2006, Number 04
<< Back Next >>
Ginecol Obstet Mex 2006; 74 (04)
Gestational diabetes. Diagnosis in early stages of the pregnancy
Sandoval RT, Oliva FB
Language: Spanish
References: 18
Page: 199-204
PDF size: 332.93 Kb.
ABSTRACT
Objective: To determine whether women with early diagnosis of gestational diabetes have an increase of the rate of gestational hypertensive disease, metabolic imbalance, higher insulin dosage requirement, perinatal morbidity and perinatal death than those in whom diabetes developed after 24th week.
Methods: All pregnant women with gestational diabetes were studied. Maternal age, pregestational body mass indexes, total weight gain during pregnancy, gestational age at diagnosis, and the timing of delivery were recorded. Two groups were studied: women with gestational diabetes diagnosed before 24 gestation weeks and those in which diabetes was diagnosed at 24 weeks or later. Total insulin dosage, rate of gestational hypertension, perinatal morbidity, perinatal death, and percentages of women with good metabolic control were analysed.
Results: In the whole group 28% were diagnosed before 24 weeks of gestation. Women that were diagnosed earlier had grater pregestational body mass indexes (30 ± 6 kg/m
2 vs 27 ± 6 kg/m
2) and total weight gain during pregnancy was lower during over all gestation (8 ± 5 kg vs 10 ± 6 kg). Insulin requirements were higher in women diagnosed earlier and there were no differences in the rates of gestational hypertension, and perinatal death. Perinatal morbidity was significantly higher in patients who were diagnosed later.
Conclusions: Early diagnosed and treatment may result in decreased perinatal morbidity. Women with early diagnosed diabetes required higher insulin dose, but they did not represent a high risk subgroup.
REFERENCES
Goldman JA, Dicker D, Feldberg D, Yeshaya A, Samuel N, Kart M. Pregnancy outcome in patients with insulin-dependt diabetes mellitus with preconceptional diabetic control: A comparative study. Am J Obstet Gynecol 1986;155:293-7.
Damm P, Kuhl C, Bertelsu A, Molsted-Pederson L. Predictive factors for the development of diabetes, in women with previous gestational diabetes mellitus. Am J Obstet Gynecol 1992;167:607-16.
Bartha JL, Martínez-Del Fresno P, Comino Delgado R. Gestational diabetes mellitus during early pregnancy. Am J Obstet Gynecol 2000;182:346-50.
Meyer WJ, Carbone J, Gauthier DW, Gottmann DA. Early gestational glucose screening and gestational diabetes. J Reprod Med 1996;41:288-94.
Super DM, Edelberg SC, Philipson EH, Hertz RH, Kalhan SC. Diagnosis of gestational diabetes in early pregnancy. Diabetes Care 1991;14:288-94.
Schmidt D, Duncan BB, Recchelt AJ. Two hour 75 g Oral Tolerance Test early in pregnancy detects most cases of Gestational Diabetes. Diabetes Care 2002;25:804-8.
Svare J, Hansen B, Molsted-Pederson L. Perinatal complications in women with gestational diabetes mellitus. Significance of diagnosis early in pregnancy. Acta Obstet Gynecol Scand 2001;80;890-94.
Freinkel N. Gestational Diabetes 1979: Philosophical and practical aspects of a major public health problem. Diabetes Care 1980;3:399-401.
Expert Commitee on the 2002 Diagnosis and Classification of diabetes mellitus. Diabetes Care 2002;25:S5-S11.
Diagnosis and management of preeclampsia and eclampsia ACOG practice Bulletin. Am J Obstet Gynecol 2002;99:159-67.
Boriboonhirunsarn D, Sunsaneevitahayakul P, Nuchangrid M. Incidence of gestational diabetes mellitus diagnosed before 20 weeks of gestation. J Med Assoc Thai 2004;87:1017-21.
Meyer WJ, Carbone J, Gauthier DW, Gottmann DA. Early gestational glucose screening and gestational diabetes. J Reprod Med 1996;41:675-9.
Sandoval T, Jiménez G, Uribe S, Partida-Hernández G, González S, Arreola F. Morbimortalidad perinatal en mujeres con diabetes mellitus y embarazo. Ginec Obstet Mex 1995;63:181-5.
Bartha JL, Martínez Del Fresno P, Comino-Delgado R. Early diagnosis of gestational diabetes mellitus and prevention of diabetes-related complications. Eur J Obstet Gynecol Reprod Biol 2003;109:41-4.
Szilagy A, Feledi E, Csaba I, Pejtsik B. Early screening of gestational diabetes in high risk pregnancy cases. Orv Hetil 1989;130:839-42.
Rossi G, Somigliana E, Moschetta M, et al. Adequate timing of fetal ultrasound to guide metabolic therapy in mild gestational diabetes mellitus. Results from a randomized study. Acta Obstet Gynecol Scand 2000;79:649-54.
Shushan A, Ezra Y, Samueloff A. Early treatment of gestational reduces the rate of fetal macrosomia. Am J Perinatol 1997;14:243-6.
Sameshima H, Kamitomo M, Kajiya S, et al. Early glycemic control reduces large-for-gestational –age infants in 250 Japanese gestational diabetes pregnancies. Am J Perinatol 2000;17:371-6.