Adecuación del cribado de diabetes mellitus en mujeres con antecedente de diabetes gestacional / Suitability of screening for diabetes mellitus in women with a history of gestational diabetes

Objetivo. Evaluar a largo plazo la adecuación del cribado de diabetes mellitus de tipo 2 en mujeres con diagnóstico previo de diabetes gestacional en Atención Primaria. El objetivo secundario fue determinar los factores clínicos que modifican la adecuación del cribado. Material y métodos. Estudio observacional de cohortes. Se seleccionó al total de pacientes con el diagnóstico de diabetes gestacional durante de los años 2000-2009 (n=470) en el Complexo Hospitalario Universitario de Ourense. Se procedió a la revisión de la historia clínica electrónica, valorando la existencia y el año de realización de la última glucemia basal. El tiempo medio de seguimiento fue de 12,9 años. Se consideró cribado adecuado la constancia en la historia clínica de una glucemia basal en los últimos 3 años. Se analizaron las siguientes variables: adecuación del cribado de diabetes mellitus de tipo 2, edad, índice de masa corporal, diabetes gestacional en más de una gestación, medio rural/urbano. Se realizó el análisis descriptivo de los datos. Para la determinación de las diferencias entre subgrupos se utilizó la prueba Chi2 y la prueba t de Student. Se consideró significación estadística p<0,05. Resultados. El control a largo plazo de estas pacientes fue muy irregular. Solo el 67,0% del grupo a estudio realizó cribado de diabetes mellitus de tipo 2. Ni la edad, ni el índice de masa corporal, ni el lugar de residencia, ni el año del diagnóstico modificaron el grado de seguimiento. Las pacientes con más de un episodio de diabetes gestacional presentaron un control glucémico posterior que alcanzó el 94,1%. Conclusión. La adecuación del cribado en nuestra área es muy irregular y altamente mejorable (AU)

Objective. To assess long-term suitability of screening for type 2 diabetes mellitus in women with a previous diagnosis of gestational diabetes in Primary Care. The secondary objectives were to determine if there were clinical factors that modified the usefulness of the screening. Material and methods. An observational cohort type study was performed, which included all patients with the diagnosis of gestational diabetes during the years 2000 to 2009 (n=470) in the University Hospital Complex of Ourense. The electronic medical records were reviewed to assess the existence of gestational diabetes and the year of the last fasting blood glucose. The mean follow-up time was 12.9 years. The screening for evidence of a fasting blood glucose in the last 3 years was considered adequate. The following variables were analysed: adequacy of screening for type 2 diabetes mellitus, age, body mass index, gestational diabetes in more than one gestation, and rural/urban environment. A descriptive analysis of the data was performed, using Chi2 and Student's t-test to determine differences between subgroups. Statistical significance was considered as P<.05 Results. The long-term monitoring of these patients was very irregular. Only 67.08% of the study group underwent diabetes mellitus type 2 screening. The level of follow-up was not associated with age, BMI, the place of residence, or the year of diagnosis. In patients with more than one episode of gestational diabetes, subsequent blood glucose control was achieved in 94.1%. Conclusion. The adequacy of the screening in our area is very irregular and highly improvable (AU)

[Suitability of screening for diabetes mellitus in women with a history of gestational diabetes]. / Adecuación del cribado de diabetes mellitus en mujeres con antecedente de diabetes gestacional.

OBJECTIVE: To assess long-term suitability of screening for type 2 diabetes mellitus in women with a previous diagnosis of gestational diabetes in Primary Care. The secondary objectives were to determine if there were clinical factors that modified the usefulness of the screening. MATERIAL AND METHODS: An observational cohort type study was performed, which included all patients with the diagnosis of gestational diabetes during the years 2000 to 2009 (n=470) in the University Hospital Complex of Ourense. The electronic medical records were reviewed to assess the existence of gestational diabetes and the year of the last fasting blood glucose. The mean follow-up time was 12.9 years. The screening for evidence of a fasting blood glucose in the last 3 years was considered adequate. The following variables were analysed: adequacy of screening for type 2 diabetes mellitus, age, body mass index, gestational diabetes in more than one gestation, and rural/urban environment. A descriptive analysis of the data was performed, using Chi2 and Student's t-test to determine differences between subgroups. Statistical significance was considered as P<.05 RESULTS: The long-term monitoring of these patients was very irregular. Only 67.08% of the study group underwent diabetes mellitus type 2 screening. The level of follow-up was not associated with age, BMI, the place of residence, or the year of diagnosis. In patients with more than one episode of gestational diabetes, subsequent blood glucose control was achieved in 94.1%. CONCLUSION: The adequacy of the screening in our area is very irregular and highly improvable.

Retraso de crecimiento intrauterino severo: ¿es posible su cribado en el primer trimestre de gestación? / Severe intrauterine growth retardation: Is screening feasible in the first trimester of pregnancy?

Objetivo: Determinar si existe una relación entre los niveles plasmáticos de proteína A asociada a la gestación (PAPP-A) expresada en múltiplos de la mediana (MoM) con el retraso de crecimiento intrauterino (RCIU), independientemente de otros parámetros clínicos o ecográficos. Valorar si los valores de PAPP-A son capaces de predecir el riesgo de RCIU. Material y método: Estudio epidemiológico, observacional, analítico, tipo casos y controles, desarrollado entre enero de 2012 y septiembre de 2013 con pacientes del Complexo Hospitalario Universitario de Ourense. El tamaño muestral fue de 138 gestantes y sus respectivos recién nacidos. Para la determinación de las diferencias en las PAPP-A entre casos y controles se utilizó la prueba U de Mann-Whitney. Se realizó la representación gráfica mediante modelos GAM con respuesta gaussiana y binaria para conocer el comportamiento de los valores de la PAPP-A con respecto a los pesos de los recién nacidos y el riesgo de presentar un feto con RCIU respectivamente. Los valores de la PAPP-A fueron obtenidos de las muestras extraídas para el cribado combinado del primer trimestre entre la semana 11 + 3 y 13 + 5 de amenorrea. El estudio estadístico se realizó con el paquete SPSS 15.0 y Epidat 3.0. Se consideró significación estadística para una p < 0,05. Resultados: Los valores de PAPP-A expresados en MoM se comportan como un predictor independiente de retraso de crecimiento fetal, sin estar influidos por factores maternos o parámetros ecográficos fetales precoces. Un valor de PAPP-A (MoM) por debajo de 0,33 MoM puede predecir pesos fetales inferiores al percentil 3, para un intervalo de confianza al 95% (0,24-0,56). Un valor de PAPP-A (MoM) inferior a 0,4 MoM tiene un riesgo relativo de RCIU del 2,50; superior, incluso, al que presenta el consumo de tabaco en la gestación (RR: 1,7). Conclusiones: El cribado combinado de cromosomopatías fetales es actualmente una práctica habitual en la mayoría de los hospitales. A partir de los datos que este nos ofrece, es posible seleccionar a un grupo de pacientes con mayor riesgo de alteraciones de la placentación, sin que ello suponga un incremento del gasto sanitario, facilitando la optimización de los recursos materiales y humanos

Objective: To determine if there is a relationship between pregnancy-associated plasma protein-A (PAPP-A) levels, expressed in multiples of the median (MoM), and intrauterine growth retardation (IUGR) independently of other clinical or ultrasound parameters. To assess whether PAPP-A values are able to predict the risk of IUGR. Material and method: An epidemiological, observational, analytical, case-control study was conducted between January 2012 and September 2013 in patients attending the University Hospital Complex of Ourense. The sample consisted of 138 pregnant women and their respective newborns. Differences in PAPP-A between cases and controls were determined by the Mann-Whitney U test. Graphs were plotted using GAM models with Gaussian and binary response to determine the behavior of PAPP-A values with respect to birthweight and the risk of intrauterine growth restriction, respectively. PAPP-A values were obtained from samples taken for combined first trimester screening at weeks 11 + 3 and 13 + 5 of amenorrhea. The statistical analysis was conducted with the statistical package SPSS 15.0 and Epidat 3.0. Statistical significance was set at P < .05. Results: PAPP-A values, expressed as MoM, behaved as an independent predictor of IUGR, without being influenced by maternal factors or early fetal ultrasound parameters. A PAPP-A value (MoM) below 0.33 MoM predicted fetal weights below the 3rd percentile for a 95% confidence interval (0.24-0.56). A PAPP-A value (MoM) of less than 0.4 MoM had a relative risk of IUGR of 2.50, which was even higher than that posed by smoking during pregnancy (RR: 1,7). Conclusion: Combined screening of fetal chromosomal abnormalities is currently routine practice in most hospitals. The data provided by this screening can be used to select a group of patients at increased risk of alterations of placentation, without increasing health costs, thus facilitating the optimization of material and human resources

[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.