title: [Application of multidisciplinary educational program in high-risk pregnancies due to endocrine diseases].
abstract: OBJECTIVE
  to investigate the application of a multidisciplinary educational program to high-risk pregnancies due to endocrine diseases.
  
  
  METHODS
  we retrospectively evaluated the application of a multidisciplinary educational program to 185 pregnant women with endocrine diseases referred to a maternity specialized in high-risk pregnancy. All pregnant women received multidisciplinary prenatal care from a team consisting of endocrinologists, obstetricians, sonographers, nurses and dietitians. Oral and written information about healthy habits, diabetes care, use of artificial sweeteners and exercise during pregnancy was given to all patients at the first endocrine consultation. An individualized nutrition plan was prepared on the occasion of the first visit to the nutritionist. In bi-weekly and monthly endocrine and nutritional visits, respectively, information about healthy changes in lifestyle was emphasized and the weight was recorded. Adherence to physical activity and nutritional counseling was self-reported. We compared the weekly weight before and after the intervention, fetal weight at birth, rate of macrosomia and low birth weight, and frequency of cesarean delivery among the four categories of body mass index (BMI) before pregnancy (<18.5, from 18.5 to 24.9, from 25 to 29.9 and >30 kg/m²).
  
  
  RESULTS
  the main disease of referral was diabetes (84.9%). One third of the pregnant women (31.2%) were overweight and 42.5% were obese before pregnancy. Most women was first seen by the multidisciplinary team in the third trimester of pregnancy (64.1%) and 50.5% exceeded the recommended weight gain at first evaluation. Obese women exceeded the recommended weight gain in 62.5% of cases. After the intervention, the percentage of women who exceeded the recommended weekly weight gain was reduced in all categories of pre-pregnancy BMI, although a statistically significant difference was found only in the group with normal pre-pregnancy BMI (40.6 versus 21.9%, p = 0.03). At birth, average fetal weight was similar among the various BMI categories (p=0.277). Macrosomia was more frequent in women who were overweight and obese before pregnancy. Cesarean delivery was the most frequent route of delivery, regardless of pre-pregnancy BMI.
  
  
  CONCLUSIONS
  in high-risk pregnancies due to endocrine disorders, a multidisciplinary educational approach limits excessive weekly weight gain despite the advanced gestational age.
authors.affiliation: Ambulatório de Endocrinopatias, Maternidade Referência Professor José Maria de Magalhães Netto, Clínica Médica do Hospital Santa Izabel – Salvador (BA), Brasil. alinafeitosa@yahoo.com.br
authors.forename: Alina Coutinho Rodrigues
authors.initials: AC
authors.lastname: Feitosa
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Queiroz
authors.forename: Adriana Matos
authors.initials: AM
authors.lastname: Vianna
authors.forename: Minna
authors.initials: M
authors.lastname: Schleu
mesh_terms: D000328:Adult; D004700:Endocrine System Diseases / Q000628:therapy*; D005260:Female; D006801:Humans; D010348:Patient Care Team; D010353:Patient Education as Topic / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors