[Incidence and clinical risk factors for the development of diabetes mellitus in women with previous gestational diabetes]. / Incidencia y factores clínicos de riesgo de diabetes mellitus en mujeres con diabetes gestacional previa.

BACKGROUND: Gestational diabetes is considered a variant of diabetes mellitus as they share a common pathophysiological basis: insulin resistance in target and insufficient secretion of it by pancreatic p-cell bodies. Pregnancy is a unique physiological situation provides an opportunity to identify future risk of diabetes mellitus. OBJECTIVE: To determine the long-term incidence of diabetes mellitus in women who have previously been diagnosed with gestational diabetes and identifying clinical risk factors for developing the same. METHODS: nested case-control cohort study. 671 patients between 1996 and 2009 were diagnosed with gestational diabetes were selected. The incidence of diabetes mellitus was estimated and 2 subgroups were formed: Group A or cases: women who develop diabetes mellitus after diagnosis of gestational diabetes. Group B or control: random sample of 71 women with a history of gestational diabetes in the follow-up period remained normoglycemic. Both groups were studied up to 18 years postpartum. By studying Kaplan Meier survival of the influence of different gestational variables it was obtained in the later development of diabetes mellitus with time parameter and COX models for categorical variables were applied. Significant variables were studied by multivariate Cox analysis. In all analyzes the Hazard ratio was calculated with confidence intervals at 95%. RESULTS: The incidence of diabetes mellitus was 10.3% in patients with a history of gestational diabetes. They were identified as risk factors in the index pregnancy to later development of diabetes mellitus: greater than 35 and younger than 27 years maternal age, BMI greater than 30 kg/m2, hypertensive disorders of pregnancy, insulin therapy, poor metabolic control and more than a complicated pregnancy with gestational diabetes. CONCLUSIONS: Clinical factors have been identified in the pregnancy complicated by gestational diabetes that determine a higher probability of progression to diabetes mellitus in the medium and long term.

[Risk factors for cardiovascular disease in patients with hypertensive disorders during pregnancy. Experience of 10 years]. / Factores de riesgo de enfermedad cardiovascular en gestantes con estados hipertensivos. Experiencia de 10 años.

Background: The 8 to 10% of pregnancies are affected with hypertensive disorders of pregnancy. They are the most common obstetric complication and present significant maternal and perinatal morbidity and mortality; but also these diseases go beyond pregnancy and determine a group of women with increased cardiovascular risk in your life futura. Cardiovascular disease remains the main cause of death in the Western world and women with a history of pregnancy hypertensive disease, are at increased risk of cardiovascular complications afterwards. Therefore, pregnancy is a unique physiological situation provides an opportunity to identify a group of women who will present cardiovascular risk factors later in life. Objetive: To determine the long-term cardiovascular risk factors (chronic hypertension, type 2 diabetes mellitus, metabolic syndrome) and thyroid dysfunction incidence in women who have previously been diagnosed with "hypertensive disorders of pregnancy". Material and methods: Case-control study with retrospective collection of information from women whose pregnancy and childbirth occurred between 2000 and 2010. Case: Patients with a diagnosis of "hypertensive diseases of pregnancy" (N = 134). Control: random sample of pregnant women who were not diagnosed with hypertensive state of pregnancy and whose gestation was spent in 2000 (n = 145). The mean follow-up of both groups was 10,78 years. We have applied parametric test (T-Student for independent samples), and for those variables that did not meet that condition, we have applied the U of Mann-Whitney test. The Chi-square test was used to compare qualitative variables and Fisher's exact test. For comparison between groups, model univariate logistic regression was performed. Results: The incidence of hypertension was 41,32% in patients with a history of hypertensive pregnancy disease, with a relative risk (RR) was 9,15. The incidence of type 2 diabetes mellitus was 5,17%. Dyslipidemia was diagnosed after at 43,53% with a RR of 3,7. Metabolic syndrome reached 16,83% in the cases population with a RR of 2,63. The incidence of hypothyroidism was 8,11%. Conclusion: Patients who were diagnosed with "hypertensive state of pregnancy" are a group of women at increased risk of developing cardiovascular risk factors later in life.