Diabetes mellitus gestacional: una aproximación a los conceptos actuales sobre estrategias diagnósticas

Volumen 64, Número 4, Revista de la Facultad de Medicina

Publicado

2016-10-01

Diabetes mellitus gestacional: una aproximación a los conceptos actuales sobre estrategias diagnósticas

Gestational Diabetes Mellitus: a review of current diagnostic strategies concepts

Palabras clave:

Diabetes gestacional, Pruebas diagnósticas de rutina, Embarazo en diabéticas, Diagnóstico (es)
Diabetes, Gestational, Diagnostic Tests, Routine, Pregnancy, Diagnosis (en)

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Autores/as

Juan Sebastián Frías-Ordoñez Universidad Nacional de Colombia - Sede Bogotá - Facultad de Medicina - Bogotá, D.C. - Colombia
Clara Eugenia Pérez-Gualdrón Universidad Nacional de Colombia - Sede Bogotá - Facultad de Medicina - Departamento de Ciencias Fisiológicas - Bogotá, D.C. - Colombia.
Diego Rene Saavedra-Ortega Universidad Militar Nueva Granada - Facultad de Medicina y Ciencias de la Salud - Ginecología-Obstetricia - Bogotá, D.C. - Colombia. Fundación Clínica de la Mujer - Unidad de Ginecología y Obstetricia – Bogotá, D.C. - Colombia.

Resumen (es)
Resumen (en)

La diabetes mellitus gestacional (DMG) es un estado de intolerancia a los carbohidratos que se reconoce por primera vez durante la gestación. Los criterios iniciales para su diagnóstico fueron establecidos hace más de 50 años por O’Sullivan & Mahan, desde entonces se les han hecho modificaciones. En la actualidad, para el diagnóstico se tienen en cuenta dos métodos: el enfoque de un paso, consistente en una prueba de tolerancia oral a la glucosa (PTOG) de 2 horas con 75g de glucosa, y el enfoque de dos pasos, que se compone por una prueba de tamizaje inicial con 50g de glucosa y una PTOG con 100g de glucosa si el tamizaje fue positivo. Ambos enfoques diagnósticos han sido justificados por consensos de expertos, sin embargo aún no se ha establecido un concepto absoluto sobre qué método aplicar; para la elección del método, el clínico debe tener en cuenta diversos factores. Este artículo propone hacer una descripción histórica y exponer el estado actual del diagnóstico de la DMG.

Gestational diabetes mellitus (GDM) is a state of carbohydrate intolerance that is first recognized during pregnancy. The initial criteria for diagnosis were established more than 50 years ago by O’Sullivan & Mahan, and since then, some modifications have been made. Currently, diagnosis considers two methods: the onestep approach, consisting of an oral glucose tolerance test (OGTT) for 2 hours with 75g of glucose, and the two-step approach, which involves an initial screening test with 50g of glucose and OGTT with 100g of glucose if screening is positive. Both diagnostic approaches have been justified by expert consensus; however, an absolute concept about the method to be applied has not been established yet. To select a method, the clinician must take into account various factors. This paper proposes a historical overview and the presentation of the current status of GDM diagnosis.

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Kautzky-Willer A, Bancher-Todesca D. Endocrine changes in diabetic pregnancy. Diabetology of pregnancy. Front Diabetes. Basel, Karger. 2005;17:18-33. http://doi.org/fwfthr.

Xiang AH, Peters RK, Trigo E, Kjos SL, Lee WP, Buchanan TA. Multiple metabolic defects during late pregnancy in women at high risk for type 2 diabetes. Diabetes. 1999;48(4):848-54. http://doi.org/b45pwz.

Lain KY, Catalano PM. Metabolic changes in pregnancy. Clin. Obstet. Gynecol. 2007;50(4):938-48. http://doi.org/c63bfc.

Palani S, Joseph NM, Tegene Y, Zacharia A, Marew T. Gestational diabetes - A review. JGTPS. 2014;5(2):1673-83.

Kühl C. Glucose metabolism during and after pregnancy in normal and gestational diabetic women. Acta endocrinol. 1975;79(4):709-19. http://doi.org/bgs8pv.

Buchanan TA, Xiang AH. Gestational diabetes mellitus. J. Clin. Invest. 2005;115(3):485-91. http://doi.org/ct2t8d.

Vandorsten JP, Dodson WC, Espeland MA, Grobman WA, Guise JM, Mercer BM, et al. NIH Consensus development conference: diagnosing gestational diabetes mellitus. NIH Consens. State. Sci. 2013;29(1):1-31.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(Suppl 1):S81-90. http://doi.org/3cr.

Organización Panamericana de la Salud. Guías ALAD de diagnóstico, control y tratamiento de diabetes mellitus tipo 2. Washington, D.C.: OPS; 2008.

Forsbach-Sánchez G, Tamez-Peréz HE, Velásquez-Lara J. Diabetes and pregnancy. Arch. Med. Res. 2005;36(3):291-9. http://doi.org/d7cqw7.

Blayo A, Mandelbrot L. Screening and diagnosis of gestational diabetes. Diabetes Metab. 2004;30(6):575-80. http://doi.org/dx9dmd.

O’Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes. 1964;13:278-85.

International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676-82. http://doi.org/fm4brm.

Cutchie WA, Cheung NW, Simmons D. Comparison of international and New Zealand guidelines for the care of pregnant women with diabetes. Diabet. Med. 2006;23():460-8. http://doi.org/fnnk5k.

Metzger BE, Buchanan TA, Coustan DR, De Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007;30(Suppl 2):S251-60. http://doi.org/ckprpc.

World Health Organization. WHO Expert Committee on Diabetes Mellitus. Second Report. Geneva: Technical Report Series No. 646; 1980.

Yang X, Hsu-Hage B, Zhang H, Zhang C, Zhang Y, Zhang C. Women with impaired glucose tolerance during pregnancy have significantly poor pregnancy outcomes. Diabetes Care. 2002;25(9):1619-24. http://doi.org/c2xrxj.

Ferrara A, Weiss NS, Hedderson MM, Quesenberry CP Jr, Selby JV, Ergas IJ, et al. Pregnancy plasma glucose levels exceeding the American Diabetes Association thresholds, but below the National Diabetes Data Group thresholds for gestational diabetes mellitus, are related to the risk of neonatal macrosomia, hypoglycaemia and hyperbilirubinaemia. Diabetologia. 2007;50(2):298-306. http://doi.org/b659pr.

Duncan M. On puerperal diabetes. Trans. Obstet. Soc. Lond. 1882;24:256-85.

Miller HC. The effect of diabetic and prediabetic pregnancies on the fetus and newborn infant. J. Pediatr. 1946;29(4):455-61. http://doi.org/bqvdhh.

White P. Pregnancy Complicating Diabetes. Am. J. Med. 1949;7(5):609-16.

Carrington ER, Shuman CR, Reardon HS. Evaluation of the prediabetic state during pregnancy. Obstet Gynecol. 1957;9(6):664-9. http://doi.org/fghmd6.

Jackson WP. Studies in pre-diabetes. Br. Med. J. 1952;2(4786):690- 6. http://doi.org/bcqz8v.

Langer O, Anyaegbunam A, Brustman L, Divon M. Management of women with one abnormal oral glucose tolerance test value reduces adverse outcome in pregnancy. Am. J. Obstet. Gynecol. 1989;161(3):593-9. http://doi.org/bscs.

Landon MB, Mele L, Spong CY, Carpenter MW, Ramin SM, Casey B, et al. The relationship between maternal glycemia and perinatal outcome. Obstet. Gynecol. 2011;117(5):218-224.

Mestman JH, Anderson GV, Barton P. Carbohydrate metabolism in pregnancy. A study of 658 patients with the use of the oral glucose tolerance test and the predinisolone glucose tolerance test. Am. J. Obstet. Gynecol. 1971;109(1):41-5.

National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes. 1979;28(12):1039-57. http://doi.org/bscx.

Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am. J. Obstet Gynecol 1982;14(7):768-73. http://doi.org/bsdr.

Freinkel N, Metzger BE. Gestational diabetes: problems in classification and implications for long-range prognosis. Adv. Exp. Med. Biol. 1985;189:47-63. http://doi.org/bsds.

American College of Obstetricians and Gynecologists. Management of diabetes mellitus in pregnancy. Washington, D.C.: ACOG Technical Bulletin No. 92; 1986.

Sacks DA, Abu-Fadil S, Greenspoon JS, Fotheringham N. Do the current standards for glucose tolerance testing in pregnancy represent a valid conversion of O’Sullivan’s original criteria? Am. J. Obstet. Gynecol. 1989;161(3):638-41. http://doi.org/bsdt.

American College of Obstetricians and Gynecologists. Diabetes and pregnancy. Washington, D.C.: ACOG Technical Bulletin No. 200; 1994.

Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 1998;21(Suppl 2):B161-7.

World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications. Ginebra: WHO; 1999.

Casey BM, Lucas MJ, McIntire DD, Leveno KJ. Pregnancy outcomes in women with gestational diabetes compared with the general obstetric population. Obstet. Gynecol. 1997;90(6):869-73.

Bentley-Lewis R. Gestational Diabetes Mellitus as a Herald of Type 2 Diabetes Mellitus: An Opportunity for a Lifetime. Lancet. 2009;373(9677):1738-40. http://doi.org/bp8686.

Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N. Engl. J. Med. 2008;358(19):1991-2002. http://doi.org/bj6534.

Reaven GM. Banting Lecture 1988: The role of insulin resistance in human disease. Diabetes. 1988;37(12):1595-607. http://doi.org/fqgm8s.

Bellamy L, Casas JP, Hingorani A, Williams D. Type 2 Diabetes mellitus after gestational diabetes: A systematic review and meta-analysis. Lancet. 2009. http://doi.org/fmpvwb.

HAPO Study Cooperative Research Group. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Intl. J. Gynecol. Obstet. 2002;78(1):69-77. http://doi.org/bq9p94.

HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations with neonatal anthropometrics. Diabetes. 2009;58(2):453-9. http://doi.org/dchfd6.

Moyer VA, U.S Preventive Services Task Force. Screening for Gestational Diabetes Mellitus: U.S preventive services task force recommendation statement. Ann. Intern. Med. 2014;160(6):414- 20. http://doi.org/bsdz.

Ogden CL, Carrol MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295(13):1549-55. http://doi.org/fq4z7n.

Narayan KM, Boyle JP, Thompson TJ, Gregg EW, Williamson DF. Effect of BMI on lifetime risk for diabetes in the U.S. Diabetes Care. 2007;30(6):1562-6. http://doi.org/b3kh95.

Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999-2005. Diabetes Care. 2008;31(5):899-904. http://doi.org/fgs4x2.

Sacks DB. Diagnosis of gestational diabetes mellitus: it is time for international consensus. Clin. Chem. 2014;60(1):141-3. http://doi.org/bsd2.

Nicholson WK, Fleisher LA, Fox HE, Powe NR. Screening for gestational diabetes mellitus: a decision and cost-effectiveness analysis of four screening strategies. Diabetes Care. 2005;28(6):1482-4. http://doi.org/c78cpq.

Lavin JP, Lavin B, O’Donnell N. A comparison of costs associated with screening for gestational diabetes with two-tiered and one-tiered testing protocols. Am. J. Obstet. Gynecol. 2001;184(3):363-7. http://doi.org/cjzx7r.

Mission JF, Ohno MS, Cheng YW, Caughey AB. Gestational diabetes screening with the new IADPSG guidelines: a cost-effectiveness analysis. Am. J. Obstet. Gynecol. 2012;207(4):326.e1-9. http://doi.org/f2hdcr.

Ministerio de salud y protección social & Departamento Administrativo de Ciencia, Tecnología e Innovación - Colciencias. Guía de práctica clínica para el diagnóstico, tratamiento y seguimiento de la diabetes gestacional. Bogotá, D.C.: Guía para profesionales de la salud No. GPC-2015-49; 2015.

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