Reducción de la aparición de diabetes mellitus gestacional por adherencia por adherencia a la dieta mediterránea

El objetivo del proyecto aquí presentado es el de evaluar los criterios diagnósticos antiguos y actuales de la diabetes mellitus gestacional (DMG) y determinar el impacto potencial de su empleo en el periodo postparto; valorar el efecto del tratamiento de la DMG sobre las complicaciones materno fetales derivadas del exceso de peso; investigar posibles estrategias para prevenir la DMG; y examinar el efecto de adoptar una dieta mediterránea (DietMed) en la incidencia de la DMG. Para ello se condujeron, entre 2007-2016, cuatro estudios prospectivos diferentes y una revisión, utilizando datos disponibles en el Departamento de Análisis Clínicos, Departamento de Obstetricia y la Unidad especializada de Diabetes Gestacional del Servicio de Endocrinología y Nutrición del Hospital Clínico San Carlos de Madrid. ESTUDIO 1. El impacto de cambiar al método de un paso para el diagnóstico de DMG sobre las tasas de asistencia al cribado postparto y la presencia de desórdenes glucémicos en mujeres que tuvieron DMG. El Estudio Gestacional San Carlos. Objetivos: Comparar las tasas de desorden glucémico postparto (DGp), basado en la combinación de glucosa basal plasmática (GBP) -HbA1c, en mujeres que fueron diagnosticadas con diabetes mellitus gestacional (DMG) por los criterios de Carpenter-Coustan (CyCc) y los criterios del International Association of Diabetes and Pregnancy Study Groups (IADPSGc)..

Are women positive for the One Step but negative for the Two Step screening tests for gestational diabetes at higher risk for adverse outcomes?

INTRODUCTION: The aim of this study was to evaluate if women meeting criteria for gestational diabetes mellitus (GDM) by the One Step test as per International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria but not by other less strict criteria have adverse pregnancy outcomes compared with GDM-negative controls. The primary outcome was the incidence of macrosomia, defined as birthweight > 4000 g. MATERIAL AND METHODS: Electronic databases were searched from their inception until May 2017. All studies identifying pregnant women negative at the Two Step test, but positive at the One Step test for IADPSG criteria were included. We excluded studies that randomized women to the One Step vs. the Two Step tests; studies that compared different criteria within the same screening method; randomized studies comparing treatments for GDM; and studies comparing incidence of GDM in women doing the One Step test vs. the Two Step test. RESULTS: Eight retrospective cohort studies, including 29 983 women, were included. Five study groups and four control groups were identified. The heterogeneity between the studies was high. Gestational hypertension, preeclampsia and large for gestational age, as well as in some analyses cesarean delivery, macrosomia and preterm birth, were significantly more frequent, and small for gestational age in some analyses significantly less frequent, in women GDM-positive by the One Step, but not the Two Step. CONCLUSION: Women meeting criteria for GDM by IADPSG criteria but not by other less strict criteria have an increased risk of adverse pregnancy outcomes such as gestational hypertension, preeclampsia and large for gestational age, compared with GDM-negative controls. Based on these findings, and evidence from other studies that treatment decreases these adverse outcomes, we suggest screening for GDM using the One Step IADPSG criteria

Attitudes, behaviors, and barriers among adolescents living with obesity, caregivers, and healthcare professionals in Spain: ACTION Teens Survey Study

Although the prevalence of pediatric obesity is rising, understanding of the perceptions, attitudes, behaviors, and barriers to effective obesity care among Spanish adolescents living with obesity (ALwO), their caregivers, and healthcare professionals (HCPs) is lacking. In 2021, the cross-sectional ACTION Teens survey study was conducted in 10 countries; results from the Spanish cohort are presented herein. The survey was completed by 648 ALwO, 644 caregivers, and 251 HCPs in Spain. A total of 25% of ALwO and 43% of caregivers thought that their/their child's weight was normal, and more caregivers than ALwO perceived the ALwO's health to be at least good (95% vs. 59%, respectively). Only 53% of ALwO and 9% of caregivers reported receiving an obesity diagnosis, despite HCPs reporting they provide diagnoses to 87% of ALwO/caregivers. Although 65% of HCPs felt that ALwO may not be comfortable discussing weight, only 26% of ALwO who had discussed weight with an HCP (n = 488) reported not feeling comfortable. Inability to control hunger was a key barrier to ALwO losing weight identified by ALwO/caregivers, but not HCPs. Improved communication between the three groups, a better understanding of barriers to weight loss, and improved health education on obesity are needed in order to enhance obesity care in Spain

Diet Enriched with Olive Oil Attenuates Placental Dysfunction in Rats with Gestational Diabetes Induced by Intrauterine Programming

Scope: Offspring from rats with mild diabetes develop gestational diabetes mellitus (GDM). We tested the hypothesis that an olive oil-supplemented diet attenuates placental oxidative stress/inflammation, activation of mTOR signaling, and inhibition of peroxisome proliferator-activated receptor γ (PPARγ) and fetal overgrowth in GDM offspring from mild diabetic rats. Methods and results: Female offspring from rats with mild diabetes (group that developed GDM) and controls were fed with either a standard diet or a 6% olive oil-supplemented diet during pregnancy. On day 21 of pregnancy, plasma glucose levels in mothers and fetuses were increased in the GDM group independently of the diet. Fetal overgrowth and activation of placental mTOR signaling were partially prevented in the olive oil-treated GDM group. Placental PPARγ protein expression was decreased in GDM rats, independently of the diet. However, increases in placental lipoperoxidation, connective tissue growth factor, and matrix metalloproteinase 2 levels were prevented by the olive oil-enriched diet. Conclusion: Diets enriched with olive oil attenuate placental dysfunction and fetal overgrowth in rats with GDM induced by intrauterine programming.Fil: Capobianco, Evangelina Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; ArgentinaFil: Gomez Ribot, Dalmiro Leonardo Antonio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; ArgentinaFil: Fornes, Daiana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; ArgentinaFil: Powell, Theresa L.. Universidad de Colorado, Denver; Estados UnidosFil: Levieux, Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; ArgentinaFil: Jansson, Thomas. State University of Colorado at Boulder; Estados UnidosFil: Jawerbaum, Alicia Sandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; Argentin

Effectiveness of Following Mediterranean Diet Recommendations in the Real World in the Incidence of Gestational Diabetes Mellitus (GDM) and Adverse Maternal-Foetal Outcomes: A Prospective, Universal, Interventional Study with a Single Group. The St Carlos Study

We reported that a Mediterranean Diet (MedDiet), supplemented with extra-virgin olive oil (EVOO) and pistachios, reduces GDM incidence and several other adverse outcomes. In order to assess its translational effects in the real world we evaluated the effect of MedDiet from 1st gestational visit in GDM rate compared with control (CG) and intervention (IG) groups from the previously referred trial. As secondary objective we also compared adverse perinatal outcomes between normoglycemic and diabetic women. This trial is a prospective, clinic-based, interventional study with a single group. 1066 eligible normoglycaemic women before 12 gestational weeks were assessed. 932 women (32.4 ± 5.2 years old, pre-gestational BMI 22.5 ± 3.5 kg/m2) received a motivational lifestyle interview with emphasis on daily consumption of EVOO and nuts, were followed-up and analysed. Binary regression analyses were used to examine the risk for each pregnancy outcome, pregnancy-induced hypertension, preeclampsia, gestational weight gain (GWG), caesarean-section, perineal trauma, preterm delivery, small (SGA) and large for gestational age (LGA), and Neonatal Intensive Care Unit admissions. GDM was diagnosed in 13.9%. This rate was significantly lower than the CG: RR 0.81 (0.73–0.93), p < 0.001 and no different from the IG: RR 0.96 (0.85–1.07), p = 0.468. GWG was lower in diabetic women (10.88 ± 6.46 vs. 12.30 ± 5.42 Kg; p = 0.013). Excessive weight gain (EWG) was also lower in GDM [RR 0.91 (0.86–0.96); p < 0.001] without a significant increase of insufficient weight gain. LGA were also lower (1 (0.8%) vs. 31 (3.9%); p < 0.05)), and SGA were similar (5 (3.8%) vs. 30 (3.7%)). LGA were associated to EWG (RR 1.61 (1.35–1.91), p < 0.001). Differences in other maternal-foetal outcomes were not found. In conclusions an early MedDiet nutritional intervention reduces GDM incidence and maternal-foetal adverse outcomes and should be universally applied as 1st line therapy. GDM might not be consider as a high risk pregnancy any longer

Effects of a Mediterranean diet on blood pressure: A systematic review and meta-analysis of randomised controlled trials and observational studies

Objective: To conduct a systematic review and meta-analysis investigating effects of MedDiet on blood pressure in randomised controlled trials (RCTs) and associations of MedDiet with risk of hypertension in observational studies. Methods: PubMed, The Cochrane Library and EBSCOhost were searched from inception until January 2020 for studies that met the following criteria: 1) participants aged ≥18 years, 2) RCTs investigating effects of a MedDiet versus control on BP, 3) Observational studies exploring associations between MedDiet adherence and risk of hypertension. Random-effects meta-analyses were conducted. Meta-regression and subgroup analyses were performed for RCTs to identify potential effect moderators. Results: Nineteen RCTs reporting data on 4137 participants and 16 observational studies reporting data on 59,001 participants were included in the meta-analysis. MedDiet interventions reduced systolic and diastolic BP by a mean -1.4 mmHg (95% CI: -2.40 to -0.39 mmHg, p=0.007, I2=53.5%, Q=44.7, τ2=1.65, df=19) and -1.5 mmHg (95% CI: -2.74 to -0.32 mmHg, p=0.013, I2=71.5%, Q=51.6, τ2=4.72, df=19) versus control, respectively. Meta-regression revealed that longer study duration and higher baseline systolic BP was associated with a greater decrease in BP, in response to a MedDiet (p<0.05). In observational studies, odds of developing hypertension were 13% lower with higher versus lower MedDiet adherence (95% CI: 0.78 to 0.98, p=0.017, I2=69.6%, Q=41.1, τ2=0.03, df=17). Conclusions: Data suggest that MedDiet is an effective dietary strategy to aid BP control, which may contribute towards the lower risk of CVD reported with this dietary pattern. This study was registered with PROSPERO: CRD42019125073. KEY WORDS: Mediterranean diet, blood pressure, hypertension, cardiovascular diseas

Necrosis uterina tras sutura de compresión hemostática: reporte de caso y revisión de la literatura

Objetivos: presentar un caso de necrosis uterina tras técnica de sutura hemostática por hemorragia posparto y hacer una revisión de la literatura para determinar la técnica de sutura utilizada, los hallazgos clínicos, la técnica diagnóstica y el tratamiento realizado en los casos clínicos descritos. Materiales y métodos: se presenta el caso de una mujer de 34 años que consultó por dolor abdominal al octavo día tras cesárea por placenta previa, que precisó sutura de B-Lynch por atonía uterina y cuyo diagnóstico fue necrosis uterina. La paciente requirió histerectomía abdominal total, con evolución satisfactoria. Se realizó una búsqueda sistemática de la literatura en las bases de datos Medline vía Pubmed, Embase y Web of Science. Se buscaron series y reportes de casos y cohortes de mujeres con necrosis uterina posterior al uso de suturas de compresión uterina para control de hemorragia posparto. Se analizaron variables sociodemográficas y clínicas al diagnóstico, técnica de sutura, pruebas diagnósticas y tratamiento. Resultados: se incluyeron 23 estudios con 24 pacientes. El 83 % de las necrosis ocurrieron tras cesárea. La técnica más utilizada fue B-Lynch (66 %), seguida de Cho (25 %). Los síntomas más frecuentes fueron fiebre y dolor abdominal. La prueba diagnóstica más utilizada fue la tomografía computarizada (9 de 24 casos). En la mayoría de casos se realizó histerectomía (75 %). Conclusiones: la necrosis de la pared uterina es una complicación infrecuente pero grave. Sería recomendable el diseño de cohortes de seguimiento de mujeres sometidas a estos procedimientos para determinar la incidencia de complicaciones asociadas.</jats:p