INTRODUCTION: Although obesity is well recognized as a current public health problem, its prevalence and impact among pregnant women have been less investigated in Brazil. The objective of the study was to evaluate the impact of pre-obesity and obesity among pregnant women, describing its prevalence and risk factors, and their association with adverse pregnancy outcomes. METHODS: A cohort of 5,564 pregnant women, aged 20 years or more, enrolled at aproximately 20 to 28 weeks of pregnancy, seen in prenatal public clinics of six state capitals in Brazil were followed up, between 1991 and 1995. Prepregnancy weight, age, educational level and parity were obtained from a standard questionnaire. Height was measured in duplicate and the interviewer assigned the skin color. Nutritional status was defined using body mass index (BMI), according to World Health Organization (WHO) criteria. Odds ratios and 95% confidence interval were calculated using logistic regression. RESULTS: Age-adjusted prevalences (and 95% CI) based on prepregnancy weight were: underweight 5.7% (5.1%-6.3%), overweight 19.2% (18.1%-20.3%), and obesity 5.5% (4.9%-6.2%). Obesity was more frequently observed in older black women, with a lower educational level and multiparous. Obese women had higher frequencies of gestational diabetes, macrosomia, hypertensive disorders, and lower risk of microsomia. CONCLUSIONS: Overweight nutritional status (obesity and pre-obesity) was seen in 25% of adult pregnant women and it was associated with increased risk for several adverse pregnancy outcomes, such as gestational diabetes and pre-eclampsia.

RESUMOO diabetes mellitus do tipo 2 (DM2) resulta de defeitos na secreção e ação da insulina. Ele está freqüentemente associado à resistência à insulina, obesidade andróide, dislipidemia e hipertensão arterial, constituindo a síndrome metabólica. O tratamento atual visa diminuir a resistência à insulina e melhorar a função da célula beta pancreática com dieta, exercícios, hipoglicemiantes orais, anti-hiperglicemiantes e/ou drogas anti-obesidade. Novas drogas no tratamento do DM estão surgindo, tornando possíveis múltiplas opções terapêuticas. Este artigo apresenta uma revisão sobre o assunto. ABSTRACTType 2 diabetes mellitus results from defects in both insulin action and insulin secretion. It is frequently associated with hyperinsulinemia, central obesity, dyslipidemia and arterial hypertension, components of the so-called metabolic syndrome. The main targets of the treatment are to decrease insulin resistance and improve beta cell function with diet, exercise, oral hypoglycemic and anti-hyperglycemic agents and/or anti-obesity drugs. New drugs for the treatment of diabetes mellitus make possible multiples therapeutics options. This article reviews this subject. O DIABETES MELLITUS DO TIPO 2 (DM2) ou não insulino-dependente e a intolerância à glicose têm se tornado um dos distúrbios mais comuns em clínica médica e estão freqüentemente associados à síndrome metabólica, que se caracteriza por resistência à insulina, obesidade andróide ou central, dislipidemia e hipertensão arterial (1,2). A síndrome metabólica é responsável pela maior morbi-mortalidade por doenças cardiovasculares tanto em obesos quanto em diabéticos tipo 2.O tratamento atual do DM2 visa manter o controle glicêmico adequado, seja com dieta hipocalórica, aumento da prática de exercícios físi-cos ou uso de medicações. Existem no momento diversas opções terapêu-ticas, que podem ser utilizadas isoladamente ou em associações: sensibilizadores da ação de insulina (metformina, tiazolidinedionas), anti-hiperglicemiantes (acarbosc), secretagogos (sulfoniluréias, repaglinida, nateglinida), drogas anti-obesidade e/ou insulina. O Diabetes Control and Complications Trial (DCCT) (3), um estudo prospectivo multicêntrico sobre as diversas formas de tratamento com insulina no DM1 e, mais recentemente,

A cross-sectional study was performed involving epidemiological and clinical features of the metabolic syndrome (MS) in Spanish migrants to Brazil and their descendants. This included 479 subjects: Group A (Spanish migrants): n=215; Group B (descendants born in Brazil of Spanish parents): n=126, Group C (mixed descendants born in Brazil with either father or mother born in Spain): n=138. MS was defined according to the original NCEP/ATP III criteria and by the revised NCEP/ATP definition (glucose>or=100mg/dl). Overall prevalence of MS according to NCEP/ATP III criteria was 26.3%. Age/sex-adjusted prevalence was 27.4%. When the revised NCEP criteria were considered, overall prevalence was 30.1% (age/sex-adjusted 31.3%). The differences between the two criteria were 3.8% and 3.9% (CI -1.9-9.4%). When stratified by groups the MS was more prevalent in Group A (37.2%) and Group B (20.6%) than in Group C (10.9%). Environmental factors may have influenced the development of MS. Reason for the apparently protective role of genetic features due to admixture between populations in the mixed descendants needs to be explored.