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Federación Mexicana de Ginecología y Obstetricia, A.C.

2016, Number 07

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Ginecol Obstet Mex 2016; 84 (07)

Biochemical risk factors for the development of diabetes mellitus in women with previous gestational diabetes

Álvarez-Silvares E, Domínguez-Vigo P, Alves-Pérez MT, Domínguez-Sánchez J, González-González A

Language: Spanish
References: 27
Page: 428-439
PDF size: 449.08 Kb.


ABSTRACT

Background: Gestational diabetes comprises a heterogeneous set of hyperglycemic metabolic disorders that begin or are first detected during pregnancy. The significance of this entity goes beyond pregnancy, since there is ample scientific evidence to support that present a higher risk of developing diabetes mellitus later.
Objetive: To identify predictive biochemical factors for developing diabetes mellitus after an episode of gestational diabetes.
Material and Methods: Study cases and controls nested cohort. Patients between 1996 and 2009 were diagnosed with gestational diabetes were selected. Cases group are women who later developed diabetes mellitus, and control group: random sample of women with a history of gestational diabetes in the follow-up period remained normoglycemic. Follow-up period up to 18 years postpartum. The influence of different biochemical variables obtained in the later development of diabetes mellitus study using Kaplan Meier survival. Significant variables were studied using multivariate COX analysis. In all analyzes, the hazard ratio was calculated with confidence intervals at 95%.
Results: We registered 51 patients in the study group and 71 in the control group. Furthermore identified as risk factors in pregnancy rate for the subsequent development of diabetes mellitus certain tolerance values obtained in glucose curve diagnosed with gestational diabetes: fasting plasma glucose ›100 mg/dL (HR:7.22); glucose at 1st h ›250 mg/dL (HR:6.82); glucose between 200-250 mg/dL at 1st h (HR:2,79); glucose to 2nd h ›200 mg/dL (HR:3.33); glucose to 3rd h ›160 mg/dL (HR:1.80); and glycosylated hemoglobin › 5% (HR:5.47).
Conclusions: The values obtained from curve tolerance and glucose test O’Sullivan and amenorrhea to which perform the same will determine a group of patients should be considered at high risk for subsequent development of Mellitus diabetes.


REFERENCES

  1. Coustan RD, Jovanovic L. Gestational diabetes mellitus: glycemic control and maternal prognosis. Massachusetts: Uptodate Waltham. [en línea]. Dirección URL: .

  2. Yogev Y, Chen R, Hod M, Coustan DR, Oats JJ, McIntyre HD, et al. Hyperglycemia and adverse pregnancy outcome (HAPO) study. Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: preeclampsia. Am J Obstet Gynecol 2010;202(3):255e1-7.

  3. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. (HAPO Study Cooperative Research Group). Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358(19):1991-2002.

  4. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009;373(9677):1773-9.

  5. Sullivan SD, Umans JG, Ratner R. Gestational diabetes: implications for cardiovascular health. Curr Diabetes Rep 2012;12(1):43-52.

  6. Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest 2005;115(1):485-491.

  7. Kim C. Gestational diabetes mellitus. J Clin Invest 2005;115(3):485-491.

  8. ACOG: American College of Obstetricians and Gynecologists. Practice bulletin no. 137: Gestational diabetes mellitus. Obstet Gynecol 2013; 122(2Pt1):406.

  9. ADA 2015: American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care 2015;38(Suppl. 1):S4. DOI:10.2337/dc15-S003.

  10. Metzger BE, Buchanan TA, Coustan DR, De Leiva A, Dunger DB, Hod M, et al. Summary and Recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 2007;30(suppl):S251-S260.

  11. Bartha JL, Martínez del Fresno P, Comino-Delgado R. Postpartum metabolism and autoantibody markers in women with gestational diabetes mellitus diagnosed in early pregnancy. Am J Obstet Gynecol 2001;184(5):965-70.

  12. Summary and recommendations of the Second International Workshop-Conference on gestational diabetes mellitus. Diabetes 1985;34:123-6.

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

  14. Domínguez-Vigo P, Álvarez-Silvares E, Alves-Pérez MT, Domínguez-Sánchez J, González-González A. Incidencia y factores clínicos de riesgo de diabetes mellitus en mujeres con diabetes gestacional previa. Ginecol Obstet Mex 2016;84(4):228-242.

  15. Ekelund M, Shaat N, Almgren P, Groop L, Berntorp K. Prediction of postpartum diabetes in women with gestational diabetes mellitus. Diabetologia 2010;53(3):452-7.

  16. Sivaraman SC, Vinnamala S, Jenkins D. Gestational diabetes and future risk of diabetes. J Clin Med Res 2013;5(2):92-6.

  17. Schaefer-Graf UM, Buchanan TA, Xiang AH, Peters RK, Kjos SL. Clinical predictors for a high risk for the development of diabetes mellitus in the early puerperium in women with recent gestational diabetes mellitus. Am J Obstet Gynecol 2002;186(4):751-6.

  18. Retnakaran R, Qi Y, Sermer M, Connelly PW, Hanley AJ, Zinman B. Glucose intolerance in pregnancy future risk of prediabetes or diabetes. Diabetes Care 2008;31:2026-31.

  19. Cheung N, Helmink D. Gestational diabetes: the significance of persistent fasting hyperglycemia for the subsequent development of diabetes mellitus. J Diabetes Compl 2006;20(1):21-5.

  20. Retnakaran R, Qi Y, Sermer M, Connelly P, Zinman B, Hanley A. Isolated hyperglycemia at 1-hour on oral glucose tolerance test in pregnancy resembles gestational diabetes in predicting postpartum metabolic dysfunction. Diabetes Care 2008;31(7):1275-81.

  21. Kwak SH, Choi SH, Jung HS, Cho YM, Lim S, Cho NH, el al. Clinical and Genetic Risk Factors for Type 2 Diabetes at Early or Late Post Partum After Gestational Diabetes Mellitus. J Clin Endocrinol Metab 2013;98(4):E744-E752.

  22. Capula C, Chiefari E, Vero A, Foti DP, Brunetti A, Vero R. Prevalence and predictors of postpartum glucose intolerance in Italian women with gestational diabetes mellitus. Diabetes Res Clin Pract. 2014; 105 (2):223-30.

  23. Lee AJ, Hiscock RJ, Wein P, Walker SP, Permezel M. Gestational diabetes mellitus: clinical predictors and long-term risk of developing type 2 diabetes: a retrospective cohort study using survival analysis. Diabetes Care 2007;30(4):878-83.

  24. Albareda M, Caballero A, Badell G, Piquer S, Ortiz A, de Leiva A, el al. Diabetes and Abnormal Glucose Tolerance in Women with Previous Gestational Diabetes. Diabetes Care 2003;26(4):1199-205.

  25. National Collaborating Centre for Women´s and Children´s Health. Diabetes in pregnancy. Management of diabetes and its complications from pre-conception to the postnatal period. [en línea]. Dirección URL:

  26. Yu H, Qi X, Wang X. Application of glycated hemoglobin in the perinatal period. Int J Clin Exp Med 2014;7(12):4653-9.

  27. Granada C, Forbes J, Sangi-Haghpeykar H, Davidson C. Can overt diabetes mellitus be predicted by an early A1C value in gestational diabetics? J Reprod Med 2014;59(7-8):343-7.




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