Metabolic syndrome and birth risks
Nicoletta Di Simone1 – , Gloria Lalli2 – , Greta Barbaro3 –
1 – MD, PhD at Humanitas University, Milan
2 – MD at Humanitas University, Milan
3 – MD at Università Cattolica del Sacro Cuore, Rome
Corresponding Author: Nicoletta Di Simone
Metabolic syndrome is a condition characterized by the simultaneous presence of a cluster of risk factors leading to an increased cardiovascular risk. During pregnancy this syndrome has important repercussions on the maternal and fetal well-being and can cause important risks at the time of delivery. Pregestational hypertension increases the risk of preeclampsia, intrauterine fetal growth restriction and abruptio placentae. Also type II diabetes is a risk factor for preeclampsia and hypodevelopment but may also involve the appearance of fetal macrosomia and polyamnios. Fetal macrosomia is responsible for an increased risk of shoulder dystonia and polyamnios can determine the umbilical cord prolapse at the time of rupture of the membranes. Obesity is another element of metabolic syndrome. The obese pregnant patient has an increased risk of premature childbirth, she has a lower probability of response to the medical induction of labor and requires higher doses of oxytocin. In addition, the management of these patients is also complicated from an anesthesiological point of view: the placement of the peridural catheter is more difficult and they have a higher risk that it will displace, therefore getting a good epidural analgesia in these patients is not always easy. In obese patients, the risk of performing an urgent cesarian section is higher and leads to increased anaesthetic complications (tough intubation and difficult mechanical ventilation), intraoperative complications (increased bleeding and difficult fetal extraction) and post-operative (increased risk of surgical site infection). Still unclear are the effects of a dyslipidic state on pregnancy, although the change in lipidic profile is, within certain limits, physiological. Metabolic syndrome is therefore a condition that must be intercepted before pregnancy arises, as all the factors that compose it are modifiable.
Keywords: metabolic syndrome; pregnancy; obesity; hypertension; diabetes; delivery.
Available in LRIOG Nr.1 – 2022
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Chronic vulvar pain, recurrent candidiasis and familial diabetic risk
Critical factors emerged from the VuNet on 1183 women – Part II
Alessandra Graziottin1,2 – , Dania Gambini2, Elena Boero2– , Filippo Murina3,4 – , ricercatori del gruppo Vu-net
1 – Center of Gynecology and Medical Sexology, H. San Raffaele Resnati Milan
2 – Graziottin Foundation for the treatment of pain in women – Onlus
3 – Lower Genital Tract Pathology Service, V. Buzzi Hospital – University of Milan
4 – Italian Vulvodynia Onlus Association
Corresponding author: Alessandra Graziottin
The VuNet (Vulvodynia Network) Project is an observational study set out to investigate the epidemiological characteristics and comorbidities of chronic vulvar pain. It involved 1183 women, enrolled between December 2016 and November 2018 in 21 Italian medical centers. Supported by the collected evidence that 32% patients with vulvar pain were affected by recurrent vulvo- vaginal candidiasis (RVVC), this article aims at analyzing the role of Candida infections in the genesis of vulvar pain and dyspareunia, and diabetes, or familiarity for diabetes, as a key predisposing factor. The recurrent/persistent inflammation associated with an aberrant immune-allergic reaction to Candida antigens may be a strong co-factor for developing vestibulodynia in this cluster of patients. The co-prevalence of 17.5% patients reporting food or respiratory allergies suggests a parallel predisposition to the development of allergic reactions. The anamnesis revealed a higher rate of diabetes in first- and second-degree relatives of the patients, both from the mother’s (8.4%) and father’s side (8.6%), versus the Italian national prevalence of 5.3% for the population un- der 65. Genetic predisposition for diabetes alters the carbohydrate metabolism predisposing to vulvovaginal candidiasis. Collectively, our data highlight the importance of investigating metabolic vulnerabilities to diabetes, both in the patient and her family, and encourage appropriate lifestyles, including: a net reduction in the consumptions of glucose or saccharose, body weight control, and daily aerobic exercise to reduce peripheral insulin resistance. The ultimate goals are reducing predisposing factors for candidiasis, vestibulodynia and coital pain in this cluster of patients, and tailoring treatment accordingly.
Keywords: vulvovaginal candidiasis; vulvar pain; vestibolodynia; dyspareunia; diabetes.
Available in LRIOG Nr.2 – 2021
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