Gestational diabetes and pre-eclampsia: common antecedents?

Abstract

Objetivo: Avaliar a concordância do padrão de fatores de risco de mulheres que desenvolvem diabetes gestacional e pré-eclâmpsia. Métodos: Estudo de coorte prospectivo em clínicas de atendimento pré-natal do Sistema Único de Saúde de seis capitais do Brasil, 4.766 mulheres grávidas de 20 a 48 anos de idade foram arroladas de maneira consecutiva entre a 20º e 28º semanas de gestação. O hábito de fumar e os fatores de risco tradicionais para pré-eclâmp-sia e diabetes gestacional foram obtidos por entrevista no arrolamento. diabetes gestacional foi diagnosticada usando um teste oral de tolerância a glicose com 75 g e pré-eclâmpsia por meio de revisão de prontuário. Resultados: diabetes gestacional e pré-eclâmpsia são associadas com idade (rc 2,07; 95% Ic 1,65-2,23 e rc 1,55; 95% Ic 1,08-2,23, respectivamente), índice de massa corporal pré-gestacional (rc 1,62; 95% Ic 1,40-3,53 e rc 1,83; 95% Ic 1,52-4,80, respectivamente) e ganho de peso precocemente durante a gestação (rc 1,28; 95% Ic 1,12-1,47 e rc 1,27; 95% Ic 1,06-1,52, respectivamente).

Trisomy 18: Experience of a reference hospital from the south of Brazil

“…Abnormalities of pregnancy appear to be common among patients with trisomy 18, which can lead to complications for both the fetus and the mother. In our study we found that preeclampsia was found in 17% of pregnancies of the patients, a rate higher than that observed in Brazil, which ranges around 2-3% (2-10% worldwide) [WHO, 1988;Gaio et al, 2001;Wendland et al, 2008]. What caught our attention is the fact that the other study with Brazilian patients with trisomy 18, by Sugayama et al [1999], described an index of unspecified hypertension in pregnancy of 25%.…”

Distinct DNA Methylomes of Human Placentas Between Pre-Eclampsia and Gestational Diabetes Mellitus

“…Consistent with previous reports, although PE and GDM have distinctive clinical and pathophysiologic characteristics, they share some important similarities: both conditions develop during pregnancy, and the clinical syndromes disappear after delivery. Many risk factors such as obesity, elevated blood pressure, dyslipidemia, insulin resistance, and hyperglycemia are associated with both PE and GDM; and patients with a history of PE or GDM have increased risk of developing cardiovascular disease compared to women without such a history [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]. …”

“…The pathophysiologies of both illnesses have been shown to be associated with each other [3,4,5,6]. It appears that gestational diabetes and pre-eclampsia have several mechanisms in common: altered carbohydrate metabolism causes vascular changes such as arteriosclerosis and a glomerular filtration dysfunction, which results in a predisposition to pre-eclampsia.…”

“…Other authors cite dysfunctions such as increased insulin resistance as the cause of both illnesses [3,4,8,9]. Several authors therefore have reached the conclusion that the state of research is inadequate and ambiguous [4,8,9,10] for the difficulty of providing support for these explanations in the form of epidemiological data.…”

Abuse in Childhood or Adolescence and Gestational Diabetes

“…The potential mediating role of weight trajectories was examined in a supplemental analysis examining weight change from age 18 years to prepregnancy. Finally, the authors ran a supplemental analysis of mediation by prepregnancy smoking, which is common after abuse 29 and may be associated with GDM 30,31 ; prepregnancy smoking was defined as current smoking reported on the biennial questionnaire prior to the pregnancy.…”