Diabetes gestacionalobtención de un protocolo de actuación que permita realizar un mejor diagnóstico de la enfermedad

Abstract

Gestational diabetes is defined as carbohydrate intolerance of variable intensity, with onset or detection during gestation, regardless of treatment used to control and postnatal outcomes. This disorder has been increasing worldwide incidence in recent years. The prevalence of gestational diabetes varies between 1% and 14% of pregnancies, although in our environment (Mediterranean Area) ranges between 7% and 9%, which represents 90% of all pregnancies of risk. The clinical significance of gestational diabetes is maternal and fetal morbidity- mortality. The most common fetal anomaly is macrosomia, followed by respiratory distress, hypoglycemia, hypocalcemia, hypomagnesemia, hyperbilirubinemia, malformations and neonatal death; while in pregnant woman, the most frequent are cesareans, cardiovascular complications, diabetes mellitus and maternal mortality. All these maternal and fetal complications are reduced after appropriate treatment. Consequently, most studies and scientific societies, recommend early diagnosis of gestational diabetes to establish treatment as early as possible, when necessary, thereby reducing the complications of gestational diabetes. Despite the different consensus conferences and expert group recommendations published in recent years, there isn't still a final agreement on the best diagnostic protocol and clinical management of this disease. In Spain, the method used is screening in two steps, because it is the method recommended by the Spanish Society of Gynecology and Obstetrics, based on the recommendations of National Diabetes Data Group. This method involves first performing an oral load of 50 g of anhydrous glucose and measure blood glucose after 1 hour of ingestion, so that those women who have a blood glucose level > 140 mg/dL, you have to make them the confirmation test, 2-3 weeks after first test, consisting of administration 100 g of anhydrous glucose by via oral and measured plasma levels of glucose for 3 hours after overload, so that gestational diabetes is diagnosed when two or more plasma glucose are equal or greater: 105 mg/dl for baseline, 190 mg/dl for first hour, 165 mg/dL for second hour, and 145 mg/dl for third hour. This method is complicated, annoying and causes certain inconveniences to pregnant women such as nausea, dizziness, vomiting and malaise. In adiction, diagnosis requires women to perfom the blood glucose curve on two different days, separated by at least, one week, with the attendant problems of loss of working days. The overall objective of the study is to find a more efficient way tp screen women with gestational diabetes and get an early diagnosis of women with this disease in order to establish as soon as possible therapeutic measures to reduce the serious effects of gestational diabetes. 388 pregnant women were controlled and followen by the health service of hospital complex �Hospitales de Huelva� were studied. The action proposed in our study protocol is: 1. All women was performed O�sullivan test or oral load of 50 grams of anhydrous glucose. Nobody won�t have to test overload with 100 gr of anhydrous glucose, those pregnant women who have a plasma glucose after oral overload of 50 grams of anhydrous glucose at 60 minutes equal or above than 190 mg/dL or less than 140 mg/dL. 2. We won�t do the confirmation test to those pregnant with a glycosylated hemoglobin less than 4.85% would never would have a gestational diabetes, or greater than 5.95%, they will always have a gestational diabetes. 3. To the rest, we will apply the proposed equation (F(Z?G) = x 20t383-0i018*os) and we only will make the confirmation test when our equations tell us that patient will be at risk for gestational diabetes. Protocol proposed in this paper would lead to a reduction of 50,38% of the confirmatory tests that are currently underway. Consequently, its implementation in the Servicio Andaluz de Salud (SAS) would be a significant cost savings to the SAS, a reduction of discomfort and/or harm to women and savings money to companies where pregnant women work, ensuring that all women pregnant women with gestational diabetes in our health area are correctly diagnosed.