Historia metabólica de pacientes con antecedentes de diabetes gestacional. Seguimiento durante seis años (2013-2019) / Metabolic record of patients with history of gestational diabetes. Follow-up of patients for six years (2013-2019)

Introducción: en la provincia de La Pampa no hay registro del número de pacientes con diabetes gestacional (DG) que vuelve a control metabólico posparto, cuando se conoce el riesgo que evolucione a diabetes mellitus tipo 2 (DM2). Objetivos: analizar en el Hospital Público Interzonal (Dr. Lucio Molas) el porcentaje de mujeres con DG que volvió a control metabólico posparto y desarrolló DM2 durante seis años de seguimiento. Materiales y métodos: estudio descriptivo ambispectivo en 44 pacientes con DG diagnosticada en 2013 con seguimiento hasta el 31/12/2019. Se analizaron antecedentes previos de DG y familiares de diabetes (AFD), edad, semana de gestación del diagnóstico con glucemia/prueba de tolerancia oral a la glucosa (PTOG), índice de masa corporal (IMC), presión arterial, vía del parto, peso del recién nacido, HbA1c. Resultados: en 2013 se efectuaron 1.238 partos, 44 pacientes (3,7%) tenían DG diagnosticada, 68% mediante PTOG. Presentaban 43% AFD, 38,6% sobrepeso, 20,45% obesidad, 68,2% cesáreas y 11,4% recién nacidos con alto peso. En seis años de seguimiento, 54,5% de estas pacientes realizó control metabólico; este grupo, a diferencia del grupo sin control, presentó mayor IMC al inicio del embarazo (t:2,103; p<0,02), glucemia basal (t:10,59; p<0,001), presión arterial sistólica (t:2,629; p<0,01), diastólica (t:1,965; p<0,05) y macrosomía fetal (4 vs 1). El 33,3 % manifestó DM2 predominantemente a partir de tres años del posparto. Conclusiones: el 54,5% de las pacientes con DG concurrió a control metabólico posparto tardíamente, y el 33,3% evolucionó a DM2; incluso estas pacientes presentaron mayor número de factores de riesgo obstétricos y cardiometabólicos que el grupo sin control al inicio del embarazo.

Introduction: there is no register of the number of women with gestational diabetes (GD) that have undergone metabolic post-partum control in the province of La Pampa, even though it is well-known the increased associated risk of becoming a diabetes type 2 patient (T2DM). Objectives: to analyze at the Interzonal Public Hospital (Dr. Lucio Molas) the percentage of women with GD who returned to postpartum metabolic control and developed T2DM during six years of follow-up. Materials and methods: descriptive ambispective study in 44 patients with GD diagnosed in 2013 with follow-up until 31 December 2019. Different characteristics were analyzed in all participants: previous history of GD and family members of diabetes (FHD), age, gestational week of the diagnosis with fasting glucose or oral glucose tolerance test (OGTT), body mass index (BMI), blood pressure, delivery route, newborn weight, glycated hemoglobin (HbA1C). Results: a number of 1,238 of deliveries were performed in 2013, 44 women (3.7%) developed GD diagnosed by OGTT (68%), 43% presented FHD, 38.6% overweight, 20.45% obesity. Among the totality of deliveries 68.2% were by caesarea and 11.4% high birth weight newborns. In six years of follow-up, 54.5% of these patients underwent metabolic control, presenting this group, unlike the group without control, higher BMI at the beginning of pregnancy (t:2.103; p<0.02), fasting blood glucose (t:10 .59; p<0.001), systolic blood pressure (t:2.629; p<0.01), diastolic blood pressure (t; 1.965; p<0.05) and fetal macrosomia (4 vs 1). 33.3% developed T2DM predominantly from at three years postpartum. Conclusions: the present study reported that 54.5% of women with GD performed a late metabolic postpartum control evolving 33.3% developed T2DM presenting higher obstetric and cardiometabolic risk factors than the group without control at the beginning of pregnancy.

Baja ingesta de yodo durante la gestación / Low iodine intake during pregnancy

Introducción El yodo es un micronutriente esencial en la alimentación de la embarazada que transfiere al embrión-feto a través del transporte placentario. Existen antecedentes de su importancia para el desarrollo neurológico, pero no ha sido estudiada la relación entre ingesta de yodo y peso placentario ni su repercusión en el neonato (RN).Materiales y métodos Se analizó ingesta de yodo en 77 embarazadas, mediante eliminación urinaria de yodo (EUI) con la técnica modificada por Pino (normal ≥150μg/l). Se midió el peso placentario (PP: normal ≥500g). En el recién nacido se evaluó peso, talla y perímetro cefálico (PC). Se obtuvo el índice placentario (IP: peso placentario/ peso recién nacido) considerando normal ≥0,15.ResultadosLa EUI fue normal en 50 embarazadas (media±DE, 279μg/l±70,22μg/l) y disminuida en 27 (94μg/l ±31,49μg/l). Los RN de madres con EUI baja tenían un peso (3.357g±416,30g; n: 27) no diferente a las madres con yodurias normales (3.489g±560,59g; n: 50). Pero las madres con EUI bajo tenían un 44% de placentas con PP<500g y el análisis de los PC en los RN con bajo PP mostró que eran estadísticamente menores (PP3500g: 36,05cm±0,55cm, n: 54; PP<500g: 33,93cm±15cm, n: 23, p<0,019). El estudio con los IP fue similar aunque no alcanzó la significación estadística 0,17±0,04 (p: 0,066). Los demás parámetros no mostraron diferencias significativas. Conclusión El estudio evidencia una relación entre el PP y PC. Este hallazgo puede ser relacionado con la ingesta de yodo durante el embarazo (AU)

Introduction Iodine is considered to be an essential micronutrient in pregnant women. Iodine placental transport to the embryo-fetus is essential for hormone synthesis and is crucial for nervous system development. However, the relationship between iodine intake and placental weight and its potential implications for the newborn have not been studied. Material and methods Iodine intake was analyzed in 77 pregnant women based on urinary iodine excretion (UIE) levels, measured using Pino's modified method (normal value, ≥150μg/L). Placental weight was measured (PW: normal, ≥500g). In the newborn, weight, height, and head perimeter (HP) were also measured. Placental index (PI: placental weight/newborn weight) was calculated, and was considered normal if ≥0.15.ResultsUIE was normal in 50 pregnant women (mean±SD, 279±70.22μg/L) and decreased in 27 (94±31.49μg/L). Newborns of mothers with low UIE had a similar weight (3357±416.30g; n: 27) to those of mothers with normal UIE (3489±560.59g; n: 50). Forty-four percent of mothers with low UIE had PW <500g, and statistically lower HPs were found in newborns of mothers with low PW (PW3 500g: 36.05±0.55cm, n: 54; PW<500g: 33.93±15cm, n: 23, p<0.019). Similar results were found with PI, but they did not reach statistical significance (0.17±0.04; p=0.066). No differences were seen in all other parameters. Conclusion The study suggests the existence of a relationship between PW and HP. This finding may be related to iodine intake during pregnancy (AU)

Low iodine intake during pregnancy: relationship to placental development and head circumference in newborn.

INTRODUCTION: Iodine is considered to be an essential micronutrient in pregnant women. Iodine placental transport to the embryo-fetus is essential for hormone synthesis and is crucial for nervous system development. However, the relationship between iodine intake and placental weight and its potential implications for the newborn have not been studied. MATERIAL AND METHODS: Iodine intake was analyzed in 77 pregnant women based on urinary iodine excretion (UIE) levels, measured using Pinós modified method (normal value, ≥ 150 µg/L). Placental weight was measured (PW: normal, ≥500 g). In the newborn, weight, height, and head perimeter (HP) were also measured. Placental index (PI: placental weight/newborn weight) was calculated, and was considered normal if ≥0.15. RESULTS: UIE was normal in 50 pregnant women (mean ± SD, 279 µg/L ± 70.22 µg/L) and decreased in 27 (94 µg/L ± 31.49 µg/L). Newborns of mothers with low UIE had a similar weight (3357 g ± 416.30 g; n: 27) to those of mothers with normal UIE (3489 g ± 560.59 g; n: 50). Forty-four percent of mothers with low UIE had PW <500 g, and statistically lower HPs were found in newborns of mothers with low PW (PW(3)500 g: 36.05 cm ± 0.55 cm, n: 54; PW <500 g: 33.93 cm ± 15 cm, n:23, p<0.019). Similar results were found with PI, but they did not reach statistical significance (0,17 ± 0,04; p=0.066). No differences were seen in all other parameters. CONCLUSION: The study suggests the existence of a relationship between PW and HP. This finding may be related to iodine intake during pregnancy.