Cómo citar
1.
Espinoza Artavia AL, Fernandez Vaglio RE. Lo nuevo en diagnóstico y tratamiento de diabetes mellitus gestacional. Rev.méd.sinerg. [Internet]. 1 de abril de 2019 [citado 21 de diciembre de 2024];4(4):41 - 54. Disponible en: https://revistamedicasinergia.com/index.php/rms/article/view/180
Resumen
La diabetes mellitus gestacional es una condición en la que se desarrolla intolerancia a los carbohidratos y se diagnostica por primera vez en el embarazo sin una pre-existencia clara de diabetes tipo 1 o tipo 2. Es una patología de gran importancia debido a su creciente prevalencia y asociación a complicaciones maternas, fetales y/o neonatales que afectan a múltiples áreas de la medicina y la comunidad. Pese a que aún hay controversia respecto a su diagnóstico, múltiples estudios recomiendan el método de 2 pasos basado en un tamizaje con 50 gramos de glucosa oral y posteriormente una prueba de tolerancia de glucosa de 3 horas con una ingesta de 100 gramos de glucosa en aquellas que presenten un tamizaje positivo. El pilar del tratamiento va a consistir en la dieta y estilos de vida saludable. Para aquellas pacientes que requieran tratamiento farmacológico, el principal ente va a seguir siendo la insulina, pudiendo utilizar asimismo la metformina como una alternativa viable. Aún queda mucho por explorar y determinar en esta patología compleja, para lograr alcanzar un consenso entre las distintas guías y conseguir las mejores recomendaciones para la población a escala mundial.
Palabras clave
embarazo. diabetes gestacional. estilo de vida. insulina. glucosa.
Citas
1. American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes 2019. Diabetes Care. 2018 Dec 17;42(Supplement 1):S13-S28. https://doi.org/10.2337/dc19-s002
2. ACOG Practice Bulletin No. 190. Obstetrics & Gynecology. 2018 02;131(2):e49-e64. https://doi.org/10.1097/aog.0000000000002501
3. Bouthoorn SH, Silva LM, Murray SE, Steegers EAP, Jaddoe VWV, Moll H, Hofman A, Mackenbach JP, Raat H. Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study. Acta Diabetologica. 2014 Oct 26;52(3):445-452. https://doi.org/10.1007/s00592-014-0668-x
4. Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, Roura LC, McIntyre HD, Morris JL, Divakar H. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care#. International Journal of Gynecology & Obstetrics. 2015 Oct;131:S173-S211. https://doi.org/10.1016/s0020-7292(15)30033-3
5. Gabbe SG, Niebyl JR, Simpson JL, Landon MB, Galan HL, Jauniaux ER, Driscoll DA, Berghella V, Grobman WA. Diabetes Mellitus Complicating Pregnancy. En: Landon M, Catalano P, Gabbe S. Obstetrics Normal and Problem Pregnancies. Seventh Edition. Philadelphia: Elsevier; 2017. p. 862-899.
6. Moyer VA. Screening for Gestational Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. 2014 03 18;160(6):414-420. https://doi.org/10.7326/m13-2905
7. American Diabetes Association. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2018 Dec 17;42(Supplement 1):S165-S172. https://doi.org/10.2337/dc19-s014
8. Lowe WL, Scholtens DM, Lowe LP, Kuang A, Nodzenski M, Talbot O, Catalano PM, Linder B, Brickman WJ, Clayton P, Deerochanawong C, Hamilton J, Josefson JL, Lashley M, Lawrence JM, Lebenthal Y, Ma R, Maresh M, McCance D, Tam WH, Sacks DA, Dyer AR, Metzger BE HAPO Follow-up Study Cooperative Research Group. Association of Gestational Diabetes With Maternal Disorders of Glucose Metabolism and Childhood Adiposity. JAMA. 2018 09 11;320(10):1005-1016. https://doi.org/10.1001/jama.2018.11628
9. Farrar D, Duley L, Medley N, Lawlor DA. Different strategies for diagnosing gestational diabetes to improve maternal and infant health. Cochrane Database of Systematic Reviews. 2015; 1. Art. No.: CD007122. (Meta-analysis). https://doi.org/ 10.1002/14651858.CD007122.pub3
10. Poltavskiy E, Kim DJ, Bang H. Comparison of screening scores for diabetes and prediabetes. Diabetes Research and Clinical Practice. 2016 08;118:146-153. https://doi.org/10.1016/j.diabres.2016.06.022
11. McIntyre HD, Sacks DA, Barbour LA, Feig DS, Catalano PM, Damm P, McElduff A. Issues with the diagnosis and classification of hyperglycemia in early pregnancy. Diabetes Care. 2015 Oct 30;39(1):53-54. https://doi.org/10.2337/dc15-1887
12. Chamberlain JJ, Rhinehart AS, Shaefer CF, Neuman A. Diagnosis and Management of Diabetes: Synopsis of the 2016 American Diabetes Association Standards of Medical Care in Diabetes. Annals of Internal Medicine. 2016 03 01;164(8):542-552. https://doi.org/10.7326/m15-3016
13. Khalafallah A, Phuah E, Al-Barazan AM, Nikakis I, Radford A, Clarkson W, Trevett C, Brain T, Gebski V, Corbould A. Glycosylated haemoglobin for screening and diagnosis of gestational diabetes mellitus. BMJ Open. 2016 04;6(4):e011059. https://doi.org/10.1136/bmjopen-2016-011059
14. NICE guideline. Diabetes in pregnancy: management from preconception to the postnatal period [Internet]. The National Institute for Health and Care Excellence. 2019 [cited 9 February 2019]. Available from: https://www.nice.org.uk/guidance/ng3
15. Ali A, Shastry S, Nithiyananthan R, Ali A, Ganapathy R. Gestational diabetes–Predictors of response to treatment and obstetric outcome. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2018 01;220:57-60. https://doi.org/10.1016/j.ejogrb.2017.11.014
16. Han S, Middleton P, Shepherd E, Van Ryswyk E, Crowther CA. Different types of dietary advice for women with gestational diabetes mellitus. . Cochrane Database of Systematic Reviews. 2017;2: CD009275. https://doi.org/10.1002/14651858.cd009275.pub3
17. Thomas A, Duarte-Gardea M. Nutritional Management for Gestational Diabetes. Nutrition in the Prevention and Treatment of Disease. 4th ed. 2017. p. 709-729. https://doi.org/10.1016/B978-0-12-802928-2.00032-1
18. Hernandez TL, Brand-Miller JC. Nutrition Therapy in Gestational Diabetes Mellitus: Time to Move Forward. Diabetes Care. 2018 06 22;41(7):1343-1345. https://doi.org/10.2337/dci18-0014
19. Wang H, Jiang H, Yang L, Zhang M. Impacts of dietary fat changes on pregnant women with gestational diabetes mellitus: a randomized controlled study. Asia Pac J Clin Nutr. 2015;24(1):58-64. https://doi.org/10.6133/apjcn.2015.24.1.19
20. SMFM Statement: Pharmacological treatment of gestational diabetes. American Journal of Obstetrics and Gynecology. 2018 05;218(5):B2-B4. https://doi.org/10.1016/j.ajog.2018.01.041
21. Barbour LA, Scifres C, Valent AM, Friedman JE, Buchanan TA, Coustan D, Aagaard K, Thornburg KL, Catalano PM, Galan HL, Hay WW, Frias AE, Shankar K, Simmons RA, Moses RG, Sacks DA, Loeken MR. A cautionary response to SMFM statement: pharmacological treatment of gestational diabetes. American Journal of Obstetrics and Gynecology. 2018 Oct;219(4):367.e1-367.e7. https://doi.org/10.1016/j.ajog.2018.06.013
22. Harper LM, Glover AV, Biggio JR, Tita A. Predicting failure of glyburide therapy in gestational diabetes. Journal of Perinatology. 2016 01 21;36(5):347-351. https://doi.org/10.1038/jp.2015.216
23. Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Canadian Journal of Diabetes. 2018 04;42:S255-S282. https://doi.org/10.1016/j.jcjd.2017.10.038
24. Do Valle JB, Silva JC, Oliveira DS, Martins L, Lewandowski A, Horst W. Use of a clinical-laboratory score to guide treatment of gestational diabetes. International Journal of Gynecology & Obstetrics. 2017 Oct 11;140(1):47-52. https://doi.org/10.1002/ijgo.12326
25. Boulvain M, Senat M, Perrotin F, Winer N, Beucher G, Subtil D, Bretelle F, Azria E, Hejaiej D, Vendittelli F, Capelle M, Langer B, Matis R, Connan L, Gillard P, Kirkpatrick C, Ceysens G, Faron G, Irion O, Rozenberg P. Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial. The Lancet. 2015 06;385(9987):2600-2605. https://doi.org/10.1016/s0140-6736(14)61904-8
2. ACOG Practice Bulletin No. 190. Obstetrics & Gynecology. 2018 02;131(2):e49-e64. https://doi.org/10.1097/aog.0000000000002501
3. Bouthoorn SH, Silva LM, Murray SE, Steegers EAP, Jaddoe VWV, Moll H, Hofman A, Mackenbach JP, Raat H. Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study. Acta Diabetologica. 2014 Oct 26;52(3):445-452. https://doi.org/10.1007/s00592-014-0668-x
4. Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, Roura LC, McIntyre HD, Morris JL, Divakar H. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care#. International Journal of Gynecology & Obstetrics. 2015 Oct;131:S173-S211. https://doi.org/10.1016/s0020-7292(15)30033-3
5. Gabbe SG, Niebyl JR, Simpson JL, Landon MB, Galan HL, Jauniaux ER, Driscoll DA, Berghella V, Grobman WA. Diabetes Mellitus Complicating Pregnancy. En: Landon M, Catalano P, Gabbe S. Obstetrics Normal and Problem Pregnancies. Seventh Edition. Philadelphia: Elsevier; 2017. p. 862-899.
6. Moyer VA. Screening for Gestational Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. 2014 03 18;160(6):414-420. https://doi.org/10.7326/m13-2905
7. American Diabetes Association. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2018 Dec 17;42(Supplement 1):S165-S172. https://doi.org/10.2337/dc19-s014
8. Lowe WL, Scholtens DM, Lowe LP, Kuang A, Nodzenski M, Talbot O, Catalano PM, Linder B, Brickman WJ, Clayton P, Deerochanawong C, Hamilton J, Josefson JL, Lashley M, Lawrence JM, Lebenthal Y, Ma R, Maresh M, McCance D, Tam WH, Sacks DA, Dyer AR, Metzger BE HAPO Follow-up Study Cooperative Research Group. Association of Gestational Diabetes With Maternal Disorders of Glucose Metabolism and Childhood Adiposity. JAMA. 2018 09 11;320(10):1005-1016. https://doi.org/10.1001/jama.2018.11628
9. Farrar D, Duley L, Medley N, Lawlor DA. Different strategies for diagnosing gestational diabetes to improve maternal and infant health. Cochrane Database of Systematic Reviews. 2015; 1. Art. No.: CD007122. (Meta-analysis). https://doi.org/ 10.1002/14651858.CD007122.pub3
10. Poltavskiy E, Kim DJ, Bang H. Comparison of screening scores for diabetes and prediabetes. Diabetes Research and Clinical Practice. 2016 08;118:146-153. https://doi.org/10.1016/j.diabres.2016.06.022
11. McIntyre HD, Sacks DA, Barbour LA, Feig DS, Catalano PM, Damm P, McElduff A. Issues with the diagnosis and classification of hyperglycemia in early pregnancy. Diabetes Care. 2015 Oct 30;39(1):53-54. https://doi.org/10.2337/dc15-1887
12. Chamberlain JJ, Rhinehart AS, Shaefer CF, Neuman A. Diagnosis and Management of Diabetes: Synopsis of the 2016 American Diabetes Association Standards of Medical Care in Diabetes. Annals of Internal Medicine. 2016 03 01;164(8):542-552. https://doi.org/10.7326/m15-3016
13. Khalafallah A, Phuah E, Al-Barazan AM, Nikakis I, Radford A, Clarkson W, Trevett C, Brain T, Gebski V, Corbould A. Glycosylated haemoglobin for screening and diagnosis of gestational diabetes mellitus. BMJ Open. 2016 04;6(4):e011059. https://doi.org/10.1136/bmjopen-2016-011059
14. NICE guideline. Diabetes in pregnancy: management from preconception to the postnatal period [Internet]. The National Institute for Health and Care Excellence. 2019 [cited 9 February 2019]. Available from: https://www.nice.org.uk/guidance/ng3
15. Ali A, Shastry S, Nithiyananthan R, Ali A, Ganapathy R. Gestational diabetes–Predictors of response to treatment and obstetric outcome. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2018 01;220:57-60. https://doi.org/10.1016/j.ejogrb.2017.11.014
16. Han S, Middleton P, Shepherd E, Van Ryswyk E, Crowther CA. Different types of dietary advice for women with gestational diabetes mellitus. . Cochrane Database of Systematic Reviews. 2017;2: CD009275. https://doi.org/10.1002/14651858.cd009275.pub3
17. Thomas A, Duarte-Gardea M. Nutritional Management for Gestational Diabetes. Nutrition in the Prevention and Treatment of Disease. 4th ed. 2017. p. 709-729. https://doi.org/10.1016/B978-0-12-802928-2.00032-1
18. Hernandez TL, Brand-Miller JC. Nutrition Therapy in Gestational Diabetes Mellitus: Time to Move Forward. Diabetes Care. 2018 06 22;41(7):1343-1345. https://doi.org/10.2337/dci18-0014
19. Wang H, Jiang H, Yang L, Zhang M. Impacts of dietary fat changes on pregnant women with gestational diabetes mellitus: a randomized controlled study. Asia Pac J Clin Nutr. 2015;24(1):58-64. https://doi.org/10.6133/apjcn.2015.24.1.19
20. SMFM Statement: Pharmacological treatment of gestational diabetes. American Journal of Obstetrics and Gynecology. 2018 05;218(5):B2-B4. https://doi.org/10.1016/j.ajog.2018.01.041
21. Barbour LA, Scifres C, Valent AM, Friedman JE, Buchanan TA, Coustan D, Aagaard K, Thornburg KL, Catalano PM, Galan HL, Hay WW, Frias AE, Shankar K, Simmons RA, Moses RG, Sacks DA, Loeken MR. A cautionary response to SMFM statement: pharmacological treatment of gestational diabetes. American Journal of Obstetrics and Gynecology. 2018 Oct;219(4):367.e1-367.e7. https://doi.org/10.1016/j.ajog.2018.06.013
22. Harper LM, Glover AV, Biggio JR, Tita A. Predicting failure of glyburide therapy in gestational diabetes. Journal of Perinatology. 2016 01 21;36(5):347-351. https://doi.org/10.1038/jp.2015.216
23. Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Canadian Journal of Diabetes. 2018 04;42:S255-S282. https://doi.org/10.1016/j.jcjd.2017.10.038
24. Do Valle JB, Silva JC, Oliveira DS, Martins L, Lewandowski A, Horst W. Use of a clinical-laboratory score to guide treatment of gestational diabetes. International Journal of Gynecology & Obstetrics. 2017 Oct 11;140(1):47-52. https://doi.org/10.1002/ijgo.12326
25. Boulvain M, Senat M, Perrotin F, Winer N, Beucher G, Subtil D, Bretelle F, Azria E, Hejaiej D, Vendittelli F, Capelle M, Langer B, Matis R, Connan L, Gillard P, Kirkpatrick C, Ceysens G, Faron G, Irion O, Rozenberg P. Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial. The Lancet. 2015 06;385(9987):2600-2605. https://doi.org/10.1016/s0140-6736(14)61904-8
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