Valeur diagnostique de la kératine glyquée élevée dans le diabète gestationnel chez les gestantes de Bukavu, République Démocratique du Congo

Contexte et objectif. Le diabète gestationnel (DG) est très souvent asymptomatique, et donc diagnostiqué systématiquement au cours du dépistage prénatal. L'objectif de la présente étude a été d'évaluer la performance de la kératine glyquée pathologique versus l'HGPO, dans le diagnostic du DG et évaluer son utilité comme un indicateur associé au risque de survenue de macrosomie fœtale. Méthodes. Dans une étude transversale analytique, la glycémie à jeun et le prélèvement d'au moins 7g d'ongle ont été réalisés chez 420 gestantes porteuses d'une grossesse d'au moins 24 à 40 SA venues aux CPN dans trois structures sanitaires de Bukavu en RD Congo de juillet à décembre 2016. Le test d'HGPO avec 75g du glucose anhydre est réalisé chez celles qui avaient une glycémie à jeun ˂ 92 mg/dL. Les critères de l'IADPSG et un seuil de la kératine glyquée > 3,6 ϼmol/g d'ongle ont été utilisés pour diagnostiquer le DG et évaluer le risque de survenue de la macrosomie. Résultats. Une kératine glyquée> 3,6 µmol/g d'ongle (38.5%) est associée à la macrosomie (OR 3,35 [IC 95% : 1,86 - 6,22], p = 0,001). L'HGPO et la kératine glyquée >3,6 ϼmol/g d'ongle pour diagnostiquer le DG étaient comparables (OR 1,57, IC: 0,77 - 3,22, p = 0,205) avec une sensibilité et une spécificité, respectivement de 55,3% et 56%. Conclusion. La kératine glyquée au seuil utilisé est associée au risque de survenue de la macrosomie fœtale. Des études ultérieures sur la révision des standards de la kératine glyquée pour le diagnostic du DG sont à envisager

Resultados obstétricos asociados al incremento del índice de masa corporal durante el embarazo en el Hospital Clínico de la Universidad de Chile / No disponible

Introducción: Estudios previos muestran que el incremento en la categoría del índice de masa corporal (IMC) se asocia a un mayor riesgo de complicaciones obstétricas. Objetivo: Investigar el impacto que tiene el incremento del IMC durante el embarazo en los resultados obstétricos en el Hospital Clínico de la Universidad de Chile. Material y métodos: Estudio retrospectivo que incluye a embarazadas atendidas en el hospital entre el año 2001 y 2006. Las mujeres con embarazos únicos fueron clasificadas en las distintas categorías de IMC. El incremento del IMC se calculó como la diferencia entre el IMC del inicio y el del final de la gestación. Para comparar las variables categóricas se usó el test exacto de Fisher y para las variables continuas el test de la t para comparación de 2 medias. Resultados: El estudio incluyó a 5.478 mujeres: 568(10,48%) no incrementaron su categoría de IMC y4.910 (89,51%) aumentaron su IMC en 1 o más categorías. El incremento del IMC se asoció a mayor riesgo de preeclampsia (p = 0,004) y operación cesárea (p =0,009) en las pacientes con sobrepeso, no así en las pacientes con normopeso al inicio del embarazo. Las pacientes obesas presentan mayor riesgo de preeclampsia(p = 0,008), diabetes gestacional (p < 0,001), operación cesárea (p < 0,001) e infección posparto (p = 0,009).Conclusión: El incremento en la categoría de IMC se asocia a un aumento del riesgo de complicaciones obstétricas (AU)

Background: Previous studies have shown that an increase in body mass index (BMI) is associated with a greater risk of obstetric complications. Aim: To investigate the effect of an increase in BMI category on obstetric outcomes in Hospital Clínic of the University of Chile. Material and methods: A retrospective study was conducted of women followed-up in the hospital from2001 to 2006. Women with singleton pregnancies were placed in standard BMI categories. Increases in BMI were calculated as the difference between initial BMI and that at delivery. Fisher’s exact test was used to compare categorical variables and the t test between two means was used for continuous variables. Results: This study included 5,478 women: 568(10.48%) had no change in BMI category and 4.910(89.51%) increased their BMI by >= 1 category. An increase in BMI category was associated with higher rates of preeclampsia (p = 0.004) and cesarean delivery(p = 0.009) in overweight women but not in women with a healthy weight at the beginning of pregnancy. Obese women had a higher risk of preeclampsia (p =0.008), gestational diabetes (p < 0.001), cesarean delivery(p < 0.001), and postpartum infection (p = 0.009).Conclusions: An increase in BMI category is associated with a greater risk of obstetric complications (AU)

Diabetes mellitus neonatal y mutación del gen KCNJ11: presentación de un caso familiar / Neonatal diabetes mellitus and KCNJ11 gene mutation: report of a family case

La diabetes mellitus neonatal (DMN) se caracteriza por hiperglucemia que se manifiesta en el primer mes de vida, precisa insulinoterapia y dura como mínimo 2 semanas. Existen dos formas de DMN: transitoria (DMNT) y permanente (DMNP), genéticamente diferentes. Presentamos dos hermanos, con hiperglucemia sin cetosis, a los 18 días y a las 2 h de vida, respectivamente. En ambos casos las pruebas complementarias (función tiroidea, ecografías abdominales, cariotipo) resultaron normales y los anticuerpos antipancreáticos, negativos. Precisaron insulinoterapia hasta los 92 días y los 5 meses de vida, respectivamente. La madre presentó diabetes gestacional en ambos embarazos y, posteriormente, se le diagnosticó diabetes mellitus, con anticuerpos negativos. En el estudio del gen KCNJ11, cuyas alteraciones se asocian principalmente a DMNP, se halló en los tres pacientes la mutación E229K, la cual está relacionada con DMNT. En la DMN es imprescindible el estudio genético para establecer el pronóstico más preciso possible (AU)

Neonatal diabetes mellitus (NDM) is characterized by hyperglycemia within the first month of life and insulin dependence for at least two weeks. There are two types of NDM, transient (TNDM) and permanent (PNDM), which are genetically different. We report the case of two brothers who developed hyperglycemia without ketosis on the 18th day and 2 h of life, respectively. Thyroid function tests, abdominal ultrasound and karyotype where normal and there were no pancreatic antibodies. The first one required insulin therapy for the first 92 days of life and the second for 5 months. The mother developed gestational diabetes during both pregnancies and she was later diagnosed diabetes mellitus (without antibodies).They were studied for mutations in KCNJ11 gene (principally related to the permanent form). The three of them showed the E229K mutation (frequently associated with the transient form). A genetic study is essential in NDM to achieve the most accurate prognosis posible (AU)

Diabetes mellitus y embarazo: resultados perinatales en estudio de 3 años / Diabetes mellitus and pregnancy: perinatal results in a 3 years study

Fundamento: La diabetes constituye la complicación médica más frecuente en el embarazo, lo que incide directamente en los resultados perinatales. Objetivos: Determinar el efecto de la diabetes sobre los resultados perinatales. Métodos: Se realizó un estudio descriptivo, de serie de casos. De un universo de 13 603 partos realizados desde el 1ro de enero del 2003 al 31 de diciembre del 2005, en el Servicio de Obstetricia del Hospital Universitario Dr Gustavo Aldereguía Lima de Cienfuegos, se tomó una muestra de 229 gestantes con diabetes. Se determinaron las tasas de bajo peso, prematuridad, malformaciones congénitas, muertes fetales tardías, macrosomía, asfixia y tasa de cesárea en las gestantes diabéticas; así como el riesgo de estas complicaciones para este grupo con respecto a las gestantes no diabéticas y entre la diabetes gestacional y pregestacional. Resultados: La incidencia de diabetes y embarazo fue de 1,68 por ciento. El riesgo de prematuridad (17,4 por ciento), de bajo peso del recién nacido (13,1 por ciento), macrosomía (15,3 por ciento), malformaciones (3,5 por ciento), muerte neonatal (0,4 por ciento), muerte fetal tardía (0,9 por ciento) y parto por cesárea (64,2 por ciento) se incrementó en la población diabética, con respecto a la no diabética. La diabetes pregestacional resultó tener mayores riesgos con respecto a la gestacional, para el parto pretérmino, las malformaciones congénitas mayores y las muertes fetales tardías. Conclusiones: A pesar de que la provincia muestra una incidencia baja de diabetes en el embarazo, el riesgo de resultados perinatales adversos es considerable para este grupo, en especial en pacientes con diabetes pregestacional(AU)

Background: Diabetes constitutes the most frequent medical complication during pregnancy, and it has a direct impact on the perinatal results. Objectives: To determine the effect of the diabetes on perinatal results. Methods: A descriptive study of series of cases was carried out. Of an universe of 13 603 childbirths from January 1st, 2003 to December 31st, 2005, in the Obstetric Service of the University Hospital Dr Gustavo Aldereguía Lima in Cienfuegos, a sample of 229 pregnant women with diabetes was taken. Rates were determined for under weight, premature births, congenital malformations, late fetal deaths, macrosomia, asphyxia and assessment of caesarean operation in the diabetic women; as well as the risk of these complications for this group with regard to the non diabetic pregnant women and between the gestational and pre-gestational diabetes. Results: Diabetes incidence and pregnancy was of 1, 68 percent. The risk of premature birth (17,4 percent), of under weight of the newborn (13,1 percent), macrosomia (15,3 percent), malformations (3,5 percent), neonatal death (0,4 percent), late fetal death (0,9 percent) and birth by Caesarean operation (64,2 percent) was higher in the diabetic population, with regard to the non diabetic. The pre- gestational diabetes turned out to have bigger risks with regard to the gestational one regarding the premature childbirth, the most important congenital malformations and the late fetal deaths. Conclusion: Although the province shows a low incidence of diabetes in the pregnancy, the risk of adverse perinatal results is considerable for this group, especially in pre-gestational diabetic women(AU)

Valor predictivo del síndrome metabólico en la gestación para el desarrollo de diabetes mellitus / Predictive value of metabolic syndrome in pregnancy for the development of diabetes mellitus and factors of short-term vascular risk for mother and child after birth (gestaMET)

Objetivos. Evaluar la presencia de diabetes mellitus (DM) o alteraciones en el metabolismo de la glucosa, la presencia de obesidad y los factores de riesgo vascular a corto plazo tras el parto en mujeres con síndrome metabólico gestacional (SMG). Evaluar la incidencia de obesidad, dislipidemia, alteraciones en las cifras de glucemia, presión arterial (PA) o lípidos, a corto plazo tras el parto, en los hijos de mujeres con SMG. Diseño. Estudio de cohortes. Emplazamiento. En total, 42 centros de atención primaria. Participantes. Cohorte de estudio (CE): mujeres con SMG y sus hijos. Cohorte control (CC): mujeres sin criterios primarios de SMG y sus hijos. Tamaño muestral: CE: 980 mujeres y CC: 980 mujeres. Muestreo consecutivo. Mediciones. Madre: antropometría, sobrecarga oral de 75 g, perfil lipídico, insulinemia, PA, hábitos tóxicos, encuesta nutricional y actividad física. Niño: peso, talla, PA, encuesta nutricional, determinaciones de glucemia, insulinemia y perfil lipídico. Padre: antropometría, PA, glucemia, perfil lipídico, insulinemia, hábitos tóxicos, encuesta nutricional y actividad física. Estudiaremos genes relacionados con la resistencia insulínica en todos los sujetos. Análisis estadístico. Comparación de proporciones mediante el test de la *2, diferencias de medias mediante el ANOVA. Evaluación del efecto de la exposición intraútero mediante análisis de regresión logística y de regresión de COX, controlando las potenciales variables de confusión y de interacción. Discusión. Con este estudio podremos contribuir al conocimiento sobre el momento de inicio de la diabetes y el riesgo vascular, y sobre el momento óptimo de iniciar estrategias de prevención

Objectives. To evaluate the presence of diabetes mellitus (DM) or short-term alterations in glucose metabolism, obesity and vascular risk factors after birth in women with pregnancy metabolic syndrome (PMS). To evaluate the incidence of obesity, lipaemia, glucaemia disorder, blood pressure (BP), or lipid figures in the period after birth in children of women with PMS. Design. Cohort study. Setting. Forty two primary care centres. Participants. Study cohort (SC): women with PMS and their children. Control cohort (CC): women without primary criteria of PMS and their children. Sample size: SC, 980 women and CC, also 980. Consecutive sampling. Measurements. Mother: basic data, 75 g oral overload, lipid profile, insulinaemia, toxic habits, nutrition survey, and physical activity. Child: weight, height, BP, nutrition survey, glucaemia, insulinaemia, and lipid profile. Father: basic data, BP, glucaemia, lipid profile, insulinaemia, toxic habits, nutrition survey, and physical activity. We will study genes related to insulin resistance in all subjects. Statistical analysis. Comparison of proportions with *2 test; ANOVA to measure means. Evaluation of effect of intra-uteral exposure through logistical regression and COX regression, whilst controlling potentially confusing and interactive variables. Discussion. This study will contribute to locating the moment when diabetes and vascular risk start and to finding the optimum moment for starting prevention strategies

Síndrome de Cushing en el embarazo / Cushing's syndrome in pregnancy

El síndrome de Cushing durante la gestación es una enfermedad poco frecuente dado el alto índice de esterilidad que produce. align="left"> A lo largo del embarazo existe una variación del metabolismo de los esteroides que conlleva un hipercorticismo fisiológico y adaptativo por lo que en presencia de este síndrome un correcto diagnóstico y un posterior tratamiento son de gran importancia para disminuir la morbimortalidad maternofetal

Cushing's syndrome during pregnancy is uncommon, given the high rates of infertility it produces. Throughout pregnancy, steroid metabolism varies, leading to physiological and adaptive hypercorticism. Proper diagnosis and treatment of this syndrome is essential to reduce fetal and maternal morbidity and mortality

Factores de riesgo para macrosomía en recién nacidos hijos de madre con diabetes gestacional / Risk factors for macrosomy in newborn children of mothers with diabetes, gestational

La diabetes representa una de las condiciones médicas que con más frecuencia complican el embarazo y tiene la mayor repercusión no solo sobre la madre y el feto, sino también sobre el recién nacido. Determinar las condiciones maternas que se asocian con la aparición de macrosomía en la descendencia. Estudio analítico que incluyó 159 gestantes con diabetes gestacional atendidas en el Servicio de Obstetricia del Hospital Provincial Universitario Dr Gustavo Aldereguía Lima de Cienfuegos, en los años 2003- 2004. Se evaluaron la edad materna, paridad, antecedentes de hipertensión, de diabetes gestacional y de macrofeto, valoración nutricional al inicio del embarazo, color de la piel, tiempo gestacional al diagnóstico, valor de la PTG a las 2 horas, tiempo gestacional al parto. Se realizó un análisis multivariado mediante una regresión logística. Resultados y Conclusioes: La obesidad y el diagnóstico de diabetes gestacional por encima de las 23 semanas fueron el grupo de variables que más se asociaron con la aparición de macrosomía(AU)

[Overweight and obesity as common risk factors for gestational diabetes mellitus (GDM), perinatal macrosomy in offspring and type-2 diabetes in mothers]. / Nadwaga i otyltosc--ogniwem laczacym cukrzyce ciazowa, makrosomie urodzeniowa i cukrzyce typu 2.

UNLABELLED: Gestational diabetes mellitus (GDM) affects about 5% of all pregnancies and results in an increased incidence of Caesarean sections, perinatal traumas and neonatal complications. Macrosomy, i.e., an excessive birth-weight is observed in newborns from these pregnancies. In the majority of cases, diabetes regression is observed directly after pregnancy termination, however, in 15-60% of these patients, diabetes mellitus develops in later years of life. The goal of the study was an assessment of the risk factors for GDM development in gestation, perinatal macrosomy in offspring from GDM-affected pregnancies and overt diabetes mellitus in women after GDM. MATERIAL AND METHODS. The study involved 146 women with GDM and 1806 women with normal carbohydrate metabolism during pregnancy, 506 newborns of gestational diabetic mothers and 993 newborns of healthy mothers, as well as 200 women with a history of GDM during the years 1990-1999 (the mean time period after GDM - 3.1 +/- 6.0 years). The recognized risk factors of GDM and perinatal macrosomy were evaluated, together with the incidence of overt diabetes mellitus after GDM-affected pregnancy. RESULTS: An analysis of multifactor logistic regression demonstrated that the independent risk factors for GDM include: BMI 3 25 kg/m2 before pregnancy (OR - 2.38), the history of diabetes in family (OR - 1.67), and the third pr further pregnancy (OR - 1.81) - p < 0.05. In turn, experienced obstetric failures and delivery of child with macrosomy features revealed insignificant - p > 0.05. Perinatal macrosomy correlated with mother's BMI and glycaemia during the 2nd hour of diagnostic test (75 g OGTT). No correlations were observed among mother's age, fasting glycaemia levels and HbA1c in mothers. In the group of GDM-affected women, diabetes mellitus type 2 was diagnosed in 34 (17.0%) patients. The the actual BMI > 25 kg/m2 and glycaemia values in the 2nd hour of diagnostic test in the course of GDM diagnosis (p < 0.05). The risk of diabetes was not enhanced in that group of women by family history of diabetes, the age of GDM onset (< 25 years of life), the week of gestation when GDM was diagnosed (< 25 hbd), and the type of GDM therapy (insulin vs. diet) p > 0.05 CONCLUSIONS: Overweight and obesity are both risk factors of gestational diabetes mellitus, delivery of child with macrosomy features and of overt diabetes mellitus later in life.

Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: differences among 4 racial/ethnic groups.

OBJECTIVES: We examined associations between obesity, diabetes, and 3 adverse pregnancy outcomes--primary cesarean delivery, preterm birth, and low birth-weight (LBW)--by racial/ethnic group. Our goal was to better understand how these associations differentially impact birth outcomes by group in order to develop more focused interventions. METHODS: Data were collected from the 1999, 2000, and 2001 New York City birth files for 329,988 singleton births containing information on prepregnancy weight and prenatal weight gain. Separate logistic regressions for 4 racial/ethnic groups predicted the adverse pregnancy outcomes associated with diabetes. Other variables in the regressions included obesity, excess weight gain, hypertension, preeclampsia, and substance use during pregnancy (e.g., smoking). RESULTS: Chronic and gestational diabetes were significant risks for a primary cesarean and for preterm birth in all women. Diabetes as a risk for LBW varied by group. For example, whereas chronic diabetes increased the risk for LBW among Asians, Hispanics, and Whites (adjusted odds ratios=2.28, 1.69, and 1.59), respectively, it was not a significant predictor of LBW among Blacks. CONCLUSIONS: In this large, population-based study, obesity and diabetes were independently associated with adverse pregnancy outcomes, highlighting the need for women to undergo lifestyle changes to help them control their weight during the childbearing years and beyond.

[Gestational diabetes: an update]. / Le diabète gestationnel.

Gestational diabetes mellitus is one of the major medical complications of pregnancy. This review describes the short and long term consequences of this affection, the screening strategy and the diagnosis approach. The obstetrical management and the diabetes treatment with dietary strategies reducing carbohydrate intake and minimising the postprandial glucose levels are explained. Insulin treatment indication, place of insulin analogues, and use of oral antihyperglycaemic agents are also discussed.

Diagnostic controversy: gestational diabetes and the meaning of risk for pima Indian women.

Gestational diabetes is the one form of this well known, chronic disease of development that disappears. After the birth of the child, the mother's glucose levels typically return to normal. As a harbinger of things to come, gestational diabetes conveys greater risk for later type 2 (previously "non-insulin dependent") diabetes in both the mother and child. Thus, pregnant women have become a central target for prevention of this disease in the entire Pima population. Based on ethnographic interviews conducted between 1999 and 2000, I discuss the negotiated meanings of risk, "borderline" diabetes, and women's personal knowledge and experiences of diabetes, particularly during the highly surveilled period of pregnancy. I also highlight the heterogeneity of professional discourse pertaining to gestational diabetes, most notably the debate surrounding its diagnosis. Significantly, women's narratives reveal the same set of questions as is raised in the professional debate. Implications for diabetes prevention and for balancing the increased surveillance of pregnant women with clinical strategies that privilege their experience and perspectives are also discussed.

[Analysis of risk factors for perinatal brachial plexus palsy]. / Analiza czynników ryzyka okoloporodowych uszkodzen splotu ramiennego.

OBJECTIVES AND DESIGN: Risk factors of obstetrical brachial plexus palsy include: (1) large birth weight, (2) shoulder dystocia and prolonged second stage of labour, (3) instrumental vaginal delivery (forceps delivery, vacuum extraction), (4) diabetes mellitus and mother's obesity, (5) breech presentation, (6) delivery and infant with obstetrical brachial plexus palsy in antecedent delivery. The purpose was analysis of the classical risk factors for brachial plexus palsy based on our own clinical material. MATERIAL AND METHODS: Clinical material consists of 83 children with obstetrical brachial plexus palsy treated at the Department of Trauma and Hand Surgery (surgically--54, conservatively--29). Control group consists of 56 healthy newborns. Data recorded included: birth weight, body length, head and chest circumference, Apgar test at 1 min., type of brachial palsy and side affected, type of birth, presentation, duration of delivery (II stage), age of mother, mother's diseases, parity. RESULTS: The infants treated surgically have had a significantly higher birth weight, body height, head and chest circumference, in compression with control group and group treated conservatively. The differences were statistically important. Shoulder dystocia occurred in 32.9% of all vaginal delivery. Instrumental vaginal delivery was observed in 11.3% and breech presentation in 4.9% cases. There were no incidences of obstetrical brachial plexus palsy recurrence. Diabetes mellitus and mother's obesity was found in 3 cases. CONCLUSIONS: (1) Fetal macrosomia is the important risk factor of the obstetrical brachial plexus palsy. (2) Obstetrical brachial plexus palsy may occur also in the absence of the classical risk factors.

Metabolic and vascular abnormalities in subjects at risk for type 2 diabetes: the early start of a dangerous situation.

Various groups at risk for type 2 diabetes have been identified, including individuals with family history of type 2 diabetes, obesity, prior gestational diabetes, polycystic ovary syndrome, metabolic syndrome, hypertension, dyslipidemia and particularly those with pre-diabetes (impaired glucose tolerance and/or impaired fasting glucose). To various degrees, all these groups have also been identified with significant vascular abnormalities that range from endothelial dysfunction and low-grade or sub-clinical inflammation to evident atherosclerosis. The mechanisms involved in establishing a link between the risk of type 2 diabetes and vascular dysfunction are multiple and complex. The presence in the circulation of various cytokines, hormones and substrates associated with increased visceral fat and insulin resistance, the frequent appearance of associated cardiovascular risk factors and/or the possibility of some genetically determined intrinsic vascular abnormalities are all explanatory mechanisms that are being evaluated in clinical research. Whereas the possibility of appreciating a significant reduction in cardiovascular outcomes in long-term prospective clinical trials in all these groups at risk for type 2 diabetes is still lacking, understanding these mechanisms and recognizing how various interventions may improve vascular health is a worthwhile area of research that may translate into important clinical strategies to reduce the burden of type 2 diabetes and cardiovascular disease.

Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.

BACKGROUND: We conducted a randomized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications. METHODS: We randomly assigned women between 24 and 34 weeks' gestation who had gestational diabetes to receive dietary advice, blood glucose monitoring, and insulin therapy as needed (the intervention group) or routine care. Primary outcomes included serious perinatal complications (defined as death, shoulder dystocia, bone fracture, and nerve palsy), admission to the neonatal nursery, jaundice requiring phototherapy, induction of labor, cesarean birth, and maternal anxiety, depression, and health status. RESULTS: The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent vs. 4 percent; relative risk adjusted for maternal age, race or ethnic group, and parity, 0.33; 95 percent confidence interval, 0.14 to 0.75; P=0.01). However, more infants of women in the intervention group were admitted to the neonatal nursery (71 percent vs. 61 percent; adjusted relative risk, 1.13; 95 percent confidence interval, 1.03 to 1.23; P=0.01). Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group (39 percent vs. 29 percent; adjusted relative risk, 1.36; 95 percent confidence interval, 1.15 to 1.62; P<0.001), although the rates of cesarean delivery were similar (31 percent and 32 percent, respectively; adjusted relative risk, 0.97; 95 percent confidence interval, 0.81 to 1.16; P=0.73). At three months post partum, data on the women's mood and quality of life, available for 573 women, revealed lower rates of depression and higher scores, consistent with improved health status, in the intervention group. CONCLUSIONS: Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman's health-related quality of life.

Screening for gestational diabetes mellitus.

The term 'gestational diabetes mellitus' is unsatisfactory as it refers to a heterogeneous group of women, including those with minimal abnormality of carbohydrate metabolism and those with undiagnosed type II diabetes. However, perinatal morbidity is increased even in the group of women who have only impaired glucose tolerance; the mothers are at increased risk of subsequent development of diabetes, and there may also be long-term implications for the offspring. Current research is aiming to define the blood glucose levels at which risks increase so that clinical management can be appropriately directed. When available, the criteria required to justify population screening in pregnancy should be satisfied. The glucose challenge and fasting glucose tests are the leading contenders as appropriate screening tests to determine who should have the diagnostic glucose tolerance test. However, until this is reviewed, the widely used scheme of risk factors as a screening method should continue, as it detects at least 50% of women with gestational diabetes.

Controversies around gestational diabetes. Practical information for family doctors.

OBJECTIVE: To summarize some of the issues facing primary care physicians who are seeing increasing numbers of patients with gestational diabetes mellitus (GDM) and to explore new developments in use of oral hypoglycemics during pregnancy. QUALITY OF EVIDENCE: All the literature on screening for GDM offers level III evidence. Much of the literature on treatment is also level III, but newer studies offer level I evidence and are more useful for daily practice. Existing research leaves many important questions unanswered; research findings are inconsistent among studies, and treatment strategies are challenging to implement. MAIN MESSAGE: Recent studies have clarified that rates of neonatal mortality and congenital malformations are not higher among the offspring of mothers with GDM. Treatment might affect birth weight, but whether treatment is associated with reductions in rates of shoulder dystocia and cesarean section is unclear. Several level I studies conclude that the oral hypoglycemic glyburide can be used safely and effectively during the second and third trimesters of pregnancy. CONCLUSION: Management of GDM remains a controversial area in obstetric care. It is a growing area of research, and new developments that might clarify risk and simplify treatment are expected in the coming years.

Diabetes gestacional: su complejidad y repercusión en la evolución del embarazo y salud del recién nacido / Gestational diabetes: complexity and effect on the course of pregnancy and neonatal outcome

Objetivo: Establecer diferentes grupos de riesgo para el desarrollo de complicaciones perinatales en mujeres con diabetes gestacional. Pacientes y métodos: Se estudiaron 115 mujeres diabéticas gestacionales controladas en nuestro centro entre enero de 2001 a enero de 2004. Para el análisis de los datos se aplicó el paquete estadístico SPSS 11.0. Resultados: Las mujeres que presentaron un inicio más temprano de la diabetes gestacional necesitaron tratamiento con insulina más tempranamente, y en dosis más altas, que aquellas en las que el inicio fue más tardío. Asimismo, un mayor índice de masa corporal pregestacional condicionó una necesidad de insulina en mayor dosis para el control adecuado de la diabetes gestacional. Conclusión: Considerar a este grupo (inicio diabético temprano en la gestación e índice de masa corporal elevado pregestacional) como de alto riesgo, para mantener un control más exhaustivo (con un tratamiento mas activo y adecuado control ecográfico)

Objective: To establish distinct risk groups for the development of perinatal complications in women with gestational diabetes. Patients and methods: We studied 115 women with gestational diabetes managed in our center from January 2001 to January 2004. For statistical analysis the SPSS 11.0 package was used. Results: Women with earlier onset of gestational diabetes required higher doses of insulin therapy and at an earlier gestational age than women with later onset. A higher body mass index at the beginning of pregnancy was also associated with the need for higher insulin doses to control diabetes. Conclusion: Women with onset of gestational diabetes early in pregnancy and high pre-gestational body mass index should be considered as a group at high risk and should be closely followed-up with more active treatment and suitable ultrasonographic monitoring

El intervalo intergenésico: un factor de riesgo para complicaciones obstétricas y neonatales / The intergenesic interval: a risk factor for obstetric and neonatal complications

Objetivo: Determinar el impacto del intervalo intergenésico sobre la morbilidad maternofetal. Materiales y métodos: Estudio de cohorte, realizado del 1 de mayo al 31 de diciembre de 2002 en el Departamento de Ginecología y Obstetricia del Complejo Hospitalario Metropolitano de la Caja del Seguro Social de Panamá. Se incluyeron pacientes con antecedentes de embarazo previo que ingresaron a la institución con diagnóstico de aborto o embarazo de cualquier edad gestacional y que egresaron con terminación del embarazo actual. Se excluyeron primigestas, pacientes con enfermedad preexistente al embarazo y de las que no se recolectó datos completos. Se correlacionaron patologías obstétricas, resultado neo natal y período intergenésico. El análisis de datos se realizó con EPI-INFO 2002, X2, OR con IC del 95% y p = 49 meses es un factor de riesgo para desarrollar preeclampsia (OR: 29; IC del 95%, 19-45), DPPNI (OR: 3,6; IC del 95% 1,2-11) Y para culminar su embarazo por cesárea (OR: 10,1; IC del 95% 6-17). Conclusión: Un período intergenésico = 49 meses está asociado con un incremento del riesgo para complicaciones obstétricas y neonatales. El período intergenésico óptimo para prevenir complicaciones matemofetales es de 25 a 48 meses (AU)

Objective: To determine the impact of the interval between pregnancies on maternal-foetal morbidity. Materials Method: A cohort study carried out from 1 st May until 31st December 2002 in the Gynaecology and Obstetric Department of the Metropolitan Hospital Complex (Social Security) in Panama. We inc1uded patients with previous pregnancies, and who were admitted with spontaneous abortion, and patients of any gestational age who were admitted because of pregnancy termination. We exc1uded primigravidas, patients with a disease existing before pregnancy, and those with incomplete records. We correlated obstetric pathologies, neonatal outcome, and the interval between pregnancies. Statistical analysis was made with EPI-INFO 2002, Chi-square. The odds ratio (OR) had a confidence interval (CI) of 95% and p = 49 months is a risk factor for the development of pre-ec1ampsia OR 29 (95% CI, 19-45), placental abruption OR 3.6 (95% CI, 1.2-11) and caesarean section OR 10.1 (95% CI, 6-17). Conclusions: An interval between pregnancies = 49 months are associated with an increase in obstetric and neonatal complications, thus the period between 25 and 48 months is optimal to prevent maternal-foetal complications (AU)

Efecto de la diabetes gestacional sobre los resultados perinatales / Effect of the gestational diabetes on perinatal results

Se llevó a efecto un estudio observacional, de tipo cohorte, para evaluar el efecto de la diabetes gestacional sobre los resultados perinatales en 100 gestantes con diabetes mellitus, ingresadas en el Hospital Ginecoobstétrico Mariana Grajales de Santiago de Cuba durante el período comprendido del 1 de enero del 2000 al 31 de diciembre del 2001. Entre los resultados evaluados se encontró una primacía del crecimiento intrauterino retardado pretérmino, así como de la muerte y macrosomía fetales, mientras que entre las complicaciones posnatales predominaron las alteraciones metabólicas en los hijos de estas pacientes, además de que en ellas prevalecieron el parto por operación cesárea y la asociación de hipertensión inducida por el embarazo e infección urinaria. Se recomienda ejecutar otro estudio donde se evalúen estas mismas variables, pero en embarazadas diabéticas con tratamiento insulínico o sin él(AU)