Hepatic elimination of drugs in gestational diabetes

Background: The liver is the major metabolic clearance organ for chemical agents from the human body. Pregnancy is associated with several physiological changes that may affect one or more of these factors, and also induces changes in the hepatic clearance of certain drugs. The aim of this paper was to review some of the currently available information in the field to provide some insights about the relevance of these changes on the clearance of some drugs. Methods: A comprehensive literature search was carried out to identify eligible studies from MEDLINE/PubMed, EMBASE and SCIELO databases through 1970 first semester. Results: Gestational Diabetes Mellitus (GDM) is a frequent disease commonly associated with other entities as obesity, hypertension, dyslipidemia, non-alcoholic fatty liver disease, prothrombotic conditions, changes in intestinal microbiome. These entities, together with the glycemic fluctuations associated with GDM might affect the determinants of the hepatic clearance (hepatic blood flow, the unbound fraction of drugs, and the hepatic intrinsic clearance). GDM is frequently associated with multi-drug treatments. While many of these drugs are cleared by the liver, little is known about the clinical relevance of these GDM associated pharmacokinetic changes. Conclusion: Considering the frequency of the disease and the effects that these pharmacokinetic changes might have on the mother and child, the need for further research seems advisable. In the meantime, cautious clinical judgment in the management of drug administration in women affected by this disease is recommended.Fil: González, Claudio Daniel. Universidad de Buenos Aires; Argentina. Centro de Educación Medica E Invest.clinicas; ArgentinaFil: Alvariñas, Jorge. Sociedad Argentina de Neurología Infantil; ArgentinaFil: Bolaños, Ricardo. Ministerio de Salud. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica; ArgentinaFil: Di Girolamo, Guillermo. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Educational interventions to improve maternal‐foetal outcomes in women with gestational diabetes

To evaluate improvement in gestational diabetes (GDM) outcomes for mothers and their offspring induced by education provided to the healthcare team (HCTM) and women with GDM, plus coordination between primary care units (PCU) and highly complex maternity (HCM) facilities.Fil: Gorbán de Lapertosa, Silvia. Universidad Nacional del Nordeste; ArgentinaFil: Elgart, Jorge Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: González, Claudio D.. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Alvariñas, Jorge. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Enrique Tornú; ArgentinaFil: Camin, Paula. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Doctor Cosme Argerich.; ArgentinaFil: Mezzabotta, Leonardo. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Doctor Cosme Argerich.; ArgentinaFil: Salzberg, Susana. Instituto Centenario, Department Of Medical Research; Argentina. Instituto Centenario, Salud y Calidad de Vida; ArgentinaFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; Argentin

Level of motivation and physical activity in primary education students

The study is aimed at determining the relationship between the index of physical activity and the motivation toward school tasks of Primary Education students. To this end, a descriptive, quasi-experimental design was employed. The instruments used for the study included PAQ-C and the Questionnaire on students’ motivation toward their studies. Among the results, it should be noted that Primary Education students’ motivation toward their studies is high, although the level of physical activity is relatively low for this age group. The level of physical activity is higher in boys than girls. The level of motivation, as well as achievement motivation, and causal attributions of achievement are higher in girls, but self-efficacy is higher in boys. The higher the level of physical activity practice, the higher the level of motivation toward their studies, but also the higher the achievement motivation, causal attribution and self-efficacy. Children with greater obesity levels have less motivation. According to these results, it is important to design actions that encourage the regular practice of physical activity, especially among girls. This should be done in different contexts, beyond the subject of Physical Education and in different populations. Interventions should take into account family and environmental factors, or the local environment and its resources

Telomere length in the two extremes of abnormal fetal growth and the programming effect of maternal arterial hypertension

We tested the hypothesis that leukocyte telomere length (LTL) is associated with birth weight in both extremes of abnormal fetal growth: small (SGA) and large for gestational age newborns (LGA). Clinical and laboratory variables of the mothers and the neonates were explored; 45 newborns with appropriate weight for gestational age (AGA), 12 SGA and 12 LGA were included. Whether the differences might be explained by variation in OBFC1 (rs9419958) and CTC1 (rs3027234) genes associated with LTL was determined. A significant association between birth weight and LTL was observed; LTL was significantly shorter in LGA newborns (1.01 ± 0.12) compared with SGA (1.73 ± 0.19) p < 0.005, mean ± SE. Maternal (Spearman R = −0.6, p = 0.03) and neonatal LTL (R = −0.25, p = 0.03) were significantly and inversely correlated with maternal history of arterial hypertension in previous gestations. Neonatal LTL was not significantly associated with either rs9419950 or rs3027234, suggesting that the association between neonatal LTL and birth weight is not influenced by genetic variation in genes that modify the interindividual LTL. In conclusion, telomere biology seems to be modulated by abnormal fetal growth; modifications in telomere length might be programmed by an adverse environment in utero.Fil: Tellechea, Mariana Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Fernández Gianotti, Tomás. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Alvariñas, Jorge. Policlínico Bancario; ArgentinaFil: González, Claudio Daniel. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Farmacología; ArgentinaFil: Sookoian, Silvia Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Pirola, Carlos José. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentin

Edu Gest: Programa de educación a mujeres con diabetes en el embarazo

La diabetes es la enfermedad metabólica de desarrollo más frecuente durante la gestación. Su prevalencia es del 10% pero está subdiagnosticada como resultado de la combinación de consulta tardía, no cumplimiento de normas de detección en mujeres con alto riesgo obstétrico en el primer nivel de atención y existencia de barreras socioeconómicas e institucionales para una derivación oportuna a un Centro de Mayor Complejidad. La Facultad de Medicina de la UNNE mediante una alianza estratégica con el Ministerio de Salud de la Provincia de Corrientes; la Municipalidad de Corrientes, Referentes Nacionales en el tema y el CENEXA. Centro de Endocrinología Experimental de Endocrinología Aplicada (UNLP-CONICET La Plata), de la Universidad de La Plata, presentó el proyecto de “Educar a mujeres con diabetes en el embarazo (EDUGEST)” a la World Diabetes Foundation logrando su aprobación y cofinanciación. El objetivo del proyecto es mejorar el diagnóstico, la calidad de atención y el tratamiento de embarazadas con diabetes gestacional (DG), capacitando al equipo de salud e implementando un programa de educación terapéutica destinado a esta población.Consejo Nacional de Investigaciones Científicas y TécnicasUniversidad Nacional del NordesteFacultad de Ciencias Médica

Education of pregnant women with gestational diabetes (EDUGEST): data collected in the recruitment period

Introducción: la prevalencia de diabetes gestacional (DG) en Argentina es de 4,7%, lo que implica mayor riesgo de desarrollar complicaciones tanto maternas como del recién nacido, prevenibles mediante un diagnóstico precoz y un tratamiento oportuno. Objetivos: promover la consulta precoz, el diagnóstico oportuno y el tratamiento adecuado mediante un programa de educación estructurado y multidisciplinario a nivel de Centros de Atención Primaria de la Salud (CAPs) y maternidades. Materiales y métodos: se reclutaron embarazadas con DG en CAPs y maternidades de Buenos Aires, Corrientes, Chaco y Ciudad Autónoma de Buenos Aires (CABA), con la participación de obstetras, diabetólogos, enfermeras, asistentes sociales, educadores, nutricionistas y médicos comunitarios. Para el diagnóstico de DG se aplicaron los criterios de la Asociación Latinoamérica de Diabetes (ALAD) y se relevaron simultáneamente hábitos nutricionales y parámetros clínicos, metabólicos y terapéuticos. También se desarrollaron cursos de educación y seguimiento durante el embarazo, parto, postparto y lactancia. Resultados: las embarazadas con DG consultaron tardíamente (la mayoría en el tercer trimestre de embarazo) y presentaron factores de riesgo para DG no prevenibles (el más frecuente fue el antecedente familiar de diabetes) y prevenibles (obesidad, hipertrigliceridemia y macrosomía) en embarazos previos. Conclusiones: el EduGest pretende interrumpir el círculo vicioso generado por la DG sobre la futura diabetes mellitus tipo 2 en la madre y el niño al promover la adopción de hábitos saludables.Introduction: in Argentina the prevalence of gestational diabetes (GD) is 4.7%, accounting for a higher risk of developing complications in both the mother and the baby which could be prevented by early diagnosis and timely treatment. Objectives: to promote early consultation, timely diagnosis and adequate treatment through a structured and multidisciplinary education Program in Primary Healthcare (PHU) and maternity (PMU) units. Materials and methods: pregnant women with DG were recruited in PHU and PMU from Buenos Aires, Corrientes, Chaco and CABA, Argentina. The program included the participation of obstetricians, diabetologists, nurses, social workers, educators, nutritionists and community doctors. The ALAD diagnostic criteria for DG were applied. Simultaneously, nutritional habits, clinical, metabolic and therapeutic parameters were recorded. Education and follow-up courses were developed during pregnancy, delivery, after delivery and breastfeeding. Results: late consultation was frequent in pregnant women with GD (mainly during the third trimester), who presented both non-preventable (the most frequent being family history of diabetes) and preventable (obesity, hypertriglyceridemia and macrosomia) risk factors for GD in previous pregnancies. Conclusions: EduGest is aimed at breaking the vicious circle of DG on the future development of type 2 diabetes in the mother and the baby by promoting the adoption of healthy habits.Instituto de Investigaciones Bioquímicas de La Plat

Education of pregnant women with gestational diabetes (EDUGEST): data collected in the recruitment period

Introducción: la prevalencia de diabetes gestacional (DG) en Argentina es de 4,7%, lo que implica mayor riesgo de desarrollar complicaciones tanto maternas como del recién nacido, prevenibles mediante un diagnóstico precoz y un tratamiento oportuno. Objetivos: promover la consulta precoz, el diagnóstico oportuno y el tratamiento adecuado mediante un programa de educación estructurado y multidisciplinario a nivel de Centros de Atención Primaria de la Salud (CAPs) y maternidades. Materiales y métodos: se reclutaron embarazadas con DG en CAPs y maternidades de Buenos Aires, Corrientes, Chaco y Ciudad Autónoma de Buenos Aires (CABA), con la participación de obstetras, diabetólogos, enfermeras, asistentes sociales, educadores, nutricionistas y médicos comunitarios. Para el diagnóstico de DG se aplicaron los criterios de la Asociación Latinoamérica de Diabetes (ALAD) y se relevaron simultáneamente hábitos nutricionales y parámetros clínicos, metabólicos y terapéuticos. También se desarrollaron cursos de educación y seguimiento durante el embarazo, parto, postparto y lactancia. Resultados: las embarazadas con DG consultaron tardíamente (la mayoría en el tercer trimestre de embarazo) y presentaron factores de riesgo para DG no prevenibles (el más frecuente fue el antecedente familiar de diabetes) y prevenibles (obesidad, hipertrigliceridemia y macrosomía) en embarazos previos. Conclusiones: el EduGest pretende interrumpir el círculo vicioso generado por la DG sobre la futura diabetes mellitus tipo 2 en la madre y el niño al promover la adopción de hábitos saludables.Introduction: in Argentina the prevalence of gestational diabetes (GD) is 4.7%, accounting for a higher risk of developing complications in both the mother and the baby which could be prevented by early diagnosis and timely treatment. Objectives: to promote early consultation, timely diagnosis and adequate treatment through a structured and multidisciplinary education Program in Primary Healthcare (PHU) and maternity (PMU) units. Materials and methods: pregnant women with DG were recruited in PHU and PMU from Buenos Aires, Corrientes, Chaco and CABA, Argentina. The program included the participation of obstetricians, diabetologists, nurses, social workers, educators, nutritionists and community doctors. The ALAD diagnostic criteria for DG were applied. Simultaneously, nutritional habits, clinical, metabolic and therapeutic parameters were recorded. Education and follow-up courses were developed during pregnancy, delivery, after delivery and breastfeeding. Results: late consultation was frequent in pregnant women with GD (mainly during the third trimester), who presented both non-preventable (the most frequent being family history of diabetes) and preventable (obesity, hypertriglyceridemia and macrosomia) risk factors for GD in previous pregnancies. Conclusions: EduGest is aimed at breaking the vicious circle of DG on the future development of type 2 diabetes in the mother and the baby by promoting the adoption of healthy habits.Fil: Gorban de Lapertosa, Silvia Beatriz. Universidad Nacional del Nordeste. Facultad de Medicina; ArgentinaFil: Alvariñas, Jorge. Hospital General de Agudos Dr. Enrique Tornú; ArgentinaFil: Elgart, Jorge Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Salzberg, Susana. Instituto Centenario; ArgentinaFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; Argentin

Guidelines for the treatment of the diabetes mellitus type 2. Argentine Society of Diabetes

Objetivos: 1) actualizar la Guía de Tratamiento de la Diabetes Mellitus tipo 2 de la Sociedad Argentina de Diabetes publicada en el año 2010; 2) proveer al equipo de salud una herramienta actualizada para el manejo terapéutico de las personas con esta patología. Materiales y métodos: se convocó a un grupo de expertos, miembros titulares de la Sociedad Argentina de Diabetes, para analizar los trabajos disponibles en distintas fuentes, clasificándolos de acuerdo a su nivel de evidencia (Tabla 2), éste podrá observarse en negrita al final del párrafo correspondiente; sobre esta base se modificó la guía 2010 actualizando sus contenidos. Se designó un comité de redacción responsable de la compaginación final del documento. Conclusiones: los cambios en el estilo de vida continúan siendo la primera opción terapéutica, la metformina es la droga de primera línea, si no existen contraindicaciones para su uso o intolerancia, cualquiera de las otras familias de fármacos antidiabéticos, la insulina y sus análogos pueden usarse como monoterapia o asociadas entre sí teniendo en cuenta sus contraindicaciones, siempre y cuando no se utilicen juntas aquellas con mecanismos de acción similar. Los algoritmos 1 y 2 pueden considerarse la síntesis de la propuesta actual, elaborada para orientar la toma de decisiones respecto del tratamiento de la DMT2.Objectives: 1) update the Guidelines for the Treatment of the Diabetes Mellitus Type 2 of the Argentine Society of Diabetes, published in 2010; 2) provide to the health team updated guidance for the therapeutic management of people with this disease. Material and methods: a group of experts, full members of the Argentine Society of Diabetes, was convened to analyze the papers available from different sources, classifying them according to their level of evidence (Table 2), written in bold at the end of the paragraph; on this basis the 2010 guideline was modified to update contents. A drafting committee responsible for the final layout of the document was appointed. Conclusions: changes in lifestyle remain the first therapeutic option, metformin is the drug of first line, if there are no contraindications for use or intolerance, any of the other families of antidiabetic drugs, insulin and insulin analogs, can be used as monotherapy or associated, taking into account their contraindications and not using together those with similar action mechanisms. Algorithms 1 and 2 can be considered the synthesis of the current proposal.Facultad de Ciencias MédicasCentro de Endocrinología Experimental y Aplicad

Metformin and pregnancy outcomes: Evidence gaps and unanswered questions

Background: Metformin is sometimes used as an alternative to insulin in gestational diabetes mellitus (GDM). It is also used to achieve ovulation in polycystic ovary syndrome (PCOS). Pre-natal exposure to metformin results from its continuation after a successful ovulation in women with PCOS, its maintenance in women with pre-gestational diabetes or the installation of metformin in GDM. Little is known about the potential consequences of metformin exposure on pregnancy outcomes and offspring development. The aim of this review is to summarize the metformin effects on pregnancy outcomes and offspring development. Gaps in the available evidence and unanswered questions are also discussed. Methods: A comprehensive literature search was carried out to identify eligible studies from MEDLINE/PubMed, EMBASE and SCIELO databases through 1995 first semester. Results: Several factors limit the effect of metformin on embryos. In contrast, placental transport of metformin is effective allowing for a higher fetal exposure; the impact of this finding remains unclear. It seems that the interruption of metformin after a pregnancy diagnosis in women with PCOS is not associated with a higher miscarriage risk and it continuation does not seem to impair the maternal metabolic prognosis or prevent emerging GDM. Conclusions: It seems to have no sense to prolong the use of metformin after a pregnancy diagnosis in women with PCOS. Patients with GDM may be treated with metformin under on judicious basis, and a careful attachment to clinical guidelines and regulations is recommended. The long-term effects of pre-natal exposure to metformin on the offspring remain uncertain.Fil: González, Claudio Daniel. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Alvariñas, Jorge. Sociedad Argentina de Diabetes; ArgentinaFil: Gonzalez Bagnes, Maria Florencia. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Di Girolamo, Guillermo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiologicas "prof. Dr. Alberto C. Taquini".; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Maternal pregestational BMI is associated with methylation of the PPARGC1A promoter in newborns.

We explored peroxisome proliferator-activated receptor-γ co-activator 1α gene (PPARGC1A), peroxisome proliferatoractivated receptor-γ gene (PPARG), and transcription factor A mitochondrial gene (Tfam) promoter DNA methylation in newborns between both extremes of abnormal fetal growth: Small (SGA) and large for gestational age (LGA) in relation to the mother’s characteristics. We further sought for the association of rs9930506 variant at FTO gene and the promoter patterns of DNA methylation in the aforementioned genes, in relation to the offspring’s birth weight. In a cross-sectional study, 88 healthy pregnant women and their babies were included. According to the offspring birth weight, there were 57 newborns with appropriate weight for gestational age (AGA), 17 SGA, and 14 LGA. After bisulphite treatment of umbilical cord genomic DNA, a real-time methylation-specific PCR was used to determine the promoter methylation status in selected CpGs. Promoter methylated DNA/unmethylated DNA ratio, expressed as mean ± s.e., was 0.82 ± 0.15 (45% of alleles) for PPARGC1A, and 0.0044 ± 0.0006 (0.4% of alleles) for Tfam. PPARG promoter was almost 100% methylated in all samples. In univariate analysis, there was no association among characteristics of the newborn and gene promoter methylation. None of the maternal features were related with the status of promoter methylation, except for a positive correlation between maternal BMI and PPARGC1A promoter methylation in umbilical cord (Pearson correlation coefficient r = 0.41, P = 0.0007). Finally, FTO rs9930506 AA homozygous in the LGA group showed decreased levels of methylated PPARGC1A in comparison with AG + GG genotypes and AGA and SGA infants. In conclusion, our findings suggest a potential role of promoter PPARGC1A methylation in metabolic programming.Fil: Gemma, Carolina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Sookoian, Silvia Cristina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Alvariñas, Jorge. Ciudad Autónoma de Buenos Aires. Policlínico Bancario. Unidad de Nutrición ; ArgentinaFil: Garcia, Silvia Ines. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Quintana, Laura Beatriz. Ciudad Autónoma de Buenos Aires. Policlínico Bancario. Unidad de Nutrición ; ArgentinaFil: Kanevsky, Diego. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: González, Claudio D.. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Farmacología; ArgentinaFil: Pirola, Carlos José. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin