Sensitivity of fasting glucose for gestational diabetes mellitus screening in Mexican adolescents based on International Association of Diabetes and Pregnancy Study Groups criteria: a diagnostic accuracy study based on retrospective data analysis.

OBJECTIVE: To evaluate fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) among Mexican adolescents using International Association of Diabetes and Pregnancy Study Groups criteria. DESIGN: Retrospective cohort study. SETTING: Level-three medical institution in Mexico City. PARTICIPANTS: The study population comprised 1061 adolescent women aged 12-19 years with singleton pregnancies, who underwent a 75 g oral glucose tolerance test (OGTT) between 11 and 35 weeks of gestation. PRIMARY AND SECONDARY OUTCOME MEASURES: The sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios LR (+) and LR (-), respectively) with 95% CIs for selected FPG cut-off values were compared. Secondary measures were perinatal outcomes in women with and without GDM. RESULTS: GDM was present in 71 women (6.7%, 95% CI 5.3% to 8.4%). The performances of FPG at thresholds of ≥80 (4.5 mmol/L), 85 (4.7 mmol/L) and 90 mg/dL (5.0 mmol/L) were as follow (95% CI): Sn: 97% (89% to 99%), 94% (86% to 97%) and 91% (82% to 95%); Sp: 50% (47% to 53%), 79% (76% to 81%) and 97% (95% to 97%); PPV: 12% (9% to 15%), 23% (18% to 28%) and 64% (54% to 73%); NPV: 99% (98.5% to 99.9%) for all three cut-offs; LR (+): 1.9 (1.8 to 2.1), 4.3 (3.8 to 5.0) and 26.7 (18.8 to 37.1) and LR (-): 0.06 (0.02 to 0.23), 0.07 (0.03 to 0.19) and 0.09 (0.04 to 0.19), respectively. No significant differences in perinatal outcomes were found between adolescents with and without GDM. CONCLUSIONS: An FPG cut-off of ≥90 mg/dL (5.0 mmol/L) is ideal for GDM screening in Mexican adolescent women. An FPG threshold of 90 mg/dL would miss 6 (8.5%) women with GDM, pick up 34 (3.4%) women without GDM and avoid 962 (90.7%) OGTTs.

The importance of gestational diabetes beyond pregnancy.

Diabetes mellitus is the main health problem affecting Mexico's population. The mechanisms by which susceptibility to it is acquired and diabetes develops are topics of ongoing research. In order to prevent type 2 diabetes, one of the challenges is to fully understand gestational diabetes and the hormonal changes and altered carbohydrate metabolism that are associated with it during fetal development. A recent study by the Instituto Nacional de Perinatología found a 12.9% prevalence of gestational diabetes; if the current criteria suggested by the American Diabetes Association were applied, this figure would rise to almost 30%. Identifying mothers and children at high risk of developing diabetes mellitus and its comorbid conditions will help facilitate the timely implementation of preventive measures. This will be a rational use of economic resources in Mexico that will vitally benefit public health.

[Effect of betamethasone in blood glucose levels in pregnant diabetic women at risk of preterm birth]. / Efecto de la betametasona en la glucemia de diabéticas embarazadas en riesgo de nacimiento pretérmino.

BACKGROUND: The bethametasone (BTM) induced hyperglycemia is not adequately known and managed in diabetic pregnant women. OBJECTIVE: To compare the betamethasone-induced hyperglycemia in pregnant women either healthy or with gestational or type 2 diabetes mellitus (diabetes mellitus). MATERIAL AND METHODS: Forty volunteer pregnant women at risk of premature rupture of membranes who received betamethasone (12 mg i.m. every 24 hours, 2 doses) were divided in four groups (10 women each): G1, healthy; G2, Diet treated diabetes mellitus; G3, Diet plus insulin treated diabetes mellitus; G4, type 2 diabetes mellitus treated with diet (n=6) or diet and insulin (n=4). Pre (p) and 2h-postprandial (pp) capillary blood glucose was measured throughout the day during 5 days of hospitalization. Student't test for independent and dependent samples was used. RESULTS: G1 had no significant changes in p or pp glucose. In G2 four women required de novo insulin administration while insulin dose was increased 39 to 112% and 26 to 64% in all women in G3 and G4, respectively to maintain p and pp glucose levels <95 mg/dL and < 120 mg/dL, respectively. The greatest changes occurred between days 2 to 4 after betamethasone. CONCLUSION: Betamethasone-induced hyperglycemia was greater in insulin treated women with gestational or type 2 diabetes and should not be administrated on an out-patient basis.

Neurodesarrollo en infantes con antecedente de hipotiroidismo congénito / Neurodevelopment in infants with congenital hypothyroidism antecedents

Introducción: Los estudios de seguimiento de infantes con hipotiroidismo congénito con tratamiento temprano, muestran que no existen diferencias con respecto al coeficiente intelectual que se encuentra en la población general. Material y métodos: Estudio de cohorte retrospectivo. Veinticuatro hipotiroideos fueron detectados a través del Programa de Tamiz Neonatal y comparados con un grupo testigo. Los recién nacidos fueron valorados entre los seis meses y los siete años de edad mediante el índice de desarrollo (ID) de Bayley, el coeficiente intelectuales (Cl) de Terman Merril y la prueba Hiskey Nebraska para detectar infantes con hipoacusia. Resultados: Dieciocho infantes hipotiroideos mostraron Cl o ID normal o alto. Uno con ID de Bayley porabajo del promedio, dos con Cl por abajo del promedio y uno con hipoacusia y capacidad de aprendizaje baja. No se encontraron diferencias con respecto al grupo control. El uso de ototóxicos, prematurez e hiperbilirrubinemia, fueron las causas que explicaron los coeficientes bajos entre los hipotiroideos y el grupo control. Conclusiones: El Cl y el ID en el grupo de hipotiroidismo tratado tempranamente no difirió con los resultados del grupo testigo.

Introduction: Follow-up studies of hypothyroid infants who received early treatment evidence the presence of the same IQ vs. the general population. Material and methods: Retrospective cohort study. Twenty-four hypothyroid infants detected in neonatal screening were compared to a control group. The newborns were assessed from six months to seven years based on Bayley's infant development scales (ID), the Terman-Merril IQ (Cl) and the learning aptitude of the heard of hearing with the Hiskey-Nebraska test (CA). Results: Twenty hypothyroid infants showed a normal or high Cl or ID. One of the infants with a ID result below the mean, two with an Cl below the mean, one hearing impaired infant with low learning aptitude. No differences were found vs. the control group. The use of ototoxic medications, prematurity and hyperbilirubinemia explain the low coefficients between the hypothyroid individuals and the control. Conclusions: The Cl and the ID results in the hypothyroid group who received early treatment showed no difference vs. the control group.

[Gestational diabetes mellitus. Experience at a third level hospital]. / Diabetes mellitus gestacional. Experiencia en una institución de tercer nivel de atención.

BACKGROUND: The prevalence of type 2 diabetes mellitus and of gestational diabetes mellitus is high in the Mexican population; thus, strategies to improve its detection and prevent obstetric and perinatal complications are essential. PATIENTS AND METHODS: During the period 2000-2004 a total of 8,074 pregnant women were studied from the day of performance, 50-g, 1 hour glucose screening test for gestational diabetes mellitus (ST-GDM) until the end of pregnancy using the same protocol: ST-GDM was performed immediately after 14 weeks of gestation in high-risk women and between 24-28 weeks in those with regular risk. Two weeks later 100-g, 3 hour oral glucose tolerance test (3h-OGTT) was performed in women with ST-GDM [symbol: see text] 130 but < 180 mg/dL, and patients were classified according to Freinkel's criteria in class A1, A2 and B1 gestational diabetes mellitus. All women received a diet according to their ideal weight for gestational age and, when necessary, insulin was added to achieve an adequate glycemic control. RESULTS: From 8,074 glucose screening tests for gestational diabetes mellitus, 37.2% (n = 2,997) were positive and 17.2% (n = 514) diagnostic for gestational diabetes mellitus (serum glucose [symbol: see text] 180 mg/dL). In 2,483 patients, ST-GDM was positive but negative for gestational diabetes (serum glucose >130 but <180 mg/dL); in 1,070 of them (43.0%) gestational diabetes mellitus was diagnosed by means of 3h-OGTT. The diagnosis of class A1 gestational diabetes mellitus was done in 908 patients (84.9%), A2 in 188 (11.8%) and B1 in 51 (3.2%). Patients with gestational diabetes diagnosed only by an abnormal ST-GDM were classified as class A1 gestational diabetes mellitus. Gestational age at diagnosis by ST-GDM was 12.4 +/- 4.7 weeks and 27.4 +/- 5.8 weeks when diagnosed by a 3h-OGTT. The total daily dose of insulin required was related to Freinkel's classification: 16.0% (n = 215/1,345) with class A1 gestational diabetes mellitus required 0.48 +/- 0.33 U/day/kg and 85.0% (n = 43/51) with class B1 needed 1.0 +/- 0.32 U/day/kg at the end of pregnancy, which occurred at 38.2 +/- 2.0 weeks in all 3 groups. In decreasing order of occurrence perinatal complications were: pregnancy-induced hypertension (specially in class B1 gestational diabetes mellitus), urinary tract infections and premature rupture of membranes. Birth weights either < 2,500 g or > 4,000 g were more frequent among women with class B1 gestational diabetes, than in the other 2 groups. After pregnancy ended (6-8 weeks), 52.2% of women with gestational diabetes (mostly class B1) was diagnosed with permanent type 2 diabetes mellitus. DISCUSSION: In this study the percentage of pregnant women diagnosed as having gestational diabetes mellitus exclusively by ST-GDM was high (17.2%). Freinkel's classification of such disease predicted higher risk in women with class B1 gestational diabetes mellitus for: 1) obstetric complications, 2) higher doses of insulin to achieve an adequate glycemic control; 3) newborns' birth weight < 2,500 g or > 4,000 g for gestational age, 4) having type 2 diabetes mellitus in late puerperium.

Gestational diabetes mellitus and glucose intolerance among Mexican pregnant adolescents.

There is an increasing incidence of type 2 diabetes mellitus (DM) among adolescents (especially females), and the serum glucose concentrations in pregnant women <25 years during a 3-h oral glucose tolerance test (3-h OGTT) seem to be lower than those of pregnant women >25 years. Among 115 Mexican pregnant adolescents (<18 years) we analyzed their serum glucose concentrations during: a) 1-h 50-g glucose challenge test (GCT) performed at 24-28 weeks of gestation (n = 103) or at 29-35 weeks of gestation (n = 12); b) A standard 3-h OGTT performed 3-5 days later. Eight adolescents had an abnormal GCT, three of whom also had an abnormal 3-h OGTT. Sixteen adolescents (13 with previously normal GCT) had an abnormal 3-h OGTT, 15 classified as GGI and one as gestational DM (GDM). Serum glucose concentrations in adolescents with GGI were higher than in adolescents with normal 3-h OGTT: a) at 60 and 120 min during the 3-h OGTT (p < 0.001); and b) when expressed as the area under the glucose curve (p < 0.001). Adolescents with GGI had serum glucose concentrations during the 3-h OGTT similar to adult, non-diabetic pregnant Mexican women. It is suggested that GGI in pregnant adolescents may represent an early sign of a future deterioration in glucose metabolism, leading to a higher risk for GDM in future pregnancies and/or type 2 DM in adulthood. Thus, the current criteria to diagnose GDM in adults may not completely apply to adolescents, especially in ethnic groups with high risk for glucose abnormalities and considering the frequency of multiparous adolescents, especially in developing countries.

Elevada incidencia de hiperestrogenemia y de dislipidemia en un grupo de hombres infértiles / Hyperestrogen and dyslipidemia high-incidence in a group of infertile men

Objetivo. Describir algunas alteraciones metabólicas y endocrinas en un grupo de hombres de parejas estériles. Métodos. Incluimos 106 hombres en forma consecutiva, con el propósito de analizar sus muestras séricas para la determinación por duplicado de hormona luteinizante (LH), hormona foliculoestimulante (FSH), estradiol (E2), testosterona libre (TL), 17alfa-hidroxiplrogesterona (17OHP), androstenediona (A), sulfato de dehidroepiandrosterona (S-DHEA), prolactina (PRL), insulina, glucosa, colesterol total y triglicéridos. Resultados. Se encontró una incidencia de dislipidemia de 65 por ciento (hipercolesterolemia aislada, hipertrigliceridemia aislada o ambas) en el grupo, donde 80 por ciento de los pacientes son menores de 40 años. No se encontró correlación con obesidad, sobrepeso o con alguna alteración endócrina o tipo de alteración espermática. En el grupo completo se encontró una correlación positiva entre E2 y FSH (r = 0.67, p < 0.0001) que continuó siendo significativamente en el subgrupo de hombres con hiperestrogenismo (n = 27, r = 0.68, p < 0.0001) pero no en el subgrupo de hombres con estradiol sérico normal (n = 79, r = 0.10, NS). Otras alteraciones: obesidad en 18 por ciento, sobrepeso 30.2 por ciento, diabetes mellitus 4.7 por ciento, intolerancia a la glucosa 15 por ciento, hipertensión arterial 26 por ciento (14/53), hipogonadismo hipergonadotrófico 3.7 por ciento. Conclusión. De los 106 pacientes consecutivos, sólo ocho (8.4 por ciento) no tuvieron alguna de las alteraciones endócrinas o metabólicas descritas. Estos datos son significativos ya que 83 por ciento de los pacientes son menores de 40 años. Es novedosa la correlación positiva encontrada entre el E2 y la FSH cuando los niveles séricos de estradiol exceden de 50 pg/mL.