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Wang QH, Liu LH, Ying H, Chen MX, Zhou CJ, Li H. Clinically significant changes in anal sphincter hiatal area in patients with gestational diabetes mellitus and pelvic organ prolapse. World J Diabetes 2024; 15:1726-1733. [PMID: 39192856 PMCID: PMC11346099 DOI: 10.4239/wjd.v15.i8.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/07/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The prevalence of pelvic organ prolapse (POP) increases with age and parity. Specifically, the prevalence of POP among women aged 20 to 39 is 9.7%, while it rises to 49% among women over 80 years old. Additionally, as the number of deliveries increases, the prevalence of POP also rises accordingly, with a rate of 12.8% for women with one delivery history, 18.7% for those with two deliveries, and 24.6% for women with three or more deliveries. It causes immense suffering for pregnant women. AIM To evaluate the relationship between the levator ani muscle's hiatus (LH) area and POP in patients with gestational diabetes mellitus (GDM) using perineal ultra-sound. METHODS The study cohort comprised 104 patients aged 29.8 ± 3.7 years who sought medical care at our institution between January 2021 and June 2023. All were singleton pregnancies consisting of 75 primiparas and 29 multiparas, with an average parity of 1.7 ± 0.5. According to the POP diagnostic criteria, the 104 subjects were divided into two groups with 52 members each: POP group (patients with GDM combined with POP) and non-POP group (patients with GDM without POP). Perineal ultrasound was used to measure differences in the anteroposterior diameter, transverse diameter, and LH area. Receiver operating characteristic curves were drawn to determine the optimal cutoff values for the LH anteroposterior diameter, transverse diameter, and area for diagnosing POP. RESULTS Statistically significant increase in the LH area, anteroposterior diameter, and lateral diameter were observed in the POP group compared with the non-POP group (P < 0.05). Both groups exhibited markedly elevated incidence rates of macrosomia and stress urinary incontinence. For the POP group, the area under the curve (AUC) for the LH area was 0.906 with a 95% confidence interval (CI): 0.824-0.988. The optimal cutoff was 13.54cm², demonstrating a sensitivity of 83.2% and a specificity of 64.4%. The AUC for the anteroposterior diameter reached 0.836 with a 95%CI: 0.729-0.943. The optimal cutoff was 5.53 cm with a sensitivity of 64.2% and a specificity of 73.4%. For the lateral diameter, its AUC was 0.568 with a 95%CI: 0.407-0.729. The optimal cutoff was 4.67 cm, displaying a sensitivity of 65.9% and a specificity of 69.3%. Logistic regression analysis unveiled that age, body weight, number of childbirths, total number of pregnancies, and gestational weight gain constituted the independent risk factors for the cooccurrence of GDM and POP. CONCLUSION Three-dimensional perineal ultrasonography of LH size and shape changes can effectively diagnose POP. Age, weight, number of births, number of pregnancies, and weight gain during pregnancy are independent risk factors affecting the cooccurrence of GDM and POP. GDM can increase the LH area in patients, and an enlarged LH leads to an increased incidence of POP.
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Affiliation(s)
- Qing-Hong Wang
- Department of Sonography, People's Hospital Affiliated to Shandong First Medical University, Jinan 271100, Shandong Province, China
| | - Li-Hua Liu
- Department of Sonography, People's Hospital Affiliated to Shandong First Medical University, Jinan 271100, Shandong Province, China
| | - Hua Ying
- Department of Sonography, People's Hospital Affiliated to Shandong First Medical University, Jinan 271100, Shandong Province, China
| | - Ming-Xu Chen
- Department of Sonography, People's Hospital Affiliated to Shandong First Medical University, Jinan 271100, Shandong Province, China
| | - Chang-Jiang Zhou
- Department of Sonography, People's Hospital Affiliated to Shandong First Medical University, Jinan 271100, Shandong Province, China
| | - Hui Li
- Department of Obstetrics and Gynecology, People's Hospital Affiliated to Shandong First Medical University, Jinan 271100, Shandong Province, China
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Sartorao Filho CI, Nunes SK, Magyori ABM, Calderon IMP, Barbosa AMP, Rudge MVC. The role of Gestational Diabetes Mellitus and pelvic floor 3D-ultrasound assessment during pregnancy predicting urinary incontinence: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:637. [PMID: 37670226 PMCID: PMC10478418 DOI: 10.1186/s12884-023-05932-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 08/17/2023] [Indexed: 09/07/2023] Open
Abstract
Postpartum urinary incontinence may have a severe impact on women's health. Despite pregnancy and parturition being the most recognized risk factors, methods to identify new pregnant predictor risk factors are needed. Our study investigated the Gestational Diabetes Mellitus, clinical and pelvic floor 3D-ultrasound markers in pregnant women as predictors for 6-18 months of urinary incontinence. This prospective cohort study included nulliparous pregnant women submitted to Gestational Diabetes Mellitus screening in the second trimester. Pelvic floor 3D Ultrasound was performed at the second and third trimesters of gestation to evaluate the pelvic floor muscles and functions. Clinical data, the ICIQ-SF, and ISI questionnaires for urinary incontinence were applied in the third trimester and 6-18 months postpartum. Univariate analysis (P < .20) to extract risk factors variables and multivariate logistic regression analysis (P < .05) to obtain the adjusted relative ratio for urinary incontinence were performed. A total of 93 participants concluded the follow-up. Using the variables obtained by univariate analysis and after adjustments for potential confounders, multivariate analysis revealed that Gestational Diabetes Mellitus exposure was a solid and independent risk factor for 6-18 months of urinary incontinence (Adjusted RR 8.08; 95%CI 1.17-55.87; P:0.034). In addition, a higher Hiatal area observed in distension maneuver from the second to third trimester was negatively associated (Adjusted RR 0.96; 95%CI 0.93-0.99; P:0.023). In conclusion, Gestational Diabetes Mellitus was positively associated with 6-18 months of urinary incontinence, and higher Hiatal area distension was negatively associated.
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Affiliation(s)
- Carlos Izaias Sartorao Filho
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Benedito Spinardi st 1440, Botucatu, Assis- São Paulo State, 19815-110, Brazil.
- Educational Foundation of Assis Municipality (FEMA), Medical School, Assis, Brazil.
| | - Sthefanie K Nunes
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Benedito Spinardi st 1440, Botucatu, Assis- São Paulo State, 19815-110, Brazil
| | - Adriely B M Magyori
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Benedito Spinardi st 1440, Botucatu, Assis- São Paulo State, 19815-110, Brazil
| | - Iracema M P Calderon
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Benedito Spinardi st 1440, Botucatu, Assis- São Paulo State, 19815-110, Brazil
| | - Angelica M P Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Benedito Spinardi st 1440, Botucatu, Assis- São Paulo State, 19815-110, Brazil
- School of Philosophy and Sciences, Department of Physiotherapy and Occupational Therapy, São Paulo State University, Marília, Sao Paulo, Brazil
| | - Marilza V C Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Benedito Spinardi st 1440, Botucatu, Assis- São Paulo State, 19815-110, Brazil
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Wang Q, Wu X, Jia Y, Zhang D, Sun X, Wang J. Gestational diabetes mellitus and pelvic floor function 6 weeks postpartum in Chinese women. Int Urogynecol J 2023; 34:1619-1626. [PMID: 36651966 DOI: 10.1007/s00192-022-05438-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/02/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION AND HYPOTHESIS With the significant increase in its incidence, gestational diabetes mellitus (GDM) has received growing attention for its effect on pelvic floor function. This study was aimed at investigating the association of GDM with pelvic floor function and diastasis recti abdominis (DRA) in postpartum women. METHODS This is a retrospective cohort study. At 6 weeks postpartum, 1,133 postpartum women with vaginal delivery underwent routine examinations including measurement of the pelvic floor muscle (PFM) strength and endurance, determination of the stress urinary incontinence (SUI) by questionnaire, quantification of pelvic organ prolapse (POP) and assessment of DRA. Statistical analysis was performed using binary logistic regression and multiple linear regression analysis. RESULTS One hundred and seventy-six (176) of the 1,133 women were confirmed to be suffering from GDM, with a rate of 15.53% (176 out of 1,133). The age and pre-pregnancy body mass index of the GDM group were significantly higher than those without GDM (p < 0.05). The GDM group was more likely to have smaller gestational age and a higher chance of having to undergo a lateral episiotomy. No statistically significant differences are found in PFM endurance (B: -0.025, p = 0.462) or PFM strength (B: -0.001, p = 0.979) between women with and without GDM. And these two groups are not significantly different in terms of the prevalence of SUI (19.3% vs 20.4%), POP (35.8% vs 37.5%) and DRA (29.0% vs 25.8%; p > 0.05). CONCLUSIONS Pelvic floor muscle function and SUI/POP/DRA prevalence of women at 6 weeks postpartum are not significantly affected by GDM.
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Affiliation(s)
- Qing Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, No.11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing, 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
- Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China
| | - Xiaotong Wu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, No.11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing, 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
- Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China
| | - Yuanyuan Jia
- Department of Obstetrics and Gynecology, Peking University People's Hospital, No.11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing, 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
- Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China
| | - Di Zhang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, No.11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing, 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
- Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China
| | - Xiuli Sun
- Department of Obstetrics and Gynecology, Peking University People's Hospital, No.11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing, 100044, China.
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing, China.
- Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China.
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, No.11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing, 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
- Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China
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Alves FCB, de Oliveira RG, Reyes DRA, Garcia GA, Floriano JF, Shetty RHL, Mareco EA, Dal-Pai-Silva M, Payão SLM, de Souza FP, Witkin SS, Sobrevia L, Barbosa AMP, Rudge MVC. Transcriptomic Profiling of Rectus Abdominis Muscle in Women with Gestational Diabetes-Induced Myopathy: Characterization of Pathophysiology and Potential Muscle Biomarkers of Pregnancy-Specific Urinary Incontinence. Int J Mol Sci 2022; 23:12864. [PMID: 36361671 PMCID: PMC9658972 DOI: 10.3390/ijms232112864] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 08/27/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is recognized as a "window of opportunity" for the future prediction of such complications as type 2 diabetes mellitus and pelvic floor muscle disorders, including urinary incontinence and genitourinary dysfunction. Translational studies have reported that pelvic floor muscle disorders are due to a GDM-induced-myopathy (GDiM) of the pelvic floor muscle and rectus abdominis muscle (RAM). We now describe the transcriptome profiling of the RAM obtained by Cesarean section from GDM and non-GDM women with and without pregnancy-specific urinary incontinence (PSUI). We identified 650 genes in total, and the differentially expressed genes were defined by comparing three control groups to the GDM with PSUI group (GDiM). Enrichment analysis showed that GDM with PSUI was associated with decreased gene expression related to muscle structure and muscle protein synthesis, the reduced ability of muscle fibers to ameliorate muscle damage, and the altered the maintenance and generation of energy through glycogenesis. Potential genetic muscle biomarkers were validated by RT-PCR, and their relationship to the pathophysiology of the disease was verified. These findings help elucidate the molecular mechanisms of GDiM and will promote the development of innovative interventions to prevent and treat complications such as post-GDM urinary incontinence.
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Affiliation(s)
- Fernanda Cristina Bergamo Alves
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, Brazil
| | - Rafael Guilen de Oliveira
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, Brazil
| | - David Rafael Abreu Reyes
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, Brazil
| | - Gabriela Azevedo Garcia
- Postgraduate Program in Materials Science and Technology (POSMAT), School of Sciences, São Paulo State University (UNESP), Bauru 17033-360, Brazil
| | - Juliana Ferreira Floriano
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, Brazil
| | - Raghavendra Hallur Lakshmana Shetty
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, Brazil
- Center for Biotechnology, Pravara Institute of Medical Sciences (Deemed to be University), Rahata Taluk, Ahmednagar District, Loni 413736, India
| | - Edson Assunção Mareco
- Environment and Regional Development Graduate Program, University of Western São Paulo (UNOESTE), Presidente Prudente 19050-680, Brazil
| | - Maeli Dal-Pai-Silva
- Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-689, Brazil
| | | | | | - Steven S. Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY 10065, USA
- Laboratory of Virology, Institute of Tropical Medicine, University of Sao Paulo Faculty of Medicine, São Paulo 05403-000, Brazil
| | - Luis Sobrevia
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, Brazil
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
- Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, E-41012 Seville, Spain
- Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD 4029, Australia
- Department of Pathology and Medical Biology, University of Groningen, 9713GZ Groningen, The Netherlands
- Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey 64710, Mexico
| | - Angélica Mércia Pascon Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, Brazil
- Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marilia 17525-900, Brazil
| | - Marilza Vieira Cunha Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, Brazil
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Prudencio CB, Nunes SK, Pinheiro FA, Sartorão Filho CI, Nava GTDA, Salomoni SE, Pedroni CR, Rudge MVC, Barbosa AMP. Gestational diabetes is associated with alteration on pelvic floor muscle activation pattern during pregnancy and postpartum: Prospective cohort using electromyography assessment. Front Endocrinol (Lausanne) 2022; 13:958909. [PMID: 36277705 PMCID: PMC9582526 DOI: 10.3389/fendo.2022.958909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objective Gestational diabetes mellitus (GDM) is a comorbidity which may cause acute and lifelong disorders to mother and child. Alterations in muscular and connective tissues have been associated with GDM in translation studies, characterizing gestational diabetic myopathy. Pregnancy-specific urinary incontinence and sexual disabilities, disorders that depend on the pelvic floor muscle (PFM) integrity, are also associated with GDM both during and after pregnancy. The aim was to compare PFM activation patterns between GDM and non-GDM women from 24-30 gestational weeks to 18-24 months postpartum during a standard clinical test during gestation and postpartum. Methods We conducted a prospective three-time-point cohort study from gestation (24-30 weeks-T1, and 36-38 weeks-T2) to 18-24 months postpartum (T3). PFM electromyography was recorded in primigravida or primiparous women with one previous elective c-section with or without the diagnosis of GDM according to the American Diabetes Association criteria. A careful explanation of the muscle anatomy and functionality of the PFM was given to participants before EMG assessment. The outcome measures were PFM activation patterns assessed during pregnancy and postpartum, comparing intra and between groups. PFM activation patterns were assessed by normalized electromyography signal at rest and during 1-second (sec) phasic, 10-sec hold, and 60-sec sustained contractions. Results Demographic and obstetric data showed homogeneity between groups. The GDM group achieved peak PFM EMG amplitudes similarly to the non-GDM group, but they took longer to return to baseline levels during the ~1-sec contraction (flicks). During 10-sec hold contractions, the GDM group sustained lower levels of PFM activation than the non-GDM group at both 36-38 weeks of gestation and 18-24 months postpartum when compared to the non-GDM group. Conclusion The results suggest that GDM impaired PFM control mainly on 1-sec flicks and 10-sec hold contraction, which appears to develop during late pregnancy and extends long-term postpartum. This motor behavior may play a role on pelvic floor dysfunctions.
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Affiliation(s)
- Caroline Baldini Prudencio
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | - Sthefanie Kenickel Nunes
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | - Fabiane Affonso Pinheiro
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | - Carlos Izaias Sartorão Filho
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | | | | | | | - Marilza Vieira Cunha Rudge
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | - Angélica Mércia Pascon Barbosa
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
- São Paulo State University (Unesp), School of Philosophy and Sciences, Marilia, Brazil
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Prudencio CB, Nunes SK, Pinheiro FA, Filho CIS, Antônio FI, de Aquino Nava GT, Rudge MVC, Barbosa AMP. Relaxin-2 during pregnancy according to glycemia, continence status, and pelvic floor muscle function. Int Urogynecol J 2022; 33:3203-3211. [PMID: 35657397 DOI: 10.1007/s00192-022-05245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS 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. METHODS This is a cross-sectional study evaluating 282 pregnant women from 24 weeks of gestation. The participants were divided 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 subdivided 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
| | - Sthefanie Kenickel Nunes
- Postgraduate Program on Tocogynecology, São Paulo State University (UNESP), São Paulo, Botucatu, Brazil
| | - Fabiane Affonso Pinheiro
- Postgraduate Program on Tocogynecology, São Paulo State University (UNESP), São Paulo, Botucatu, Brazil
| | | | - Flávia Ignácio Antônio
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Guilherme Thomaz de Aquino Nava
- Department of Physical Education, Institute of Biosciences of Rio Claro, São Paulo State University (UNESP), São Paulo, Rio Claro, Brazil
| | | | - Angélica Mércia Pascon Barbosa
- Postgraduate Program on Tocogynecology, São Paulo State University (UNESP), São Paulo, Botucatu, Brazil. .,School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
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Catinelli BB, Rossignoli PS, Floriano JF, Carr AM, de Oliveira RG, Dos Santos NJ, Úbeda LCC, Spadella MA, Hallur RLS, Sobrevia L, Felisbino SL, Calderon IMP, Barbosa AMP, Rudge MVC. Reversal of diabetic-induced myopathy by swimming exercise in pregnant rats: a translational intervention study. Sci Rep 2022; 12:7375. [PMID: 35513450 PMCID: PMC9072313 DOI: 10.1038/s41598-022-10801-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/29/2022] [Indexed: 11/09/2022] Open
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.
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Affiliation(s)
- Bruna B Catinelli
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Patrícia S Rossignoli
- Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marília, São Paulo, Brazil
| | - Juliana F Floriano
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Aline M Carr
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Rafael G de Oliveira
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Nilton J Dos Santos
- Laboratory of Extracellular Matrix Biology, Department of Structural and Functional Biology, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Department of Structural and Functional Biology, Institute of Biology (IB), UNICAMP, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Lara C C Úbeda
- University of Marília (UNIMAR), Marília, São Paulo, Brazil
| | | | - Raghavendra L S Hallur
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Pravara Institute of Medical Sciences (Deemed to be University), Loni, Rahata Taluk, Ahmednagar District, Maharashtra, 413736, India
| | - Luis Sobrevia
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024, Santiago, Chile
- Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, 41012, Seville, Spain
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD, 4029, Australia
- Division of Pathology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ, Groningen, The Netherlands
| | - Sérgio L Felisbino
- Laboratory of Extracellular Matrix Biology, Department of Structural and Functional Biology, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Iracema M P Calderon
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Angélica M P Barbosa
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marília, São Paulo, Brazil
| | - Marilza V C Rudge
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.
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Pinheiro FA, Sartorão Filho CI, Prudencio CB, Nunes SK, Pascon T, Hallur RLS, Takano L, Enriquez EMA, Catinelli BB, Carr AM, Junginger B, Rudge MVC, Barbosa AMP. Pelvic floor muscle dysfunction at 3D transperineal ultrasound in maternal exposure to gestational diabetes mellitus: A prospective cohort study during pregnancy. Neurourol Urodyn 2022; 41:1127-1138. [PMID: 35419878 DOI: 10.1002/nau.24927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/31/2022] [Accepted: 03/15/2022] [Indexed: 11/12/2022]
Abstract
AIM 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Fabiane A Pinheiro
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Carlos I Sartorão Filho
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil.,Department of Medical Health, Medical School, Fundação Educacional do Município de Assis (FEMA, Assis Municipality Educational Foundation (FEMA), Assis, São Paulo State, Brazil
| | - Caroline B Prudencio
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Sthefanie K Nunes
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Tawana Pascon
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Ragavendra L S Hallur
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil.,Center for Biotechnology, Pravara Institute of Medical Sciences (Deemed to be University), Loni, Maharashtra, India
| | - Luis Takano
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil.,Department of Medical Health, Medical School, Fundação Educacional do Município de Assis (FEMA, Assis Municipality Educational Foundation (FEMA), Assis, São Paulo State, Brazil
| | - Eusébio M A Enriquez
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Bruna B Catinelli
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Aline M Carr
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Baerbel Junginger
- Department of Gynecology, Pelvic Floor Center Charitè, Charitè University Hospital, Berlin, Germany
| | - Marilza V C Rudge
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Angélica M P Barbosa
- Postgraduate Program on Tocogynecology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil.,Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marilia, São Paulo State, Brazil
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Floriano JF, Emanueli C, Vega S, Barbosa AMP, Oliveira RGD, Floriano EAF, Graeff CFDO, Abbade JF, Herculano RD, Sobrevia L, Rudge MVC. Pro-angiogenic approach for skeletal muscle regeneration. Biochim Biophys Acta Gen Subj 2022; 1866:130059. [PMID: 34793875 DOI: 10.1016/j.bbagen.2021.130059] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/01/2021] [Indexed: 12/19/2022]
Abstract
The angiogenesis process is a phenomenon in which numerous molecules participate in the stimulation of the new vessels' formation from pre-existing vessels. Angiogenesis is a crucial step in tissue regeneration and recovery of organ and tissue function. Muscle diseases affect millions of people worldwide overcome the ability of skeletal muscle to self-repair. Pro-angiogenic therapies are key in skeletal muscle regeneration where both myogenesis and angiogenesis occur. These therapies have been based on mesenchymal stem cells (MSCs), exosomes, microRNAs (miRs) and delivery of biological factors. The use of different calls of biomaterials is another approach, including ceramics, composites, and polymers. Natural polymers are use due its bioactivity and biocompatibility in addition to its use as scaffolds and in drug delivery systems. One of these polymers is the natural rubber latex (NRL) which is biocompatible, bioactive, versatile, low-costing, and capable of promoting tissue regeneration and angiogenesis. In this review, the advances in the field of pro-angiogenic therapies are discussed.
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Affiliation(s)
- Juliana Ferreira Floriano
- São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo 18.618-687, Brazil; National Heart and Lung Institute, Imperial College London, London, UK.
| | - Costanza Emanueli
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sofia Vega
- São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo 18.618-687, Brazil; Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | | | | | | | | | - Joelcio Francisco Abbade
- São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo 18.618-687, Brazil
| | | | - Luis Sobrevia
- São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo 18.618-687, Brazil; Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville E-41012, Spain; University of Queensland, Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD, 4029, Queensland, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, 9713GZ Groningen, the Netherlands.
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10
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Pelvic floor muscle training and postural balance in elderly women: An exploratory single arm trial. J Bodyw Mov Ther 2022; 29:279-285. [DOI: 10.1016/j.jbmt.2021.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/12/2021] [Accepted: 09/24/2021] [Indexed: 12/11/2022]
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11
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Vesentini G, Barbosa AMP, Floriano JF, Felisbino SL, Costa SMB, Piculo F, Marini G, Nunes SK, Reyes DRA, Marcondes JPC, Hallur RLS, Rozza AL, Magalhães CG, Costa R, Abbade JF, Corrente JE, Calderon IMP, Matheus SMM, Rudge MVC. Deleterious effects of gestational diabetes mellitus on the characteristics of the rectus abdominis muscle associated with pregnancy-specific urinary incontinence. Diabetes Res Clin Pract 2020; 166:108315. [PMID: 32679058 DOI: 10.1016/j.diabres.2020.108315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/05/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
Abstract
AIMS To evaluate the effects of gestational diabetes mellitus (GDM) on the structural characteristics of the rectus abdominis muscle (RAM) and its indirect effects on pregnancy-specific urinary incontinence (PSUI). METHODS A total of 92 pregnant women were divided into four groups, according to their clinical conditions: non-GDM continent, non-GDM associated PSUI, GDM continent and GDM associated PSUI. The muscle morphometry (histochemistry and immunohistochemistry) for the fiber types and collagen fiber distribution, the ultrastructural analysis (transmission electron microscopy), the protein expression of fiber types and calcium signaling (Western blotting), and the content of types I and III collagen fiber (ELISA) in RAM collected at delivery were assessed. RESULTS The GDM groups presented a significantly increased number of slow fibers and slow-twitch oxidative fiber expression; decreased fiber area, number of fast fibers, and area of collagen; an increase in central nuclei; ultrastructural alterations with focal lesion areas such as myeloid structures, sarcomere disorganization, and mitochondrial alteration. The PSUI groups presented a considerable decrease in types I and III collagen contents and the localization of collagen fiber. CONCLUSIONS Our data reveal that GDM causes morphological, biochemical and physiological changes in the RAM, and this might predispose women to PSUI.
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Affiliation(s)
- Giovana Vesentini
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Angélica M P Barbosa
- São Paulo State University (UNESP), School of Philosophy and Sciences, Department of Physical Therapy and Occupational Therapy, Marilia, São Paulo State, Brazil
| | - Juliana F Floriano
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Sérgio L Felisbino
- São Paulo State University (UNESP), Institute of Biosciences, Department of Morphology, Botucatu, São Paulo State, Brazil
| | - Sarah M B Costa
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Fernanda Piculo
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Gabriela Marini
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil; Universidade Sagrado Coração, Department of Health Sciences, Bauru, São Paulo, Brazil
| | - Sthefanie K Nunes
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - David R A Reyes
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - João P C Marcondes
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Raghavendra L S Hallur
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Ariane L Rozza
- São Paulo State University (UNESP), Institute of Biosciences, Department of Morphology, Botucatu, São Paulo State, Brazil
| | - Cláudia G Magalhães
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Roberto Costa
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Joelcio F Abbade
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - José E Corrente
- São Paulo State University (UNESP), Institute of Biosciences, Biostatistics Department, Botucatu, São Paulo, Brazil
| | - Iracema M P Calderon
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Selma M M Matheus
- São Paulo State University (UNESP), Institute of Biosciences, Department of Anatomy, Botucatu, São Paulo State, Brazil
| | - Marilza V C Rudge
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil.
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