Diabetes gestacional: perfil e evolução de um grupo de pacientes do Hospital das Clínicas da UFMG

Objetivos: a finalidade deste trabalho foi avaliar a presenca de fatores de risco, tipo e resposta ao tratamento, incidencia de complicacoes maternas, fetais e perinatais, alem de persistencia do diabetes pos-parto. Metodos: foram acompanhadas 66 portadoras de diabetes mellitus gestacional (DMG) no periodo de janeiro de 2007 a dezembro de 2008. Para isso, utilizou-se protocolo preestabelecido. Resultados: a historia familiar de diabetes foi positiva em 65% dos casos. Destaca-se o fato de que apenas 30% das pacientes apresentaram indice de massa corporal (IMC) pre-concepcional normal (entre 18 e 25). Em contrapartida, 35% apresentaram sobrepeso (IMC entre 25 e 29,9) e outros 35% encontraram-se distribuidas entre diversos graus de obesidade. Quanto ao IMC ao termino da gestacao, 35% das gestantes encontravam-se em obesidade grau I (entre 30 e 34,9) e 13% em obesidade grau III (IMC acima de 40). Os sintomas sugestivos de diabetes ocorreram em 45,5% das pacientes. O diagnostico de DMG foi estabelecido por glicemias de jejum alteradas em 45% do grupo e a insulinoterapia foi necessaria em 53%. As complicacoes maternas ocorreram em 42% das gestantes, principalmente pre- -eclâmpsia e infeccao do trato urinario. As complicacoes fetais ocorreram em 46% dos casos, principalmente macrossomia e polidrâmnio. A morbidade perinatal foi elevada e acometeu 62% dos recem-nascidos, sendo hipoglicemia neonatal a complicacao mais frequente. A taxa de diabetes pos-parto foi de 18%. Destaca-se tambem alta porcentagem de pacientes (37%) que nao retornaram ao servico de endocrinologia apos o parto para confirmacao da persistencia ou nao do DM. Cesariana e parto vaginal tiveram praticamente a mesma prevalencia, com 51,5 e 48,5%, respectivamente. Ocorreram quatro mortes subitas intrautero, o que corresponde a 6% das pacientes analisadas. Conclusao: nossos achados estao em concordância com a literatura, tendo em vista a alta morbidade perinatal, fetal e materna observada e caracteristica...(AU) Objectives: This study aims at evaluating the presence of risk factors, type and response to treatment, incidence of maternal complications, fetal and perinatal, and persistence of postpartum diabetes. Methods: A total of 66 women with gestational diabetes mellitus (GDM) between January 2007 and December 2008 were studied. A pre-established protocol was followed. Results: a family history of diabetes was positive in 65% of the cases. Only 30% of patients had pre-conception normal (between 18 and 25) body mass index (BMI). On the other hand, 35% were overweight (BMI between 25 and 29.9) and 35% presented several degrees of obesity. According to the BMI at the end of pregnancy, 35% of the women were in obesity class I (between 30 and 34.9) and 13% in class III obesity (BMI above 40). Suggestive symptoms of diabetes were found in 45.5% of the patients. Diagnosis of GDM was established by impaired fasting blood glucose in 45% of the group. Insulin therapy was applied in 53% of the cases. Maternal complications were found in 42% of pregnant women, particularly preeclampsia and urinary tract infection. Fetal complications were found in 46% of the cases, especially macrosomia and polyhydramnios. The rate of perinatal morbidity was high and affected 62% of newborns, and neonatal hypoglycemia was the most frequent complication. Postpartum diabetes rate was 18%. Also, a high percentage of patients (37%) have not returned to the endocrinology service after delivery to confirm or not the persistence of DM. Cesarean and vaginal showed a very similar prevalence, with 51.5 and 48.5% respectively. Four intrauterine sudden deaths were registered, which represents 6% of patients analyzed. Conclusion: The findings of this study are in accordance to the literature, once high perinatal, fetal and maternal morbidity, are observed and characteristic of DMG.(AU)