Recomendaciones para el manejo de las pacientes con diabetes pregestacional
DOI:
https://doi.org/10.47196/diab.v51i4.43Palabras clave:
diabetes, embarazo, diabetes pregestacionalResumen
La diabetes mellitus pregestacional afecta el desarrollo de la gestación y se asocia a complicaciones maternas y feto-neonatales. Si bien hace algunos años la mayoría de las pacientes con diabetes pregestacional era diabética tipo 1, la prevalencia de mujeres con diabetes tipo 2 en edad reproductiva aumentó asociada al incremento de la obesidad. La paciente con diabetes pregestacional con mal control presenta mayor riesgo de complicaciones desde el inicio y hasta el final de embarazo.
El control metabólico adecuado, el correcto estado nutricional y el tratamiento de las complicaciones maternas previenen las complicaciones o reducen su severidad. Por ello, es fundamental la programación del embarazo para prevenir el daño en las primeras semanas de gestación. Además es necesario el riguroso seguimiento clínico durante todo el embarazo.
En este contexto, en el marco del Comité de Diabetes y Embarazo, y a través del estudio de evidencias científicas y estudios vinculados, surgen estas recomendaciones para mujeres con diabetes pregestacional.
Citas
Neuman I, Pantoja T, Peñaloza B, Cifuentes L, Rada G. El sistema GRADE: un cambio en la forma de evaluar la calidad de la evidencia y la fuerza de las recomendaciones. Revista Med Chile 2014; 142:630-635
Faingold MC, Lamela C, Gheggi M, Lapertosa S, Di Marco I, Basualdo MN, Rovira G, et al. Recomendaciones para gestantes con diabetes pregestacional. Rev Soc Arg Diab 2010; 44(2):93-107.
Ministerio de Salud. Presidencia de la Nación Argentina. Guía para el diagnóstico y tratamiento de la hipertensión en el embarazo; 2010.
Ministerio de Salud. Presidencia de la Nación Argentina. Métodos anticonceptivos. Guía práctica para profesionales de la salud; 2012.
Ministerio de Salud. Presidencia de la Nación Argentina. Recomendaciones para la Práctica del Control preconcepcional, prenatal y puerperal. Dirección Nacional de Maternidad e Infancia; 2013.
ACOG. Commitee Opinion 560. Medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121:908.
American Diabetes Association. Management of diabetes in pregnancy. Diabetes Care 2016; 39(1):94-98.
American Diabetes Association. Management of diabetes in pregnancy. Diabetes Care 2015; 38(1):77-79.
American Diabetes Association Guide 2012. Nutrition Therapy for Diabetes. Second edition.
Bailey TS, Grunberger G, Bode BW, Handelsman Y, Hirsch IB, Jovanovič L, Lawrence Roberts V, Rodbard V, Tamborlane WV, Walsh J. AACE and ACE 2016 outpatient CGM Consensus Statement. Endocr Pract 2016; 22:231-261.
Blumer I, Hadar E, Hadden DR, Jovanovič L, Mestman JH, Murad MH, Yogev Y. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab, 2013; 98(11):4227-4249.
Canadian Agency for Drug and Technologies in Health. Intravenous Insulin Infusions in Labouring Women: Guidelines. 2011. Disponible en: https://www.cadth.ca/media/pdf/DM/Rapid_Response_Insulin_Infusions_During_Labour_e.pdf.
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Clinical Practice Guidelines for the prevention and management of Diabetes in Canada. Canadian Journal of Diabetes 2013; 37(Suppl1):1-212.
Guideline Development Group. Management of diabetes from preconception to the postnatal period: summary of NICE guidance. BMJ 2008; 336(7646):714-717.
National Collaborating Centre for Women's and Children's Health (UK). Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. Intrapartum care. National Institute for Health and Care Excellence (UK) 2015; NICE Guideline, Nº 3. Disponible en: nice.org.uk/guidance/ng3.
Organización Mundial de la Salud. Criterios médicos de elegibilidad para el uso de anticonceptivos. Cuarta Edición. 2009. Disponible en: http://apps.who.int/iris/bitstream/10665/44710/1/9789243563886_spa.pdf.
Organización Mundial de la Salud. Criterios médicos de elegibilidad para el uso de anticonceptivos. Quinta Edición. 2015. Disponible en: http://apps.who.int/iris/bitstream/10665/205016/1/WHO_RHR_15.07_spa.pdf?ua=1.
Organización Mundial de la Salud. Recomendaciones OMS para la prevención y el tratamiento de la pre-eclampsia y eclampsia. 2013. Disponible en: http://apps.who.int/iris/bitstream/10665/119742/1/WHO_RHR_14.17_spa.pdf.
Ottawa (ON): Canadian Agency for Drugs and Technologies in Health. Insulin pumps for adults with type 1 diabetes: a review of clinical effectiveness, cost-effectiveness and guidelines 2015. Disponible en: https://www.cadth.ca/insulin-pumps-adults-type-1-diabetes-review-clinical-effectiveness-cost-effectiveness-and-guidelines.
Shields L, Tsay GS. California diabetes and pregnancy program sweet success guidelines for care. California Department of Public Health website. Revised July 2012. Disponible en: http://www.cdappsweetsuccess.org/Portals/0/Guidelines/Guidelines for Care_All 1.
Thompson D, Berger H, Feig D, Gagnon R, Kader T, Keely E, Kozak S, et al. Clinical practice guidelines diabetes and pregnancy. Can J Diabetes 2013; 37 (Suppl 1):168-183.
Rasmussen KL, Yaktine A. Weight gain during pregnancy. Reexamining the Guidelines. Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines.Washington (DC): National Academies Press (US); 2009.ISBN-13: 978-0-309-13113.
Jensen DM, Korsholm L, Ovesen P, Beck-Nielsen H, Moelsted-Pedersen L, Westergaard JG, Moeller M, Damm P. Peri-conceptional A1C and risk of serious adverse pregnancy outcome in 933 women with type 1 diabetes. Diabetes Care 2009; 32:1046-1048.
Feig DS, Donovan LE, Corcoy R, Murphy KE, Amiel SA, Hunt KF, Asztalos E, Barrett JFR, Sanchez JJ, de Leiva A, Hod M, Jovanovic L, Keely E, McManus R, Hutton EK, Meek CL, Stewart ZA, Wysocki T, O'Brien R, Ruedy K, Kollman C, Tomlinson G, Murphy HR; CONCEPTT Collaborative Group. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet. 2017 Sep 14. pii: S0140-6736(17)32400-5. doi: 10.1016/S0140-6736(17)32400-5.
Hernandez TL, Friedman JE, Van Pelt RE, Barbour LA. Patterns of Glycemia in Normal Pregnancy Should the current therapeutic targets be challenged? Diabetes Care 2011; 34(7): 1660-1668.
Rebolledo OR, Actis Dato SM, Gagliardino JJ. Niveles de fructosamina en embarazadas con distinta edad de gestación y niños de primera y segunda infancia. Rev Soc Argent Diab 1997; 31(4):131-9.
Drever E, Tomlinson G, Bai AD, Feig DS. Insulin pump use compared with intravenous insulin during labour and delivery: the INSPIRED observational cohort study. Diabet Med 2016; 33(9):1253-1259.
Farrar D, Tuffnell DJ, West J, West HM. Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes. Cochrane Database of Systematic Reviews 2016; (6):CD005542.
Heller S, Damm P, Mersebach H, Skjøth TV, Kaaja i, Hod M, Duràn-García S, et al. Hypoglycemia in type 1 diabetic pregnancy: role of preconception insulin aspart treatment in a randomized study. Diabetes Care 2010; 33(3):473-477.
Hod M, Mathiesen ER, Jovanovič L, McCance DR, Ivanisevic M, Durán-Garcia S, Brøndsted L, et al. A randomized trial comparing perinatal outcomes using insulin detemir or neutral protamine Hagedorn in type 1 diabetes. J Matern Fetal Neonatal Med 2014; 27(1):7-13.
Mathiesen ER, Kinsley B, Amiel SA, Heller S, McCance D, Duran S, Bellaire S, Raben A; Insulin Aspart Pregnancy Study Group. Maternal glycemic control and hypoglycemia in type 1 diabetic pregnancy: a randomized trial of insulin aspart versus human insulin in 322 pregnant women. Diabetes Care 2007; 30(4):771-6.
McElduff A, Moses RG. Insulin Therapy in Pregnancy. Endocrinol Metab Clin N Am 2012; 41(1):161-173.
Pollex E, Moretti ME, Koren G, Feig DS. Safety of insulin glargine use in pregnancy: a systematic review and meta-analysis. Ann Pharmacother 2011; 45(1):9-16.
Ibrahim MI, Hamdy A, Shafik A, Taha S, Anwar M, Faris M. The role of adding metformin in insulin-resistant diabetic pregnant women: a randomized controlled trial. Arch Gynecol Obstet 2014; 289(5):959-965.
Jiang YF, Chen XY, Ding T, Wang XF, Zhu ZN, Su SW. Comparative efficacy and safety of OADs in management of GDM: network meta-analysis of randomized controlled trials. J Clin Endocrinol Metab 2015; 100(5):2071-2080.
Rowan JA, Rush EC, Obolonkin V, Battin M, Wouldes T, Hague WM. Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition at 2 years of age. Diabetes Care 2011; 34(10):2279-84.
Rowan JA, Hague WM. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med 2008 8; 358(19):2003-15.
Regan AK. The safety of maternal immunization. Hum Vaccin Innmunother 2016; 19:1-5.
Swamy GK, Heine P. Vaccinations for pregnant Women. Obstet Gynecol 2015; 125(1): 212-226.
Vizzotti C, Neyro S, Katz N, Juárez MV, Pérez Carrega ME, Aquino A, Kaski Fullone F. Maternal immunization in Argentina: A storyline from the prospective of a middle income country. Vaccine 2015; 33: 6413-6419.
Gunderson EP. Intensive nutrition therapy for gestational diabetes. Rationale and current issues. Diabetes Care 1997; 20(2):221-226.
Moreno-Castilla C, Hernandez M, Bergua M, et al. Low-carbohydrate diet for the treatment of gestational diabetes: a randomized controlled trial. Diabetes Care 2013; 36:2233-8.
Calvo EB, López LB, Balmaceda Y, et al. Referente charts for weight gain and body mass index during pregnancy obtained from a healthy cohort. J Matern and Fetal & Neonatal Medicine. 2009; 22 (1):36-42.
Tremblay A, Gilbert J. Milk products, insulin resistance syndrome and type 2 diabetes. J Am Coll Nutr 2009; 28 Suppl 1:S91-S102.
Anjana RM, Sudha V, Lakshmipriya N, Anitha C, Unnikrishnan R, Bhavadharini B, Mahalakshimi MM, et al. Physical activity patterns and gestational diabetes outcomes. The wings Project. Diabetes Res Clin Pract 2016; 116:253-262.
Koivusalo SB, Rönö K, Klemetti MM, Roine RP, Lindström J, Erkkola M, Kaaja RJ, et al. Gestational diabetes mellitus can be prevented by lifestyle intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL): A Randomized Controlled Trial. Diabetes Care 2016; 39(1):24-30.
Rasmussen KL, Laugesen CS, Ringholm L, Vestgaard M, Damm P, Mathiesen ER. Progression of diabetic retinopathy during pregnancy in women with type 2 diabetes. Diabetologia 2010; 53(6):1076-1083.
Pallardo Sánchez, Luis Felipe. Diabetes y embarazo. Editorial EDIKAMED. Edición 2008.
Sibai BM, Viteri OA. Diabetic ketoacidosis in pregnancy. Obstet Gynecol 2014; 123(1):167-178.
Simmons D. Diabetes and obesity in pregnancy. Best Pract Res Clin Obstet Gynaecol 2011; 25: 25-36.
Jensen DM, Damm P, Ovesen P, Mølsted-Pedersen L, Beck-Nielsen H, Westergaard JG, Moeller M, et al. Microalbuminuria, preeclampsia and preterm delivery in pregnancy with type 1 diabetes: results from a nationwide Danish study. Diabetes Care 2010; 33:90-94.
Mathiesen ER, Ringholm L, Feldt-Rasmussen B, Clausen P, Damm P. Obstetric nephrology: pregnancy in women with diabetic nephropathy. The role of antihypertensive treatment. Clin J Am Soc Nephrol 2012; 7(12): 2081-2088.
Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, Harper A, et al. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006-2008. The eighth report on confidential enquiries into maternal deaths in the United Kingdom. BJOG 2011; 118(1):1-203.
Roberts D, Brown J, Mendley N, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3: CD004454.
O’Reilly M, Avalos G, Dennedy MC, O’Sullivan EP, Dunne FP. Breast feeding is asssociated with reduced post partum maternal glucose intolerance after gestational Diabetes. Ir Med J. 2012; 105(5):31-36.
Pereira PF, Alfenas R de C, Araujo RM. Does breathfeeding influence the risk of developing Diabetes Mellitus in children? A Review of current evidence. J Pediatr (Rio J) 2014; 90(1):7-15.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Dirección Nacional de Derecho de Autor, Exp. N° 5.333.129. Instituto Nacional de la Propiedad Industrial, Marca «Revista de la Sociedad Argentina de Diabetes - Asociación Civil» N° de concesión 2.605.405 y N° de disposición 1.404/13.
La Revista de la SAD está licenciada bajo Licencia Creative Commons Atribución – No Comercial – Sin Obra Derivada 4.0 Internacional.
Por otra parte, la Revista SAD permite que los autores mantengan los derechos de autor sin restricciones.
