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Introdução: A incidência de diabetes na gestação aumenta em todo o mundo. O descontrole glicêmico pode desencadear desfechos maternos, fetais e neonatais desfavoráveis. Quando o tratamento inicial com atividade física e dieta hipocalórica falha, medidas farmacológicas são insulina e/ou hipoglicemiantes orais. O uso da insulina é amplamente difundido e aceito no meio clínico. Os hipoglicemiantes orais, como a metformina, usados de forma mais tímida, mostram resultados promissores no meio científico. Objetivo: Entender e refletir sobre o uso da metformina durante a gestação no serviço de Pré-Natal de Alto Risco do HC-UFMG, comparando-o à literatura. Pacientes e métodos: Acompanhamento das gestantes diabéticas nas consultas de Endocrinologia do HC-UFMG que fizeram uso de metformina, entre os meses de dezembro de 2015 e junho de 2016. Resultados e discussão: Um total de sete pacientes tiveram indicação do uso da metformina durante a gravidez. Os achados seguiram tendência descrita na literatura. A maioria das diabéticas chegam ao Pré-Natal do HC-UFMG com metformina de uso prévio suspensa pelo serviço de origem. As pacientes do estudo apresentavam resistência à insulina prévia à gestação e já tinham feito uso de metformina. Nenhuma paciente apresentou efeito colateral, seguindo tendência descrita na literatura de que, quando existentes, e normalmente gastrointestinais, esses efeitos desaparecem ao longo do tempo de uso. Os profissionais sentem-se muitas vezes mais seguros com a introdução da metformina após comprovação de morfologia fetal normal ao ultrassom. O uso oral da metformina é melhor recebido pela paciente que a aplicação injetável da insulina. Os controles glicêmicos do estudo conseguiram levar as pacientes ao termo ou até que outra comorbidade associada determinasse a necessidade da antecipação do parto, como pré-eclâmpsia. O ganho de peso durante a gravidez foi na maioria dos casos dentro da faixa recomendável considerando o IMC pré-gestacional. Conclusão: A literatura afirma que a metformina durante a gravidez mostra-se segura para o binômio mãe-feto no curto prazo e é eficaz. Apesar disso, a metformina é ainda pouco usada nos serviços de pré-natal no Brasil, mesmo no HC-UFMG. É recomendável que haja integração entre os serviços de assistência à gestante, com contato da rede básica a atualizações sobre metformina praticadas na rede especializada. A tendência dos países desenvolvidos é regulamentar tal fármaco de fácil utilização pela paciente, segurança na prescrição, na administração e no controle dos efeitos glicêmicos, além de melhor logística de transporte e armazenamento. Mostra-se urgente a realização de estudos clínicos brasileiros que embasem o uso amplo da metformina na gravidez. Introduction: The incidence of diabetes in pregnancy increases worldwide. Glycemic uncontrol can trigger unfavorable maternal, fetal and neonatal outcomes. When the initial treatment with physical activity and hypocaloric diet fails, pharmacological measures are insulin and / or oral hypoglycemic agents. The use of insulin is widely diffused and accepted in the clinical setting. Oral hypoglycemic agents, such as metformin, used more timidly, show promising results in the scientific setting. Objective: To understand and reflect on the use of metformin during pregnancy in the HC-UFMG high-risk prenatal service, comparing it to the literature. Patients and methods: Follow-up of diabetic pregnant women at the HC-UFMG endocrinology clinic, who used metformin between December 2015 and June 2016. Results and discussion: A total of seven patients had been indicated for the use of metformin during pregnancy. The findings followed a trend described in the literature. Most of the diabetic pregnants arrive at HC-UFMG with metformin of previous use suspended by the service of origin. Patients in the study had insulin resistance prior to gestation and had already taken metformin. No patient presented side effects, following a trend described in the literature that, when present, and usually gastrointestinal, these effects disappear along the time of use. Professionals are often safer with the introduction of metformin after evidence of normal fetal morphology on ultrasound. The oral use of metformin is better received by the patient than the injectable application of insulin. The study's glycemic controls succeeded in bringing the patients to term or until another associated comorbidity determined the need for early delivery, such as pre-eclampsia. Weight gain during pregnancy was in most cases within the recommended range considering pre-gestational BMI. Conclusion: The literature states that metformin during pregnancy is safe for the mother-fetus binomial in the short term and is effective. Despite this, metformin is still rarely used in prenatal services in Brazil, even in HCUFMG. It is recommended that there be integration between services of assistance to pregnant women, with contact of the basic network with updates on metformin practiced in the specialized network. The tendency of developed countries is to regulate such a patient-friendly drug, safely on prescription, administration and control of glycemic effects, as well as better transportation and storage logistics. It is urgent to carry out Brazilian clinical studies that support the widespread use of metformin in pregnancy.

Objective To evaluate the association of Doppler of uterine artery and flow-mediated dilation of brachial artery (FMD) in the assessment of placental perfusion and endothelial function to predict preeclampsia. Materials and Methods A total of 91 patients considered as at risk for developing preeclampsia were recruited at the prenatal unit of the authors' institution. All the patients underwent FMD and Doppler of uterine arteries between their 24th and 28th gestational weeks. Calculations of sensitivity and specificity for both isolated and associated methods were performed. Results Nineteen out of the 91 patients developed preeclampsia, while the rest remained normotensive. Doppler flowmetry of uterine arteries with presence of bilateral protodiastolic notch had sensitivity of 63.1% and specificity of 87.5% for the prediction of preeclampsia. Considering a cutoff value of 6.5%, FMD showed sensitivity of 84.2% and specificity of 73.6%. In a parallel analysis, as the two methods were associated, sensitivity was 94.2% and specificity, 64.4%. Conclusion The association of Doppler study of uterine arteries and FMD has proved to be an interesting clinical strategy for the prediction of preeclampsia, which may represent a positive impact on prenatal care of patients considered as at high-risk for developing such a condition.