Nivel de evidencia: II-3

RESUMEN

Objetivos: determinar si las mujeres con diagnóstico temprano de diabetes gestacional tienen: mayor riesgo de padecer enfermedad hipertensiva, descontrol metabólico, mayores requerimientos de dosis de insulina y más enfermedades y muerte perinatal, en comparación con las mujeres con diagnóstico de diabetes gestacional después de la semana 24 de embarazo.

Pacientes y método: se estudiaron embarazadas con diagnóstico de diabetes gestacional. En todas se obtuvieron los siguientes datos: edad materna, índice de masa corporal antes del embarazo, ganancia de peso durante el embarazo y semanas de embarazo al momento del diagnóstico y del parto. Las pacientes se dividieron en dos grupos: mujeres con diagnóstico de diabetes antes de la semana 24 y a la semana 24 o posteriormente. Se realizaron comparaciones de dosis de insulina, frecuencia de enfermedad hipertensiva, morbilidad y mortalidad perinatal, y porcentaje de mujeres con control metabólico.

Resultados: del total de mujeres estudiadas, 28% se detectaron tempranamente. Estas tuvieron índice de masa corporal antes del embarazo mayor (30 ± 6 kg/m² vs 27 ± 6 kg/m²) y ganaron menos peso durante el embarazo (8 ± 5 vs 10 ± 6). Los requerimientos de insulina fueron mayores en las mujeres detectadas tempranamente y no hubo diferencia entre ambos grupos en la frecuencia de la enfermedad hipertensiva ni en la mortalidad perinatal. La morbilidad fue mayor en las mujeres detectadas tardíamente.

Conclusiones: el diagnóstico y tratamiento temprano de la diabetes gestacional disminuye la morbilidad perinatal. Las mujeres con diabetes gestacional de aparición temprana, a pesar de que requieren mayores dosis de insulina, no representan un subgrupo de alto riesgo.

Palabras clave: diabetes gestacional, diagnóstico temprano.

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 24^th 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/m² vs 27 ± 6 kg/m²) 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.

Key words: gestational diabetes, early diagnosis.