Introdução: As gestantes são particularmente vulneráveis a problemas relacionados a medicamentos (PRMs), principalmente as de alto risco com quadros de diabetes mellitus (DM) e a diabetes mellitus gestacional (DMG). Apesar da sua relevância, são escassos dados sobre a frequência, tipo e causa da insulinoterapia em gestantes hospitalizadas. Objetivo: caracterizar os PRM associados a insulinoterapia em gestantes hospitalizadas segundo a frequência, tipo e causa. Método: Coorte prospectivo (set/2019 a jun/2022) que incluiu 547 gestantes hospitalizadas em acompanhamento diário. Os problemas relacionados à terapia anti-hipertensiva foram classificados de acordo com as diretrizes da Pharmaceutical Care Network Europe (PCNE v 9.0). Os dados foram apresentados descritivamente e a comparação entre a ocorrência de PRM frente ao tipo de insulina foi avaliada via teste do qui-quadrado (Stata v 15.0). Resultados: Durante o período de estudo, 320 (58,5%) gestantes apresentaram quadros de diabetes sendo 32,2% gestacional e 26,3% mellitus. Foram identificados 163 PRM em 201 pacientes diabéticas (63,8%), média de 0,8 ± 0,8 PRM por paciente. Foram identificadas prescrições de insulina humana regular (62,1%), insulina humana NPH (35,3%) e insulinas análogas (2,6%). A maioria dos PRMs foram relacionados à inefetividade terapêutica (144, 88,3%), sobretudo relacionada a seleção da dose. A ocorrência de hipoglicemia foi reduzida (7, 4,3% dos PRMs). Não houve diferença entre a ocorrência de PRM de inefetividade quanto aos diferentes tipos de insulinas (p=0,732): análogas (100%) vs NPH (89%) vs regular (85,5%). As primeiras 48h de tratamento concentram 62,7 dos PRMs, decrescendo para 10,2% no terceiro e quarto dia. Conclusão: Os problemas relacionados à insulinoterapia são frequentes em gestantes hospitalizadas nas primeiras 48h, sobretudo relacionado a inefetividade terapêutica associada à seleção de dose inadequada. São raros eventos hipoglicêmicos.
Notas
O registro foi originalmente publicado em português. A versão em inglês foi traduzida com o apoio de inteligência artificial.
Abstract
Introduction: Pregnant women, especially those at high risk with conditions like diabetes mellitus (DM) and gestational diabetes mellitus (GDM), are particularly vulnerable to medication-related problems (MRPs). Despite their significance, there is limited data regarding the frequency, type, and causes of insulin therapy-related MRPs among hospitalized pregnant women. Objective: The aim of this study was to characterize insulin therapy-related MRPs in hospitalized pregnant women, focusing on their frequency, types, and causes. Method: A prospective cohort study was conducted from September 2019 to June 2022, involving 547 hospitalized pregnant women under daily monitoring. Medication-related problems were classified according to the Pharmaceutical Care Network Europe (PCNE v 9.0) guidelines. Data were presented descriptively, and the occurrence of MRPs across different insulin types was compared using the chi-square test (Stata v 15.0). Results: During the study period, 320 (58.5%) pregnant women had diabetes, with 32.2% having gestational diabetes and 26.3% having pre-existing diabetes mellitus. A total of 163 MRPs were identified in 201 diabetic patients (63.8%), averaging 0.8 ± 0.8 MRPs per patient. Prescriptions included regular human insulin (62.1%), NPH human insulin (35.3%), and insulin analogs (2.6%). The majority of MRPs were related to therapeutic ineffectiveness (88.3%), primarily attributed to dose selection. The occurrence of hypoglycemia was minimal (7 cases, 4.3% of MRPs). There was no significant difference in the occurrence of ineffectiveness-related MRPs among different insulin types (p=0.732): analogs (100%) vs NPH (89%) vs regular (85.5%). The first 48 hours of treatment accounted for 62.7% of MRPs, decreasing to 10.2% on the third and fourth days. Conclusion: Insulin therapy-related MRPs are frequent in hospitalized pregnant women, particularly within the first 48 hours, mainly due to ineffective therapy associated with inadequate dose selection. Hypoglycemic events are rare.
Notes
The record was originally published in Portuguese. The English version was translated with the support of artificial intelligence.
