ABSTRACT
Resumen: OBJETIVO: comparar la prevalencia y resultados perinatales adversos de la diabetes mellitus gestacional en mujeres embarazadas adolescentes utilizando tres criterios diagnósticos internacionales diferentes. MATERIAL Y MÉTODOS: estudio comparativo y observacional de cohorte retrospectiva efectuado en adolescentes a quienes se tomó una curva de tolerancia oral a la glucosa de 75g-2 h, entre las 24 y 28 semanas de gestación. Se analizaron la prevalencia y los resultados perinatales adversos, con criterios del Fifth International Workshop-Conference on Gestational Diabetes Mellitus, International Association of Diabetes and Pregnancy Study Groups y National Institute for Health and Care Excellence. RESULTADOS: se estudiaron 493 adolescentes en quienes se obtuvo una prevalencia de diabetes mellitus gestacional de: 0.2, 6.3 y 1.8%, con los criterios del Fifth International Workshop-Conference on Gestational Diabetes Mellitus, International Association of Diabetes and Pregnancy Study Groups y National Institute for Health and Care Excellence, respectivamente. La prevalencia de diabetes mellitus gestacional fue significativamente mayor con los criterios de la International Association of Diabetes and Pregnancy Study Groups, sin diferencias significativas en los resultados perinatales adversos al utilizar cualquiera de los tres criterios. CONCLUSIÓN: la prevalencia de diabetes mellitus gestacional según los criterios de la International Association of Diabetes and Pregnancy Study Groups es 3 veces mayor que con los criterios del National Institute for Health and Care Excellence y 30 veces mayor con los criterios de la Fifth International Workshop-Conference on Gestational Diabetes Mellitus. No hubo riesgo incrementado de resultados perinatales adversos en adolescentes con diabetes mellitus gestacional; sin embargo, podrían tener mayor riesgo de padecer diabetes mellitus tipo 2 a largo plazo.
Abstract: OBJECTIVE: To compare the prevalence and perinatal outcomes of gestational diabetes mellitus in adolescent women using three international diagnostics criteria. METHODS: An observational retrospective cohort study, 493 adolescents were included, an oral glucose tolerance test 75g-2 h was performed, between 24 and 28 weeks of gestation, the prevalence and adverse perinatal outcomes was analyzed, with criteria of Fifth International Workshop-Conference on Gestational Diabetes Mellitus, International Association of Diabetes and Pregnancy Study Groups and National Institute for Health and Care Excellence. RESULTS: The prevalence of gestational diabetes mellitus was: 0.2%, 6.3% and 1.8%, with the criteria of Fifth International Workshop-Conference on Gestational Diabetes Mellitus, International Association of Diabetes and Pregnancy Study Groups and National Institute for Health and Care Excellence, respectively. The prevalence of gestational diabetes mellitus was significantly higher with criteria of the International Association of Diabetes and Pregnancy Study Groups; there were no significant differences among adverse perinatal outcomes when using any of the three criteria. CONCLUSION: Prevalence of gestational diabetes mellitus using the criteria of the International Association of Diabetes and Pregnancy Study Groups is 3 times higher than National Institute for Health and Care Excellence criteria and 30 times higher than the Fifth International Workshop-Conference on Gestational Diabetes Mellitus criteria. There was no increased risk of adverse perinatal outcomes in adolescents with gestational diabetes mellitus; however, adolescents may be at increased risk of developing type 2 diabetes mellitus long term.
ABSTRACT
Resumen: OBJETIVO: determinar los valores de referencia del Homeostatic Model Assessment Insulin Resistance (HOMA-IR) y Quantitative Insulin Sensitivity Check Index (QUICKI) para establecer el diagnóstico de resistencia a la insulina en mujeres mexicanas no embarazadas y embarazadas, por trimestre de gestación. MATERIALES Y MÉTODOS: estudio transversal al que se incluyeron mujeres embarazadas y no embarazadas sin alteraciones concomitantes, mayores de18 años de edad, índice de masa corporal pregestacional entre 18.5-24.9 kg/m2. A todas las participantes se les realizó la curva de tolerancia a la glucosa oral de 75 g-2h. Se excluyeron las mujeres con diabetes gestacional o cualquier alteración pregestacional, índice de masa corporal pregestacional menor de 18.5 o más o menos mayor de 25 kg/m2 y embarazo múltiple. Se calcularon los percentiles 5 y 95 como valores de referencia para definir resistencia a la insulina por HOMA-IR y QUICKI en mujeres sin embarazo y en cada trimestre del embarazo. Resultados: se incluyeron 400 mujeres, agrupadas de la siguiente forma: Grupo de mujeres sin embarazo (SE): n=42, grupo trimestre (T) 1: n=82, grupo T2: n=159 y grupo T3: n=117. Los valores de referencia de HOMA-IR para el percentil 5 y 95 fueron: 0.33-2.6, 0.35-1.6, 0.40-2.9 y 0.38-2.6 y para QUICKI: 0.33-0.46, 0.35-0.46, 0.32-0.45 y 0.33-0.45, para los grupos SE, T1, T2 y T3, respectivamente. Conclusión: el valor de referencia de HOMA-IR para establecer el diagnóstico de resistencia a la insulina en mujeres mexicanas no embarazadas (SE) es ≥ 2.6 y en pacientes embarazadas por trimestre: T1 ≥1.6, T2 ≥2.9 y T3 ≥2.6; respecto de QUICKI, los valores de referencia son SE <0.33, T1 <0.35, T2 <0.32 y T3 <0.33, respectivamente.
Abstract: OBJECTIVE: To determine the reference values of Homeostasis Model Assessment Insulin Resistance, (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI) to define insulin resistance (IR) in women without pregnancy (WP) and each trimester of pregnancy among Mexican women. METHODS: Cross-sectional study, women without pregnancy and pregnant women age >18 years, without pathologies, pre-pregnancy body mass index (BMI) between 18.5-24.9 kg/m2 were included. All participants underwent CTOG 75gr-2h to rule out diabetes. We excluded women with gestational diabetes or any pre-pregnancy pathology, pre-pregnancy BMI <18.5 or ≥25 kg/m2 and multiple pregnancy. Percentiles 5 and 95 were calculated as reference values to define RI by HOMA-IR and QUICKI in women without pregnancy and each trimester of pregnancy. RESULTS: A total of 400 women were included, which were grouped as follows: Group of women without pregnancy (SE): n = 42, quarter Group (T) 1: n = 82, T2 Group: n = 159 and T3 group: n = 117. The reference values of HOMA-IR for the 5th and 95th percentile were: 0.33-2.6, 0.35-1.6, 0.40-2.9 and 0.38-2.6 and QUICKI: (0.33 to 0.46, 0.35 to 0.46, 0.32 to 0.45 and 0.33- 0.45, for groups SE, T1, T2 and T3, respectively. CONCLUSION: The reference value of HOMA-IR to define RI in Mexican women should be ≥2.6 and the T1 ≥1.6, T2 pregnancy: ≥2.9 and T3 ≥2.6 and QUICKI in women <0.33, T1 <0.35, T2 <0.32 and T3 <0.33.