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Advisor(s)
Abstract(s)
Introdução: A diabetes gestacional (DG) é o distúrbio metabólico mais comum
durante a gravidez. Os dados mais recentes de Portugal apontam que 8,8% das grávidas
desenvolveram DG em 2018 e a sua incidência parece ter vindo a crescer em resposta
ao aumento da obesidade, inatividade física e idade materna nas últimas décadas. A
DG é o resultado da disfunção patológica das células ß num ambiente de resistência
crónica à insulina, característico da grávida. A amamentação materna traz vantagens
quer para a mulher quer para o recém-nascido, no entanto ainda não é clara a
influência da DG neste processo, nem os seus benefícios específicos na prevenção da
diabetes mellitus tipo 2 (DM2).
Objetivo: Conhecer a evidência científica atual relativamente à influência da DG na
amamentação e à influência da amamentação no risco futuro de DM2 em mulheres
com DG prévia.
Metodologia: Realizou-se uma revisão da literatura científica nas bases de dados
PubMed e o Google Scholar e utilizaram-se as seguintes palavras-chave: “diabetes”,
“gestational diabetes”, “gestational diabetes mellitus”, “type 2 diabetes”,
“breastfeed”,” breast milk” e “lactation”.
Resultados: Constatou-se em vários artigos que as mulheres com DG apresentaram
menor taxa de amamentação exclusiva e que a duração de amamentação foi inferior à
de mães saudáveis. Um dos motivos reportados é o atraso na lactogénese II, que se
caracteriza como a sensação de “ingurgitamento mamário” referida pela mulher, que
ocorre mais de 72h após o parto e que dificulta o início da amamentação. A DG mal
controlada também é responsável por complicações perinatais e pelo aumento da
necessidade de cuidados especiais para o recém-nascido, o que contribui para o
afastamento materno-infantil e consequentemente para a introdução precoce do leite
de fórmula que tem implicações na adesão à amamentação. As mulheres com DG
parecem ter ainda um risco 10 vezes superior de desenvolver DM2 no futuro. Foram
reportados efeitos benéficos da amamentação na diminuição deste risco, possivelmente
por permitir preservar a integridade funcional das células ß durante mais tempo.
Assim, apesar da clara necessidade e importância da amamentação nestas mulheres,
são também estas as que experienciam mais dificuldades à sua iniciação e manutenção
quando comparado com mulheres saudáveis.
Conclusão e perspetivas futuras: Concluiu-se que existe evidência científica
robusta que permite afirmar que a amamentação materna reduz o risco de DM2 ao
longo da vida da mulher, e que a DG, especialmente se mal controlada, influencia negativamente a amamentação materna. Como tal, é importante apostar no diagnóstico
precoce e no adequado controlo da glicemia da grávida com DG, pois irá provavelmente
potenciar uma maior adesão e duração da amamentação materna. É importante ainda
promover a literacia das grávidas quanto aos benefícios da amamentação para as
próprias, além dos já conhecidos para a criança e sensibilizar os profissionais de saúde
para um acompanhamento mais individualizado e para o incentivo da amamentação
materna, em especial nesta população.
Introduction: Gestational diabetes (GD) is the most common metabolic disorder during pregnancy. The most recent data from Portugal show that 8.8% of pregnant women developed GD in 2018 and its incidence seems to have been growing in response to the rise in obesity, physical inactivity, and maternal age in recent decades. GD is the result of pathological dysfunction of ß cells in an environment of chronic insulin resistance, characteristic of pregnant women. Breastfeeding brings advantages to both woman and the newborn, however the influence of GD in this process is not yet clear, nor its specific benefits in the prevention of type 2 diabetes mellitus (DM2). Objective: The main objective of the present investigation was to find out the current scientific evidence regarding the influence of GD on breastfeeding and the influence of breastfeeding on the future risk of DM2 in women with previous GD. Methods: A review of the scientific literature was conducted in PubMed and Google Scholar databases and the following keywords were used: "diabetes", "gestational diabetes", "gestational diabetes mellitus", "type 2 diabetes", "breastfeed”, “breast milk” and “lactation”. Priority was given to the most recent articles written in English, Portuguese, Spanish and French. Results: It was found in several articles that women with GD had a lower rate of exclusive breastfeeding, and that the duration of breastfeeding was shorter than healthy mothers. One of the reasons reported is the delay in lactogenesis II, which is defined as the sensation of “breast engorgement” reported by the woman, which occurs more than 72 hours after delivery and makes it difficult to start breastfeeding. Poorly controlled GD is also responsible for perinatal complications and the increased need for special care for the newborn, which contributes to maternal and child distancing and, consequently, to the early introduction of formula milk, which has implications for breastfeeding adherence. Women with GD appear to have a 10-fold increased risk of developing DM2 in the future. Beneficial effects of breastfeeding have been reported to reduce this risk, possibly because it allows to preserve the functional integrity of ß cells for a longer time. Thus, despite the clear need and importance of breastfeeding in these women, they are also the ones who experience more difficulties in its initiation and maintenance when compared to healthy women. Conclusion and future perspectives: This study allowed us to conclude that there is robust scientific evidence that supports the allegation that breastfeeding reduces the risk of DM2 throughout a woman's life, and that GD, especially if poorly controlled, negatively influences breastfeeding. As such, it is important to focus on early diagnosis and adequate glycemic control of pregnant women with GD, as it will likely enhance greater adherence and duration of breastfeeding. It is also important to promote the literacy of pregnant women regarding the benefits of breastfeeding for them, in addition to those already known for the child, and to raise awareness of health professionals to adopt a individualized follow-up and to encourage breastfeeding, especially in this population.
Introduction: Gestational diabetes (GD) is the most common metabolic disorder during pregnancy. The most recent data from Portugal show that 8.8% of pregnant women developed GD in 2018 and its incidence seems to have been growing in response to the rise in obesity, physical inactivity, and maternal age in recent decades. GD is the result of pathological dysfunction of ß cells in an environment of chronic insulin resistance, characteristic of pregnant women. Breastfeeding brings advantages to both woman and the newborn, however the influence of GD in this process is not yet clear, nor its specific benefits in the prevention of type 2 diabetes mellitus (DM2). Objective: The main objective of the present investigation was to find out the current scientific evidence regarding the influence of GD on breastfeeding and the influence of breastfeeding on the future risk of DM2 in women with previous GD. Methods: A review of the scientific literature was conducted in PubMed and Google Scholar databases and the following keywords were used: "diabetes", "gestational diabetes", "gestational diabetes mellitus", "type 2 diabetes", "breastfeed”, “breast milk” and “lactation”. Priority was given to the most recent articles written in English, Portuguese, Spanish and French. Results: It was found in several articles that women with GD had a lower rate of exclusive breastfeeding, and that the duration of breastfeeding was shorter than healthy mothers. One of the reasons reported is the delay in lactogenesis II, which is defined as the sensation of “breast engorgement” reported by the woman, which occurs more than 72 hours after delivery and makes it difficult to start breastfeeding. Poorly controlled GD is also responsible for perinatal complications and the increased need for special care for the newborn, which contributes to maternal and child distancing and, consequently, to the early introduction of formula milk, which has implications for breastfeeding adherence. Women with GD appear to have a 10-fold increased risk of developing DM2 in the future. Beneficial effects of breastfeeding have been reported to reduce this risk, possibly because it allows to preserve the functional integrity of ß cells for a longer time. Thus, despite the clear need and importance of breastfeeding in these women, they are also the ones who experience more difficulties in its initiation and maintenance when compared to healthy women. Conclusion and future perspectives: This study allowed us to conclude that there is robust scientific evidence that supports the allegation that breastfeeding reduces the risk of DM2 throughout a woman's life, and that GD, especially if poorly controlled, negatively influences breastfeeding. As such, it is important to focus on early diagnosis and adequate glycemic control of pregnant women with GD, as it will likely enhance greater adherence and duration of breastfeeding. It is also important to promote the literacy of pregnant women regarding the benefits of breastfeeding for them, in addition to those already known for the child, and to raise awareness of health professionals to adopt a individualized follow-up and to encourage breastfeeding, especially in this population.
Description
Keywords
Aleitamento Materno Amamentação Diabetes Diabetes Gestacional Diabetes Mellitus Tipo 2