DIABETES AND PREGNANCY IN WOMEN FROM DEVELOPING COUNTRIES LIVING IN ITALY

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DIABETES AND PREGNANCY IN WOMEN FROM DEVELOPING
COUNTRIES LIVING IN ITALY
OBSTETRICS GYNECOLOGY INTEGRATED DEPARTMENT
PISA-HOSPITAL - UNIVERSITY SANITARY FIRM S.
CHIARA HOSPITAL - PISA
OGASH Academy

• 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 HERAs 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
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XVII Statistic Dossier Caritas/Migrantes 2007
I WAS STRANGER AND YOU RECEIVED ME IN YOUR
HOMES
Come, You that are
blessed by my FatherBecause 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
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ITALY AND MIGRATIONS
European Migration Network - Rapporto
Caritas/Migrantes 2007

• 
  Up to Date 2007
• gt 3.7 million immigrants living in
  Italy !
• (6 of total
  population)?
• From more than
  191 Countries all over the world
• 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).
• Women 50, age 15-44 years (66)?
• Foreign Neonates 1 out of 10

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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. 
• Migrating Pregnant Women from Developing
  Countries present often extra risks to develop
  altered glycemic metabolism than others

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MAJOR RISK FOR DIABETES in PREGNANT
WOMEN MIGRATING FROM DEVELOPING COUNTRIES

• The determinants were found to include
• 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
• healthy migrant effect
• adherence to traditional diets.

Emerg. Themes Epidemiology v. 3, 2006
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Project DIABETES to improve Communication
and Mutual Understanding

AUSL Reggio Emilia, Italy
Natality in the Migrants Community is
significantly higher than in Italian Population.
Diabetes rate in Pregnancy coyld be relevant.
The Tables on Diabetes and Pregnancy (Prof. A.
Lapolla)
12 tables translated in 14 languages,
addressed to diabetic women who would like to
have pregnancy and to the women at risk for
diabetes during pregnancy

• Issues
• how to recognize GDM ?
• What is GDM ?
• Physical exercise
• Nutrition
• Therapy
• The Post-partum period

The internet web-site www.modusonline.it/immigrat
i/
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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
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
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FINAL MESSAGE CARE GOALS !to
improve the Clinical Management of Diabetic
Pregnants Migrating from Developing Countries

• Pregestational Diabetes ( type 1 gt type 2 in
  reproductive years) improve sensibility to
  pregnancy planning and early monitoring.
• Folic Acid pre-conceptional supplementation till
  to 12 week
• Pre and Gestational Diabetes Careful nutritional
  and healthy lifestyle education
• Diabetic Ps. intensive clinical checking every
  7-15 days to verify the self-monitoring ability
  and the glyco-metabolic balance without and with
  Insulin-therapy
• Increased sensibility to postpartum glycaemic
  check and Breastfeeding
• Multidisciplinary integrated approach
  Diabetologist, Obstetric, Dietologist Nurse,
  Midwife, Cultural Mediators