RESUMO
BACKGROUND: There is ample evidence that gestational diabetes mellitus has a direct influence on urinary incontinence and pelvic floor muscles. There are no standardized pelvic floor muscle exercise programs in the literature for the physiotherapy and differ in the type of exercise, intensity, type and duration of application, and the frequency and duration of treatment sessions. The aim of this systematic review will be to investigate that Pelvic Floor Muscle Training can prevent and/or decrease the pregnancy specific urinary incontinence in women with gestational diabetes mellitus or gestational hyperglycemia. METHODS: We will perform a systematic review according to the Cochrane methodology of Randomized Controlled Trials. An overall search strategy will be developed and adapted for Embase, MEDLINE, LILACS, and CENTRAL databases, with the date of consultation until June 2020. The MeSH terms used will be "Pregnancy", "Hyperglycemia", "Diabetes Mellitus, Type 2", "Diabetes Mellitus, Type 1", "Pregnancy in Diabetics", "Diabetes, Gestational", "Urinary Incontinence", "Pelvic Floor Muscle Strength". Primary outcomes: improvement or cure of pregnancy specific urinary incontinence (which can be assessed by questionnaires, and tools such as tampon test, voiding diary, urodynamic study). Secondary outcomes: improvement of pelvic floor muscle strength (pelvic floor functional assessment, perineometer, electromyography, functional ultrasonography), improved quality of life (questionnaires), presence or absence of postpartum Urinary Incontinence and adverse effects. Quality assessment by Cochrane instrument. Metanalysis if plausible, will be performed by the software Review Manager 5.3. DISCUSSION: The present study will be the first to analyze the effectiveness of pelvic floor exercises in pregnant women with Gestational Diabetes Mellitus or Hyperglycemia, who suffer from pregnancy specific urinary incontinence. Randomized Controlled Trials design will be chosen because they present the highest level of evidence. It is expected to obtain robust and conclusive evidence to support clinical practice, in addition to promoting studies on the theme and contributing to new studies. TRIAL REGISTRATION: Systematic review registration: PROSPERO CRD42017065281.
Assuntos
Complicações do Diabetes/prevenção & controle , Diabetes Gestacional/reabilitação , Terapia por Exercício/métodos , Diafragma da Pelve/fisiopatologia , Incontinência Urinária/prevenção & controle , Complicações do Diabetes/etiologia , Complicações do Diabetes/fisiopatologia , Complicações do Diabetes/reabilitação , Feminino , Humanos , Gravidez , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/reabilitaçãoAssuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Endocrinologia , Metabolismo , Diabetes Gestacional , Diabetes Gestacional/classificação , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/prevenção & controle , Diabetes Gestacional/reabilitação , Diabetes Gestacional/terapia , UruguaiRESUMO
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
La gestación ha sido considerada ®diabetogénica¼ debido a los cambios metabólicos que conducen a una marcada resistencia a la insulina. Esta alteración se asocia con un aumento de la morbilidad perinatal, en parte por la macrosomía que produce, y que si no es tratada también puede aumentar un poco la mortalidad perinatal. Se estima que el 47 por ciento de las mujeres que padecen diabetes mellitus gestacional, desarrolla una diabetes mellitus no insulino dependiente después de cinco años. Se recomienda el tamizaje para la diabetes gestacional en todas las pacientes embarazadas. La prueba de tamizaje se realiza con una carga de 50g de glucosa oral entre semanas 24 y 28 de la gestación. Las pacientes con resultados positivos en esta prueba usualmente deben ser sometidas a una prueba de tolerancia a la glucosa de 3 horas para definir el diagnóstico. Se describe la fisiopatología de este trastorno y se analizan los principales factores de riesgo asociados. Por último, se dan las recomendadas en la conferencia internacional de trabajo en diabetes gestacional para el tamizaje y diagnóstico.