Publication: Resultados del tratamiento de pacientes con diabetes gestacional. Análisis de factores relacionados con el peso neonatal
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2017-08-29
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Universidad Complutense de Madrid
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Abstract
La diabetes gestacional (DG) se define como una intolerancia hidrocarbonada de intensidad variable diagnosticada por primera vez durante la gestación, independientemente del tratamiento empleado para su control y de su evolución postparto. La DG no controlada está vinculada al desarrollo de macrosomía fetal y otras complicaciones derivadas de esta. Los criterios para el diagnóstico de esta patología y por tanto la identificación de la población en riesgo (mujeres gestantes y fetos) son muy variados, siendo este punto motivo de fuerte controversia científica. En la actualidad las dos posturas más enfrentadas y debatidas son: Estrategia en 1 paso: sobrecarga oral de glucosa con 75 g de forma universal a las semanas 24-28 de gestación con determinación de glucemia venosa de forma basal y a los 60 y 120 minutos considerando DG si 1 o más puntos son patológicos: Basal> 92 mg/dl , 60 min > 180 mg/dl, 120 min > 153 mg/dl Estrategia en 2 pasos: 1. Sobrecarga oral de glucosa con 50g (despistaje universal): Si a los 60 minutos presenta glucemia ≤140 (130 o 135 mg/dl según las guías) se procede al 2º paso. 2. Sobrecarga oral de glucosa con 100g (diagnóstica): Determinación de glucemia basal y a los 60,120 y 180 minutos. En el presente trabajo se han seguido los criterios diagnósticos recomendados actualmente por la Sociedad Española de Diabetes que corresponden las del National Diabetes Data Group (NDDG) consistentes en 2 o más puntos patológicos de los siguientes: Basal ≥ 105 mg/dl, 60 min ≥190 mg/dl, 120 min ≥ 165 mg/dl, 180 min ≥145...
Gestational diabetes (GD) is defined as a carbohydrate intolerance of variable severity first diagnosed during pregnancy, regardless of the treatment used to control it or its postpartum evolution. Uncontrolled GD is associated with the development of fetal macrosomia and other complications derived therefrom. The criteria for the diagnosis of this pathology, and therefore, for the identification of the at-risk population (pregnant women and fetuses) vary greatly and are cause for fierce scientific dispute. Currently, the two most opposing and debated positions are: One-step strategy: universal oral glucose tolerance test with 75g of glucose at 24-28 weeks gestation, with determination of fasting venous glucose level and glucose levels at 60 and 120 minutes, with GD being diagnosed if one or more values are pathological: Fasting> 92 mg/dl, 60 min > 180 mg/dl, 120 min > 153 mg/dl Two-step strategy: 1. Oral glucose tolerance test with 50g of glucose (universal screening): If at 60 minutes, glucose level is >140 (130 or 135 mg/dl depending on guidelines), proceed to step two. 2. Oral glucose tolerance test with 100g of glucose (diagnostic): Determination of fasting glucose level and glucose level at 60, 120, and 180 minutes. In this work we have followed the diagnostic criteria currently recommended by the Sociedad Española de Diabetes (Spanish Diabetes Association), which match those of the National Diabetes Data Group (NDDG), consisting of two or more of the following values at pathological levels: Fasting ≥105 mg/dl, 60 min ≥190 mg/dl, 120 min ≥ 165 mg/dl, 180 min ≥145...
Gestational diabetes (GD) is defined as a carbohydrate intolerance of variable severity first diagnosed during pregnancy, regardless of the treatment used to control it or its postpartum evolution. Uncontrolled GD is associated with the development of fetal macrosomia and other complications derived therefrom. The criteria for the diagnosis of this pathology, and therefore, for the identification of the at-risk population (pregnant women and fetuses) vary greatly and are cause for fierce scientific dispute. Currently, the two most opposing and debated positions are: One-step strategy: universal oral glucose tolerance test with 75g of glucose at 24-28 weeks gestation, with determination of fasting venous glucose level and glucose levels at 60 and 120 minutes, with GD being diagnosed if one or more values are pathological: Fasting> 92 mg/dl, 60 min > 180 mg/dl, 120 min > 153 mg/dl Two-step strategy: 1. Oral glucose tolerance test with 50g of glucose (universal screening): If at 60 minutes, glucose level is >140 (130 or 135 mg/dl depending on guidelines), proceed to step two. 2. Oral glucose tolerance test with 100g of glucose (diagnostic): Determination of fasting glucose level and glucose level at 60, 120, and 180 minutes. In this work we have followed the diagnostic criteria currently recommended by the Sociedad Española de Diabetes (Spanish Diabetes Association), which match those of the National Diabetes Data Group (NDDG), consisting of two or more of the following values at pathological levels: Fasting ≥105 mg/dl, 60 min ≥190 mg/dl, 120 min ≥ 165 mg/dl, 180 min ≥145...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 21-01-2016