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Fatores preditores de disglicemia no pĆ³sparto em mulheres com diabetes gestacional
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IntroduĆ§Ć£o: A Diabetes Gestacional (DG) Ć© uma forma de intolerĆ¢ncia Ć glicose diagnosticada durante a gravidez e que nĆ£o estava presente previamente Ć conceĆ§Ć£o. Associa-se a vĆ”rias complicaƧƵes, nomeadamente a um risco aumentado de disglicemia pĆ³s-parto. Objetivos: Estudar a prevalĆŖncia e os fatores de risco de disglicemia na prova de tolerĆ¢ncia Ć glicose oral (PTGO) de reclassificaĆ§Ć£o realizada 6 a 8 semanas apĆ³s o parto em mulheres com diagnĆ³stico de DG. MĆ©todos: Foi realizado um estudo observacional tipo coorte retrospetivo com base na consulta dos registos clĆnicos das grĆ”vidas com diagnĆ³stico de DG seguidas na consulta de Medicina Materno-Fetal da Unidade Local de SaĆŗde Santa Maria cujo parto ocorreu entre janeiro de 2020 e dezembro de 2022. Foi realizada uma anĆ”lise estatĆstica para identificar os fatores preditores de um resultado alterado na PTGO de reclassificaĆ§Ć£o. Resultados: Na PTGO de reclassificaĆ§Ć£o, 12,3% mulheres apresentaram disglicemia. Observou-se uma diferenƧa estatisticamente significativa entre as mulheres com e sem um resultado alterado na PTGO de reclassificaĆ§Ć£o relativamente ao valor de glicemia em jejum no 1Āŗ trimestre (p <0,001), ao valor mĆ©dio de HbA1c do 2Āŗ trimestre (p=0,049) e Ć dose mĆ”xima diĆ”ria de metformina prescrita (p=0,001). O valor de glicemia em jejum no 1Āŗ trimestre revelou ser o Ćŗnico fator preditor de disglicemia estatisticamente significativo (OR=1,080; IC 95%=1,030-1,132; p=0,001). Segundo o modelo de regressĆ£o logĆstica binĆ”ria construĆdo [Ļ2(2)=15,738; p=<0,001; R2Nagelkerke=0,452], por cada mg/dL de glicemia em jejum acima dos 92mg/dL durante o 1Āŗ trimestre, o risco de apresentar um resultado alterado na PTGO de reclassificaĆ§Ć£o aumenta 1,080 vezes. ConclusĆ£o: Em mulheres com diagnĆ³stico de DG do 1Āŗ trimestre, quanto maior o valor de glicemia em jejum ao diagnĆ³stico, mais provĆ”vel Ć© a manutenĆ§Ć£o das alteraƧƵes da glicemia apĆ³s o parto.
Introduction: Gestational Diabetes Mellitus (GDM) is a type of glucose intolerance diagnosed during pregnancy that was not present before conception. It is linked to multiple complications, including an increased risk of dysglycemia after delivery. Objective: This study aims to investigate the prevalence and risk factors for dysglycemia in the reclassification oral glucose tolerance test (OGTT) conducted 6 to 8 weeks after delivery in women diagnosed with GDM. Methods: A retrospective cohort observational study was carried out based on the medical records of pregnant women diagnosed with GDM who were followed at the Obstetric Clinic of Unidade Local de SaĆŗde de Santa Maria, and whose delivery occurred between January of 2020 and December of 2022. A statistical analysis was performed to identify the predictors of an abnormal reclassification OGTT result. Results: In the reclassification OGTT, 12.3% of women exhibited dysglycemia. A statistically significant difference was observed between women with and without an abnormal reclassification OGTT result in the first trimester fasting glucose levels (p < 0.001), the mean HbA1c value in the second trimester (p = 0.049), and the maximum daily dose of metformin (p = 0.001). The first trimester fasting glucose level was the only statistically significant predictor of dysglycemia (OR = 1.080; 95% CI = 1.030-1.132; p = 0.001). According to the binary logistic regression model [Ļ2(2) = 15.738; p < 0.001; R2Nagelkerke = 0.452], for every mg/dL of fasting glucose above 92 mg/dL during the first trimester, the risk of an abnormal reclassification OGTT result increases by 1.080 times. Conclusion: In women diagnosed with GDM during the first trimester, a higher fasting glucose value at diagnosis is associated with a greater likelihood of persistent postpartum glycemic abnormalities.
Introduction: Gestational Diabetes Mellitus (GDM) is a type of glucose intolerance diagnosed during pregnancy that was not present before conception. It is linked to multiple complications, including an increased risk of dysglycemia after delivery. Objective: This study aims to investigate the prevalence and risk factors for dysglycemia in the reclassification oral glucose tolerance test (OGTT) conducted 6 to 8 weeks after delivery in women diagnosed with GDM. Methods: A retrospective cohort observational study was carried out based on the medical records of pregnant women diagnosed with GDM who were followed at the Obstetric Clinic of Unidade Local de SaĆŗde de Santa Maria, and whose delivery occurred between January of 2020 and December of 2022. A statistical analysis was performed to identify the predictors of an abnormal reclassification OGTT result. Results: In the reclassification OGTT, 12.3% of women exhibited dysglycemia. A statistically significant difference was observed between women with and without an abnormal reclassification OGTT result in the first trimester fasting glucose levels (p < 0.001), the mean HbA1c value in the second trimester (p = 0.049), and the maximum daily dose of metformin (p = 0.001). The first trimester fasting glucose level was the only statistically significant predictor of dysglycemia (OR = 1.080; 95% CI = 1.030-1.132; p = 0.001). According to the binary logistic regression model [Ļ2(2) = 15.738; p < 0.001; R2Nagelkerke = 0.452], for every mg/dL of fasting glucose above 92 mg/dL during the first trimester, the risk of an abnormal reclassification OGTT result increases by 1.080 times. Conclusion: In women diagnosed with GDM during the first trimester, a higher fasting glucose value at diagnosis is associated with a greater likelihood of persistent postpartum glycemic abnormalities.
DescriĆ§Ć£o
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Diabetes gestacional PTGO de reclassificaĆ§Ć£o Fatores preditores Disglicemia Endocrinologia