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TRATAMIENTO MÉDICO NUTRICIONAL EN LA MUJER EMBARAZADA CON DIABETES

María Belén Tapia, Solange Houssay, Guadalupe Vanoli, Julio César Bragagnolo

Resumen


Introducción: se ha observado un incremento en el diagnóstico de diabetes gestacional (DG) en mujeres embarazadas a nivel mundial durante los últimos años, siendo la prevalencia estimada de 14% a nivel global y de 10,36% en Argentina según el criterio diagnóstico de la Asociación Latinoamericana de Diabetes (ALAD). El plan de alimentación adecuado y el cambio en el estilo de vida asociados al automonitoreo de la glucemia capilar (AMGC) constituyen pilares fundamentales para alcanzar el objetivo glucémico en dos tercios de los casos de DG. A pesar de su importancia y de su recomendación en la práctica clínica, existe información científica limitada respecto de cuál es la prescripción alimentaria óptima para mejorar los resultados tanto en la madre como en el niño.

Objetivos: analizar el componente nutricional en el tratamiento de la mujer embarazada con diabetes y conocer cuáles podrían ser las recomendaciones para lograr los objetivos mencionados a través del análisis de la evidencia científica actual. La información proveniente de estudios randomizados y controlados es heterogénea, pero de dichos estudios surge que la intervención temprana con dieta, ejercicio y consejos sobre cambio de estilo de vida durante el primer trimestre o al inicio del segundo puede disminuir el riesgo de DG.

El tratamiento médico nutricional en DG se basa en el control de la cantidad y la distribución de los hidratos de carbono para obtener el control glucémico óptimo sin hipoglucemias ni cetosis. El otro componente esencial es la ingesta calórica para la adecuada ganancia de peso.

 


Palabras clave


Dieta; nutrición; embarazo; diabetes.

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Referencias


Landon MB, Spong C, Thom E, et. al; for the Unice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361:1339-1348

Boney CM, Verna A, Tucker R, Vodir BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity and gestational diabetes mellitus. Pediatrics 2005; Mar115(3): e290-e296.

Sacks KN, Friger M, Shiham-Vardi I, Abokaf H, et al. Prenatal exposure to gestational diabetes mellitus as an independent risk factor for long-term neuropsychiatric morbidity of the offspring. American Journal of Obstetrics and Gynecology 2016; 380.e1-380.e5

Xiang A, Wang X, Martínez M, Walthall J, et al. Association of maternal diabetes with autism. JAMA 2015; 313(14):1425-1434.

Holmes VA, Young IS, Patterson CC, et. al. Diabetes and pre-eclampsia intervention trial study group. Optimal glycemic control, pre-eclampsia and gestational hypertension in women with type 1 diabetes in the Diabetes and Pre-Eclampsia Intervention Trial. Diabetes Care 2011 Aug; 34(8):1683-8.

Dabelea D, Hanson RC, Lindsay RS, et al. Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: a study of discordant sibships. Diabetes 2000 Dec; 49(12):2208-11.

American Diabetes Association. Management of diabetes in pregnancy. Sec 13. In: Standards of Medical Care in Diabetes-2017. Diabetes Care 2017; 40(Suppl.1): S114-S119.

American Diabetes Association. Clinical practice recommendations gestational diabetes mellitus. Diabetes Care 2001; 24(Suppl.1): S77-S79.

Metzger BE, Coustan DR. Summary and recommendations of the Forth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care 1998 Aug; 21 (Suppl 2): B161-7

Agarwal MM. Gestational diabetes mellitus: an update on the current international diagnostic criteria. World J Diabetes 2015; 6(6):782-791.

Metzger BE, Contreras M, Sacks DA, et al; Study Cooperative Research Group (HAPO). Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358:991-2002.

Diagnostic criteria and classification of hyperglycemia first detected in pregnancy. Geneva: World Health Organization; 2013 (WHO/NMH/MND/13.2). Disponible en: http://www.who. int/diabetes/publications/Hyperglycemia_ Pregnancy. Acceso: 24%5/2020.

Metzger BE, Buchanan Th A, et al. Summary and recommendations of the Fifth International Workshop Conference on Gestational Diabetes Mellitus. Diabetes Care July 2007 Jul; 30(Suppl 2): S251-60.

Innes DE, Byers TE, Marshall JA, et al. Association of a woman´s own birth weight with subsequent risk for gestational diabetes. JAMA 2002; 287: 2534-254.

Guanguata L, Linnenkap U, Beagley J, et al. Global estimates of the prevalence of hyperglycemia in pregnancy. Diabetes Res Clin Pract 2014; 103(2):176-185.

Ricart W, López J, Mozas J, et al. Potential impact of American Diabetes Association (2000) criteria for diagnosis of gestational diabetes mellitus in Spain. Diabetologia 2005 Jun; 48(6):1135-1141.

Salzberg S, Alvariñas J, López G, et al. Guías de diagnóstico y tratamiento de diabetes gestacional. ALAD 2016. Rev ALAD 2016; 6:155-69.

Sucasini MR, Lewin ML, Aguera D, et al. Prevalencia de diabetes gestacional en Argentina y complicaciones materno-feto-neonatales según los distintos criterios diagnósticos. Reporte Preliminar. Revista de la Sociedad Argentina de Diabetes 2014; 48:82-83.

Battelino T, Danne T, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the International Consensus on Time in Range. Diabetes Care Aug 2019; 42(8):1593-1603. Doi: 10.2337/dci19-0028.

Bain E, Crane M, Tieu J, et al. Diet and exercise intervention for preventing gestational diabetes mellitus. Cochrane Data Base Syst Rev 2015; 4.

Management of diabetes in pregnancy. Standards of Medical Care. En: Diabetes-2020. American Diabetes Association. Diabetes Care 2020 Jan; 43(Suppl 1): S183-S192.

Rovira G, Jawerbaum S, Glastein L. Recomendaciones para el tratamiento de pacientes con diabetes pregestacional. Sociedad Argetina de Diabetes. Grupo Latinoamericacno de Diabetes y Embarazo. ALAD 2018. Rev ALAD 2018;8.

Lapertosa S, et al. Educación terapéutica de mujeres con diabetes gestacional (EduGest)/Educación terapéutica de mujeres con diabetes gestacional. Revista de la Sociedad Argentina de Diabetes Vol. 53 Nº 3 Suplemento septiembre-diciembre de 2019; 121-126.

Jovanovic C, Peterson L, Peterson CM, Reed GF, et al. Maternal postprandial glucose levels and infant birth weight. The diabetes in early pregnancy study. The National Institute of Child Health and Human development. Am J Obstet Gynecol 1991; 164:103-111.

Food and Nutrition Board, Institute of Medicine: Nutrition During Pregnancy. Part 1: Weight gain. Part 2: Nutrient supplements, Washington DC: National Academy of Sciences 1990.

Food and Nutrition Board, Institute of Medicine: Nutrition During Pregnancy. Part 2: Nutrient Supplements, Washington DC: National Academy of Sciences 1990. Citas repetidas.

NICE, National Institute for Health and Care Excellence. Gestational diabetes, risk assessment, testing, diagnosis and management. Disponible en: http://pathways.nice.org.uk/pathways/diabetes-in-pregnancy. Actualizado el 4 de junio de 2019: 1-10. Acceso: 26/5/2020.

Dolatkhah, Neda, Haji Faraji Majid. Nutrition therapy in managing women with gestational diabetes: literature review. Journal of Family and Reproductive Health 2018; Vol 12, Nº 2.

López L, Suárez M. Fundamentos de nutrición normal. Ed. Ateneo 2º Edición 2017.

Ministerio de Salud De la Nación. Nutrición y embarazo. Recomendaciones en nutrición para los equipos de salud. Dirección Nacional de Maternidad e Infancia. Buenos Aires: Ministerio de Salud, 2012. Disponible en: www.msal.gob.ar embarazo y nutrición-Ministerio de salud. Acceso: 26/05/2020.

American Diabetes Association. Nutrition recommendations and intervention for diabetes: a position statement of de ADA. Diabetes Care 2008; 31 (suppl 1): 561-578.

Yamamoto J, Kellet J, Balsells M, Patterson A, Hadar E, Sola I, Gich I, et al. Gestational diabetes mellitus and diet: a systematic review and meta-analysis of randomized controlled trials examining the impact of modified dietary interventions on maternal glucose control and neonatal birth weight. Diabetes Care 2018; 41:1346-1361.

National Academy of Sciences, Ed. Dietary reference intake: energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and aminoacids (macronutrients). Washington DC, National Academy Press 2005.

Girolami D, González-Infantino C. Clínica y terapéutica en la nutricion del adulto. Buenos Aires. Ed. El Ateneo, 2008.

Fats and fatty acids in human nutrition report of an expert consultation. FAO Food and Nutrition Paper 91, FAO, Rome, 2010.

Greemberg J, Bell S, et al. Omega-3 fatty acid supplementation during pregnancy 2008;1: 162-169

Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega-3 fatty acid addition during pregnancy. Cochrane Database of Systematic Reviews 2018; Issue 11. Art. Nº: CD003402. Doi: 10.1002/14651858.CD003402.pub3.

Hull H, Herman, Gibbs H. The effect of high dietary fiber intake on gestational weight gain, fat accrual and postpartum weight retention: a randomized clinical trial. BMC pregnancy and childbirth 2020; 20:2013

Duarte-Gadea M, González-Pacheco D, Reader D, et al. Academy of Nutrition and dietetics gestational diabetes evidence-based nutrition practice guideline. Journal of Nutrition and Dietetics 2018; 2212-2672.

Kalkwarf H, Bell R, et al. Dietary fiber intake and insulin requirements in pregnant women with type 1 diabetes. Journal of the American Dietetic Association 2001; 101: 305-310.

Cereceda-Bujaico M, Quintana-Salinas M. Consideraciones para la adecuada alimentación durante el embarazo. Revista Peruana de Ginecololgía y Obstetricia 2014; 60(2):153-159.

Comité Nacional de Hematología. Sociedad Argentina de Pediatría. Anemia ferropénica. Arch Argent Pediatr 2001; 99(2):162-167.

Hofmeyr GJ, Lawrie T, Duley L, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2018 Oct 1;10(10):CD001059.

Regil L, Palacios C, Lombardo L. Vitamin D Supplementation for women during pregnancy. Cochrane Database of Systematic Reviews January 2016 Jan 14;(1):CD008873.

Palacios C, Trak-Fellermeier MA, Martínez RX, López-Pérez L, Lips P, Salisi JA, John JC, Peña-Rosas JP. Regimens of vitamin D supplementation for women during pregnancy. Cochrane Database of Systematic Reviews 2019; Issue 10. Art. Nº: CD013446.

Caudill MA. Prenatal and postnatal health: evidence of increased choline needs. J Am diet assoc 2010; 110:1198-206.

WHO recomendations for prevention and tretament of preclampsiaand eclampsia. Geneva: World Health organization; 2011.

Tsirou E, Grammatikopoulou M, et al Guidelines for medical nutrition therapy in gestational diabetes mellitus: systematic review and critical appraisal. Journal of the Academy of Nutrition and Dietetics 2019; 2212-2672.

Laviada-Molina H, Escobar-Duque I, Peryra E, et al. Consenso de la Asociación Latinoamericana de Diabetes sobre el uso de edulcorantes no calóricos en personas con diabetes. Rev ALAD 2018; 8:152:74.

Mulder EJ, Tegaldo L, et al. Foetal responde to maternal coffe intake: role of habitual versus nonhabitual caffein consumption. J Phsychopharmacol 2010; 24: 1641

Moses R, Barker M, Winter M, Petocz P, Brand-Miller J. Can a low-glycemic index diet reduce the need for insulin in gestational diabetes mellitus? Diabetes Care 2009; 32:996-1000.

Wen-Jun Ma, Zhi-Hong Huang, Bi-Xia Huang, Ben-Hua Qi, Yan-Jun Zhang, et al. Intensive low-glycemic-load dietary intervention for the management of glycaemia and serum lipids among women with gestational diabetes: a randomized control trial. Public Health Nutrition 2015; 18(8):1506-1513.

Jenkins DJA, Kendall CWC, McKeown Eyssen G, Josse AR, Ngyuen TH, Corrigan S, Banach MS, Ares S, Mitchell S, Emam A, Augustin LSA, Parker TL, Leiter LA. Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial. JAMA 2008; 300(23):2742-2753.

Moreno-Castilla C, Hernández M, Bergua M, Álvarez M, Arce M, et al. Low carbohydrate diet for treatment of gestacional diabetes mellitus. Diabetes Care 2013; 36: 2233-2238.

Wei J, Heng W, Gao J. Effect of low glycemic index diets on gestational diabetes mellitus. A meta-analysis of randomized controlled clinical trials. Medicine (Baltimore) 2016; 95(22): e 3792.

Asemi Z, Samimi M, Tabassi Z, Esmaillzadeh A. The effect of DASH diet on pregnancy outcomes in gestational diabetes: a randomized controlled clinical trial. Eur J of Clin Nutr 2014; 68(4):490-495.

Yamamoto J, Kellet J, Balsells M, Patterson A, Hadar E, Sola I, Gich I, et al. Gestational diabetes mellitus and diet: a systematic review and meta-analysis of randomized controlled trials examining the impact of modified dietary interventions on maternal glucose control and neonatal birth weight. Diabetes Care 2018; 41:1346-1361.

Keys A, Menotti A, Karvonen MJ, Aravanis C, Blackburn H, Buzina R, Djordjevic BS, Dontas AS, Fidanza F, Keys MH, Kromhout D, Nedeljkovic S, Punsar S, Seccareccia F, Toshima H. The diet and 15-year death rate in the seven countries study. Am J Epidemiol 1986; 124:903-915.

Karamanos B, Thanopoulou A, Anastasiou E, et al. Relation of the mediterranean diet with the incidence of gestacional diabetes. Eur J Clin Nutr 2014; 68: 8-13.

Schoenaker DA, Soedamah-Muthu SS, Callaway LK, Mishra GD. Pre-pregnancy dietary patterns and risk of gestational diabetes mellitus: results from an Australian population-based prospective cohort study. Diabetologia 2015; 58:2726-35.

Assaf-Balut C, García de la Torre N, Durán A, Fuentes M, Bordiú E, del Valle L, et al. (2017) A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): A randomized controlled trial: The St. Carlos GDM prevention study. PLoS One 2017 Oct 19; 12(10):e0185873.

Doi. org/10.1371/journal.pone.0185873

Trichopoulos D, Lagiou P. Mediterranean diet and cardiovascular epidemiology. Eur J Epidemiol 2004; 19:7-8.

López-García E, Schulze MB, Fung TT, et al. Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 2004, 80:1029-35.

Dai J, Jones DP, Goldberg J, et al. Association between adherence to the mediterranean diet and oxidative stress. Am J Clin Nutr 2008; 88:1364-70.

Tobias DK, Hu FB, Chavarro J, Rosner B, Mozaffarian D, Zhang C. Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus. Arch Intern Med 2012; 172:1566-72.

Mozas-Moreno J, Gómez-Fernández J, Olmedo-Requena R, Jiménez-Moleón JJ. Dieta mediterránea y diabetes gestacional. Revisión. Nutr Clin Med 2016; X (1): 54-67.




DOI: http://dx.doi.org/10.47196/diab.v54i2.245

Copyright (c) 2020 Sociedad Argentina de Diabetes Asociación Civil

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