Gutiérrez GHI, Carrillo IMJ, Pestaña MS, Santamaría FM

Language: Spanish
References: 18
Page: 187-192
PDF size: 373.08 Kb.

ABSTRACT

Background: Diabetes mellitus complicates 3-5% of all pregnancies and is a major cause of perinatal morbidity and mortality. The diet and insulin have revolutionized the care related with pregnancy complicated by diabetes mellitus.
Objective: To report the management experience in patients with diabetes and pregnancy at the Instituto Materno Infantil, Estado de México.
Patients and method: A descriptive, retrospective, observational and cross-sectional study of pregnant women with diabetes and pregnancy was conducted from 2003 to 2004.
Results: We included 55 pregnant women who had: gestational diabetes 30 (54.4%), pregestational diabetes 24 (43.6%), and carbohydrate intolerance 1 (1.8%); every one of them were controlled either with diet, insulin or both. The mean age was 30.6, 80% with family history of type 2 diabetes mellitus, 9% gestational diabetes. Gestational diabetes was diagnosed in 33.3% by abnormal 50 g glucose screening and 46.6% with oral glucose tolerance test (OGTT). The main complications among the patients were urinary disease (61.3%) and the major fetal malformation were those related with cardiovascular disease (9.09%). The most frequent mode of delivery was cesarean section (58%) and birth weight was of 3,146 g.
Conclusions: The main risk factors identified among women in the study group were as follow: More than 25 years of age and family history of diabetes mellitus. We observed a progressive increase in the insulin dosage. The most consistent complications among the patients were urinary infection and the major fetal malformation was cardiovascular disease.

REFERENCES

1. Zimmet P. Challenges in diabetes epidemiology: From de West to the rest. Diabetes Care 1992;15:232-52.

2. Ben-Haroush Y, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with type 2 diabetes. Diabetes Med 2004;21(2):103-13.

3. Yogev Y, Langer O, Xenakis EM, Rosenn B. Glucose screening in Mexican-American women. Obstet Gynecol 2004;103(6):1241-6.

4. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2005;(28):1.

5. Vidaeff AC, Yeomans ER, Ramin SM. Gestational diabetes: A field of controversy. Obstet Gynecol Surv 2003;58(11):759-69.

6. Evans E, Patryr R. Management of gestational diabetes mellitus and pharmacyes, role in patient education. Am J Health Syst Pharm 2004;61(7):1460-5.

7. Expert Committee on the Diagnosis and Clasification of Diabetes Mellitus American Diabetes Association: Clinical practice recomendations 2002. Diabetes Care 2002;25supl:1-147.

8. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in US adults: The third National Health and Nutrition Examination Survey, 1988–1994. Diabetes Care 1998;21:518-24.

9. Normas y procedimientos en perinatología. México: Instituto de Perinatología-MPM, 2003;pp:20-6.

10. Gabbe S, Pratt R, Power M, et al. Management of diabetes mellitus by obstetrician-gynecologists. Obstetrics & Gynecology 2004;103(6):1229-34.

11. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologist. Obstet Gynecol 2001;98(3):525-38.

12. American Diabetes Association. Insulin administration. Diabetes Care 2002;25suppl.

13. Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzáles O. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med 2000;343(16):1134-8.

14. Gleisher N. Tratamiento de las complicaciones clínicas del embarazo. 3a ed. Madrid: Panamericana, 1988;pp:545-55.

15. Schuartz R, Terramo KA. Effects of diabetic pregnancy on the fetus and newborn. Semin Perinatol 2000;24(2)120-35.

16. Reece EA, Homko CJ. Why do diabetic women deliver malformed infants? Clin Obstet Gynecol 2000;43(1):32-45.

17. 17. Normas y procedimientos en perinatología. México: Instituto Nacional de Perinatología-MPM, 2003; pp:20-3.

18. Griffith J, Conway DL. Care of diabetes in pregnancy. Obstet Gynecol Clin North Am 2004;31(2):243-56.