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Advisor(s)
Abstract(s)
Introdução: A gravidez é um processo biológico natural caracterizado também por ser um período de elevada susceptibilidade para a mulher e, por consequência, para o feto. Assim, o desenvolvimento de patologias como diabetes gestacional ou hipertensão na gravidez não só perturba o desenvolvimento normal da gestação como pode significar um grande risco para o aparecimento de doenças crónicas no futuro.
Objetivos: Para além da associação com complicações na gravidez, esta revisão bibliográfica irá debruçar-se sobre a relação entre hipertensão e diabetes gestacional, pois embora ambas sejam fatores de risco independentes para efeitos adversos da gravidez, pode-se esperar que a presença de ambos tenha consequências adicionais sobre os resultados obstétricos.
Métodos: Através da base de dados eletrónica Pubmed-Medline, foram selecionados artigos publicados entre 2000 e 2019, em inglês ou português, com base nos respetivos títulos e resumo. Os termos de pesquisa utilizados foram: Hipertensão; diabetes; gestacional; gravidez.
Desenvolvimento: A diabetes gestacional e as patologias hipertensivas da gravidez representam respostas anormais aos desafios fisiológicos e metabólicos da gravidez e identificam mulheres com risco elevado de diabetes e de patologia cardiovascular para o longo da vida.
A hipertensão induzida pela gravidez define-se como o desenvolvimento de uma nova hipertensão arterial numa mulher grávida, após as 20 semanas de gestação. Uma gravidez complicada por hipertensão tem um risco aumentado de consequências neonatais e maternas adversas, incluindo morte perinatal, baixo crescimento fetal, parto prematuro, pré-eclâmpsia e cesariana.
De acordo com as orientações mais recentes, a diabetes que ocorre durante a gestação, pode ser definida como diabetes pré-gestacional (pré-existente), diabetes gestacional (definida por glicémia plasmática superior a 92 mg/dL e inferior a 125 mg/dL às 0 horas, igual ou superior a 180 mg/dL no final da primeira hora ou entre 153 mg/dL e 199 mg/dL às 2h) ou diabetes na gravidez (quando os valores glicémicos são iguais ou superiores a 126 mg/dL às 0 horas ou iguais ou superiores a 200mg/dL às 2h). A maioria das mulheres com diabetes pré-gestacional tem diabetes mellitus tipo 1 (ou tipo 2 em populações específicas com maior incidência de obesidade e sedentarismo em idades mais jovens).
O risco de diabetes mellitus tipo 2 entre mulheres que tiveram diabetes gestacional começa logo após o parto, e uma grande percentagem das mulheres afetadas irá desenvolver diabetes nos anos subsequentes. De igual forma, em mulheres que desenvolvem distúrbios hipertensivos durante a gestação (como hipertensão gestacional, pré-eclâmpsia ou eclâmpsia), verifica-se um aumento no risco de desenvolverem hipertensão e doenças cardiovasculares no futuro. Assim, salienta-se a importância de uma obtenção por parte dos profissionais de saúde do histórico da gravidez como parte da entrada clínica de rotina e de uma avaliação dos fatores de risco cardiovasculares.
Conclusão: A prevalência relativamente alta de ambas as patologias – diabetes e hipertensão gestacionais – torna-as uma precupação a nível de saúde pública pelos riscos que a ausência de diagnóstico atempado e respectivo tratamento acarretam para a saúde materna e/ou fetal. Desta forma, a instituição precoce de medidas terapêuticas (farmacológicas ou não farmacológicas) com vista ao controlo destas duas entidades é de extrema importância e pode, em grande parte dos casos, prevenir eventos adversos indesejáveis.
Introduction: Pregnancy is a natural biological process characterized by being a period of high susceptibility for the woman and, consequently, for the fetus. The development of pathologies such as gestational diabetes or hypertension in pregnancy not only affects the normal development of gestation but may also pose a great risk for the onset of chronic diseases in the future. Objectives: In addition to the association with complications in pregnancy, this review will focus on the relationship between hypertension and gestational diabetes, since they both are independent risk factors for adverse effects of pregnancy. Consequently, we can expect that the presence of both has additional consequences on obstetric outcomes. Methods: Using the Pubmed-Medline electronic database, articles published between 2000 and 2019, in English or Portuguese, were selected based on their titles and abstract. The research terms used were: hypertension; diabetes; gestational; pregnancy. Development: Gestational diabetes and hypertensive disorders of pregnancy represent abnormal responses to the physiological and metabolic challenges of pregnancy and identify women at high risk for diabetes and cardiovascular disease for life. Gestacional hypertension is defined as the development of new arterial hypertension in a pregnant woman after 20 weeks of gestation. A pregnancy complicated by hypertension has an increased risk of adverse neonatal and maternal consequences, including perinatal death, low fetal growth, preterm delivery, preeclampsia, and cesarean section. According to the most recent guidelines, diabetes occurring during pregnancy can be defined as pre-gestational diabetes (pre-existing), gestational diabetes (defined as plasma glycemia greater than 92 mg / dL and less than 125 mg / dL at or above 180 mg / dL at the end of the first hour or between 153 mg / dL and 199 mg / dL at 2 h) or diabetes in pregnancy (when glycemic values are equal to or greater than 126 mg / dL at 0 hours or equal to or greater than 200mg / dL at 2h). Most women with pre-gestational diabetes have type 1 diabetes mellitus (or type 2 in specific populations with a higher incidence of obesity and sedentary lifestyle at younger ages). The risk of type 2 diabetes mellitus among women who have had gestational diabetes begins soon after birth, and a large percentage of affected women will develop diabetes in subsequent years. Similarly, in women who develop hypertensive disorders during pregnancy (such as gestational hypertension, preeclampsia, or eclampsia), there is an increased risk of developing hypertension and cardiovascular disease in the future. Thus, it is important that health professionals obtain the clinical history of pregnancy as part of routine clinical evaluation and also an evaluation of cardiovascular risk factors. Conclusion: The relatively high prevalence of both pathologies - gestational diabetes and hypertension - makes them a public health concern due to the risks that maternal and / or fetal health may have in the absence of early diagnosis and treatment. So the early institution of therapeutic measures (pharmacological or non-pharmacological) for the control of these two entities is extremely important and can, in most cases, prevent undesirable adverse events.
Introduction: Pregnancy is a natural biological process characterized by being a period of high susceptibility for the woman and, consequently, for the fetus. The development of pathologies such as gestational diabetes or hypertension in pregnancy not only affects the normal development of gestation but may also pose a great risk for the onset of chronic diseases in the future. Objectives: In addition to the association with complications in pregnancy, this review will focus on the relationship between hypertension and gestational diabetes, since they both are independent risk factors for adverse effects of pregnancy. Consequently, we can expect that the presence of both has additional consequences on obstetric outcomes. Methods: Using the Pubmed-Medline electronic database, articles published between 2000 and 2019, in English or Portuguese, were selected based on their titles and abstract. The research terms used were: hypertension; diabetes; gestational; pregnancy. Development: Gestational diabetes and hypertensive disorders of pregnancy represent abnormal responses to the physiological and metabolic challenges of pregnancy and identify women at high risk for diabetes and cardiovascular disease for life. Gestacional hypertension is defined as the development of new arterial hypertension in a pregnant woman after 20 weeks of gestation. A pregnancy complicated by hypertension has an increased risk of adverse neonatal and maternal consequences, including perinatal death, low fetal growth, preterm delivery, preeclampsia, and cesarean section. According to the most recent guidelines, diabetes occurring during pregnancy can be defined as pre-gestational diabetes (pre-existing), gestational diabetes (defined as plasma glycemia greater than 92 mg / dL and less than 125 mg / dL at or above 180 mg / dL at the end of the first hour or between 153 mg / dL and 199 mg / dL at 2 h) or diabetes in pregnancy (when glycemic values are equal to or greater than 126 mg / dL at 0 hours or equal to or greater than 200mg / dL at 2h). Most women with pre-gestational diabetes have type 1 diabetes mellitus (or type 2 in specific populations with a higher incidence of obesity and sedentary lifestyle at younger ages). The risk of type 2 diabetes mellitus among women who have had gestational diabetes begins soon after birth, and a large percentage of affected women will develop diabetes in subsequent years. Similarly, in women who develop hypertensive disorders during pregnancy (such as gestational hypertension, preeclampsia, or eclampsia), there is an increased risk of developing hypertension and cardiovascular disease in the future. Thus, it is important that health professionals obtain the clinical history of pregnancy as part of routine clinical evaluation and also an evaluation of cardiovascular risk factors. Conclusion: The relatively high prevalence of both pathologies - gestational diabetes and hypertension - makes them a public health concern due to the risks that maternal and / or fetal health may have in the absence of early diagnosis and treatment. So the early institution of therapeutic measures (pharmacological or non-pharmacological) for the control of these two entities is extremely important and can, in most cases, prevent undesirable adverse events.
Description
Keywords
Consequências Diabetes Gestacional Gravidez Hipertensão Prevenção Terapêutica