Gestational Diabetes Mellitus (GDM) Risk for Declared Family History of Diabetes, in Combination with BMI Categories

Abstract

Whether categories of family history of diabetes can act as independent risk factors for gestational diabetes mellitus (GDM-1, -2) has not yet been established, and neither has it been established how categories of body mass index (BMI) affect these relationships. A group of 912 women without chronic diseases, recruited in the first trimester, was investigated: 125 (13.7%) women developed GDM-1 (treated with diet); 21 (2.3%) women developed GDM-2 (treated with insulin); and a control group consisted of 766 non-diabetic women. A multiple logistic regression was used to evaluate adjusted odds ratios (AOR (95% confidence intervals)) of GDM-1 and GDM-2 for declared diabetes in the parents or grandparents (separately). These relationships were investigated in the whole cohort and subgroups of pre-pregnancy BMI. (1) Some categories of the family history were independent risk factors of GDM-1 or GDM-2. Compared to ‘absence of diabetes in the family’, women with diabetes in the father had a 3.68-fold increase in GDM-1 risk (AOR-b = 3.68 (2.23–6.07)), and women with diabetes in the mother had a 2.13-fold increase in GDM-1 risk (AOR-b = 2.13 (1.1−4.14)) and a 4.73-fold increase in GDM-2 risk (AOR-b = 4.73 (1.26−17.77)). Women with diabetes in the grandmother had a 2.34-fold increase in GDM-1 risk (AOR-b = 2.34 (1.29−4.24)). (2) The cumulative assessment of diabetes in the parents and/or grandparents was not related to the intensification of the risk of GDM, except for the increased risk of GDM-1 for diabetes in both mother and grandmothers simultaneously (AOR-b = 8.80 (1.16−66.57)), however, this group was very small. (3) The analyses in the subgroups of BMI categories showed that diabetes in the father was also an independent risk factor of GDM in the subgroup of pregnant women with normal BMI. In the subgroups of overweight and/or obesity, the risk of GDM for paternal and maternal diabetes was approximately twice as high as compared to the results of pregnant women with normal BMIs. Additionally, apart from the maternal influence of diabetes, the results suggest a significant influence of diabetes in the father on the risk of GDM, even (interestingly) in lean pregnant women.

Diabetes gestacional: revisão de literatura / Gestational diabetes: literature review

“…Segundo as diretrizes da American Diabetes Associations de 2021, diabetes mellitus gestacional (GDM) é uma doença especifica da gravidez, sendo definida como "diabetes que é diagnóstica pela primeira vez no segundo ou terceiro trimestre da gravidez que claramente não é diabetes evidente". 2,3 A ocorrência de DMG em uma gestação anterior é um dos principais fatores de risco para DMG (Entre 40 e 73% das mulheres experimentaram a recorrência da diabetes gestacional em gestação posteriores). Além disso, dados de estudos epidemiológicos e de cirurgia bariátrica sugerem que a redução do peso corporal previamente a gestação reduz Brazilian Journal of Development, Curitiba, v.7, n.12, p. 111367-111372 dec. 2021 a chance de desenvolver diabetes gestacional.…”

“…Entretanto, ainda são necessários estudos de maior relevância de evidencia para comprovar o real impacto dessa mudança de vida na etiopatogenese da doença. 1,2,5 Existem outros fatores de risco para diabetes na gestação como a obesidade ou sobrepeso, a idade materna superior a 35 anos, o histórico familiar de parentes de primeiro grau com diabetes, glicemia jejum entre 100 a 125mg/dl ou HBA1 entre 5,8 e 6,4 e etnia hispânica ou raça nativa americana, asiática e afro-americana. 1,2.5 O diabetes gestacional foi descrito pela primeira vez na Alemanha em 1824 e, em 1926, Lambie defendeu o teste oral de tolerância a glicose (TOTG) para cálculo do equilíbrio cetogênico-anticetogênico.…”

“…O tratamento não farmacológico inclui mudanças dietéticas e prática de atividade, ao passo que o tratamento farmacológico conta com a insulina como aliada principal. 1,2,3,5 A meta terapêutica nas gestantes é glicemia em jejum até 95mg/dL, glicemia 1 hora pós-prandial até 140mg/dL e a glicemia 2 horas pós-prandial até 120mg/dL. 7 O diagnóstico e o tratamento do diabetes gestacional são importantes para evitar a morbimortalidade materno-fetal.…”

“…7 O diagnóstico e o tratamento do diabetes gestacional são importantes para evitar a morbimortalidade materno-fetal. 1,2,3,5…”

Effects of Early Nursing Monitoring on Pregnancy Outcomes of Pregnant Women with Gestational Diabetes Mellitus under Internet of Things

“…Fetal heart rate (FHR) monitoring is an important way of prenatal examination. Through 20 minutes of FHR monitoring, the trend of FHR can be figured out intuitively from the fetal heart curve, whether the fetus intrauterine hypoxia can be judged, and fetal health status can be assessed, which is usually suitable for the fetus in the perinatal period [ 10 , 11 ]. If the pregnant woman is at high risk with advanced age, or she has pregnancy complications, the FHR monitoring needs to be performed in advance to avoid that fetal hypoxia is not noticed in time [ 12 ].…”