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Abstract(s)
Introdução: A Diabetes Gestacional (DG) é uma condição definida como “qualquer nível de intolerância à glicose, com início durante a gravidez, que resulta em hiperglicemia de gravidade variável”. A prevalência em Portugal tem vindo a aumentar, sendo de 7,2% em 2015, segundo dados divulgados pela Sociedade Portuguesa de Diabetologia. Sabe-se que está associada a complicações a curto e a longo prazo, quer para a grávida, quer para o recém-nascido. Na prática obstétrica, a atuação médica centra-se no rastreio/diagnóstico precoce da DG e no tratamento para controlo da glicemia ao longo da gravidez e prevenção da morbilidade fetal. Têm-se perspetivado atitudes clínicas que visam prevenir ou atrasar o surgimento da DG em mulheres com risco acrescido.
Objetivo: Este trabalho tem como objetivo fazer uma revisão da literatura existente e reunir informação sobre as medidas farmacológicas e não farmacológicas que podem ser usadas para prevenir o aparecimento desta condição em mulheres de risco e diminuir a morbilidade associada.
Métodos: para a realização deste trabalho, foi realizada uma pesquisa bibliográfica nas bases de dados PubMed e Cochrane. Os critérios de inclusão foram: estudos realizados em mulheres com pelo menos 1 fator de risco para DG, sem diabetes prévia à gravidez, em mulheres já grávidas, com o intuito de prevenir o aparecimento de DG. Assim sendo, foram excluídos artigos referentes a abordagens com início antes da conceção, no pós-parto e para tratamento da DG já diagnosticada. Apenas artigos escritos em português, inglês e alemão foram incluídos.
Resultados: foram incluídos nesta revisão da literatura 54 publicações. Destas, 19 são referentes às intervenções de atividade física/exercício físico, 7 à alimentação e 8 combinação de ambos (intervenção estilo de vida). Além disso, das estratégias novas foram encontrados 2 estudos sobre o efeito da Vitamina D, 6 publicações sobre a suplementação com mio-inositol, 5 acerca do potencial dos probióticos, 1 sobre o uso de óleo de peixe e, finalmente, 6 com utilização de metformina para prevenção da DG. Das intervenções, apenas algumas parecem ter potencial para reduzir a incidência de DG em grávidas com fatores de risco, tendo ocorrido em alguns estudos com suplementação com mio-inositol e de probióticos, além dos associados à alimentação e estilo de vida.
Conclusão: algumas destas estratégias parecem ter potencial na prevenção da DG. No entanto, ainda não existem estudos suficientes nem de dimensão adequada que validem essas intervenções. Para além de apostar na prevenção e controlo pré-concecional dos FR modificáveis, é importante identificar os subgrupos que terão maior benefício com estas novas intervenções estudadas e aperfeiçoar o diagnóstico e tratamento, quando não for possível preveni-la.
Introduction: Gestational Diabetes (GD) is a condition defined as "any level of glucose intolerance, with onset during pregnancy, resulting in hyperglycemia of varying severity". The prevalence in Portugal is increasing, being of 7.2% in 2015, according to data of the Portuguese Society of Diabetology. GD is known to be associated with short and long-term complications, for both mother and child. The clinical practice focuses only on early screening/diagnosis and treatment of GD for better glycemic control throughout pregnancy and prevention of fetal morbidity. There are some new clinical interventions that aim to prevent or delay DG in high risk women. Goal: This study aims to review existing literature on this topic and gather information on pharmacological and non-pharmacological interventions that can be used to prevent this condition in pregnant women at risk, reducing associated complications. Methods: for this literature review a research was carried out in PubMed and Cochrane databases. Inclusion criteria were: studies performed in pregnant women with at least 1 risk factor for GD, without overt diabetes, in order to prevent the onset of GD. Therefore, articles referring to approaches that started before conception, on the postpartum period or was refered to treatment of previously diagnosed DG were excluded. Only articles written in portuguese, english and german were included. Results: 54 studies were included in this literature review. Out of these, 19 refer to physical activity/exercise interventions, 7 to diet only and 8 refer to the combination of both (also known as “lifestyle intervention”). In addition, 2 studies on the effect of Vitamin D, 6 publications on myo-inositol supplementation, 5 on the potential of probiotics, 1 on the use of fish oil and, finally, 6 on the use of metformin for the prevention of DG. Only a few seem to have the potential to reduce the incidence of GD in pregnant women with risk factors, like is shown in some studies with myo-inositol and probiotic supplementation and in those associated with diet and lifestyle interventions. Conclusion: some of these strategies seem to have potential in DG prevention. However, there are still insufficient data to support their application in clinical practice. The existing studies vary immensely among themselves. In addition to focus on the pre-pregnancy prevention and control of modifiable risk factors, it is important to identify the subgroups that will most benefit from these new interventions and improve diagnosis and treatment when it is not possible to prevent gestational diabetes.
Introduction: Gestational Diabetes (GD) is a condition defined as "any level of glucose intolerance, with onset during pregnancy, resulting in hyperglycemia of varying severity". The prevalence in Portugal is increasing, being of 7.2% in 2015, according to data of the Portuguese Society of Diabetology. GD is known to be associated with short and long-term complications, for both mother and child. The clinical practice focuses only on early screening/diagnosis and treatment of GD for better glycemic control throughout pregnancy and prevention of fetal morbidity. There are some new clinical interventions that aim to prevent or delay DG in high risk women. Goal: This study aims to review existing literature on this topic and gather information on pharmacological and non-pharmacological interventions that can be used to prevent this condition in pregnant women at risk, reducing associated complications. Methods: for this literature review a research was carried out in PubMed and Cochrane databases. Inclusion criteria were: studies performed in pregnant women with at least 1 risk factor for GD, without overt diabetes, in order to prevent the onset of GD. Therefore, articles referring to approaches that started before conception, on the postpartum period or was refered to treatment of previously diagnosed DG were excluded. Only articles written in portuguese, english and german were included. Results: 54 studies were included in this literature review. Out of these, 19 refer to physical activity/exercise interventions, 7 to diet only and 8 refer to the combination of both (also known as “lifestyle intervention”). In addition, 2 studies on the effect of Vitamin D, 6 publications on myo-inositol supplementation, 5 on the potential of probiotics, 1 on the use of fish oil and, finally, 6 on the use of metformin for the prevention of DG. Only a few seem to have the potential to reduce the incidence of GD in pregnant women with risk factors, like is shown in some studies with myo-inositol and probiotic supplementation and in those associated with diet and lifestyle interventions. Conclusion: some of these strategies seem to have potential in DG prevention. However, there are still insufficient data to support their application in clinical practice. The existing studies vary immensely among themselves. In addition to focus on the pre-pregnancy prevention and control of modifiable risk factors, it is important to identify the subgroups that will most benefit from these new interventions and improve diagnosis and treatment when it is not possible to prevent gestational diabetes.
Description
Keywords
Alimentação Atividade Física Diabetes Gestacional Estilo de Vida Gravidez Metformina Mio-Inositol Óleo de Peixe Prevenção Probióticos Vitamina D