Care cost for pregnant and parturient women with diabetes and mild hyperglycemia

Abstract

OBJECTIVE:To compare inpatient and outpatient care costs for pregnant/ parturient women with diabetes and mild hyperglycemia. METHODS:A prospective observational quantitative study was conducted in the Perinatal Diabetes Center in the city of Botucatu, Southeastern Brazil, between 2007 and2008. Direct and indirect costs and disease-specifi c costs (medications and tests) were estimated. Thirty diet-treated pregnant women with diabetes were followed up on an outpatient basis, and 20 who required insulin therapy were hospitalized. RESULTS:The cost of diabetes disease (prenatal and delivery care) was US$ 3,311.84 for inpatients and US$ 1,366.04 for outpatients. CONCLUSIONS:Direct and indirect costs as well as total prenatal care cost were higher for diabetic inpatients while delivery care costs and deliverypostpartum hospitalization were similar. Prenatal and delivery-postpartum care costs were higher for these patients compared to those paid by Brazilian National Health System. Pregnancies complicated by diabetes are associated with an increased risk of maternal and neonatal complications. The most serious maternal complication is the risk of developing type 2 diabetes within 10-12 years after birth. 21 Perinatal complications include macrosomia and increased risk of birth trauma and intrapartum hypoxia/ asphyxia, high C-section rates, delayed pulmonary maturation and consequent risk of respiratory distress syndrome, and metabolic disorders at birth including hypoglycemia, hypocalcemia and hypomagnesemia. 19All these conditions worsen neonatal prognosis and increase perinatal mortality. In addition, Rudge et al 17 demonstrated that pregnant women with mild hyperglycemia (normal 100-g glucose tolerance test [GTT] and abnormal blood glucose profi le) have perinatal outcomes comparable to those of diabetic women and should be treated following the same protocol.Perinatal outcomes with either diabetes or mild hyperglycemia are directly associated to maternal metabolic control. Maternal hyperglycemia should be carefully controlled with either diet alone or diet plus insulin therapy so that effective blood glucose normalization can be achieved and adverse perinatal outcomes prevented. Newborns of pregnant women with inadequate blood glucose control (mean blood glucose >130 mg/dL in the third trimester) are reported to show macrosomia in 52.4%, fetal death in 14.3%, and malformations in 8.2%. Over the past decades, improved maternal and perinatal outcomes of diabetic RESUMO OBJETIVO: Comparar custos de hospitalização e de atenção ambulatorial em gestantes/parturientes diabéticas e com hiperglicemia leve. MÉTODOS:Estudo observacional, prospectivo, quantitativo descritivo realizado em centro de diabete perinatal em Botucatu, SP, entre 2007 e 2008. Foram estimados os custos por absorção diretos e indiretos disponíveis na instituição e os custos específi cos para a doença (medicamentos e exames). As 30 gestantes diabéticas tratadas com dieta foram acompanhadas em ambulatório e 20 tratadas com dieta mais insulina ...

Prenatal care satisfaction: perception of caregivers with diabetes mellitus

“…A study carried out by Nachum et al (24) also showed that the outpatient treatment allows the patient to perform home glycemic control in order to avoid distancing between the pregnant woman and her family, in addition to reducing trauma psychological, mental and social consequences of hospitalization. Moreover, authors such as Cavassini et al (25) have demonstrated that outpatient care is more economically advantageous than hospitalization during prenatal care.…”

Implicações das restrições alimentares na vida diária de mulheres com diabete melito gestacional

“…No que tange ao manejo do DMG, destaca-se que 60% das gestantes podem se manter euglicêmicas somente com a realização de dieta e atividade física, sem acarretar maiores riscos para a gravidez 5 e, a hiperglicemia materna deveria ser cuidadosamente controlada apenas com a dieta 12 . Nessa perspectiva, um estudo que utilizou a intervenção educativa como implementação de autocuidado e aderência terapêutica concluiu que após o desenvolvimento da intervenção com um grupo de diabéticos, este obteve resultados melhores quanto à adesão ao tratamento, conhecimento da doença, estratégias para conservar o seu bem-estar e responsabilidade com a sua saúde, gerando uma nova noção nutricional quando comparado a um grupo controle (não recebeu intervenção) 13 .…”

“…Esta deve planejar, negociar e acomodar as preferências alimentares da mulher de forma a facilitar a adaptação e seguimento à dieta que foi proposta pelo profissional que acompanha a parte nutricional da sua gestação de alto risco [22][23][24] No que concerne à reeducação alimentar, salienta-se que, para muitos indivíduos, o ato de comer representa um dos maiores gozos da vida, uma forma de equilibrar algo ou até mesmo uma maneira de desprezar um problema ou decepção 10,12,14,15,[20][21][22][23][24] . Unido ao exposto, a privação de comer alguns alimentos, às vezes, pode causar sentimentos de descontentamento nas grávidas 24 .…”

The Role of Gestational Diabetes Mellitus and Pelvic Floor 3D-ultrasound assessment during pregnancy predicting Urinary Incontinence: Preliminary results from a prospective cohort study

“…(7) Reports con rm that GDM and UI are two clinical entities with substantial social and economic burdens associated with signi cant direct and indirect public health costs. (18,19) Despite these observations, the link between GDM and long-term UI remains mostly unexplored. Thus, developing 3DUS markers of hyperglycemic myopathy during pregnancy as predictors of long-term UI is necessary to further intervention propositions.…”