Pregnancy: Pregestational and Gestational Management

Abstract

Gestational diabetes (GD) is a complication of pregnancy with an incidence of up to 16%, characterized by alteration in carbohydrate metabolism. It is a condition that favors greater risk of developing complications such as congenital malformations, stillbirth, preeclampsia, fetal macrosomia, polyhydramnios, greater index of cesareans, and hemorrhagic complications that it brings. Its etiology is multifactorial, including genetic determinants such as ethnicity; lifestyle, where sedentary lifestyle plays the most important role; easy access to high-caloric foods; and the socioeconomic level, where the lower strata have the highest risk. Diagnosis is easy to perform from the identification of women of reproductive age with risk factors and from the first prenatal visit, by measuring blood glucose. General measures such as lifestyle and diet modification of the pregnant patient are the beginning of treatment. In the case of not reaching control of glucose levels, oral hypoglycemic drug and insulin are the basis of treatment with the object of maximum reduction of complications for both mother and neonate.

Glossary

ACOG

The American College of Obstetricians and Gynecologists.

ADA

The American Diabetes Association.

BMI

Is the result of dividing the weight of a person in kilograms by the square of his height in meters.

Congenital malformations

are anatomic alterations that occur in the intrauterine stage and may be alterations in organs, extremities or systems, due to environmental, genetic factors, deficiencies in nutrient capture, or consumption of noxious substances.

ENSANUT 2012

National Health and Nutrition Survey 2012 (Mexico).

FDA

The Food and Drug Administration.

Fetal macrosomia

Traditionally, fetal macrosomia has been defined as arbitrary weight at birth, such as 4000, 4100, 4500, or 4536 grams. It is currently defined as a fetus that is large for gestational age (> 90 percentile).

GD

Gestational diabetes, which is defined as alteration in carbohydrate metabolism diagnosed for the first time in the second or third trimester of gestation.

HAPO Study

Hyperglycemia and Adverse Pregnancy Outcomes study.

IADPSG

The International Association of Diabetes and Pregnancy Study Groups.

Insulin

From the Latin “isla.” It is a polypeptide hormone formed by 51 amino acids, produced and secreted by the beta cells of the Islets of Langerhans of the pancreas. Discovered by Frederick Grant Banting, Charles Best, James Collip, and J.J.R. Macleod of the University of Toronto, Canada in 1921.

NIH

National Institutes of Health.

Obesity

Obesity and overweight are defined as abnormal or excessive accumulation of fat that may prejudice health. A simple way to measure obesity is the body mass index (BMI), which is the weight of a person divided by height in meters squared. A person with BMI equal or above 30 is considered obese and with a BMI equal or greater than 25 is considered overweight.

Oral hypoglycemic drugs

Antidiabetic drugs which are classified as sulfonylureas, biguanides, alpha-glucosidase inhibitors, meglitinides (repaglinide, nateglinide) and thiazolidinediones.

Perinatal mortality

is the fetus and newborn risk of dying as a consequence of the reproductive process.

Premature birth

According to WHO, birth that occurs after week 20 and before 37 complete weeks.

T1D

Type 1 diabetes, which is secondary to the destruction of the beta cells of the pancrease, and in general leads to absolute insulin deficiency.

T2D

Type 2 diabetes, which is due to a progressive loss of insulin secretion.

WHO

World Health Organization.

Women of reproductive age

Women between 15 and 44 years.