ORCID Profile
0000-0003-4744-1930
Current Organisation
Pontificia Universidade Catolica de Sao Paulo Faculdade de Ciências Exatas e Tecnologia
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Publications
Pelvic floor muscle dysfunction at 3D transperineal ultrasound in maternal exposure to gestational diabetes mellitus: A prospective cohort study during pregnancy
Publisher: Wiley
Date: 14-04-2022
DOI: 10.1002/NAU.24927
Abstract: This study aimed to assess, for the first time, the dynamic morphometry of pelvic floor muscles (PFM) using three‐dimensional transperineal ultrasound (3D‐TPUS) and its progression at two‐time points of gestation between women with and without gestational diabetes mellitus (GDM), and whether the PFM dysfunction is connected to GDM. The study comprised 83 consecutive pregnant women with ( n = 38) and without ( n = 45) GDM screened at 24–30 and 38–40 weeks of gestation. 3D‐TPUS and a mobility test were used to quantify PFM dynamic morphometry during maximum contraction and the Valsalva maneuver. When compared to the control group, GDM women had no significant variations in all levator hiatal dimensions at 24–30 weeks of gestation. Meanwhile, women with GDM experienced an increase in levator hiatal area (LHa) ( p 0.000) during PFM contraction and enlargement in LHa ( p 0.001) during Valsalva maneuver ( p = 0.010) at 38–40 weeks of gestation. As a result, the mobility index among GDM women had a lower value ( p = 0.000). The dynamic morphometry development of PFM in GDM women at two stages during pregnancy revealed a substantial decrease ( p = 0.000) in all LHa dimensions of contraction, distension, and mobility. Using 3D‐TPUS, we found that GDM women had a specific pattern of PFM functional changes in the third trimester of pregnancy. These initial findings revealed alterations in PFM functionality, such as decreased contractility, distensibility, or mobility. This dysfunctional PFM could contribute to the long‐term development of pelvic floor dysfunction years after a GDM pregnancy.
Reversal of diabetic-induced myopathy by swimming exercise in pregnant rats: a translational intervention study
Publisher: Springer Science and Business Media LLC
Date: 05-05-2022
DOI: 10.1038/S41598-022-10801-Z
Abstract: Gestational diabetes mellitus (GDM) plus rectus abdominis muscle (RAM) myopathy predicts long-term urinary incontinence (UI). Atrophic and stiff RAM are characteristics of diabetes-induced myopathy (DiM) in pregnant rats. This study aimed to determine whether swimming exercise (SE) has a therapeutic effect in mild hyperglycemic pregnant rats model. We hypothesized that SE training might help to reverse RAM DiM. Mild hyperglycemic pregnant rats model was obtained by a unique subcutaneous injection of 100 mg/kg streptozotocin (diabetic group) or citrate buffer (non-diabetic group) on the first day of life in Wistar female newborns. At 90 days of life, the rats are mated and randomly allocated to remain sedentary or subjected to a SE protocol. The SE protocol started at gestational day 0 and consisted of 60 min/day for 6 days/week in a period of 20 days in a swim tunnel. On day 21, rats were sacrificed, and RAM was collected and studied by picrosirius red, immunohistochemistry, and transmission electron microscopy. The SE protocol increased the fiber area and diameter, and the slow-twitch and fast-twitch fiber area and diameter in the diabetic exercised group, a finding was also seen in control sedentary animals. There was a decreased type I collagen but not type III collagen area and showed a similar type I/type III ratio compared with the control sedentary group. In conclusion, SE during pregnancy reversed the RAM DiM in pregnant rats. These findings may be a potential protocol to consider in patients with RAM damage caused by GDM.
Effectiveness of the pelvic floor muscle training on muscular dysfunction and pregnancy specific urinary incontinence in pregnant women with gestational diabetes mellitus: A systematic review protocol
Publisher: Public Library of Science (PLoS)
Date: 07-12-2020
DOI: 10.1371/JOURNAL.PONE.0241962
Abstract: There is le evidence that gestational diabetes mellitus has a direct influence on urinary incontinence and pelvic floor muscles. There are no standardized pelvic floor muscle exercise programs in the literature for the physiotherapy and differ in the type of exercise, intensity, type and duration of application, and the frequency and duration of treatment sessions. The aim of this systematic review will be to investigate that Pelvic Floor Muscle Training can prevent and/or decrease the pregnancy specific urinary incontinence in women with gestational diabetes mellitus or gestational hyperglycemia. We will perform a systematic review according to the Cochrane methodology of Randomized Controlled Trials. An overall search strategy will be developed and adapted for Embase, MEDLINE, LILACS, and CENTRAL databases, with the date of consultation until June 2020. The MeSH terms used will be "Pregnancy", "Hyperglycemia", "Diabetes Mellitus, Type 2", "Diabetes Mellitus, Type 1", "Pregnancy in Diabetics", "Diabetes, Gestational", "Urinary Incontinence", "Pelvic Floor Muscle Strength". Primary outcomes : improvement or cure of pregnancy specific urinary incontinence (which can be assessed by questionnaires, and tools such as t on test, voiding diary, urodynamic study). Secondary outcomes : improvement of pelvic floor muscle strength (pelvic floor functional assessment, perineometer, electromyography, functional ultrasonography), improved quality of life (questionnaires), presence or absence of postpartum Urinary Incontinence and adverse effects. Quality assessment by Cochrane instrument. Metanalysis if plausible, will be performed by the software Review Manager 5.3. The present study will be the first to analyze the effectiveness of pelvic floor exercises in pregnant women with Gestational Diabetes Mellitus or Hyperglycemia, who suffer from pregnancy specific urinary incontinence. Randomized Controlled Trials design will be chosen because they present the highest level of evidence. It is expected to obtain robust and conclusive evidence to support clinical practice, in addition to promoting studies on the theme and contributing to new studies. Systematic review registration: PROSPERO CRD42017065281 .
Relaxin-2 during pregnancy according to glycemia, continence status, and pelvic floor muscle function
Publisher: Springer Science and Business Media LLC
Date: 03-06-2022
DOI: 10.1007/S00192-022-05245-Y
Abstract: To investigate relaxin-2 concentration comparing gestational diabetes mellitus (GDM) and non-GDM patients during pregnancy according to urinary incontinence (UI) and pelvic function status. This is a cross-sectional study evaluating 282 pregnant women from 24 weeks of gestation. The participants were ided into two groups, non-GDM and GDM, according to American Diabetes Association's diabetes mellitus gestational threshold. In addition, according to subanalysis, both groups were sub ided according to the presence of pregnancy-specific urinary incontinence: non-GDM continent, non-GDM incontinent, GDM continent, and GDM incontinent. All participants filled in questionnaires on clinical, obstetric, and urinary continence status (International Consultation on Incontinence Questionnaire-Short Form, ICIQ-SF, and Incontinence Severity Index, ISI), followed by pelvic floor muscle evaluation by the PERFECT scheme in which strength, endurance, and speed of contractions were evaluated. Serum relaxin-2 concentrations were significantly lower in pregnant women with pregnancy-specific urinary incontinence in both non-GDM and GDM patients, but GDM showed the lowest concentration. In addition, the stratification of the groups according to pelvic floor muscle strength showed that pregnant patients with GDM and modified Oxford scale 0-2 had significantly lower levels than those who were non-GDM and GDM with Modified Oxford Scale 3-5. Relaxin-2 level was much lower in GDM incontinent pregnant women with MOS 0-2 compared to the other three groups. Lower relaxin-2 concentration was associated with the presence of pregnancy-specific urinary incontinence, but the combination of GDM, pregnancy-specific urinary incontinence, and lower levels of pelvic floor strength led to lower levels of relaxin-2 compared to the other three groups.
Related Organisations
Pontificia Universidade Catolica De Sao Paulo Faculdade De Ciências Exatas E Tecnologia
Location: Brazil
Universidade Estadual Paulista Júlio De Mesquita Filho
Location: Brazil
Related Funding Activities
No related grants have been discovered for Sthefanie Nunes.