Transcript DIABETES AND PREGNANCY IN WOMEN FROM DEVELOPING …

OBSTETRICS – GYNECOLOGY INTEGRATED DEPARTMENT
PISA-HOSPITAL - UNIVERSITY SANITARY FIRM
S. CHIARA HOSPITAL - PISA
OGASH Academy
DIABETES AND PREGNANCY
IN WOMEN FROM
DEVELOPING COUNTRIES LIVING IN ITALY
Lorella Battini, Master on Bioethics and Education
GENERAL COORDINATOR OF OGASH INSTITUTIONS AND HOSPITALS;
CONTINENTAL (EUROPE) CHAIRMAN OF OGASH;
Prize-winner of Prof. Ioseb Jordania International Prize-2008
Prize-winner of HERA’s GOLDEN PRIZE 2006
First Level Medical Manager at Obstetrics-Gynaecology
Unit II-AOUP
(Incaricated Chief : Dr. P. Bottone, Senior Consultant: Prof. V. Facchini)
Post-graduate Advanced Course on DIABETES AND PREGNANCY
Pisa, Italy, February 22-23, 2008, Chairmen: G. Di Cianni, S. Del Prato
XVII° Statistic Dossier
Caritas/Migrantes 2007
“ I WAS STRANGER
AND YOU RECEIVED ME IN YOUR
HOMES …”
Come, You that are blessed by my
Father…Because whenever you did this
for the least important of these brothers
of mine,
You did this for Me
JESUS
The Final Judgement
Mt, 25, 34-36
ITALY AND MIGRATIONS
European Migration Network - Rapporto Caritas/Migrantes 2007
Up to Date 2007:
> 3.7 million immigrants living in Italy !
(6% of total population)
From more than 191 Countries all over the world
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Middle-East Europe (Romania, Albania and Ucraina, Polonia),
Northern Africa (Marocco, Algeria, Tunisia, Sudan, Libia)
Eastern Asia (China, Philippines)
Indiann Sub-continent (Pakistan, India, Sri Lanka).
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Women : 50%, age: 15-44 years (66%)
Foreign Neonates: 1 out of 10
The impact of “pregnancy” on developing diabetes in
Migrating Women.
PREGNANCY
Besides the Type I, Pregestational Diabetes, Women are at increased
risk for developing diabetes during pregnancy :
• The form of the disease is known as Gestational Diabetes Mellitus
(GDM) (in its various clinical patterns) and occurs because the body
cannot produce enough insulin to meet the extra needs of
pregnancy.
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Migrating Pregnant Women from Developing Countries present
often extra risks to develop altered glycemic metabolism than others
“ MAJOR RISK FOR DIABETES “
in
PREGNANT WOMEN MIGRATING FROM DEVELOPING COUNTRIES
The determinants were found to include
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nutrition transition
physical inactivity
gene-environment interaction
stress
other factors such as ethnic susceptibility
However, certain contradictory trends were also seen in some migrant
communities and have been explained by various phenomena such as :
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“ healthy migrant effect “
adherence to traditional diets.
Emerg. Themes Epidemiology v. 3, 2006
Project : “DIABETES
…to improve Communication and Mutual Understanding “
AUSL Reggio Emilia, Italy
The Tables on
Diabetes
and Pregnancy
(Prof. A. Lapolla)
Natality in the Migrants Community is
significantly higher than in Italian
Population.
Diabetes rate in Pregnancy coyld be
relevant.
12 tables translated in 14 languages,
Issues:
• how to recognize GDM ?
• What is GDM ?
• Physical exercise
• Nutrition
•Therapy
•The Post-partum period
addressed to diabetic women who would
like to have pregnancy and to the women at
risk for diabetes during pregnancy
The internet web-site:
www.modusonline.it/immigrati/
THE JOINT INTERDEPARTMENT DIABETOLOGIC-OBSTETRIC SERVICE
for DIABETES and PREGNANCY at CISANELLO HOSPITAL: “Our Experience and Results ”
(Hospital-University Department PISA-ITALY)
Diabetologists: G. Di Cianni, L. Volpe, A. Bertolotto, C.Lencioni
Gynaecologist: L. Battini
Dietologist: M. Corfini
Nurses: M. Carnevale, A. Favati, L. Tesi
Pregnant Diabetic Women from Developing
Countries at Cisanello Department (10%out of all
Patients )
12%
4%
Eastern Europe
10%
Africa
Asia
Subcontinente Indiano
74%
Pregestational Type 1 Diabetes: 2%
Ceasarean Section rate: 37.7% large for date Babies : 3%
IUGR: 13 % Mean GA at Delivery: 38 ws.
Superimposed Preeclampsia: 2% Outpts. Check Frequency : 7-15 days; Follow up post partum: 3%
Data collection: Dr Veronica Resi
FINAL MESSAGE:
“ CARE “ GOALS !
to improve the Clinical Management of Diabetic
Pregnants Migrating from Developing Countries
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Pregestational Diabetes ( type 1 > type 2 in reproductive years): improve sensibility to
pregnancy planning and early monitoring.
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Folic Acid pre-conceptional supplementation till to 12° week
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Pre and Gestational Diabetes: Careful nutritional and healthy lifestyle education
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Diabetic Ps. intensive clinical checking: every 7-15 days to verify the selfmonitoring ability and the glyco-metabolic balance without and with Insulintherapy
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Increased sensibility to postpartum glycaemic check and Breastfeeding
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Multidisciplinary integrated approach: Diabetologist, Obstetric, Dietologist
Nurse, Midwife, Cultural Mediators