Avaliação ultrassonográfica de parâmetros do crescimento fetal: relação com a hiperglicemia materna
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Data
2011-06-26
Autores
Luminoso, Daniele [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A causa mais freqüente de mortalidade perinatal em gestantes diabéticas é a malformação congênita, enquanto a principal causa de morbidade é o crescimento fetal anômalo. Anormalidades na oferta de nutrientes ao feto provavelmente desencadeiam alterações na trajetória do crescimento fetal. A hiperglicemia materna é apontada como a primeira determinante do crescimento fetal excessivo, devido a oferta de grandes quantidades de glicose ao feto, o que desencadeia hiperinsulinemia fetal. O crescimento fetal excessivo pode ser identificado em fetos grandes para idade gestacional (GIG),definidos como aqueles com peso acima do percentil 90 ou pela macrossomia, definida por peso ao nascimento acima de 4000g. A típica fetopatia diabética é caracterizada pelo aumento de proteínas corporais totais, glicogênio e gordura, além do aumento (hiperplasia e hipertrofia) de órgãos internos como fígado, coração, tecido adiposo e tecido das ilhotas pancreáticas. Este aumento seletivo dos órgãos internos contribui para uma composição corporal desarmônica que pode não ser revelada pelo peso corporal ou altura. O controle glicêmico em gestantes diabéticas está relacionado com melhora da morbidade perinatal, mas as taxas de macrossomia nestas gestações continuam altas, quando comparadas com grupo controle. A avaliação ultrassonográfica é capaz de detectar fetos em risco para crescimento excessivo, usando a medida da circunferência abdominal (CA). Foi demonstrado e estabelecido que a CA fetal acima do percentil 75 para a idade gestacional está relacionada com fetos em alto risco para crescimento excessivo e aumenta a chance para que estes fetos sejam grandes para a idade gestacional (GIG). Este achado (CA > percentil 75) vem sendo utilizado como ferramenta adicional ao ajuste da dose de insulina naquelas pacientes que fazem uso desta medicação. Quando a circunferência abdominal...
The aim of this study was to analyze the Sonographic Evaluation of Fetal Biometry and Amniotic Fluid Index (AFI) in Relation to Maternal Mean Glycemic Levels (MGL) in pregnancies complicated by diabetes mellitus. We hypothesized that maternal hyperglycemia would result in an increased of fetal growth parameters and AFI and that combined analysis of these would point out those fetuses at high risk for disproportional growth. his is an observational, retrospective, cross section, analytic study of 305 singleton pregnancies complicated by diabetes mellitus. Fetal biometric parameters (Head Circumference - HC, Abdominal Circumference - AC and Head Circumference to Abdominal Circumference ratio - HC/AC) and the Amniotic Fluid Index (AFI) were transformed in centiles and correlated to the daily maternal mean glycemic levels (MGL). The diabetic patients were divided according to the mean glycemic levels performed within two weeks of the ultrasound examination in two (< 120 and ≥ 120mg/dL) or three groups (< 100, 100-119 and ≥ 120mg/dL). The fetal sonographic parameters were evaluated overall gestational ages. In order to evaluate if mean glycemic level could have a specific influence on sonographic parameters in different gestation ages we have also subdivided the patients according to gestational age in two (< 25 and ≥ 25weeks) or three (< 25, 25-32 and ≥ 33weeks) groups. Kruskal-Wallis test was used as distribution comparison when three different groups were present, and when statistical significance was found, Mann-Whitney was used to test differences within groups. Mann-Whitney was also used as mean of comparison when two different groups were present. Correlation between the variables was assessed by linear correlation (Spearman). We have performed five different analysis. The first one, was the evaluation of the difference between the ultrasound parameters in two different maternal... (Complete abstract click electronic access below)
The aim of this study was to analyze the Sonographic Evaluation of Fetal Biometry and Amniotic Fluid Index (AFI) in Relation to Maternal Mean Glycemic Levels (MGL) in pregnancies complicated by diabetes mellitus. We hypothesized that maternal hyperglycemia would result in an increased of fetal growth parameters and AFI and that combined analysis of these would point out those fetuses at high risk for disproportional growth. his is an observational, retrospective, cross section, analytic study of 305 singleton pregnancies complicated by diabetes mellitus. Fetal biometric parameters (Head Circumference - HC, Abdominal Circumference - AC and Head Circumference to Abdominal Circumference ratio - HC/AC) and the Amniotic Fluid Index (AFI) were transformed in centiles and correlated to the daily maternal mean glycemic levels (MGL). The diabetic patients were divided according to the mean glycemic levels performed within two weeks of the ultrasound examination in two (< 120 and ≥ 120mg/dL) or three groups (< 100, 100-119 and ≥ 120mg/dL). The fetal sonographic parameters were evaluated overall gestational ages. In order to evaluate if mean glycemic level could have a specific influence on sonographic parameters in different gestation ages we have also subdivided the patients according to gestational age in two (< 25 and ≥ 25weeks) or three (< 25, 25-32 and ≥ 33weeks) groups. Kruskal-Wallis test was used as distribution comparison when three different groups were present, and when statistical significance was found, Mann-Whitney was used to test differences within groups. Mann-Whitney was also used as mean of comparison when two different groups were present. Correlation between the variables was assessed by linear correlation (Spearman). We have performed five different analysis. The first one, was the evaluation of the difference between the ultrasound parameters in two different maternal... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Gravidez, Líquido amniótico - Exame - Índices, Hiperglicemia
Como citar
LUMINOSO, Daniele. Avaliação ultrassonográfica de parâmetros do crescimento fetal: relação com a hiperglicemia materna. 2011. 55 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2011.