Palabras clave
insulina
intolerancia a la glucosa
embarazo
preeclampsia
riesgo
incidencia
Cómo citar
Resumen
Contexto: la diabetes mellitus gestacional (DMG) se define como cualquier grado de intolerancia a la glucosa con inicio o primer reconocimiento durante el embarazo, la mayoría de los casos se resuelven al finalizar la gestación. El control adecuado de la glucosa es esencial para reducir el riesgo de complicaciones. Tradicionalmente, se ha utilizado la insulina como tratamiento estándar, sin embargo, recientemente la metformina ha emergido como una alternativa terapéutica.
Objetivos: este estudio busca evaluar los resultados maternos en pacientes con diabetes mellitus gestacional tratados con insulina o metformina.
Metodología: se realizó una búsqueda sistemática en PubMed, Embase y Cochrane, incluyendo ensayos clínicos aleatorizados (ECAs).
Resultados: la presente revisión incluyó 19 ensayos clínicos aleatorizados con un total de 4320 pacientes y analizó seis desenlaces maternos. La hipertensión inducida por el embarazo fue menor en el grupo tratado con metformina (RR: 0,65; IC 95 %: 0,49–0,87; p = 0,77; I² = 0 %), al igual que la preeclampsia (RR: 0,57; IC 95 %: 0,46–0,72; p = 0,08; I² = 39 %) y la incidencia de cesárea (LCLS) (RR: 0,92; IC 95 %: 0,85–0,99; p = 0,0002; I² = 63 %). El parto inducido también fue menor con metformina (RR: 0,85; IC 95 %: 0,76–0,95; p = 0,01; I² = 57 %). La incidencia de parto vaginal normal fue mayor en el grupo de metformina (56,1 %) (RR: 1,09; IC 95 %: 1,03–1,17; p = 0,002; I² = 61 %). No se encontraron diferencias estadísticas significativas entre grupos en el parto prematuro (RR: 0,91; IC 95 %: 0,74–1,13; p = 0,002; I² = 60 %).
Conclusiones: Este metaanálisis presenta evidencia del uso de metformina en el tratamiento de la diabetes mellitus gestacional, mostrando diferencias significativas en la reducción de las tasas de preeclampsia, hipertensión gestacional y partos por cesárea, al tiempo que aumenta los partos vaginales espontáneos. La insulina puede utilizarse de manera complementaria si es necesario, aunque parece estar asociada con resultados maternos menos favorables.
Citas
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