Desfechos perinatais em mulheres gestantes com diagnóstico prévio de diabetes mellitus tipo 2 tratadas em maternidade pública durante a pandemia covid-19

Abstract

The prevalence of preexisting diabetes in pregnancy has grown in the last decades, primarily due to a marked rise in the worldwide prevalence of type 2 diabetes (T2DM). In Brazil, there are 6.9% of adults living with T2DM. These numbers are largely related to rising rates of obesity and unhealthy diets. Pregnancy in women with T2DM is associated with a high risk of unfavorable maternal and fetal outcomes. The COVID-19 pandemic has made it difficult to access prenatal care. Due to the high risk of complications, this population needs accessible and specialized care. Objective: To describe the profile of pregnant women with T2DM followed in a specialized service, during the COVID-19 pandemic. Methodology: Descriptive and retrospective study, with data collection from the medical records of pregnant women with T2DM attended at the diabetology outpatient clinic in a universitary maternity hospital, between march 2020 and march 2023. Results: 192 medical records of all pregnant women assisted due to DM using insulin since the beginning of pregnancy were reviewed. We excluded 43 with diagnosis of GDM, 47 with overt diabetes, 29 with type 1 diabetes and 2 with atypical DM. We included 71 pregnant women (67,3%) with a diagnosis of T2DM. Average age was 33.9 (19-49) years old, 81.4% self-reported non-white skin color and 61.4% were married. Schooling years were less than 9 in 25,6%; 50,7% between 9 and 12 and 11,26 % over 12. Mean pregestational BMI were 31.5 (19-44.9) kg/m2. Average gestational age (GA) in the first medical appointment was 15 (6+1 to 31+4 weeks) weeks. We found that 54,9% gained weight above recommended, 33,8% complicated with preeclampsia and 87% had cesarean deliveries. We found neonatal complications in 29% of pregnancies: 1,4 % fetal malformation, 18 % LGA babies and 8,4% SGA, 16,9% preterms, 9% neonatal hypoglycemia, 14% admitted in neonatal intensive care and 5,4% stillbirth. Conclusion: Pregnant women with T2DM have late access to specialized prenatal care, gain excessive weight and are at high risk of hypertensive complications. The prevalence of complications is also high in the offspring. The role of the COVID-19 pandemic in worsening perinatal outcomes in this high-risk population should be evaluated in future studies.