Objetivos del control metabólico en la paciente con diabetes mellitus gestacional para prevención de la morbilidad fetal
ABSTRACT Gestational diabetes mellitus (GDM) is associated with maternal and fetal morbidity, which has been related to maternal glycemia. Various reports indicate that intensive therapy of GDM decreases the risk of perinatal morbidity. Self-monitoring of blood glucose (SMBG) provides crucial information in guiding therapy. In recent workshops and conferences on GDM, metabolic goals were lowered to those approaching the normal range. Currently recommended levels of maternal capillary blood glucose are ≤ 95 mg/dl in the fasting state, ≤ 140 mg/dl at 1 hour and/or ≤ 120 mg/dl at 2 hours after meals or even lower. However, surveys evaluating current clinical practice have described wide variations in adherence to these recommendations for SMBG, as well as in the metabolic control goals. In addition, the use of fetal measurements to guide metabolic control has been proposed.
American Journal of Obstetrics and Gynecology 08/1978; 131(5):560-80. · 3.97 Impact Factor
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ABSTRACT: Of 1839 pregnant women screened prospectively, 52 were identified to have glucose intolerance. Ten additional pregnant women identified as having glucose intolerance before the universal screening were also included in the study cohort. These 62 patients were followed in a perinatal high-risk clinic with weekly plasma glucose determinations. The patients were treated with diet and, in addition, 21 of 62 were treated with insulin therapeutically. By observational cohort design, the infants and a comparable number of matched controls were evaluated for evidence of neonatal morbidities and classified into percentile for birth weight. Compared with the control group, the operative mode of delivery, the mean birth weight, the birth-weight percentile, the male/female ratio, the frequency of low Apgar score (less than or equal to 6 at 1 min), and the number of infants with congenital anomalies were significantly higher in the infants born to the glucose-intolerant mothers. Although the mean maternal blood sugar was maintained within a reasonably euglycemic range, the usual neonatal morbidities were not eliminated entirely. Further understanding and management of glucose intolerance in pregnancy is necessary to further diminish or eliminate neonatal morbidities.Diabetes 07/1985; 34 Suppl 2:61-5. DOI:10.2337/diab.34.2.S61 · 8.47 Impact Factor
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ABSTRACT: The long-term effects on offspring of abnormal glucose tolerance detected during pregnancy were examined in 552 Pima Indian offspring 5-24 yr of age. Fasting hyperinsulinemia, presumably reflecting increased insulin resistance, occurred at an earlier age in the offspring of women who had abnormal glucose tolerance during pregnancy, and these offspring were more obese and had higher rates of abnormal glucose tolerance. When confounding factors were controlled, a 1 mM higher 2-h postload glucose concentration during pregnancy resulted in a significantly higher prevalence of diabetes in the offspring (odds ratio = 162). Maternal 2-h glucose concentration during pregnancy was also a significant predictor of glucose concentration during pregnancy in the offspring (P = 0.011). Thus, the metabolic abnormalities associated with the diabetic pregnancy result in long-term effects on the offspring, including insulin resistance, obesity, and diabetes, which in turn may contribute to transmission of risk for developing the same problems in the next generation.Diabetes 01/1992; 40 Suppl 2:126-30. DOI:10.2337/diab.40.2.S126 · 8.47 Impact Factor