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Master Thesis

Diabète associé à la mucoviscidose au cours de la grossesse : caractéristiques, prise en charge et pronostic

Abstract : Introduction: In recent years, the lengthening of the life expectancy of patients with cystic fibrosis has led to the management of pregnancies more frequently in this population, often with associated diabetes. The main objective of our study was to describe the characteristics and management of diabetes during pregnancy in patients with cystic fibrosis. The secondary objectives were to see if diabetes had a pejorative impact on the course of pregnancy and the occurrence of maternal-fetal complications.
Materials and methods: We carried out a retrospective multicenter study including patients followed at the Centers of Resources and Skills of Cystic Fibrosis (CRCM) in Nice, Lyon and Marseille, from data collected on pregnancies occurring between 2005 and 2020. The patients either had pre-existing diabetes, or diagnosed during pregnancy. In a second step, this group was compared to pregnant patients, suffering from cystic fibrosis, free from diabetes (control group).
Results: The study group consisted of 24 pregnant patients with cystic fibrosis with diabetes: 15 patients had pre-pregnancy diabetes and 9 patients had gestational diabetes. 75% of patients received insulin therapy during pregnancy, 33% of gestational diabetes was insulin. The mean glycated hemoglobins during pregnancy ranged from 5.6% to 5.8%. The control group consisted of 24 pregnant patients with cystic fibrosis without diabetes. Compared to non-diabetic patients, diabetic patients were more often colonized with Pseudomonas Aeruginosa, had a higher proportion of exocrine pancreatic insufficiency, were more often carriers of the homozygous delF508 mutation, and had a lower pre-pregnancy FEV1. During pregnancy, they required more intravenous antibiotics and hospitalizations, and their overall weight gain was lower. There was no difference between the two groups with regard to occurrence of preeclampsia, term, fetal weight or need for a cesarean section. During pregnancy, FEV1 decreased significantly similarly in both groups, but returned to baseline one year postpartum.
Conclusion: Diabetes associated with cystic fibrosis appears to be associated with exocrine pancreatic insufficiency and the homozygous delF508 genotype. During pregnancy, it seems that maternal condition is impacted more severely in case of diabetes, although this may also reflect a more severe genotype or more altered lung condition. The pregnancies in these patients deserve a regular and multidisciplinary follow-up which remains to be codified.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03022339
Contributor : Bibliothèque Universitaire de Médecine Nice <>
Submitted on : Tuesday, November 24, 2020 - 5:28:33 PM
Last modification on : Wednesday, March 31, 2021 - 3:14:40 AM

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  • HAL Id : dumas-03022339, version 1

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Cloé Velin. Diabète associé à la mucoviscidose au cours de la grossesse : caractéristiques, prise en charge et pronostic. Médecine humaine et pathologie. 2020. ⟨dumas-03022339⟩

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