM in GDM patients. PROM increases adverse pregnancy outcomes in GDM. HbA1c, insulin, and HOMA-IR can predict the risk of PROM in GDM. Conclusions: The effective prediction of preterm PROM can be achieved through the monitoring of serum HbA1c, insulin levels, and insulin resistance in patients with GDM.
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BACKGROUND: Early prediction of Gestational Diabetes Mellitus (GDM) risk is of particular importance as it may enable more efficacious interventions and reduce cumulative injury to mother and fetus. The aim of this study is to develop machine learning (ML) models, for the early prediction of GDM using widely available variables, facilitating early intervention, and making possible to apply the prediction models in places where there is no access to more complex examinations. METHODS: The dataset used in this study includes registries from 1,611 pregnancies. Twelve different ML models and their hyperparameters were optimized to achieve early and high prediction performance of GDM. A data augmentation method was used in training to improve prediction results. Three methods were used to select the most relevant variables for GDM prediction. After training, the models ranked with the highest Area under the Receiver Operating Characteristic Curve (AUCROC), were assessed on the validation set. Models with the best results were assessed in the test set as a measure of generalization performance. RESULTS: Our method allows identifying many possible models for various levels of sensitivity and specificity. Four models achieved a high sensitivity of 0.82, a specificity in the range 0.72-0.74, accuracy between 0.73-0.75, and AUCROC of 0.81. These models required between 7 and 12 input variables. Another possible choice could be a model with sensitivity of 0.89 that requires just 5 variables reaching an accuracy of 0.65, a specificity of 0.62, and AUCROC of 0.82. CONCLUSIONS: The principal findings of our study are: Early prediction of GDM within early stages of pregnancy using regular examinations/exams; the development and optimization of twelve different ML models and their hyperparameters to achieve the highest prediction performance; a novel data augmentation method is proposed to allow reaching excellent GDM prediction results with various models.
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Diabetes Gestacional , Gravidez , Feminino , Humanos , Diabetes Gestacional/diagnóstico , Estudos Prospectivos , Sensibilidade e Especificidade , Curva ROC , Aprendizado de MáquinaRESUMO
Gestational diabetes mellitus (GDM) is recognized as a "window of opportunity" for the future prediction of such complications as type 2 diabetes mellitus and pelvic floor muscle disorders, including urinary incontinence and genitourinary dysfunction. Translational studies have reported that pelvic floor muscle disorders are due to a GDM-induced-myopathy (GDiM) of the pelvic floor muscle and rectus abdominis muscle (RAM). We now describe the transcriptome profiling of the RAM obtained by Cesarean section from GDM and non-GDM women with and without pregnancy-specific urinary incontinence (PSUI). We identified 650 genes in total, and the differentially expressed genes were defined by comparing three control groups to the GDM with PSUI group (GDiM). Enrichment analysis showed that GDM with PSUI was associated with decreased gene expression related to muscle structure and muscle protein synthesis, the reduced ability of muscle fibers to ameliorate muscle damage, and the altered the maintenance and generation of energy through glycogenesis. Potential genetic muscle biomarkers were validated by RT-PCR, and their relationship to the pathophysiology of the disease was verified. These findings help elucidate the molecular mechanisms of GDiM and will promote the development of innovative interventions to prevent and treat complications such as post-GDM urinary incontinence.
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Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Doenças Musculares , Incontinência Urinária , Gravidez , Humanos , Feminino , Diabetes Gestacional/metabolismo , Reto do Abdome/metabolismo , Cesárea/efeitos adversos , Diabetes Mellitus Tipo 2/complicações , Transcriptoma , Incontinência Urinária/genética , Biomarcadores , Perfilação da Expressão GênicaRESUMO
In order to evaluate and compare the specific immune response of pregnant women (PW) chronically infected with Toxoplasma gondii, with and without gestational diabetes mellitus (GDM), and the humoral response of their respective newborns (NB), the study was carried out on 81 PW (34 GDM and 47 controls) from whose medical records the results of the oral glucose tolerance test (OGTT) were obtained, and blood samples were collected at the third trimester of pregnancy; also, on 45 NBs (20 GDM and 25 controls) from whom umbilical cord blood samples were obtained. Humoral immunity was analyzed by measuring anti-T. gondii total IgG, IgG subclasses and IgG avidity. To evaluate cellular immunity, peripheral blood mononuclear cells (PBMC) from 32 PW (16 GDM and 16 controls) were cultured, supernatant cytokines were determined, and flow cytometry was performed to analyze the expression at lymphocytes of surface molecules, cytokines and transcription factors. All PW and NBs were positive for total IgG, and the prevalent subclass was IgG1. There was a negative correlation between the OGTT glycemia of PW and the levels of total IgG, IgG1 and IgG avidity. The IgG avidity of the GDM group was significantly lower than the control group. Patients from the GDM group had a higher number of T lymphocytes expressing markers of cell activation and exhaustion (CD28 and PD-1). In the presence of T. gondii soluble antigen (STAg) the amount of CD4+ T cells producing IFN-γ, IL-10 and IL-17 was significantly lower in the GDM group, while there was no difference between groups in the number of CD4+ CD25HighFOXP3+LAP+ functional Treg cells. Additionally, under STAg stimulus, the secretion of IL-17, IL-4, TNF and IL-2 cytokines at PBMCs culture supernatant was lower in the GDM group. In conclusion, there was a correlation between the increase in blood glucose and the decrease in levels of anti-T. gondii antibodies, associated with the decreased IgG avidity in patients who develop GDM. Also, the GDM group had decreased immune responses in Th1, Th2 and Th17 profiles, suggesting an association between GDM and the negative modulation of the humoral and cellular immune responses against T. gondii.
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Diabetes Gestacional , Toxoplasma , Anticorpos Antiprotozoários , Glicemia , Antígenos CD28 , Citocinas/metabolismo , Feminino , Humanos , Imunidade Celular , Imunoglobulina G , Recém-Nascido , Interleucina-10 , Interleucina-17 , Interleucina-2 , Interleucina-4 , Leucócitos Mononucleares/metabolismo , Gravidez , Receptor de Morte Celular Programada 1 , Fatores de TranscriçãoRESUMO
Gestational diabetes mellitus (GDM), is one of the most important pregnancy complications affecting approximately 15% of pregnant women. It is related to several gestational adverse outcomes in the fetus, e.g., macrosomia, shoulder dystocia, stillbirth, neonatal hypoglycemia, and respiratory distress. Women with GDM have a high risk of developing type 2 diabetes in the future. The pathogenesis of GDM is not completely understood; nevertheless, two factors could contribute to its development: ß-cell dysfunction and failure in insulin secretion in response to insulin resistance induced by gestation. Both processes, together with the physiological activities of the insulin-like growth factors (IGFs), play a crucial role in glucose transport to the fetus and hence, fetal growth and development. IGFs (both IGF-1 and IGF-2) and their binding proteins (IGFBPs) regulate glucose metabolism and insulin sensitivity. Maternal nutritional status determines the health of the newborn, as it has substantial effects on fetal growth and development. Maternal obesity and an energy-dense diet can cause an increase in insulin and IGF-1 serum levels, producing metabolic disorders, such as insulin resistance, GDM, and high birth weight (> 4,000 g) due to a higher level of body fat. In this way, in GDM pregnancies there is an increase in IGF-1 and IGF-2 serum levels, and a decrease in IGFBP-1 and 4 serum levels, suggesting the crucial role of the insulin/IGF system in this gestational outcome. Here, the present review tries to elucidate the role that energy-dense diets and the insulin/IGF-1 signaling pathway perform in GDM pregnancies.
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Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Resistência à Insulina , Dieta , Feminino , Humanos , Recém-Nascido , Insulina , Fator de Crescimento Insulin-Like I/metabolismo , Fator de Crescimento Insulin-Like II , GravidezRESUMO
AIM: To estimate the annual burden of gestational diabetes mellitus (GDM) in Mexico. METHODS: A model was built to conduct estimates from a healthcare system perspective, namely, the incremental costs of GDM pregnancy compared with non-GDM pregnancy from the first trimester until childbirth. The model used probabilities from the literature and surveys, and costs obtained from the Ministry of Health and national healthcare institutions. Scenario analyses were performed to estimate the GDM burden at different levels of incidence. RESULTS: Although a non-GDM pregnancy cost on average USD 1880.6 (low risk was USD 1043.9 and high risk was USD 1673.5), a pregnancy with GDM cost USD 2934.9. Therefore, the total additional cost was USD 1576.2 per case. Given the considerable variability of the GDM incidence in Mexico, the total burden could range from USD 86.8 to USD 827.4 million per year. CONCLUSIONS: GDM is one of the most frequent complications of pregnancy, but research has been insufficient regarding its epidemiological and economic burden in Latin America. This paper shows that the GDM economic burden in Mexico is substantial despite only accounting for short-term medical costs. Further research to assess the GDM incidence and evaluate its long-term consequences from a broader societal perspective in Mexico is recommended.
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Efeitos Psicossociais da Doença , Diabetes Gestacional/economia , Diabetes Gestacional/epidemiologia , Adulto , Feminino , Humanos , México , GravidezRESUMO
Introducción: se conoce que en los últimos años, el manejo obstétrico ha enfatizado el control estricto de la glicemia en la madre y que ha mejorado la sobrevida fetal, la cual es directamente proporcional a la glicemia media materna. Objetivo: caracterizar los principales resultados en la experiencia hospitalaria sobre la vigilancia obstétrica y metabólica en la atención de gestantes diabéticas en el Hospital General Ciro Redondo García, Centro de Referencia Territorial en Artemisa. Métodos: se realizó un estudio observacional analítico, prospectivo y de corte longitudinal en el Hospital General Docente Ciro Redondo García de Artemisa desde junio de 2005 hasta junio de 2012. De un universo de 2 140 gestantes ingresadas, 240 fueron diagnosticadas diabéticas, constituyendo la muestra de estudio, Resultados: como diabéticas gestacionales (DG) se clasificó el 77,5 porciento, mientras que las diabéticas pregestacionales (DPG) constituyeron el 22,5 porciento. Los grupos de edades de 31 a 36 años y de 20 a 25 años fueron los de mayor predominio en la diabetes gestacional pregestacional para un 29,1 porciento y un 33,3 porciento respectivamente. Los factores de riesgo de mayor predominio en el estudio fueron: la obesidad (44,2 porciento), la edad mayor de 34 años, polihidramnios, macrosomía previa y los abortos espontáneos (38,7; 18; 8,1; y 6,6 porciento respectivamente). Otros factores de riesgo fueron los antecedentes familiares de diabetes mellitus de las gestantes, el diagnóstico de la diabetes gestacional después de las 20 semanas, la cesárea como el tipo de parto de mayor predominio y la edad gestacional a término al parto. Conclusiones: en un valorado sistema de salud pública como el cubano, se debe tomar medidas pertinentes para monitorear y controlar la morbilidad y complicaciones de las gestantes diabéticas(AU)
Background: it is known that, in recent years, obstetric management has made emphasis on the strict control of glycemia in the mother and the fetal survival has been improved, which is directly proportional to the mean maternal glycemia. Objective: to characterize the principal results in the hospital experience on obstetric and metabolic surveillance in the management of pregnant diabetic women in Ciro Redondo García General Hospital, Regional Reference Center in Artemisa. Methods: an observational analytical prospective cross-longitudinal study was conducted in Ciro Redondo García General Hospital in Artemisa from June 2005 to June 2012. From a universe of 2 140 pregnant women admitted in the hospital, 240 were diagnosed diabetics, representing them, the sample of the study. Results: the 77.5 percent of them were classified as gestational diabetic women (GD) whereas pregestational diabetic women (PGD) represented the 22.5 percent. The 31-36 and 20-25 age groups were the most predominant in gestational and pregestational diabetes, for a 29.1 percent and a 33.3 percent, respectively. The most predominant risk factors in the study were: obesity (44.2 percent), age over 34 years, polyhydramnios, previous macrosomia, and spontaneous abortion (38.7, 18, 8.1, 6.6 percent, respectively). Other risk factors were: family antecedents of diabetes mellitus in pregnant women, the time of diagnosis of gestational diabetes after the 20 weeks, the caesarean section as the most predominant type of delivery, and gestational age at delivery at term. Conclusions: in a valued Public Health System such as the Cuban one, appropriate measures should be taken to monitor and control morbidity and complications in pregnant diabetic women(AU)
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Humanos , Feminino , Gravidez , Diabetes Gestacional/epidemiologia , Gravidez em Diabéticas/epidemiologia , Estudos Prospectivos , Estudos Longitudinais/métodos , Estudos Observacionais como Assunto , CubaRESUMO
Introducción: se conoce que en los últimos años, el manejo obstétrico ha enfatizado el control estricto de la glicemia en la madre y que ha mejorado la sobrevida fetal, la cual es directamente proporcional a la glicemia media materna. Objetivo: caracterizar los principales resultados en la experiencia hospitalaria sobre la vigilancia obstétrica y metabólica en la atención de gestantes diabéticas en el Hospital General Ciro Redondo García, Centro de Referencia Territorial en Artemisa. Métodos: se realizó un estudio observacional analítico, prospectivo y de corte longitudinal en el Hospital General Docente Ciro Redondo García de Artemisa desde junio de 2005 hasta junio de 2012. De un universo de 2 140 gestantes ingresadas, 240 fueron diagnosticadas diabéticas, constituyendo la muestra de estudio, Resultados: como diabéticas gestacionales (DG) se clasificó el 77,5 por ciento mientras que las diabéticas pregestacionales (DPG) constituyeron el 22,5 por ciento .Los grupos de edades de 31 a 36 años y de 20 a 25 años fueron los de mayor predominio en la diabetes gestacional pregestacional para un 29,1 por ciento y un 33,3 por ciento respectivamente. Los factores de riesgo de mayor predominio en el estudio fueron: la obesidad (44,2 por ciento ), la edad mayor de 34 años, polihidramnios, macrosomía previa y los abortos espontáneos (38,7; 18; 8,1; y 6,6 por ciento respectivamente). Otros factores de riesgo fueron los antecedentes familiares de diabetes mellitus de las gestantes, el diagnóstico de la diabetes gestacional después de las 20 semanas, la cesárea como el tipo de parto de mayor predominio y la edad gestacional a término al parto. Conclusiones: en un valorado sistema de salud pública como el cubano, se debe tomar medidas pertinentes para monitorear y controlar la morbilidad y complicaciones de las gestantes diabéticas
Background: it is known that, in recent years, obstetric management has made emphasis on the strict control of glycemia in the mother and the fetal survival has been improved, which is directly proportional to the mean maternal glycemia. Objective: to characterize the principal results in the hospital experience on obstetric and metabolic surveillance in the management of pregnant diabetic women in Ciro Redondo García General Hospital, Regional Reference Center in Artemisa. Methods: an observational analytical prospective cross-longitudinal study was conducted in Ciro Redondo García General Hospital in Artemisa from June 2005 to June 2012. From a universe of 2 140 pregnant women admitted in the hospital, 240 were diagnosed diabetics, representing them, the sample of the study. Results: the 77.5 percent of them were classified as gestational diabetic women (GD) whereas pregestational diabetic women (PGD) represented the 22.5 percent .The 31-36 and 20-25 age groups were the most predominant in gestational and pregestational diabetes, for a 29.1 percent and a 33.3 percent, respectively. The most predominant risk factors in the study were: obesity (44.2 percent ), age over 34 years, polyhydramnios, previous macrosomia, and spontaneous abortion (38.7, 18, 8.1, 6.6 percent respectively). Other risk factors were: family antecedents of diabetes mellitus in pregnant women, the time of diagnosis of gestational diabetes after the 20 weeks, the caesarean section as the most predominant type of delivery, and gestational age at delivery at term. Conclusions: in a valued Public Health System such as the Cuban one, appropriate measures should be taken to monitor and control morbidity and complications in pregnant diabetic women