Controversias actuales en el diagnóstico de la diabetes mellitus gestacional

  • José Fernando Botero Arango Clínica Integral de Diabetes – CLID. Medellín
  • Claudia Monsalve Arango Universidad Pontificia Bolivariana. Medellín
  • Alex Ramírez Rincón Universidad Pontificia Bolivariana. Medellín
  • Natalia Aristizabal Henao Universidad Pontificia Bolivariana. Medellín
  • José Luis Torres Grajales Universidad Pontificia Bolivariana. Medellín
  • Esdras Martín Vásquez Mejía Clínica Integral de Diabetes – CLID. Medellín
  • Alberto Villegas Perrase Clínica Integral de Diabetes – CLID. Medellín
  • Andrés Felipe Palacio Barrientos Clínica Integral de Diabetes – CLID. Medellín

Resumen

La diabetes gestacional es una condición que se reconoce por primera vez en el embarazo y está asociada a serias complicaciones maternas, fetales y perinatales en el corto y largo plazo. El tema más controversial ha sido la forma para realizar el diagnóstico por la existencia de múltiples criterios diagnósticos. Esta situación se ha vuelto más compleja en los últimos años a partir de la implementación de la estrategia de un paso, propuesta por la International Association of Diabetes and Pregnancy Study Groups (IADPSG, por sus iniciales en inglés), cuya aplicación aumentó la incidencia de la enfermedad hasta un 17,8% en comparación con la estrategia tradicional de dos pasos (tamización y prueba confirmatoria), con la que la incidencia siempre se había estimado entre 6 y 7%. La evidencia actual no ha demostrado que el enfoque de un paso sea superior a la estrategia de dos pasos, en términos de complicaciones, costos y salud pública. Dados los beneficios de la intervención, por disminución de la incidencia de desenlaces adversos como macrosomía, distocia de hombros, recién nacidos grandes para la edad gestacional e hipertensión materna, se justifica la realización del tamizaje universal en las gestantes.

Abstract
Gestational diabetes is any glucose abnormality first recognized in pregnancy. It has been associated with maternal, fetal and newborn complications. Which diagnostic method to use has been a source of controversy (75 gram OGTT vs the two step approach 50 gram followed by 100 gram OGTT). Since the recommendations made by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) of using the 75 gram OGTT it has been argued that the incidence would rise from approximately 6-7% to 17,8%. There is no evidence that the one step strategy is superior to the two step approach in terms of reduction of complications or from an economical stand point. Regardless of the method used to make the diagnosis it has been shown that treatment of GDM (gestational diabetes) decreases the incidence of large for gestational age, shoulder distocia, macrosomia and maternal hypertension. Universal screening should be recommended to all pregnant patients.

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Biografía del autor

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Especialista en Medicina Interna y Endocrinología Clínica. Clínica Integral de Diabetes – CLID. Medellín, Colombia.

Profesor programa Endocrinología, diabetes y metabolismo del adulto. Universidad Pontificia Bolivariana. Medellín, Colombia.

 

 

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Especialista en Medicina Interna. Residente de Endocrinología, diabetes y metabolismo del adulto, Universidad Pontificia Bolivariana. Medellín, Colombia.

##submission.authorWithAffiliation##

Especialista en Medicina Interna. Residente de Endocrinología, diabetes y metabolismo del adulto, Universidad Pontificia Bolivariana. Medellín, Colombia.

##submission.authorWithAffiliation##

Especialista en Medicina Interna. Residente de Endocrinología, diabetes y metabolismo del adulto, Universidad Pontificia Bolivariana. Medellín, Colombia.

##submission.authorWithAffiliation##

Especialista en Medicina Interna y Endocrinología Clínica. Clínica Las Américas. Medellín, Colombia

Profesor programa Endocrinología, diabetes y metabolismo del adulto. Universidad Pontificia Bolivariana. Medellín, Colombia.

##submission.authorWithAffiliation##

Especialista en Medicina Interna y Endocrinología Clínica. Clínica Integral de Diabetes – CLID. Medellín, Colombia.

##submission.authorWithAffiliation##

Especialista en Medicina Interna y Diabetología. Clínica Integral de Diabetes – CLID. Medellín, Colombia.

##submission.authorWithAffiliation##

Especialista en Medicina Interna y Endocrinología Clínica. Clínica Integral de Diabetes – CLID. Medellín, Colombia.

Profesor programa Endocrinología, diabetes y metabolismo del adulto. Universidad Pontificia Bolivariana. Medellín, Colombia.

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Publicado
2017-03-27
##submission.howToCite##
BOTERO ARANGO, José Fernando et al. Controversias actuales en el diagnóstico de la diabetes mellitus gestacional. Revista Colombiana de Endocrinología, Diabetes & Metabolismo, [S.l.], v. 2, n. 3, p. 5-13, mar. 2017. ISSN 2389-9786. Disponible en: <http://revistaendocrino.org/index.php/rcedm/article/view/89>. Fecha de acceso: 13 dic. 2019
Sección
Articulos de Revisión