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Characterization of gestational hyperglycemia and gestational urinary incontinence markers in the prediction of urinary incontinence 6-12 months postpartum


Literature data indicates a strong association between hyperglycemia and urinary incontinence (UI) and the increased of UI throughout the pregnancy, but do not value the binomial hyperglycemia during pregnancy and urinary incontinence during pregnancy. The prevalence of UI ranges from 25% to 50% before pregnancy and may reach up to 75% during pregnancy, with a sharp rise during pregnancy and worsened in the last months of pregnancy. The "gestational urinary incontinence" (GUI) is the involuntary urine loss that starts during pregnancy, despite the high percentage, is poorly investigated and valued during prenatal care. In Brazil, there are few studies evaluating the incidence and prevalence in population-based surveys pointing incidence of 35%.The gestational diabetes (GDM) was important for prevalence of GUI (50.8% vs. 31.6%) and UI two years after cesarean delivery (44.8% vs. 18.4%).Moreover, multivariate analysis showed that the GDM was a risk factor for the occurrence of GUI (OR 2.26; 95% CI 1.116- 4.579) and pelvic floor muscle dysfunction (PFMD) in the postpartum period (OR20.416; IC3 .548 - 117,479). The relationship between GDM, GUI, PFMD and UI two years after cesarean delivery has directed our experimental investigations in recent years. Several of these translational studies show morphological, immunohistochemical and ultrastructural changes in periurethral muscles and the rectus abdominis muscle in pregnant rats with long-term mild and short-term severe diabetes. International literature has lack evidence of this association and our research group is currently on the bench to bed in translational research, attempting the pathophysiological characterization of this binomial: GUI and gestational hyperglycemia. There is little scientific evidence that pathophysiological knowledge in the timeline between gestational hyperglycemia diagnosis associated with the GUI with increasing outcome of the UI and PFMD one to two years post-cesarean delivery. Our experimental results and the lack of similar studies in the literature indicate the need for early stage bench to bed, seeking to study the rectus abdominis muscle (RAM) and muscle recovery markers in hyperglycemic pregnant woman. The Research Ethics Committee FMB / UNESP has authorized the harvest of RAM during cesarean delivery to analyze the possible pathophysiological basis of this binomial: GUI and gestational hyperglycaemia (CAAE 41570815.0.0000.5411/protocol number 986.465 and CAAE: No 20639813.0.0000.5411 protocol number 401.058).Therefore, in face of our experimental knowledge, the questions of the Research Ethics Committee, the Perinatal Diabetes Research Centre (Projeto Infra IV/FAPESP) where hyperglycemia diagnostic tests are performed, monitoring prenatal and delivery, the follow-up of these women and the research laboratory (Experimental Research Laboratory in Gynecology and Obstetrics - LAPGO), our research group fulfils the necessary conditions to answer some questions regarding this research project: 1- Will the RAM of pregnant women with gestational hyperglycemia and GUI present morphological and extracellular matrix changes? 2- Is the CCL7 a recovery marker of urethral tissue in women with GUI and is altered in pregnant women with gestational hyperglycemia?Finally, this research project aims to: 1-Analyze the ultrastructure, protein expression, morphology and enzyme activity in the fibers of the RAM of hyperglycemic pregnant women and GUI; 2-To characterize serum CCL7 in pregnant women with gestational hyperglycemia and GUI from the 12th-18th week of pregnancy until 6-12 months postpartum. (AU)

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Scientific publications (5)
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
GIOVANA VESENTINI; REGINA EL DIB; LEONARDO AUGUSTO RACHELE RIGHESSO; FERNANDA PICULO; GABRIELA MARINI; GUILHERME AUGUSTO RAGO FERRAZ; IRACEMA DE MATTOS PARANHOS CALDERON; ANGÉLICA MÉRCIA PASCON BARBOSA; MARILZA VIEIRA CUNHA RUDGE. Pelvic floor and abdominal muscle cocontraction in women with and without pelvic floor dysfunction: a systematic review and meta-analysis. Clinics, v. 74, . (14/26852-6, 16/09710-9)
SARTORAO FILHO, CARLOS IZAIAS; PASCON BARBOSA, ANGELICA MERCIA; CUNHA RUDGE, MARILZA VIEIRA. The ``Carousel{''}: a new simulation model for assessing the female pelvic examination in medical education. International Journal of Gynecology & Obstetrics, v. 156, n. 2, . (16/09710-9)
SARTORAO FILHO, CARLOS IZAIAS; BARBOSA, ANGELICA MERCIA PASCON; CALDERON, IRACEMA DE MATTOS PARANHOS; RUDGE, MARILZA VIEIRA CUNHA. Assessment of Pelvic Floor Disorders due to the Gestational Diabetes Mellitus Using Three-Dimensional Ultrasonography: A Narrative Review. Revista Brasileira de Ginecologia e Obstetrícia, v. 44, n. 12, p. 7-pg., . (16/09710-9)
VESENTINI, GIOVANA; BARBOSA, ANGELICA M. P.; DAMASCENO, DEBORA C.; MARINI, GABRIELA; PICULO, FERNANDA; MATHEUS, SELMA M. M.; HALLUR, RAGHAVENDRA L. S.; NUNES, STHEFANIE K.; CATINELLI, BRUNA B.; MAGALHAES, CLAUDIA G.; et al. Alterations in the structural characteristics of rectus abdominis muscles caused by diabetes and pregnancy: A comparative study of the rat model and women. PLoS One, v. 15, n. 4, . (16/09710-9, 16/01743-5, 14/26852-6)
VESENTINI, GIOVANA; BARBOSA, ANGELICA M. P.; FLORIANO, JULIANA F.; FELISBINO, SERGIO L.; COSTA, SARAH M. B.; PICULO, FERNANDA; MARINI, GABRIELA; NUNES, STHEFANIE K.; REYES, DAVID R. A.; MARCONDES, JOAO P. C.; et al. Deleterious effects of gestational diabetes mellitus on the characteristics of the rectus abdominis muscle associated with pregnancy-specific urinary incontinence. Diabetes Research and Clinical Practice, v. 166, p. 12-pg., . (14/26852-6, 16/09710-9)

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