Fasting glucose in the first trimester: An initial approach to diagnosis of gestational diabetes | Endocrinología, Diabetes y Nutrición (English ed.)

array:24 ["pii" => "S2530018019300034" "issn" => "25300180" "doi" => "10.1016/j.endien.2019.01.001" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "217" "copyright" => "SEEN and SED" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Endocrinol Diabetes Nutr. 2019;66:11-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 242 "formatos" => array:2 [ "HTML" => 184 "PDF" => 58 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S2530016418301770" "issn" => "25300164" "doi" => "10.1016/j.endinu.2018.06.012" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "217" "copyright" => "SEEN y SED" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Endocrinol Diabetes Nutr. 2019;66:11-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 589 "formatos" => array:2 [ "HTML" => 399 "PDF" => 190 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "ORIGINAL" "titulo" => "Glucemia basal en el primer trimestre como acercamiento inicial al diagnóstico de la diabetes en el embarazo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "11" "paginaFinal" => "18" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Fasting glucose in the first trimester: An initial approach to diagnosis of gestational diabetes" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1333 "Ancho" => 2145 "Tamanyo" => 148700 ] ] "descripcion" => array:1 [ "es" => "Distribución de los resultados de las pruebas de cribado y diagnóstico. AMHG: alteración del metabolismo hidrocarbonado gestacional." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Teresa López del Val, Victoria Alcázar Lázaro, Concepción García Lacalle, Beatriz Torres Moreno, Gabriela Castillo Carbajal, Beatriz Alameda Fernandez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Teresa" "apellidos" => "López del Val" ] 1 => array:2 [ "nombre" => "Victoria" "apellidos" => "Alcázar Lázaro" ] 2 => array:2 [ "nombre" => "Concepción" "apellidos" => "García Lacalle" ] 3 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Torres Moreno" ] 4 => array:2 [ "nombre" => "Gabriela" "apellidos" => "Castillo Carbajal" ] 5 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Alameda Fernandez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2530018019300034" "doi" => "10.1016/j.endien.2019.01.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018019300034?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016418301770?idApp=UINPBA00004N" "url" => "/25300164/0000006600000001/v1_201901040643/S2530016418301770/v1_201901040643/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2530018019300046" "issn" => "25300180" "doi" => "10.1016/j.endien.2018.06.007" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "218" "copyright" => "SEEN and SED" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Endocrinol Diabetes Nutr. 2019;66:19-25" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 166 "formatos" => array:2 [ "HTML" => 111 "PDF" => 55 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Analysis of the characteristics of patients with diabetes mellitus who attend a tertiary hospital emergency department for a hypoglycemic event" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "19" "paginaFinal" => "25" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de las características de los pacientes con diabetes mellitus que consultan por hipoglucemia en el servicio de urgencias de un hospital terciario" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1085 "Ancho" => 2167 "Tamanyo" => 92828 ] ] "descripcion" => array:1 [ "en" => "Type of insulin regimen used in patients with type 2 diabetes mellitus." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jordi Caballero-Corchuelo, Fernando Guerrero-Pérez, Paula García-Sancho de la Jordana, Manuel Pérez-Maraver" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Jordi" "apellidos" => "Caballero-Corchuelo" ] 1 => array:2 [ "nombre" => "Fernando" "apellidos" => "Guerrero-Pérez" ] 2 => array:2 [ "nombre" => "Paula" "apellidos" => "García-Sancho de la Jordana" ] 3 => array:2 [ "nombre" => "Manuel" "apellidos" => "Pérez-Maraver" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2530016418301782" "doi" => "10.1016/j.endinu.2018.06.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016418301782?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018019300046?idApp=UINPBA00004N" "url" => "/25300180/0000006600000001/v1_201901300632/S2530018019300046/v1_201901300632/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S253001801930006X" "issn" => "25300180" "doi" => "10.1016/j.endien.2019.01.002" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "207" "copyright" => "SEEN and SED" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Endocrinol Diabetes Nutr. 2019;66:4-10" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 72 "formatos" => array:2 [ "HTML" => 40 "PDF" => 32 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Serum ghrelin and obestatin levels in HIV-infected patients: Effect of 36 weeks of antiretroviral treatment" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "4" "paginaFinal" => "10" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Niveles séricos de Ghrelina y Obestatina en pacientes infectados con VIH: efecto de 36 semanas de tratamiento antirretroviral" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2273 "Ancho" => 1511 "Tamanyo" => 171465 ] ] "descripcion" => array:1 [ "en" => "Obestatin levels in HIV infected patients prior and post-36 weeks of ART. (A) Median obestatin levels of HIV patients before (BL) and after 36 weeks of ART (W36), unpaired comparison was performed by means of Mann–Whitney test. (B) Paired comparison of obestatin levels before and after 36 weeks of ART, Wilcoxon matched-pairs signed rank test was performed." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Edgar A. Rivera-Leon, Iris M. Llamas-Covarrubias, Raul A. Soria-Rodriguez, Sergio Sanchez-Enriquez, Luz A. González-Hernández, Jaime F. Andrade-Villanueva, Mara A. Llamas-Covarrubias" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Edgar A." "apellidos" => "Rivera-Leon" ] 1 => array:2 [ "nombre" => "Iris M." "apellidos" => "Llamas-Covarrubias" ] 2 => array:2 [ "nombre" => "Raul A." "apellidos" => "Soria-Rodriguez" ] 3 => array:2 [ "nombre" => "Sergio" "apellidos" => "Sanchez-Enriquez" ] 4 => array:2 [ "nombre" => "Luz A." "apellidos" => "González-Hernández" ] 5 => array:2 [ "nombre" => "Jaime F." "apellidos" => "Andrade-Villanueva" ] 6 => array:2 [ "nombre" => "Mara A." "apellidos" => "Llamas-Covarrubias" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S253001801930006X?idApp=UINPBA00004N" "url" => "/25300180/0000006600000001/v1_201901300632/S253001801930006X/v1_201901300632/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Fasting glucose in the first trimester: An initial approach to diagnosis of gestational diabetes" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "11" "paginaFinal" => "18" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Teresa López del Val, Victoria Alcázar Lázaro, Concepción García Lacalle, Beatriz Torres Moreno, Gabriela Castillo Carbajal, Beatriz Alameda Fernandez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Teresa" "apellidos" => "López del Val" "email" => array:1 [ 0 => "teresaldv@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Victoria" "apellidos" => "Alcázar Lázaro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Concepción" "apellidos" => "García Lacalle" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Beatriz" "apellidos" => "Torres Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Gabriela" "apellidos" => "Castillo Carbajal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Beatriz" "apellidos" => "Alameda Fernandez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Endocrinología y Nutrición, Hospital Severo Ochoa, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Análisis Clínicos, Hospital Severo Ochoa, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Glucemia basal en el primer trimestre como acercamiento inicial al diagnóstico de la diabetes en el embarazo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1334 "Ancho" => 2168 "Tamanyo" => 142926 ] ] "descripcion" => array:1 [ "en" => "Distribution of screening and diagnostic test results. ACMP: altered carbohydrate metabolism in pregnancy." ] ] ] "textoCompleto" => "IntroductionGestational diabetes mellitus (GDM) is diabetes diagnosed in pregnancy and without evidence of prior diabetes.<a class="elsevierStyleCrossRef" href="#bib0140">1</a> When in addition to a pregestational predisposition to diabetes (genetic factors, obesity and other causes of insulin resistance)<a class="elsevierStyleCrossRef" href="#bib0145">2</a> a patient develops contrainsular effects inherent to the physiological adaptation to pregnancy,<a class="elsevierStyleCrossRef" href="#bib0150">3</a> we observe the pathological alterations of carbohydrate metabolism referred to as GDM. In most cases GDM is a mild and self-limiting condition, though even so it significantly increases the risk of obstetric, fetal and perinatal complications that can be avoided with appropriate medical treatment.<a class="elsevierStyleCrossRefs" href="#bib0155">4–6</a>In general, the association of the physiological effects of pregnancy with susceptibility to type 2 diabetes does not give rise to an all-or-nothing situation, but rather to a continuous variation in the before and after oral glucose glycemia values. In some cases, a pregestational predisposition mainly gives rise to insulin resistance with a relative increase in fasting blood glucose versus postprandial blood glucose. In other cases, a reduced beta-cell response to glucose overload occurs, with normal fasting and high postprandial glycemia values. In some instances both alterations occur together. These two different types of physiopathological behavior condition the diagnostic efficacy of the criteria based on fasting blood glucose values or glycemia after an oral glucose tolerance test (OGTT). In this regard, the HAPO study<a class="elsevierStyleCrossRef" href="#bib0170">7</a> showed both fasting blood glucose and glycemia after an oral glucose tolerance test to be linearly related to obstetric and neonatal adverse effects, with no clear cut-off point.There is no prior gold standard for estimating either the true prevalence of GDM or the sensitivity and specificity of each diagnostic criterion. This is why it is so important to seek consensus criteria when selecting pregnant women who should receive full medical care for GDM, thereby maximizing its benefits without needlessly incrementing the costs. Furthermore, since not all pregnant women are at the same risk of developing GDM, we also have to take the strategic decision as to whether to perform a definitive diagnostic test in all pregnant women (“one-step criterion”), or rather perform screening tests and limit definitive tests to cases with a positive screening result (“two-step criterion”). Even within the context of screening, there are two alternative options: the O'Sullivan test (OST) or fasting blood glucose (FG). In addition, there has been controversy regarding timing, over whether there should be universal screening in the first trimester; screening in the first trimester only if there are risk factors for GDM; or no screening in the first trimester, thus leaving the entire diagnostic process for the second trimester. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the different diagnostic strategies for GDM currently used and the strategy employed in our setting.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>With regard to the diagnostic criterion, and apart from the classical criteria of Carpenter and Coustan (CC) based on OGTT<a class="elsevierStyleCrossRef" href="#bib0175">8</a> (OGTT 100g and a diagnosis of GDM if values of over 95, 180, 155 and 140mg/dl are obtained after 0, 60, 120 and 180min) and the National Diabetes Data Group (NDDG)<a class="elsevierStyleCrossRef" href="#bib0180">9</a> (OGTT 100g with two or more values above 105, 190, 165 and 145mg/dl after 0, 60, 120 and 180min), the criterion of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) has been added,<a class="elsevierStyleCrossRef" href="#bib0185">10</a> established from the HAPO study (OGTT 75g and a diagnosis of GDM if values of over 92, 180 and 153mg/dl are obtained at one or more points after 0, 60 and 120min). Of course, this latter diagnostic criterion significantly raises the prevalence of GDM (16.1%)<a class="elsevierStyleCrossRef" href="#bib0170">7</a> with respect to the classical CC (11.6%) and NDDG (8.8%) criteria.<a class="elsevierStyleCrossRefs" href="#bib0190">11,12</a> However, the most relevant change is that a single high blood glucose value in OGTT suffices to establish the diagnosis according to the IADPSG; accordingly, a fasting blood glucose value of ≥92mg/dl is diagnostic of GDM without the need for OGTT.In any case, apart from the classical CC and NDDG criteria and the novel approach of the IADPSG, there are many other consensuses referring to the diagnostic orientation of diabetes in pregnancy. In this respect, the Endocrine Society (USA),<a class="elsevierStyleCrossRef" href="#bib0200">13</a> the World Health Organization (WHO)<a class="elsevierStyleCrossRef" href="#bib0205">14</a> and the Australasian Diabetes Society (ADIPS)<a class="elsevierStyleCrossRef" href="#bib0210">15</a> recommend the “one-step criterion”. The American College of Obstetricians and Gynecologists (ACOG)<a class="elsevierStyleCrossRef" href="#bib0215">16</a> in turn advises the “two-step criterion”. The American Diabetes Association (ADA)<a class="elsevierStyleCrossRef" href="#bib0220">17</a> advocates either option. As regards the time of the first screening, the WHO and the Endocrine Society recommend universal screening in the first trimester, while the others only recommend screening in the first trimester if there are risk factors for GDM. Lastly, the National Institute for Health and Care Excellence (NICE)<a class="elsevierStyleCrossRef" href="#bib0225">18</a> does not support the universal screening model recommended by the IADPSG.In our healthcare setting, laboratory tests are performed as prenatal screening of all pregnant women in the first trimester. The use of fasting blood glucose in such tests for the screening or diagnosis of GDM has clear cost advantages over OGTT. However, there are doubts regarding the suitability of fasting blood glucose in the first trimester (FGFT) as a screening test, and even more so as a definitive diagnostic test.The present study was designed, on the one hand, to estimate the sensitivity and specificity of FGFT as a screening and/or diagnostic test for GDM and, on the other hand, to assess the incidence of maternal and fetal complications related to diabetes among the pregnant women in our setting who met the criterion FGFT≥92mg/dl, regardless of whether they were finally diagnosed and treated as having GDM or not.Material and methodsA retrospective study was made of the 1425 women with no previous diagnosis of diabetes mellitus (DM) who underwent prenatal screening in the first trimester of pregnancy (week 10.2±2.6) during a calendar year and who were monitored throughout pregnancy and until delivery by the Obstetrics Department of Hospital Severo Ochoa (Madrid, Spain). Patients with prior DM and the 59 women who underwent prenatal screening but suffered subsequent miscarriage were excluded. Blood samples were drawn into sodium fluoride/potassium oxalate tubes and centrifuged within 30min. In our hospital, the O'Sullivan test (OST) is performed under fasting conditions, with the determination of glycemia at 0 and 60min. Glucose was measured based on an enzymatic method using hexokinase with a Cobas 8000 autoanalyzer® (Roche Diagnostics GmbH).In addition to the laboratory test data from the Biochemistry Department, information was obtained on the mother, pregnancy, delivery and the newborn infant from the primary care electronic records and obstetric discharge reports.Biochemical data included FGFT and OST in weeks 24–28. In the OST-positive patients the OGTT 100g results were also compiled. The CC criterion was used for the diagnosis of GDM.The documented maternal data included age, weight, height, the body mass index (BMI) in the first trimester stratified as normal (<25kg/m2), overweight (25–29.9kg/m2) or obese (≥30kg/m2), and any family history of diabetes. The obstetric data and complications recorded included gestational hypertension, preeclampsia, polyhydramnios, preterm delivery (defined as delivery before week 37), and delivery to term (spontaneous, induced, eutocic, instrumental) or cesarean section. The recorded complications in the newborn infant comprised the following: macrosomia (weight >4000g), hyperbilirubinemia, polyglobulia, hypoglycemia, intrauterine fetal death, malformations, trauma to the newborn resulting from labor, respiratory distress and admission to the Neonatal Intensive Care Unit.We evaluated the sensitivity and specificity of FGFT≥92mg/dl with respect to positive OST and the diagnosis of GDM (OGTT 100g according to CC criterion). The relationship between FGFT and the obstetric and fetal complications was investigated. The same variables were subsequently related to the glycemia groups <92 and ≥92mg/dl, after the patients diagnosed with GDM in the second trimester were excluded, and who therefore received specific medical treatment.The chi-squared test was used to compare two categorical variables, while the Student t-test was used for the comparison of means, in this case for checking the normal distribution of the variables and the homogeneity of variance. The Student t-test for paired groups in turn was used to compare mean glycemia in the first trimester with mean glycemia at time 0 of the OST. Binary logistic regression analysis was used to correlate binary dependent variables to different exposure variables. The SPSS version 19 statistical package was used for data analysis, and statistical significance was considered for p<0.05.The study was approved by the Ethics Committee of our hospital.ResultsThe mean age of the pregnant women was 32.6±5.0 years, with a mean BMI of 24.9±4.6kg/m2. A total of 263 (18.5%) had a family history of diabetes, 24 (1.7%) had pregestational arterial hypertension, and 211 (14.7%) were smokers. In turn, 606 (42.5%) had had one or more previous pregnancies, and 405 (28.4%) had suffered one or more previous miscarriages. Twenty-four (4.0%) of the 606 patients with previous pregnancies had experienced GDM.<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the patient characteristics according to FGFT above or below 92mg/dl.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The pregnant women with FGFT≥92mg/dl were older (33.8±4.4 versus 32.4±5.1 years; p<0.01), with a greater BMI (26.6±5.0 versus 24.6±4.5kg/m2; p<0.01), and with a more frequent family history of diabetes (29.0% versus 16.7%; p<0.01) compared with the pregnant women with FGFT<92mg/dl. Furthermore, the women with FGFT≥92mg/dl had had comparatively more previous pregnancies (53.8% versus 40.4%; p<0.01) and more prior GDM (8.6% versus 3.0%; p<0.01).<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows the distribution of the screening and diagnostic test results.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>On jointly using the term “altered carbohydrate metabolism in pregnancy” (ACMP) in reference to FGFT≥92mg/dl and/or positive OGTT, we found 238 of the 1425 pregnant women to have ACMP (16.7%). Of these 238 cases with ACMP, 39 had FGFT≥92mg/dl and positive OGTT (16.4%); 45 had FGFT<92mg/dl and positive OGTT (18.9%); and 154 had FGFT≥92mg/dl and negative OST or OGTT (64.7%). Excluding miscarriages (47/1279 [3.7%] in pregnant women with FGFT<92mg/dl and 12/205 [5.9%] in pregnant women with FGFT≥92mg/dl; p=0.3), the obstetric and perinatal adverse effects according to FGFT <92 or ≥92mg/dl are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The infants of mothers with FGFT≥92mg/dl had greater weight (3228±86 versus 3123±31g; p=0.02) and a higher percentage of macrosomia (6.9% versus 3.5%; p=0.02). After adjusting the odds ratio (OR) for the BMI, age and previous gestational diabetes, a greater proportion of macrosomia was seen to persist among the infants of mothers with FGFT≥92mg/dl (OR 1.54; 95% confidence interval [95%CI] 0.70–3.37), though the difference was no longer statistically significant. In addition, we recorded no statistically significant differences in neonatal adverse effects in mothers with FGFT≥92mg/dl, except as regards admission to neonatal care (OR 1.83; 95%CI: 1.10–3.04; p<0.05) and trauma in vaginal delivery (OR 3.1; 95%CI 1.09–8.83; p<0.04).The recorded obstetric and perinatal adverse effects according to FGFT <92 or ≥92mg/dl, excluding the 84 women diagnosed and treated for GDM, are reported in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>On excluding the patients treated for GDM, the infants of mothers with FGFT≥92mg/dl continued to register greater weight (3235±98 versus 3128±31g; p<0.05), a higher percentage of macrosomia (7.2% versus 3.4%; p<0.05) and a greater proportion of trauma at delivery (OR 3.10; 95%CI 1.15–8.32; p=0.02). After adjusting OR for the BMI, age and prior gestational diabetes, a greater proportion of macrosomia was seen to persist in the infants of mothers with FGFT≥92mg/dl (OR 1.50; 95%CI 0.63–3.57), though the difference was no longer statistically significant. Moreover, the differences found in percentage macrosomia, admission to neonatal care and polyhydramnios likewise failed to reach statistical significance. The remaining adverse effects were similar between the groups. In this case, statistical significance was also not modified by age or a history of prior gestational diabetes.In order to determine whether the effects seen with FGFT≥92mg/dl were due only to the overweight and obesity found to be more prevalent in this group of pregnant women, we studied the distribution of the most significant neonatal complications according to FGFT and the maternal BMI groups (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>The infants of pregnant women with FGFT≥92mg/dl had a higher prevalence of macrosomia in all the BMI groups. Furthermore, the group with FGFT<92mg/dl showed a higher proportion of macrosomia with an increasing BMI (p<0.05). We also recorded a high proportion of respiratory distress in obese mothers only in the case of FGFT≥92mg/dl. In relation to the remaining complications, the proportions tended to be higher with an increasing maternal BMI, though statistical significance was not reached.Fasting blood glucose in the first trimester (≥92mg/dl) exhibited a sensitivity of 22.9% and a specificity of 91.6% with respect to positive OST in the second trimester, and a sensitivity of 46.4% and a specificity of 88.8% with respect to the diagnosis of GDM based on the CC criterion. The prevalence of GDM with the CC criterion in pregnancies in our setting was 5.9% (2.4% with the NDDG criterion and 14.7% with the IADPSG criterion).The mean FGFT was 84.4±0.2mg/dl, with a mean fasting glucose level at time 0 of the OST of 81.53±0.2mg/dl (confidence interval for the difference of means: 2.5–3.3; p<0.001).DiscussionIn our study, the prevalence of GDM was found to be 5.9% with the CC criteria and 14.7% with the IADPSG criteria. In 2006, the Spanish Diabetes and Pregnancy Group (Grupo Español de Diabetes y Embarazo [GEDE]) estimated the prevalence of GDM according to the CC criteria to be 12%,<a class="elsevierStyleCrossRefs" href="#bib0195">12,19</a> versus 16.1% based on the IADPSG criteria.<a class="elsevierStyleCrossRefs" href="#bib0170">7,12</a> Other Spanish national publications have reported prevalence rates of between 1 and 12%.<a class="elsevierStyleCrossRef" href="#bib0230">19</a> As can be seen, even when using the same criteria, the prevalence of GDM differs significantly between studies, and this cannot be attributed solely to the different characteristics of the populations or the diagnostic strategies used. For example, in the study published by Duran et al.,<a class="elsevierStyleCrossRef" href="#bib0235">20</a> likewise conducted in the Community of Madrid, with a population of pregnant women presenting a mean age and a BMI similar to those of our own series, the prevalence of GDM with the CC criteria was 10.6% versus 35.5% with the IADPSG criteria. Altered carbohydrate metabolism in pregnancy constitutes a continuum on which the cut-off points for diagnosing GDM are decided. Therefore, with the same cut off points, a minor variability in the serum glucose measurements between different laboratories can have a very significant impact upon the proportion of pregnant women diagnosed with GDM.Assuming these underlying limitations, the first objective of our study was to determine whether a simple measurement such as FGFT is able to replace the currently used screening (OST) and diagnostic tests (OGTT 100g) referring to GDM. In this regard, the poor sensitivity of FGFT in relation to OST (22.9%) and OGTT (46.4%) shows that FGFT cannot be used as a substitute for oral glucose testing, because doing so would leave a considerable number of cases of GDM undiagnosed. In addition, the comparative analysis of the tests revealed a significant difference between the fasting glucose values of the first (84.4±0.2mg/dl) and second trimesters (81.53±0.2mg/dl). This difference should possibly be taken into account when one is considering the limiting values of the different diagnostic tests according to the trimester of pregnancy.In fact, the only partial overlap of the groups selected on pooling the women with FGFT≥92mg/dl or the women with positive OST and OGTT reflects the difference in information obtained with the two types of tests. While FGFT detects more pregnant women with insulin resistance, OGTT is mainly aimed at detecting pregnant women with postprandial carbohydrate intolerance. In our study, among the pregnant women with altered carbohydrate metabolism in pregnancy (ACMP), this partial overlap gives rise to three different groups. Firstly, we have the group with high FGFT and negative OST or OGTT 100g (64.7%), corresponding to women with insulin resistance. Secondly, we have the group with normal FGFT and positive OGTT (18.9%), corresponding to women with postprandial carbohydrate intolerance. Thirdly, we have the group with high FGFT and positive OGTT (16.4%), which pools the women with both carbohydrate metabolic alterations.Fasting glucose in the first trimester is therefore not useful as a replacement for the classical screening and diagnostic tests for GDM. Could FGFT nevertheless play a role in the medical approach to pregnancy? Our study has shown that pregnant women with high FGFT exhibit a statistically significant increase in fetal weight and macrosomia. Moreover, even accepting that the small number of complications limits the statistical significance of the findings, many studies of diabetes in pregnancy appear to reflect a relationship between high FGFT and other maternal-fetal complications attributable to GDM.<a class="elsevierStyleCrossRefs" href="#bib0240">21–25</a> Most importantly, these relationships are seen to persist when pregnant women diagnosed with GDM are excluded. In other words, women with ACMP but meeting no full criteria of GDM (the first and the most numerous group) have a carbohydrate metabolism that is sufficiently altered to cause an increased risk of complications of GDM.It seems clear that most fetal complications attributable to GDM are a result of fetal overfeeding, particularly on taking into account that evolution-based physiology is intended to cope with nutritional shortage rather than excess. Such overfeeding is mainly attributable to the maternal hyperglycemia caused by diabetes, though it is also due in part to maternal obesity and overfeeding in the course of pregnancy. In our study, the infants of women with FGFT≥92mg/dl had a higher proportion of macrosomia in all BMI categories and, in turn, there was a higher proportion of macrosomia according to the BMI in both the FGFT<92mg/dl group and the FGFT≥92mg/dl group. Although these differences were not statistically significant in all comparisons (possibly because of the small number of events observed on stratifying according to the BMI), the observed trend appears to indicate that both high FGFT and overweight and obesity are associated factors in the generation of macrosomia.The management of GDM, aimed at controlling these fetal overfeeding mechanisms, comprises two conceptually related but strategically separable components. The first component – formal diet, physical exercise and contained weight gain – comes at little cost to the healthcare system.<a class="elsevierStyleCrossRef" href="#bib0265">26</a> However, the second component – monitoring of the condition through glycemia self-control, medical supervision, and eventual drug treatment with insulin or other drugs – can result in a very significant healthcare burden, depending on the number of pregnant women finally diagnosed with GDM and referred to the endocrinology and nutrition departments.If FGFT>92mg/dl is used to screen for ACMP, we can ensure the early identification of women not only presenting an increased risk of GDM in the second trimester, but most importantly with already existing metabolic disorders that can potentially give rise to macrosomia and neonatal complications. Almost certainly, this group of women would benefit from the aforementioned first component of management for GDM (healthy eating habits and regular physical exercise), and which could be prescribed in the obstetric care setting from the first trimester and throughout the duration of pregnancy, with referral to the endocrinology clinic being reserved for those patients subsequently diagnosed with GDM on the basis of positive OST and OGTT results.Furthermore, it seems logical to assume that an increase in FGFT is only the continuation of an increase in pregestational fasting glucose, as an expression of insulin resistance present before pregnancy. Accordingly, as in the first trimester, it would make sense to prescribe dietary measures and physical exercise to all women with fasting glucose ≥92mg/dl and a wish to become pregnant (somewhat analogous to the pregestational administration of folic acid). In fact, in a recent study, women with GDM diagnosed before week 12 of pregnancy<a class="elsevierStyleCrossRef" href="#bib0270">27</a> presented the same adverse effects as patients with DM before pregnancy.Lastly, in relation to women with FGFT<92mg/dl and normal OST results, and bearing in mind that the complications attributable to GDM also occur (albeit less frequently) in women with normal glucose tolerance as a result of overfeeding in the gestational period, would it not be reasonable to make universal diet and exercise recommendations for all pregnant women?The present study has two main limitations: its retrospective design and the fact that although the number of cases allowed us to demonstrate the relationship between FGFT and the weight of the newborn infant, as well as intuit a correlation between FGFT and the maternal-fetal complications of GDM, the sample size was too small to clearly confirm the existence of such an association. In this respect, a larger sample would be needed to increase the statistical power of the trial. Furthermore, it would be advisable to conduct an interventional study in a cohort of women with FGFT>92mg/dl in order to determine whether a protocolized formal diet and physical exercise program is able to influence newborn infant weight and possible maternal-fetal complications.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1142681" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1073319" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1142680" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1073320" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-01-06" "fechaAceptado" => "2018-06-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1073319" "palabras" => array:4 [ 0 => "Gestational diabetes mellitus" 1 => "Pregnancy" 2 => "Oral glucose tolerance test" 3 => "Fasting glucose in the first trimester" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1073320" "palabras" => array:4 [ 0 => "Diabetes gestacional" 1 => "Embarazo" 2 => "Sobrecarga oral de glucosa" 3 => "Glucemia basal primer trimestre" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesTo establish whether fasting glucose levels in the first trimester (FGFT) of pregnancy ≥92mg/dl (5.1mmol/l) (FGFT) anticipate the occurrence of maternal-fetal complications of gestational diabetes mellitus. To assess whether FGFT can replace diagnosis of GDM using the classical two-step oral glucose tolerance test (OGTT). MethodsA retrospective study of 1425 pregnancies with FGFT and O'Sullivan Test (OST) and/or OGTT according to OST results in the second trimester. FGFT sensitivity and specificity were assessed as compared to the conventional diagnosis of GDM. The relationship between maternal-fetal complications and FGFT was assessed in the total group and after excluding mothers who received specific medical treatment for GDM. ResultsSensitivity and specificity of FGFT levels ≥92mg/dl were 46.4% and 88.8% as compared to diagnosis of GDM using Carpenter and Coustan criteria. In the total group, a statistically significant relationship was found between FGFT levels ≥92mg/dl and newborn weight (3228±86 versus 3123±31g; p<0.05), as well as a higher rate of macrosomia (6.9% versus 3.5%; p<0.05). This association persisted after excluding patients diagnosed with and treated for GDM (weight: 3235±98 versus 3128±31g; p<0.05; percentage of macrosomia: 7.2% versus 3.4%; p<0.05). ConclusionsFGFT is not a good substitute for conventional diagnosis of GDM in the second trimester. Pregnant women with FGFT levels ≥92mg/dl, even with no subsequent diagnosis of GDM, are a risk group for fetal macrosomia and could benefit from dietary measures and physical exercise." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Objetivos1) Determinar si una glucemia basal en el primer trimestre (GBPT) del embarazo ≥ 92mg/dl anticipa la aparición de complicaciones materno-fetales de diabetes mellitus gestacional (DMG). 2) Valorar si la GBPT puede sustituir al diagnóstico clásico de DMG mediante sobrecarga oral de glucosa (SOG). MétodosEstudio retrospectivo de 1.425 embarazos con GBPT y test de O'Sullivan (TOS) en el segundo trimestre más SOG según resultado del TOS. Valoración de la sensibilidad y especificidad de la GBPT respecto al diagnóstico clásico de DMG. Relación de las complicaciones materno-fetales con la GBPT en el grupo total y tras excluir a las madres que realizaron tratamiento médico específico de DMG. ResultadosLa sensibilidad y la especificidad de la GBPT≥92mg/dl respecto al diagnóstico de DMG en el segundo trimestre, usando los criterios clásicos basados en la SOG de Carpenter y Coustan, fueron respectivamente del 46,4 y el 88,8%. Respecto a las gestantes con GBPT<92mg/dl, las gestantes con GBPT≥92mg/dl tienen mayor peso del recién nacido (3.228±86 versus 3.123±31g; p<0,05) y mayor porcentaje de macrosomía (6,9% versus 3,5%; p<0,05). Esta relación se mantuvo tras excluir a las pacientes diagnosticadas y tratadas por DMG (peso: 3.235±98 versus 3.128±31g; p<0,05; porcentaje de macrosomía: 7,2% versus 3,4%; p<0,05). Conclusiones1) La GBPT no es un buen sustituto del diagnóstico clásico de DMG en el segundo trimestre. 2) Las gestantes con GBPT≥92mg/dl, aun sin diagnóstico posterior de DMG, constituyen un grupo de riesgo de macrosomía fetal y podrían beneficiarse de la instauración de tratamiento nutricional y ejercicio físico." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: López del Val T, Alcázar Lázaro V, García Lacalle C, Torres Moreno B, Castillo Carbajal G, Alameda Fernandez B. Glucemia basal en el primer trimestre como acercamiento inicial al diagnóstico de la diabetes en el embarazo. Endocrinol Diabetes Nutr. 2019;66:11–18." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1391 "Ancho" => 2493 "Tamanyo" => 152022 ] ] "descripcion" => array:1 [ "en" => "Diagnostic strategies for GDM." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1334 "Ancho" => 2168 "Tamanyo" => 142926 ] ] "descripcion" => array:1 [ "en" => "Distribution of screening and diagnostic test results. ACMP: altered carbohydrate metabolism in pregnancy." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT<92 (n=1239) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT≥92 (n=193) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32.4±5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33.8±4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24.6±4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.6±5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family history of diabetes, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">207 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56 (29.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous pregnancies, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">502 (40.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">104 (53.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous GDM,<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (3.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (8.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pre-gestational hypertension, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.09 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous miscarriages, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">351 (28.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 (27.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smokers, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">188 (15.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 (11.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI <25, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">659 (64.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58 (37.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI 25–29.9, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">246 (24.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63 (40.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI ≥30, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">112 (11.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 (22.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1950011.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Calculated with respect to patients with previous pregnancies. Student t-test for the comparison of means and chi-squared test for categorical variables." ] ] ] "descripcion" => array:1 [ "en" => "Patient characteristics according to fasting glucose in the first trimester (FGFT) ≥92mg/dl and <92mg/dl." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "SD: standard deviation; GDM: gestational diabetes mellitus; BMI: body mass index; n: number of patients; ns: nonsignificant; OR: odds ratio; NI: newborn infant." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Effect \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT<92, n (%) n=1239 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT≥92, n (%) n=193 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% confidence interval \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NI weight (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3123±31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3228±86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.6–191.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Macrosomia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 (3.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (6.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.07–4.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">OR adjusted for BMI, age, and previous GDM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.70–3.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trauma during vaginal delivery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.09–8.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">OR adjusted for BMI, age, and previous GDM</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission to neonatal care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">145 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 (19.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.10–3.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">OR corrected for BMI and cesarean section</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polyhydramnios \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.36<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.19–58.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pre-eclampsia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 (1.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">245 (2.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.74<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.56–13.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polyglobulia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.59<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06–5.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypoglycemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (3.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.41<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.47–4.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory distress \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (5.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.91<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.31–2.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jaundice \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 (3.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.97<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.37–2.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1950010.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "Binary logistic regression." ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "OR adjusted for BMI." ] ] ] "descripcion" => array:1 [ "en" => "Results referring to obstetric and fetal complications according to fasting glucose in the first trimester (FGFT) ≥92 and <92mg/dl." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "SD: standard deviation; GDM: gestational diabetes mellitus; BMI: body mass index; n: number of patients; ns: nonsignificant; OR: odds ratio; NI: newborn infant." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Effect \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT<92, n (%) n=1193 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT≥92, n (%) n=155 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% confidence interval \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NI weight (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3235±98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3128±31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.4–200.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Macrosomia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (7.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.27–4.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">OR adjusted for BMI, age, and previous GDM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.63–3.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trauma during vaginal delivery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.15–8.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">OR adjusted for BMI, age, and previous GDM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission to neonatal care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">134 (11.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (16.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.94–2.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">OR corrected for BMI and cesarean section \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.78–2.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polyhydramnios \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.87<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52–12.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pre-eclampsia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.02<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.28–3.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polyglobulia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypoglycemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.98<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.27–3.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory distress \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (5.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.03<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.34–3.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jaundice \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (2.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.85<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.22–3.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1950012.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "OR adjusted for BMI." ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "Binary logistic regression." ] ] ] "descripcion" => array:1 [ "en" => "Results referring to obstetric and fetal complications according to fasting glucose in the first trimester (FGFT) ≥92 and <92mg/dlin pregnant women not diagnosed with diabetes." ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "BMI: weight/height2; N: number of events; T: total number." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Effect BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT<92 N/T (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT≥92 N/T (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Macrosomia</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI <25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12/573 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/51 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI 25–29.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13/238 (5.5),<a class="elsevierStyleCrossRef" href="#tblfn0030">a</a>p=0.002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/58 (6.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI ≥30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9/109 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/32 (9.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Admission to neonatal care</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI <25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43/543 (7.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9/51 (17.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI 25–29.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31/222 (14.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7/54 (13.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI ≥30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19/100 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11/30 (36.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Polyhydramnios</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI <25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/602 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI 25–29.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/234 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/63 (3.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05<a class="elsevierStyleCrossRef" href="#tblfn0035">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI ≥30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/113 (0.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Respiratory distress</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI <25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25/567 (4.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/51 (3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI 25–29.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9/237 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/57 (1.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI ≥30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/109 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/32 (15.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1950013.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "a" "nota" => "Chi-squared test between BMI categories and macrosomia in pregnant women with FGFT<92mg/dl." ] 1 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "b" "nota" => "Fisher's exact test." ] ] ] "descripcion" => array:1 [ "en" => "Effects of pregnancy in women with glycemia ≥92 and <92mg/dl in the first trimester (FGFT) according to the BMI." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0140" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gestational diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Siri" 1 => "M.D. Kjos" 2 => "T.A. Buchanan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Eng J Med" "fecha" => "1999" "volumen" => "341" "paginaInicial" => "1749" "paginaFinal" => "1756" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0145" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etiopatogenia de la diabetes gestacional" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L.F. Pallardo Sanchez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Diabetes y embarazo" "paginaInicial" => "23" "paginaFinal" => "35" "edicion" => "4.a ed." "serieFecha" => "2015" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0150" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La adaptación metabolica en la gestación normal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L.F. Pallardo Sanchez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Diabetes y embarazo" "paginaInicial" => "3" "paginaFinal" => "15" "edicion" => "4.a ed." "serieFecha" => "2015" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0155" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of treatment of gestational diabetes mellitus on pregnancy outcomes" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group" "etal" => false "autores" => array:6 [ 0 => "C.A. Crowther" 1 => "J.E. Hiller" 2 => "J.R. Moss" 3 => "A.J. McPhee" 4 => "W.S. Jeffries" 5 => "J.S. Robinson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa042973" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2005" "volumen" => "352" "paginaInicial" => "2477" "paginaFinal" => "2486" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15951574" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0160" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A multicenter, rendomized trial of treatment for mild gestational diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.B. Landon" 1 => "C.Y. Spong" 2 => "E. Thom" 3 => "M.W. Carpenter" 4 => "S.M. Ramin" 5 => "B. Casey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0902430" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2009" "volumen" => "361" "paginaInicial" => "1339" "paginaFinal" => "1348" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19797280" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0165" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of gestational diabetes treatment: a systematic review with quality of evidence asseement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Falavigna" 1 => "M.I. Schmidt" 2 => "J. Trujillo" 3 => "L.F. Alves" 4 => "E.R. Wendland" 5 => "M.R. Torloni" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Diabetes Res Clin Pract" "fecha" => "2012" "volumen" => "98" "paginaInicial" => "396" "paginaFinal" => "405" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0170" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyperglycemia and adverse pregnancy outcomes" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "The HAPO Study Cooperative Research Group" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0707943" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2008" "volumen" => "358" "paginaInicial" => "1991" "paginaFinal" => "2002" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18463375" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0175" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Criteria for screening test for gestational diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.W. Carpenter" 1 => "D.R. Coustan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Obstet Gynecol" "fecha" => "1982" "volumen" => "144" "paginaInicial" => "768" "paginaFinal" => "773" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7148898" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0180" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "National Diabetes Data Group" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Diabetes" "fecha" => "1979" "volumen" => "28" "paginaInicial" => "1039" "paginaFinal" => "1057" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/510803" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0185" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International Association of Diabetes and Pregnancy Study Groups recomendations on the diagnosis and classification of hyperglycemia in pregnancy" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "International Association of Diabetes and Pregnancy Study Groups Consensus Panel" "etal" => true "autores" => array:6 [ 0 => "B.E. Metzger" 1 => "S.G. Gabbe" 2 => "B. Persson" 3 => "T.A. Buchanan" 4 => "P.A. Catalano" 5 => "P. Damm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc09-1848" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2010" "volumen" => "33" "paginaInicial" => "676" "paginaFinal" => "682" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20190296" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0190" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Recomendaciones IADPSG para el diagnóstico y clasificación de la hiperglucemia durante la gestación. ¿Cuáles son las implicaciones?" ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:6 [ "editores" => "R.Corcoy" "paginaInicial" => "38" "paginaFinal" => "42" "serieVolumen" => "vol. XXII" "serieTitulo" => "Educación diabetológica profesional, número 1" "serieFecha" => "2012" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0195" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nuevos criterios diagnósticos de diabetes mellitus gestacional a partir del estudio HAPO. ¿Son válidos en nuestro medio?" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Grupo Español de Diabetes y Embarazo" "etal" => false "autores" => array:4 [ 0 => "R. Corcoy" 1 => "B. Lumbreras" 2 => "J.L. Bartha" 3 => "R. Wifredo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.endonu.2010.03.020" "Revista" => array:6 [ "tituloSerie" => "Endocrinol Nutr" "fecha" => "2010" "volumen" => "57" "paginaInicial" => "277" "paginaFinal" => "280" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20541481" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0200" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabetes and pregnancy: an Endocrine Society Clinical Practice Guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Ian Blumer" 1 => "E. Hadar" 2 => "D.R. Hadden" 3 => "L. Jovanovic" 4 => "J.H. Mestman" 5 => "M. Hassan Murad" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2013" "volumen" => "98" "paginaInicial" => "4337" "paginaFinal" => "4349" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0205" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Diagnostic criteria and classification of hyperglycaemia fisrt detected in pregnancy: a Word Health Organization Guideline" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Diabetes Res Clin Pract" "fecha" => "2014" "volumen" => "103" "paginaInicial" => "341" "paginaFinal" => "363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24847517" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0210" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0010" href="http://www.bhs.org.au/airapps/Services/au/org/bhs/govdoc/files/references/14440.pdf">http://www.bhs.org.au/airapps/Services/au/org/bhs/govdoc/files/references/14440.pdf</a> [accessed 27.01.15]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Australasian Diabetes in Pregnancy Society" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2015" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0215" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practice bulletin 137: gestational diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Committee on Practice Bulletin Obstetrics" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.AOG.0000433006.09219.f1" "Revista" => array:7 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "2013" "volumen" => "122" "numero" => "Pt 1" "paginaInicial" => "406" "paginaFinal" => "416" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23969827" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0220" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Classification and diagnosis of diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "American Diabetic Association" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dcs15-2003" "Revista" => array:7 [ "tituloSerie" => "Diabetes Care" "fecha" => "2015" "volumen" => "38" "numero" => "Suppl. 1" "paginaInicial" => "S8" "paginaFinal" => "S16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26405073" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0225" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "National Institute for Health and Care Excellence (NICE). Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. NICE guidelines (NG3). Available from: <a id="intr0015" class="elsevierStyleInterRef" href="http://www.nice.org.uk/guidance/ng3/evidence">http://www.nice.org.uk/guidance/ng3/evidence</a> [accessed 14.05.15]." ] ] ] 18 => array:3 [ "identificador" => "bib0230" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aspectos epidemiológicos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. González González" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Diabetes y embarazo" "paginaInicial" => "17" "paginaFinal" => "21" "edicion" => "4.a ed." "serieFecha" => "2015" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0235" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Alejandra Duran" 1 => "S. Sofia Sáenz" 2 => "M.J. Torrejon" 3 => "E. Bordiú" 4 => "L. Del Valle" 5 => "N. Galindo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc14-0179" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2014" "volumen" => "37" "paginaInicial" => "2442" "paginaFinal" => "3245" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24947793" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0240" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Screening for gestational diabetes: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Prutsky Gabriela" 1 => "J.P. Domecq" 2 => "V. Sundaresh" 3 => "T. Elraiyah" 4 => "M. Nabhan" 5 => "L.J. Prokop" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2013-2460" "Revista" => array:6 [ "tituloSerie" => "JCEM" "fecha" => "2013" "volumen" => "98" "paginaInicial" => "4311" "paginaFinal" => "4318" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24151288" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0245" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Screening test for gestational diabetes: a systematic review for the U. Preventive Services Task Force" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Donovan" 1 => "L. Hartling" 2 => "M. Muise" 3 => "A. Guthrie" 4 => "B. Vandermeer" 5 => "D.M. Dryden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-159-2-201307160-00657" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2013" "volumen" => "159" "paginaInicial" => "115" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23712349" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0250" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The importance of fasting blood glucose in screening for gestational diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Herrera" 1 => "L. Brustman" 2 => "J. Foroutan" 3 => "S. Scarpellis" 4 => "E. Murphy" 5 => "A. Francis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/14767058.2014.935322" "Revista" => array:6 [ "tituloSerie" => "J Matern Fetal Neonatal Med" "fecha" => "2015" "volumen" => "28" "paginaInicial" => "825" "paginaFinal" => "828" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24939625" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0255" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Updated guidelines on screening for gestational diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Y. Yashdeep Gupta" 1 => "B. Bharti Kalra" 2 => "M.P. Baruah" 3 => "R. Singla" 4 => "S. Kaina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/IJWH.S82046" "Revista" => array:6 [ "tituloSerie" => "Int J Womens Health" "fecha" => "2015" "volumen" => "7" "paginaInicial" => "539" "paginaFinal" => "550" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26056493" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0260" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "First-trimester fasting hyperglycemia and adverse pregnancy outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Riskin-Mashiah" 1 => "G. Younes" 2 => "A. Damti" 3 => "R. Auslender" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc09-0688" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2009" "volumen" => "32" "paginaInicial" => "1639" "paginaFinal" => "1644" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19549728" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0265" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment with diet and exercise for women with gestational diabetes mellitus diagnosed using IADPSG criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "O. Kgosidialwa" 1 => "A.M. Egan" 2 => "L. Carmody" 3 => "B. Kirwan" 4 => "P. Gunning" 5 => "F.P. Dunne" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2015-3259" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2015" "volumen" => "100" "paginaInicial" => "4629" "paginaFinal" => "4636" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26495752" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0270" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gestational diabetes mellitus in early pregnancy: evidence for poor pregnancy outcomes despite treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.N. Sweeting" 1 => "G.P. Ross" 2 => "J. Hyett" 3 => "L. Molineaux" 4 => "M. Constantino" 5 => "A.J. Harding" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Diabetes Care" "fecha" => "2016" "volumen" => "39" "paginaInicial" => "75" "paginaFinal" => "81" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25300180/0000006600000001/v1_201901300632/S2530018019300034/v1_201901300632/en/main.assets" "Apartado" => array:4 [ "identificador" => "64496" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25300180/0000006600000001/v1_201901300632/S2530018019300034/v1_201901300632/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018019300034?idApp=UINPBA00004N"]

Statistics

Original article

Fasting glucose in the first trimester: An initial approach to diagnosis of gestational diabetes

Glucemia basal en el primer trimestre como acercamiento inicial al diagnóstico de la diabetes en el embarazo

Teresa López del Vala,

Corresponding author

teresaldv@gmail.com

Corresponding author.

, Victoria Alcázar Lázaroa, Concepción García Lacalleb, Beatriz Torres Morenoa, Gabriela Castillo Carbajala, Beatriz Alameda Fernandezc

a Servicio de Endocrinología y Nutrición, Hospital Severo Ochoa, Madrid, Spain

b Servicio de Análisis Clínicos, Hospital Severo Ochoa, Madrid, Spain

c Servicio de Urgencias, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Spain

Read

8163

Times
was read the article

706

Total PDF

7457

Total HTML

Share statistics

 array:24 [
  "pii" => "S2530018019300034"
  "issn" => "25300180"
  "doi" => "10.1016/j.endien.2019.01.001"
  "estado" => "S300"
  "fechaPublicacion" => "2019-01-01"
  "aid" => "217"
  "copyright" => "SEEN and SED"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Endocrinol Diabetes Nutr. 2019;66:11-8"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 242
    "formatos" => array:2 [
      "HTML" => 184
      "PDF" => 58
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S2530016418301770"
      "issn" => "25300164"
      "doi" => "10.1016/j.endinu.2018.06.012"
      "estado" => "S300"
      "fechaPublicacion" => "2019-01-01"
      "aid" => "217"
      "copyright" => "SEEN y SED"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Endocrinol Diabetes Nutr. 2019;66:11-8"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 589
        "formatos" => array:2 [
          "HTML" => 399
          "PDF" => 190
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Glucemia basal en el primer trimestre como acercamiento inicial al diagn&#243;stico de la diabetes en el embarazo"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "11"
            "paginaFinal" => "18"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Fasting glucose in the first trimester&#58; An initial approach to diagnosis of gestational diabetes"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 1333
                "Ancho" => 2145
                "Tamanyo" => 148700
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n de los resultados de las pruebas de cribado y diagn&#243;stico&#46; AMHG&#58; alteraci&#243;n del metabolismo hidrocarbonado gestacional&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Teresa L&#243;pez del Val, Victoria Alc&#225;zar L&#225;zaro, Concepci&#243;n Garc&#237;a Lacalle, Beatriz Torres Moreno, Gabriela Castillo Carbajal, Beatriz Alameda Fernandez"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "Teresa"
                "apellidos" => "L&#243;pez del Val"
              ]
              1 => array:2 [
                "nombre" => "Victoria"
                "apellidos" => "Alc&#225;zar L&#225;zaro"
              ]
              2 => array:2 [
                "nombre" => "Concepci&#243;n"
                "apellidos" => "Garc&#237;a Lacalle"
              ]
              3 => array:2 [
                "nombre" => "Beatriz"
                "apellidos" => "Torres Moreno"
              ]
              4 => array:2 [
                "nombre" => "Gabriela"
                "apellidos" => "Castillo Carbajal"
              ]
              5 => array:2 [
                "nombre" => "Beatriz"
                "apellidos" => "Alameda Fernandez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2530018019300034"
          "doi" => "10.1016/j.endien.2019.01.001"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018019300034?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016418301770?idApp=UINPBA00004N"
      "url" => "/25300164/0000006600000001/v1_201901040643/S2530016418301770/v1_201901040643/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2530018019300046"
    "issn" => "25300180"
    "doi" => "10.1016/j.endien.2018.06.007"
    "estado" => "S300"
    "fechaPublicacion" => "2019-01-01"
    "aid" => "218"
    "copyright" => "SEEN and SED"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Endocrinol Diabetes Nutr. 2019;66:19-25"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 166
      "formatos" => array:2 [
        "HTML" => 111
        "PDF" => 55
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Analysis of the characteristics of patients with diabetes mellitus who attend a tertiary hospital emergency department for a hypoglycemic event"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "19"
          "paginaFinal" => "25"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "An&#225;lisis de las caracter&#237;sticas de los pacientes con diabetes mellitus que consultan por hipoglucemia en el servicio de urgencias de un hospital terciario"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1085
              "Ancho" => 2167
              "Tamanyo" => 92828
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Type of insulin regimen used in patients with type 2 diabetes mellitus&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jordi Caballero-Corchuelo, Fernando Guerrero-P&#233;rez, Paula Garc&#237;a-Sancho de la Jordana, Manuel P&#233;rez-Maraver"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Jordi"
              "apellidos" => "Caballero-Corchuelo"
            ]
            1 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Guerrero-P&#233;rez"
            ]
            2 => array:2 [
              "nombre" => "Paula"
              "apellidos" => "Garc&#237;a-Sancho de la Jordana"
            ]
            3 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "P&#233;rez-Maraver"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S2530016418301782"
        "doi" => "10.1016/j.endinu.2018.06.013"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016418301782?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018019300046?idApp=UINPBA00004N"
    "url" => "/25300180/0000006600000001/v1_201901300632/S2530018019300046/v1_201901300632/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S253001801930006X"
    "issn" => "25300180"
    "doi" => "10.1016/j.endien.2019.01.002"
    "estado" => "S300"
    "fechaPublicacion" => "2019-01-01"
    "aid" => "207"
    "copyright" => "SEEN and SED"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Endocrinol Diabetes Nutr. 2019;66:4-10"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 72
      "formatos" => array:2 [
        "HTML" => 40
        "PDF" => 32
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Serum ghrelin and obestatin levels in HIV-infected patients&#58; Effect of 36 weeks of antiretroviral treatment"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "4"
          "paginaFinal" => "10"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Niveles s&#233;ricos de Ghrelina y Obestatina en pacientes infectados con VIH&#58; efecto de 36 semanas de tratamiento antirretroviral"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 2273
              "Ancho" => 1511
              "Tamanyo" => 171465
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Obestatin levels in HIV infected patients prior and post-36 weeks of ART&#46; &#40;A&#41; Median obestatin levels of HIV patients before &#40;BL&#41; and after 36 weeks of ART &#40;W36&#41;&#44; unpaired comparison was performed by means of Mann&#8211;Whitney test&#46; &#40;B&#41; Paired comparison of obestatin levels before and after 36 weeks of ART&#44; Wilcoxon matched-pairs signed rank test was performed&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Edgar A&#46; Rivera-Leon, Iris M&#46; Llamas-Covarrubias, Raul A&#46; Soria-Rodriguez, Sergio Sanchez-Enriquez, Luz A&#46; Gonz&#225;lez-Hern&#225;ndez, Jaime F&#46; Andrade-Villanueva, Mara A&#46; Llamas-Covarrubias"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Edgar A&#46;"
              "apellidos" => "Rivera-Leon"
            ]
            1 => array:2 [
              "nombre" => "Iris M&#46;"
              "apellidos" => "Llamas-Covarrubias"
            ]
            2 => array:2 [
              "nombre" => "Raul A&#46;"
              "apellidos" => "Soria-Rodriguez"
            ]
            3 => array:2 [
              "nombre" => "Sergio"
              "apellidos" => "Sanchez-Enriquez"
            ]
            4 => array:2 [
              "nombre" => "Luz A&#46;"
              "apellidos" => "Gonz&#225;lez-Hern&#225;ndez"
            ]
            5 => array:2 [
              "nombre" => "Jaime F&#46;"
              "apellidos" => "Andrade-Villanueva"
            ]
            6 => array:2 [
              "nombre" => "Mara A&#46;"
              "apellidos" => "Llamas-Covarrubias"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S253001801930006X?idApp=UINPBA00004N"
    "url" => "/25300180/0000006600000001/v1_201901300632/S253001801930006X/v1_201901300632/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Fasting glucose in the first trimester&#58; An initial approach to diagnosis of gestational diabetes"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "11"
        "paginaFinal" => "18"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Teresa L&#243;pez del Val, Victoria Alc&#225;zar L&#225;zaro, Concepci&#243;n Garc&#237;a Lacalle, Beatriz Torres Moreno, Gabriela Castillo Carbajal, Beatriz Alameda Fernandez"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "Teresa"
            "apellidos" => "L&#243;pez del Val"
            "email" => array:1 [
              0 => "teresaldv&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Victoria"
            "apellidos" => "Alc&#225;zar L&#225;zaro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Concepci&#243;n"
            "apellidos" => "Garc&#237;a Lacalle"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Beatriz"
            "apellidos" => "Torres Moreno"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Gabriela"
            "apellidos" => "Castillo Carbajal"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Beatriz"
            "apellidos" => "Alameda Fernandez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Endocrinolog&#237;a y Nutrici&#243;n&#44; Hospital Severo Ochoa&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de An&#225;lisis Cl&#237;nicos&#44; Hospital Severo Ochoa&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Urgencias&#44; Hospital de Fuenlabrada&#44; Fuenlabrada&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Glucemia basal en el primer trimestre como acercamiento inicial al diagn&#243;stico de la diabetes en el embarazo"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1334
            "Ancho" => 2168
            "Tamanyo" => 142926
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of screening and diagnostic test results&#46; ACMP&#58; altered carbohydrate metabolism in pregnancy&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Gestational diabetes mellitus &#40;GDM&#41; is diabetes diagnosed in pregnancy and without evidence of prior diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> When in addition to a pregestational predisposition to diabetes &#40;genetic factors&#44; obesity and other causes of insulin resistance&#41;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> a patient develops contrainsular effects inherent to the physiological adaptation to pregnancy&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a> we observe the pathological alterations of carbohydrate metabolism referred to as GDM&#46; In most cases GDM is a mild and self-limiting condition&#44; though even so it significantly increases the risk of obstetric&#44; fetal and perinatal complications that can be avoided with appropriate medical treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In general&#44; the association of the physiological effects of pregnancy with susceptibility to type 2 diabetes does not give rise to an all-or-nothing situation&#44; but rather to a continuous variation in the before and after oral glucose glycemia values&#46; In some cases&#44; a pregestational predisposition mainly gives rise to insulin resistance with a relative increase in fasting blood glucose versus postprandial blood glucose&#46; In other cases&#44; a reduced beta-cell response to glucose overload occurs&#44; with normal fasting and high postprandial glycemia values&#46; In some instances both alterations occur together&#46; These two different types of physiopathological behavior condition the diagnostic efficacy of the criteria based on fasting blood glucose values or glycemia after an oral glucose tolerance test &#40;OGTT&#41;&#46; In this regard&#44; the HAPO study<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> showed both fasting blood glucose and glycemia after an oral glucose tolerance test to be linearly related to obstetric and neonatal adverse effects&#44; with no clear cut-off point&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There is no prior gold standard for estimating either the true prevalence of GDM or the sensitivity and specificity of each diagnostic criterion&#46; This is why it is so important to seek consensus criteria when selecting pregnant women who should receive full medical care for GDM&#44; thereby maximizing its benefits without needlessly incrementing the costs&#46; Furthermore&#44; since not all pregnant women are at the same risk of developing GDM&#44; we also have to take the strategic decision as to whether to perform a definitive diagnostic test in all pregnant women &#40;&#8220;one-step criterion&#8221;&#41;&#44; or rather perform screening tests and limit definitive tests to cases with a positive screening result &#40;&#8220;two-step criterion&#8221;&#41;&#46; Even within the context of screening&#44; there are two alternative options&#58; the O&#39;Sullivan test &#40;OST&#41; or fasting blood glucose &#40;FG&#41;&#46; In addition&#44; there has been controversy regarding timing&#44; over whether there should be universal screening in the first trimester&#59; screening in the first trimester only if there are risk factors for GDM&#59; or no screening in the first trimester&#44; thus leaving the entire diagnostic process for the second trimester&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the different diagnostic strategies for GDM currently used and the strategy employed in our setting&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">With regard to the diagnostic criterion&#44; and apart from the classical criteria of Carpenter and Coustan &#40;CC&#41; based on OGTT<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a> &#40;OGTT 100<span class="elsevierStyleHsp" style=""></span>g and a diagnosis of GDM if values of over 95&#44; 180&#44; 155 and 140<span class="elsevierStyleHsp" style=""></span>mg&#47;dl are obtained after 0&#44; 60&#44; 120 and 180<span class="elsevierStyleHsp" style=""></span>min&#41; and the National Diabetes Data Group &#40;NDDG&#41;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a> &#40;OGTT 100<span class="elsevierStyleHsp" style=""></span>g with two or more values above 105&#44; 190&#44; 165 and 145<span class="elsevierStyleHsp" style=""></span>mg&#47;dl after 0&#44; 60&#44; 120 and 180<span class="elsevierStyleHsp" style=""></span>min&#41;&#44; the criterion of the International Association of Diabetes and Pregnancy Study Groups &#40;IADPSG&#41; has been added&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> established from the HAPO study &#40;OGTT 75<span class="elsevierStyleHsp" style=""></span>g and a diagnosis of GDM if values of over 92&#44; 180 and 153<span class="elsevierStyleHsp" style=""></span>mg&#47;dl are obtained at one or more points after 0&#44; 60 and 120<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; Of course&#44; this latter diagnostic criterion significantly raises the prevalence of GDM &#40;16&#46;1&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> with respect to the classical CC &#40;11&#46;6&#37;&#41; and NDDG &#40;8&#46;8&#37;&#41; criteria&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#44;12</span></a> However&#44; the most relevant change is that a single high blood glucose value in OGTT suffices to establish the diagnosis according to the IADPSG&#59; accordingly&#44; a fasting blood glucose value of &#8805;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl is diagnostic of GDM without the need for OGTT&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In any case&#44; apart from the classical CC and NDDG criteria and the novel approach of the IADPSG&#44; there are many other consensuses referring to the diagnostic orientation of diabetes in pregnancy&#46; In this respect&#44; the Endocrine Society &#40;USA&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a> the World Health Organization &#40;WHO&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> and the Australasian Diabetes Society &#40;ADIPS&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> recommend the &#8220;one-step criterion&#8221;&#46; The American College of Obstetricians and Gynecologists &#40;ACOG&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> in turn advises the &#8220;two-step criterion&#8221;&#46; The American Diabetes Association &#40;ADA&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> advocates either option&#46; As regards the time of the first screening&#44; the WHO and the Endocrine Society recommend universal screening in the first trimester&#44; while the others only recommend screening in the first trimester if there are risk factors for GDM&#46; Lastly&#44; the National Institute for Health and Care Excellence &#40;NICE&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> does not support the universal screening model recommended by the IADPSG&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In our healthcare setting&#44; laboratory tests are performed as prenatal screening of all pregnant women in the first trimester&#46; The use of fasting blood glucose in such tests for the screening or diagnosis of GDM has clear cost advantages over OGTT&#46; However&#44; there are doubts regarding the suitability of fasting blood glucose in the first trimester &#40;FGFT&#41; as a screening test&#44; and even more so as a definitive diagnostic test&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The present study was designed&#44; on the one hand&#44; to estimate the sensitivity and specificity of FGFT as a screening and&#47;or diagnostic test for GDM and&#44; on the other hand&#44; to assess the incidence of maternal and fetal complications related to diabetes among the pregnant women in our setting who met the criterion FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; regardless of whether they were finally diagnosed and treated as having GDM or not&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">A retrospective study was made of the 1425 women with no previous diagnosis of diabetes mellitus &#40;DM&#41; who underwent prenatal screening in the first trimester of pregnancy &#40;week 10&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;6&#41; during a calendar year and who were monitored throughout pregnancy and until delivery by the Obstetrics Department of Hospital Severo Ochoa &#40;Madrid&#44; Spain&#41;&#46; Patients with prior DM and the 59 women who underwent prenatal screening but suffered subsequent miscarriage were excluded&#46; Blood samples were drawn into sodium fluoride&#47;potassium oxalate tubes and centrifuged within 30<span class="elsevierStyleHsp" style=""></span>min&#46; In our hospital&#44; the O&#39;Sullivan test &#40;OST&#41; is performed under fasting conditions&#44; with the determination of glycemia at 0 and 60<span class="elsevierStyleHsp" style=""></span>min&#46; Glucose was measured based on an enzymatic method using hexokinase with a Cobas 8000 autoanalyzer<span class="elsevierStyleSup">&#174;</span> &#40;Roche Diagnostics GmbH&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In addition to the laboratory test data from the Biochemistry Department&#44; information was obtained on the mother&#44; pregnancy&#44; delivery and the newborn infant from the primary care electronic records and obstetric discharge reports&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Biochemical data included FGFT and OST in weeks 24&#8211;28&#46; In the OST-positive patients the OGTT 100<span class="elsevierStyleHsp" style=""></span>g results were also compiled&#46; The CC criterion was used for the diagnosis of GDM&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The documented maternal data included age&#44; weight&#44; height&#44; the body mass index &#40;BMI&#41; in the first trimester stratified as normal &#40;&#60;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; overweight &#40;25&#8211;29&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41; or obese &#40;&#8805;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; and any family history of diabetes&#46; The obstetric data and complications recorded included gestational hypertension&#44; preeclampsia&#44; polyhydramnios&#44; preterm delivery &#40;defined as delivery before week 37&#41;&#44; and delivery to term &#40;spontaneous&#44; induced&#44; eutocic&#44; instrumental&#41; or cesarean section&#46; The recorded complications in the newborn infant comprised the following&#58; macrosomia &#40;weight &#62;4000<span class="elsevierStyleHsp" style=""></span>g&#41;&#44; hyperbilirubinemia&#44; polyglobulia&#44; hypoglycemia&#44; intrauterine fetal death&#44; malformations&#44; trauma to the newborn resulting from labor&#44; respiratory distress and admission to the Neonatal Intensive Care Unit&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We evaluated the sensitivity and specificity of FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl with respect to positive OST and the diagnosis of GDM &#40;OGTT 100<span class="elsevierStyleHsp" style=""></span>g according to CC criterion&#41;&#46; The relationship between FGFT and the obstetric and fetal complications was investigated&#46; The same variables were subsequently related to the glycemia groups &#60;92 and &#8805;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; after the patients diagnosed with GDM in the second trimester were excluded&#44; and who therefore received specific medical treatment&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The chi-squared test was used to compare two categorical variables&#44; while the Student <span class="elsevierStyleItalic">t</span>-test was used for the comparison of means&#44; in this case for checking the normal distribution of the variables and the homogeneity of variance&#46; The Student <span class="elsevierStyleItalic">t</span>-test for paired groups in turn was used to compare mean glycemia in the first trimester with mean glycemia at time 0 of the OST&#46; Binary logistic regression analysis was used to correlate binary dependent variables to different exposure variables&#46; The SPSS version 19 statistical package was used for data analysis&#44; and statistical significance was considered for <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The study was approved by the Ethics Committee of our hospital&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">The mean age of the pregnant women was 32&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;0 years&#44; with a mean BMI of 24&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;6<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; A total of 263 &#40;18&#46;5&#37;&#41; had a family history of diabetes&#44; 24 &#40;1&#46;7&#37;&#41; had pregestational arterial hypertension&#44; and 211 &#40;14&#46;7&#37;&#41; were smokers&#46; In turn&#44; 606 &#40;42&#46;5&#37;&#41; had had one or more previous pregnancies&#44; and 405 &#40;28&#46;4&#37;&#41; had suffered one or more previous miscarriages&#46; Twenty-four &#40;4&#46;0&#37;&#41; of the 606 patients with previous pregnancies had experienced GDM&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the patient characteristics according to FGFT above or below 92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The pregnant women with FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl were older &#40;33&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;4 versus 32&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;1 years&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; with a greater BMI &#40;26&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;0 versus 24&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; and with a more frequent family history of diabetes &#40;29&#46;0&#37; versus 16&#46;7&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; compared with the pregnant women with FGFT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Furthermore&#44; the women with FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl had had comparatively more previous pregnancies &#40;53&#46;8&#37; versus 40&#46;4&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and more prior GDM &#40;8&#46;6&#37; versus 3&#46;0&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the distribution of the screening and diagnostic test results&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">On jointly using the term &#8220;altered carbohydrate metabolism in pregnancy&#8221; &#40;ACMP&#41; in reference to FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and&#47;or positive OGTT&#44; we found 238 of the 1425 pregnant women to have ACMP &#40;16&#46;7&#37;&#41;&#46; Of these 238 cases with ACMP&#44; 39 had FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and positive OGTT &#40;16&#46;4&#37;&#41;&#59; 45 had FGFT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and positive OGTT &#40;18&#46;9&#37;&#41;&#59; and 154 had FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and negative OST or OGTT &#40;64&#46;7&#37;&#41;&#46; Excluding miscarriages &#40;47&#47;1279 &#91;3&#46;7&#37;&#93; in pregnant women with FGFT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and 12&#47;205 &#91;5&#46;9&#37;&#93; in pregnant women with FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3&#41;&#44; the obstetric and perinatal adverse effects according to FGFT &#60;92 or &#8805;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The infants of mothers with FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl had greater weight &#40;3228<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>86 versus 3123<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31<span class="elsevierStyleHsp" style=""></span>g&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41; and a higher percentage of macrosomia &#40;6&#46;9&#37; versus 3&#46;5&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#46; After adjusting the odds ratio &#40;OR&#41; for the BMI&#44; age and previous gestational diabetes&#44; a greater proportion of macrosomia was seen to persist among the infants of mothers with FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;OR 1&#46;54&#59; 95&#37; confidence interval &#91;95&#37;CI&#93; 0&#46;70&#8211;3&#46;37&#41;&#44; though the difference was no longer statistically significant&#46; In addition&#44; we recorded no statistically significant differences in neonatal adverse effects in mothers with FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; except as regards admission to neonatal care &#40;OR 1&#46;83&#59; 95&#37;CI&#58; 1&#46;10&#8211;3&#46;04&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and trauma in vaginal delivery &#40;OR 3&#46;1&#59; 95&#37;CI 1&#46;09&#8211;8&#46;83&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The recorded obstetric and perinatal adverse effects according to FGFT &#60;92 or &#8805;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; excluding the 84 women diagnosed and treated for GDM&#44; are reported in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">On excluding the patients treated for GDM&#44; the infants of mothers with FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl continued to register greater weight &#40;3235<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>98 versus 3128<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31<span class="elsevierStyleHsp" style=""></span>g&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; a higher percentage of macrosomia &#40;7&#46;2&#37; versus 3&#46;4&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and a greater proportion of trauma at delivery &#40;OR 3&#46;10&#59; 95&#37;CI 1&#46;15&#8211;8&#46;32&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#46; After adjusting OR for the BMI&#44; age and prior gestational diabetes&#44; a greater proportion of macrosomia was seen to persist in the infants of mothers with FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;OR 1&#46;50&#59; 95&#37;CI 0&#46;63&#8211;3&#46;57&#41;&#44; though the difference was no longer statistically significant&#46; Moreover&#44; the differences found in percentage macrosomia&#44; admission to neonatal care and polyhydramnios likewise failed to reach statistical significance&#46; The remaining adverse effects were similar between the groups&#46; In this case&#44; statistical significance was also not modified by age or a history of prior gestational diabetes&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In order to determine whether the effects seen with FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl were due only to the overweight and obesity found to be more prevalent in this group of pregnant women&#44; we studied the distribution of the most significant neonatal complications according to FGFT and the maternal BMI groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The infants of pregnant women with FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl had a higher prevalence of macrosomia in all the BMI groups&#46; Furthermore&#44; the group with FGFT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl showed a higher proportion of macrosomia with an increasing BMI &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; We also recorded a high proportion of respiratory distress in obese mothers only in the case of FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; In relation to the remaining complications&#44; the proportions tended to be higher with an increasing maternal BMI&#44; though statistical significance was not reached&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Fasting blood glucose in the first trimester &#40;&#8805;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; exhibited a sensitivity of 22&#46;9&#37; and a specificity of 91&#46;6&#37; with respect to positive OST in the second trimester&#44; and a sensitivity of 46&#46;4&#37; and a specificity of 88&#46;8&#37; with respect to the diagnosis of GDM based on the CC criterion&#46; The prevalence of GDM with the CC criterion in pregnancies in our setting was 5&#46;9&#37; &#40;2&#46;4&#37; with the NDDG criterion and 14&#46;7&#37; with the IADPSG criterion&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The mean FGFT was 84&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; with a mean fasting glucose level at time 0 of the OST of 81&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;confidence interval for the difference of means&#58; 2&#46;5&#8211;3&#46;3&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">In our study&#44; the prevalence of GDM was found to be 5&#46;9&#37; with the CC criteria and 14&#46;7&#37; with the IADPSG criteria&#46; In 2006&#44; the Spanish Diabetes and Pregnancy Group &#40;<span class="elsevierStyleItalic">Grupo Espa&#241;ol de Diabetes y Embarazo</span> &#91;GEDE&#93;&#41; estimated the prevalence of GDM according to the CC criteria to be 12&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">12&#44;19</span></a> versus 16&#46;1&#37; based on the IADPSG criteria&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#44;12</span></a> Other Spanish national publications have reported prevalence rates of between 1 and 12&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a> As can be seen&#44; even when using the same criteria&#44; the prevalence of GDM differs significantly between studies&#44; and this cannot be attributed solely to the different characteristics of the populations or the diagnostic strategies used&#46; For example&#44; in the study published by Duran et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> likewise conducted in the Community of Madrid&#44; with a population of pregnant women presenting a mean age and a BMI similar to those of our own series&#44; the prevalence of GDM with the CC criteria was 10&#46;6&#37; versus 35&#46;5&#37; with the IADPSG criteria&#46; Altered carbohydrate metabolism in pregnancy constitutes a continuum on which the cut-off points for diagnosing GDM are decided&#46; Therefore&#44; with the same cut off points&#44; a minor variability in the serum glucose measurements between different laboratories can have a very significant impact upon the proportion of pregnant women diagnosed with GDM&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Assuming these underlying limitations&#44; the first objective of our study was to determine whether a simple measurement such as FGFT is able to replace the currently used screening &#40;OST&#41; and diagnostic tests &#40;OGTT 100<span class="elsevierStyleHsp" style=""></span>g&#41; referring to GDM&#46; In this regard&#44; the poor sensitivity of FGFT in relation to OST &#40;22&#46;9&#37;&#41; and OGTT &#40;46&#46;4&#37;&#41; shows that FGFT cannot be used as a substitute for oral glucose testing&#44; because doing so would leave a considerable number of cases of GDM undiagnosed&#46; In addition&#44; the comparative analysis of the tests revealed a significant difference between the fasting glucose values of the first &#40;84&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; and second trimesters &#40;81&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46; This difference should possibly be taken into account when one is considering the limiting values of the different diagnostic tests according to the trimester of pregnancy&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In fact&#44; the only partial overlap of the groups selected on pooling the women with FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl or the women with positive OST and OGTT reflects the difference in information obtained with the two types of tests&#46; While FGFT detects more pregnant women with insulin resistance&#44; OGTT is mainly aimed at detecting pregnant women with postprandial carbohydrate intolerance&#46; In our study&#44; among the pregnant women with altered carbohydrate metabolism in pregnancy &#40;ACMP&#41;&#44; this partial overlap gives rise to three different groups&#46; Firstly&#44; we have the group with high FGFT and negative OST or OGTT 100<span class="elsevierStyleHsp" style=""></span>g &#40;64&#46;7&#37;&#41;&#44; corresponding to women with insulin resistance&#46; Secondly&#44; we have the group with normal FGFT and positive OGTT &#40;18&#46;9&#37;&#41;&#44; corresponding to women with postprandial carbohydrate intolerance&#46; Thirdly&#44; we have the group with high FGFT and positive OGTT &#40;16&#46;4&#37;&#41;&#44; which pools the women with both carbohydrate metabolic alterations&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Fasting glucose in the first trimester is therefore not useful as a replacement for the classical screening and diagnostic tests for GDM&#46; Could FGFT nevertheless play a role in the medical approach to pregnancy&#63; Our study has shown that pregnant women with high FGFT exhibit a statistically significant increase in fetal weight and macrosomia&#46; Moreover&#44; even accepting that the small number of complications limits the statistical significance of the findings&#44; many studies of diabetes in pregnancy appear to reflect a relationship between high FGFT and other maternal-fetal complications attributable to GDM&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">21&#8211;25</span></a> Most importantly&#44; these relationships are seen to persist when pregnant women diagnosed with GDM are excluded&#46; In other words&#44; women with ACMP but meeting no full criteria of GDM &#40;the first and the most numerous group&#41; have a carbohydrate metabolism that is sufficiently altered to cause an increased risk of complications of GDM&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">It seems clear that most fetal complications attributable to GDM are a result of fetal overfeeding&#44; particularly on taking into account that evolution-based physiology is intended to cope with nutritional shortage rather than excess&#46; Such overfeeding is mainly attributable to the maternal hyperglycemia caused by diabetes&#44; though it is also due in part to maternal obesity and overfeeding in the course of pregnancy&#46; In our study&#44; the infants of women with FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl had a higher proportion of macrosomia in all BMI categories and&#44; in turn&#44; there was a higher proportion of macrosomia according to the BMI in both the FGFT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl group and the FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl group&#46; Although these differences were not statistically significant in all comparisons &#40;possibly because of the small number of events observed on stratifying according to the BMI&#41;&#44; the observed trend appears to indicate that both high FGFT and overweight and obesity are associated factors in the generation of macrosomia&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The management of GDM&#44; aimed at controlling these fetal overfeeding mechanisms&#44; comprises two conceptually related but strategically separable components&#46; The first component &#8211; formal diet&#44; physical exercise and contained weight gain &#8211; comes at little cost to the healthcare system&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a> However&#44; the second component &#8211; monitoring of the condition through glycemia self-control&#44; medical supervision&#44; and eventual drug treatment with insulin or other drugs &#8211; can result in a very significant healthcare burden&#44; depending on the number of pregnant women finally diagnosed with GDM and referred to the endocrinology and nutrition departments&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">If FGFT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl is used to screen for ACMP&#44; we can ensure the early identification of women not only presenting an increased risk of GDM in the second trimester&#44; but most importantly with already existing metabolic disorders that can potentially give rise to macrosomia and neonatal complications&#46; Almost certainly&#44; this group of women would benefit from the aforementioned first component of management for GDM &#40;healthy eating habits and regular physical exercise&#41;&#44; and which could be prescribed in the obstetric care setting from the first trimester and throughout the duration of pregnancy&#44; with referral to the endocrinology clinic being reserved for those patients subsequently diagnosed with GDM on the basis of positive OST and OGTT results&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Furthermore&#44; it seems logical to assume that an increase in FGFT is only the continuation of an increase in pregestational fasting glucose&#44; as an expression of insulin resistance present before pregnancy&#46; Accordingly&#44; as in the first trimester&#44; it would make sense to prescribe dietary measures and physical exercise to all women with fasting glucose &#8805;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and a wish to become pregnant &#40;somewhat analogous to the pregestational administration of folic acid&#41;&#46; In fact&#44; in a recent study&#44; women with GDM diagnosed before week 12 of pregnancy<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a> presented the same adverse effects as patients with DM before pregnancy&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Lastly&#44; in relation to women with FGFT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and normal OST results&#44; and bearing in mind that the complications attributable to GDM also occur &#40;albeit less frequently&#41; in women with normal glucose tolerance as a result of overfeeding in the gestational period&#44; would it not be reasonable to make universal diet and exercise recommendations for all pregnant women&#63;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The present study has two main limitations&#58; its retrospective design and the fact that although the number of cases allowed us to demonstrate the relationship between FGFT and the weight of the newborn infant&#44; as well as intuit a correlation between FGFT and the maternal-fetal complications of GDM&#44; the sample size was too small to clearly confirm the existence of such an association&#46; In this respect&#44; a larger sample would be needed to increase the statistical power of the trial&#46; Furthermore&#44; it would be advisable to conduct an interventional study in a cohort of women with FGFT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl in order to determine whether a protocolized formal diet and physical exercise program is able to influence newborn infant weight and possible maternal-fetal complications&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres1142681"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objectives"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1073319"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1142680"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivos"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1073320"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflicts of interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-01-06"
    "fechaAceptado" => "2018-06-27"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1073319"
          "palabras" => array:4 [
            0 => "Gestational diabetes mellitus"
            1 => "Pregnancy"
            2 => "Oral glucose tolerance test"
            3 => "Fasting glucose in the first trimester"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1073320"
          "palabras" => array:4 [
            0 => "Diabetes gestacional"
            1 => "Embarazo"
            2 => "Sobrecarga oral de glucosa"
            3 => "Glucemia basal primer trimestre"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To establish whether fasting glucose levels in the first trimester &#40;FGFT&#41; of pregnancy &#8805;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;5&#46;1<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&#41; &#40;FGFT&#41; anticipate the occurrence of maternal-fetal complications of gestational diabetes mellitus&#46; To assess whether FGFT can replace diagnosis of GDM using the classical two-step oral glucose tolerance test &#40;OGTT&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective study of 1425 pregnancies with FGFT and O&#39;Sullivan Test &#40;OST&#41; and&#47;or OGTT according to OST results in the second trimester&#46; FGFT sensitivity and specificity were assessed as compared to the conventional diagnosis of GDM&#46; The relationship between maternal-fetal complications and FGFT was assessed in the total group and after excluding mothers who received specific medical treatment for GDM&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sensitivity and specificity of FGFT levels &#8805;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl were 46&#46;4&#37; and 88&#46;8&#37; as compared to diagnosis of GDM using Carpenter and Coustan criteria&#46; In the total group&#44; a statistically significant relationship was found between FGFT levels &#8805;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and newborn weight &#40;3228<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>86 versus 3123<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31<span class="elsevierStyleHsp" style=""></span>g&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; as well as a higher rate of macrosomia &#40;6&#46;9&#37; versus 3&#46;5&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; This association persisted after excluding patients diagnosed with and treated for GDM &#40;weight&#58; 3235<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>98 versus 3128<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31<span class="elsevierStyleHsp" style=""></span>g&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#59; percentage of macrosomia&#58; 7&#46;2&#37; versus 3&#46;4&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">FGFT is not a good substitute for conventional diagnosis of GDM in the second trimester&#46; Pregnant women with FGFT levels &#8805;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; even with no subsequent diagnosis of GDM&#44; are a risk group for fetal macrosomia and could benefit from dietary measures and physical exercise&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">1&#41;</span> Determinar si una glucemia basal en el primer trimestre &#40;GBPT&#41; del embarazo &#8805; 92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl anticipa la aparici&#243;n de complicaciones materno-fetales de diabetes mellitus gestacional &#40;DMG&#41;&#46; <span class="elsevierStyleItalic">2&#41;</span> Valorar si la GBPT puede sustituir al diagn&#243;stico cl&#225;sico de DMG mediante sobrecarga oral de glucosa &#40;SOG&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de 1&#46;425 embarazos con GBPT y test de O&#39;Sullivan &#40;TOS&#41; en el segundo trimestre m&#225;s SOG seg&#250;n resultado del TOS&#46; Valoraci&#243;n de la sensibilidad y especificidad de la GBPT respecto al diagn&#243;stico cl&#225;sico de DMG&#46; Relaci&#243;n de las complicaciones materno-fetales con la GBPT en el grupo total y tras excluir a las madres que realizaron tratamiento m&#233;dico espec&#237;fico de DMG&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La sensibilidad y la especificidad de la GBPT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl respecto al diagn&#243;stico de DMG en el segundo trimestre&#44; usando los criterios cl&#225;sicos basados en la SOG de Carpenter y Coustan&#44; fueron respectivamente del 46&#44;4 y el 88&#44;8&#37;&#46; Respecto a las gestantes con GBPT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; las gestantes con GBPT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl tienen mayor peso del reci&#233;n nacido &#40;3&#46;228<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>86 versus 3&#46;123<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31<span class="elsevierStyleHsp" style=""></span>g&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; y mayor porcentaje de macrosom&#237;a &#40;6&#44;9&#37; versus 3&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Esta relaci&#243;n se mantuvo tras excluir a las pacientes diagnosticadas y tratadas por DMG &#40;peso&#58; 3&#46;235<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>98 versus 3&#46;128<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31<span class="elsevierStyleHsp" style=""></span>g&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#59; porcentaje de macrosom&#237;a&#58; 7&#44;2&#37; versus 3&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">1&#41;</span> La GBPT no es un buen sustituto del diagn&#243;stico cl&#225;sico de DMG en el segundo trimestre&#46; <span class="elsevierStyleItalic">2&#41;</span> Las gestantes con GBPT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; aun sin diagn&#243;stico posterior de DMG&#44; constituyen un grupo de riesgo de macrosom&#237;a fetal y podr&#237;an beneficiarse de la instauraci&#243;n de tratamiento nutricional y ejercicio f&#237;sico&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Please cite this article as&#58; L&#243;pez del Val T&#44; Alc&#225;zar L&#225;zaro V&#44; Garc&#237;a Lacalle C&#44; Torres Moreno B&#44; Castillo Carbajal G&#44; Alameda Fernandez B&#46; Glucemia basal en el primer trimestre como acercamiento inicial al diagn&#243;stico de la diabetes en el embarazo&#46; Endocrinol Diabetes Nutr&#46; 2019&#59;66&#58;11&#8211;18&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1391
            "Ancho" => 2493
            "Tamanyo" => 152022
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagnostic strategies for GDM&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1334
            "Ancho" => 2168
            "Tamanyo" => 142926
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of screening and diagnostic test results&#46; ACMP&#58; altered carbohydrate metabolism in pregnancy&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1239&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>193&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family history of diabetes&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">207 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;29&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous pregnancies&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">502 &#40;40&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">104 &#40;53&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous GDM&#44;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;3&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;8&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pre-gestational hypertension&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous miscarriages&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">351 &#40;28&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;27&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smokers&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">188 &#40;15&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;11&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI &#60;25&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">659 &#40;64&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;37&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI 25&#8211;29&#46;9&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">246 &#40;24&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63 &#40;40&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI &#8805;30&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">112 &#40;11&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;22&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1950011.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Calculated with respect to patients with previous pregnancies&#46; Student <span class="elsevierStyleItalic">t</span>-test for the comparison of means and chi-squared test for categorical variables&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patient characteristics according to fasting glucose in the first trimester &#40;FGFT&#41; &#8805;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and &#60;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#59; GDM&#58; gestational diabetes mellitus&#59; BMI&#58; body mass index&#59; <span class="elsevierStyleItalic">n</span>&#58; number of patients&#59; ns&#58; nonsignificant&#59; OR&#58; odds ratio&#59; NI&#58; newborn infant&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Effect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1239&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; confidence interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">NI weight &#40;mean</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3123<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3228<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;6&#8211;191&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Macrosomia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43 &#40;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;6&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;07&#8211;4&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">OR adjusted for BMI&#44; age&#44; and previous GDM</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;70&#8211;3&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Trauma during vaginal delivery</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;09&#8211;8&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">OR adjusted for BMI&#44; age&#44; and previous GDM</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Admission to neonatal care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">145 &#40;11&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;19&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;10&#8211;3&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">OR corrected for BMI and cesarean section</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Polyhydramnios&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;36<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;19&#8211;58&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pre-eclampsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">245 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;74<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;56&#8211;13&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Polyglobulia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;59<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;06&#8211;5&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypoglycemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;41<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;47&#8211;4&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory distress&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;91<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;31&#8211;2&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Jaundice&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43 &#40;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;97<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;37&#8211;2&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1950010.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Binary logistic regression&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">OR adjusted for BMI&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Results referring to obstetric and fetal complications according to fasting glucose in the first trimester &#40;FGFT&#41; &#8805;92 and &#60;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#59; GDM&#58; gestational diabetes mellitus&#59; BMI&#58; body mass index&#59; <span class="elsevierStyleItalic">n</span>&#58; number of patients&#59; ns&#58; nonsignificant&#59; OR&#58; odds ratio&#59; NI&#58; newborn infant&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Effect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; confidence interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NI weight &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3235<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3128<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;4&#8211;200&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Macrosomia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;27&#8211;4&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">OR adjusted for BMI&#44; age&#44; and previous GDM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;63&#8211;3&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trauma during vaginal delivery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;5&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;15&#8211;8&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">OR adjusted for BMI&#44; age&#44; and previous GDM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission to neonatal care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">134 &#40;11&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;16&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;94&#8211;2&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">OR corrected for BMI and cesarean section&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;78&#8211;2&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polyhydramnios&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;87<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;52&#8211;12&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pre-eclampsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;02<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;28&#8211;3&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polyglobulia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypoglycemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;98<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;27&#8211;3&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory distress&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;03<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;34&#8211;3&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jaundice&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;85<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;22&#8211;3&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1950012.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">OR adjusted for BMI&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Binary logistic regression&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Results referring to obstetric and fetal complications according to fasting glucose in the first trimester &#40;FGFT&#41; &#8805;92 and &#60;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl<span class="elsevierStyleHsp" style=""></span>in pregnant women not diagnosed with diabetes&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; weight&#47;height<span class="elsevierStyleSup">2</span>&#59; <span class="elsevierStyleItalic">N</span>&#58; number of events&#59; <span class="elsevierStyleItalic">T</span>&#58; total number&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Effect BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92<br><span class="elsevierStyleItalic">N</span>&#47;<span class="elsevierStyleItalic">T</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FGFT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>92<br><span class="elsevierStyleItalic">N</span>&#47;<span class="elsevierStyleItalic">T</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Macrosomia</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI &#60;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#47;573 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;51 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI 25&#8211;29&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#47;238 &#40;5&#46;5&#41;&#44;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;58 &#40;6&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI &#8805;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;109 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;32 &#40;9&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Admission to neonatal care</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI &#60;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#47;543 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;51 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI 25&#8211;29&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#47;222 &#40;14&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#47;54 &#40;13&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI &#8805;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#47;100 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;30 &#40;36&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Polyhydramnios</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI &#60;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;602 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI 25&#8211;29&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;234&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;63 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI &#8805;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;113 &#40;0&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Respiratory distress</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI &#60;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#47;567 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;51 &#40;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI 25&#8211;29&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;237 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;57 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI &#8805;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;109 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;32 &#40;15&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1950013.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Chi-squared test between BMI categories and macrosomia in pregnant women with FGFT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0035"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Fisher&#39;s exact test&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Effects of pregnancy in women with glycemia &#8805;92 and &#60;92<span class="elsevierStyleHsp" style=""></span>mg&#47;dl in the first trimester &#40;FGFT&#41; according to the BMI&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:27 [
            0 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gestational diabetes mellitus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Siri"
                            1 => "M&#46;D&#46; Kjos"
                            2 => "T&#46;A&#46; Buchanan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Eng J Med"
                        "fecha" => "1999"
                        "volumen" => "341"
                        "paginaInicial" => "1749"
                        "paginaFinal" => "1756"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiopatogenia de la diabetes gestacional"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46;F&#46; Pallardo Sanchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Diabetes y embarazo"
                        "paginaInicial" => "23"
                        "paginaFinal" => "35"
                        "edicion" => "4&#46;<span class="elsevierStyleSup">a</span> ed&#46;"
                        "serieFecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La adaptaci&#243;n metabolica en la gestaci&#243;n normal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46;F&#46; Pallardo Sanchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Diabetes y embarazo"
                        "paginaInicial" => "3"
                        "paginaFinal" => "15"
                        "edicion" => "4&#46;<span class="elsevierStyleSup">a</span> ed&#46;"
                        "serieFecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of treatment of gestational diabetes mellitus on pregnancy outcomes"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Australian Carbohydrate Intolerance Study in Pregnant Women &#40;ACHOIS&#41; Trial Group"
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;A&#46; Crowther"
                            1 => "J&#46;E&#46; Hiller"
                            2 => "J&#46;R&#46; Moss"
                            3 => "A&#46;J&#46; McPhee"
                            4 => "W&#46;S&#46; Jeffries"
                            5 => "J&#46;S&#46; Robinson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa042973"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2005"
                        "volumen" => "352"
                        "paginaInicial" => "2477"
                        "paginaFinal" => "2486"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15951574"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A multicenter&#44; rendomized trial of treatment for mild gestational diabetes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;B&#46; Landon"
                            1 => "C&#46;Y&#46; Spong"
                            2 => "E&#46; Thom"
                            3 => "M&#46;W&#46; Carpenter"
                            4 => "S&#46;M&#46; Ramin"
                            5 => "B&#46; Casey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0902430"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "361"
                        "paginaInicial" => "1339"
                        "paginaFinal" => "1348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19797280"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of gestational diabetes treatment&#58; a systematic review with quality of evidence asseement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Falavigna"
                            1 => "M&#46;I&#46; Schmidt"
                            2 => "J&#46; Trujillo"
                            3 => "L&#46;F&#46; Alves"
                            4 => "E&#46;R&#46; Wendland"
                            5 => "M&#46;R&#46; Torloni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Diabetes Res Clin Pract"
                        "fecha" => "2012"
                        "volumen" => "98"
                        "paginaInicial" => "396"
                        "paginaFinal" => "405"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hyperglycemia and adverse pregnancy outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "The HAPO Study Cooperative Research Group"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0707943"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2008"
                        "volumen" => "358"
                        "paginaInicial" => "1991"
                        "paginaFinal" => "2002"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18463375"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Criteria for screening test for gestational diabetes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;W&#46; Carpenter"
                            1 => "D&#46;R&#46; Coustan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Obstet Gynecol"
                        "fecha" => "1982"
                        "volumen" => "144"
                        "paginaInicial" => "768"
                        "paginaFinal" => "773"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7148898"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "National Diabetes Data Group"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes"
                        "fecha" => "1979"
                        "volumen" => "28"
                        "paginaInicial" => "1039"
                        "paginaFinal" => "1057"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/510803"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International Association of Diabetes and Pregnancy Study Groups recomendations on the diagnosis and classification of hyperglycemia in pregnancy"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "International Association of Diabetes and Pregnancy Study Groups Consensus Panel"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;E&#46; Metzger"
                            1 => "S&#46;G&#46; Gabbe"
                            2 => "B&#46; Persson"
                            3 => "T&#46;A&#46; Buchanan"
                            4 => "P&#46;A&#46; Catalano"
                            5 => "P&#46; Damm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/dc09-1848"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2010"
                        "volumen" => "33"
                        "paginaInicial" => "676"
                        "paginaFinal" => "682"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20190296"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Recomendaciones IADPSG para el diagn&#243;stico y clasificaci&#243;n de la hiperglucemia durante la gestaci&#243;n&#46; &#191;Cu&#225;les son las implicaciones&#63;"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:6 [
                        "editores" => "R&#46;Corcoy"
                        "paginaInicial" => "38"
                        "paginaFinal" => "42"
                        "serieVolumen" => "vol&#46; XXII"
                        "serieTitulo" => "Educaci&#243;n diabetol&#243;gica profesional&#44; n&#250;mero 1"
                        "serieFecha" => "2012"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nuevos criterios diagn&#243;sticos de diabetes mellitus gestacional a partir del estudio HAPO&#46; &#191;Son v&#225;lidos en nuestro medio&#63;"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Grupo Espa&#241;ol de Diabetes y Embarazo"
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Corcoy"
                            1 => "B&#46; Lumbreras"
                            2 => "J&#46;L&#46; Bartha"
                            3 => "R&#46; Wifredo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.endonu.2010.03.020"
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocrinol Nutr"
                        "fecha" => "2010"
                        "volumen" => "57"
                        "paginaInicial" => "277"
                        "paginaFinal" => "280"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20541481"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diabetes and pregnancy&#58; an Endocrine Society Clinical Practice Guideline"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Ian Blumer"
                            1 => "E&#46; Hadar"
                            2 => "D&#46;R&#46; Hadden"
                            3 => "L&#46; Jovanovic"
                            4 => "J&#46;H&#46; Mestman"
                            5 => "M&#46; Hassan Murad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2013"
                        "volumen" => "98"
                        "paginaInicial" => "4337"
                        "paginaFinal" => "4349"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Diagnostic criteria and classification of hyperglycaemia fisrt detected in pregnancy&#58; a Word Health Organization Guideline"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Res Clin Pract"
                        "fecha" => "2014"
                        "volumen" => "103"
                        "paginaInicial" => "341"
                        "paginaFinal" => "363"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24847517"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available from&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0010" href="http://www.bhs.org.au/airapps/Services/au/org/bhs/govdoc/files/references/14440.pdf">http&#58;&#47;&#47;www&#46;bhs&#46;org&#46;au&#47;airapps&#47;Services&#47;au&#47;org&#47;bhs&#47;govdoc&#47;files&#47;references&#47;14440&#46;pdf</a> &#91;accessed 27&#46;01&#46;15&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Australasian Diabetes in Pregnancy Society"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practice bulletin 137&#58; gestational diabetes mellitus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Committee on Practice Bulletin Obstetrics"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.AOG.0000433006.09219.f1"
                      "Revista" => array:7 [
                        "tituloSerie" => "Obstet Gynecol"
                        "fecha" => "2013"
                        "volumen" => "122"
                        "numero" => "Pt 1"
                        "paginaInicial" => "406"
                        "paginaFinal" => "416"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23969827"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classification and diagnosis of diabetes mellitus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "American Diabetic Association"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/dcs15-2003"
                      "Revista" => array:7 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2015"
                        "volumen" => "38"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "S8"
                        "paginaFinal" => "S16"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26405073"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "National Institute for Health and Care Excellence &#40;NICE&#41;&#46; Diabetes in pregnancy&#58; management of diabetes and its complications from preconception to the postnatal period&#46; NICE guidelines &#40;NG3&#41;&#46; Available from&#58; <a id="intr0015" class="elsevierStyleInterRef" href="http://www.nice.org.uk/guidance/ng3/evidence">http&#58;&#47;&#47;www&#46;nice&#46;org&#46;uk&#47;guidance&#47;ng3&#47;evidence</a> &#91;accessed 14&#46;05&#46;15&#93;&#46;"
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aspectos epidemiol&#243;gicos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Gonz&#225;lez Gonz&#225;lez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Diabetes y embarazo"
                        "paginaInicial" => "17"
                        "paginaFinal" => "21"
                        "edicion" => "4&#46;<span class="elsevierStyleSup">a</span> ed&#46;"
                        "serieFecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women&#58; the St&#46; Carlos Gestational Diabetes Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Alejandra Duran"
                            1 => "S&#46; Sofia S&#225;enz"
                            2 => "M&#46;J&#46; Torrejon"
                            3 => "E&#46; Bordi&#250;"
                            4 => "L&#46; Del Valle"
                            5 => "N&#46; Galindo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/dc14-0179"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2014"
                        "volumen" => "37"
                        "paginaInicial" => "2442"
                        "paginaFinal" => "3245"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24947793"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Screening for gestational diabetes&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Prutsky Gabriela"
                            1 => "J&#46;P&#46; Domecq"
                            2 => "V&#46; Sundaresh"
                            3 => "T&#46; Elraiyah"
                            4 => "M&#46; Nabhan"
                            5 => "L&#46;J&#46; Prokop"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2013-2460"
                      "Revista" => array:6 [
                        "tituloSerie" => "JCEM"
                        "fecha" => "2013"
                        "volumen" => "98"
                        "paginaInicial" => "4311"
                        "paginaFinal" => "4318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24151288"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Screening test for gestational diabetes&#58; a systematic review for the U&#46; Preventive Services Task Force"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Donovan"
                            1 => "L&#46; Hartling"
                            2 => "M&#46; Muise"
                            3 => "A&#46; Guthrie"
                            4 => "B&#46; Vandermeer"
                            5 => "D&#46;M&#46; Dryden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/0003-4819-159-2-201307160-00657"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2013"
                        "volumen" => "159"
                        "paginaInicial" => "115"
                        "paginaFinal" => "122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23712349"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The importance of fasting blood glucose in screening for gestational diabetes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Herrera"
                            1 => "L&#46; Brustman"
                            2 => "J&#46; Foroutan"
                            3 => "S&#46; Scarpellis"
                            4 => "E&#46; Murphy"
                            5 => "A&#46; Francis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/14767058.2014.935322"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Matern Fetal Neonatal Med"
                        "fecha" => "2015"
                        "volumen" => "28"
                        "paginaInicial" => "825"
                        "paginaFinal" => "828"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24939625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Updated guidelines on screening for gestational diabetes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46; Yashdeep Gupta"
                            1 => "B&#46; Bharti Kalra"
                            2 => "M&#46;P&#46; Baruah"
                            3 => "R&#46; Singla"
                            4 => "S&#46; Kaina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/IJWH.S82046"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Womens Health"
                        "fecha" => "2015"
                        "volumen" => "7"
                        "paginaInicial" => "539"
                        "paginaFinal" => "550"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26056493"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "First-trimester fasting hyperglycemia and adverse pregnancy outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Riskin-Mashiah"
                            1 => "G&#46; Younes"
                            2 => "A&#46; Damti"
                            3 => "R&#46; Auslender"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/dc09-0688"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2009"
                        "volumen" => "32"
                        "paginaInicial" => "1639"
                        "paginaFinal" => "1644"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19549728"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment with diet and exercise for women with gestational diabetes mellitus diagnosed using IADPSG criteria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "O&#46; Kgosidialwa"
                            1 => "A&#46;M&#46; Egan"
                            2 => "L&#46; Carmody"
                            3 => "B&#46; Kirwan"
                            4 => "P&#46; Gunning"
                            5 => "F&#46;P&#46; Dunne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2015-3259"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2015"
                        "volumen" => "100"
                        "paginaInicial" => "4629"
                        "paginaFinal" => "4636"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26495752"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gestational diabetes mellitus in early pregnancy&#58; evidence for poor pregnancy outcomes despite treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;N&#46; Sweeting"
                            1 => "G&#46;P&#46; Ross"
                            2 => "J&#46; Hyett"
                            3 => "L&#46; Molineaux"
                            4 => "M&#46; Constantino"
                            5 => "A&#46;J&#46; Harding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2016"
                        "volumen" => "39"
                        "paginaInicial" => "75"
                        "paginaFinal" => "81"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/25300180/0000006600000001/v1_201901300632/S2530018019300034/v1_201901300632/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "64496"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/25300180/0000006600000001/v1_201901300632/S2530018019300034/v1_201901300632/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018019300034?idApp=UINPBA00004N"
]

Article information

ISSN: 25300180
Original language: English

DOI:10.1016/j.endien.2019.01.001

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	7	0	7
2024 October	68	2	70
2024 September	109	13	122
2024 August	77	16	93
2024 July	88	10	98
2024 June	67	5	72
2024 May	78	3	81
2024 April	108	8	116
2024 March	125	7	132
2024 February	169	4	173
2024 January	151	4	155
2023 December	137	8	145
2023 November	127	5	132
2023 October	200	3	203
2023 September	107	4	111
2023 August	79	1	80
2023 July	91	8	99
2023 June	77	4	81
2023 May	122	13	135
2023 April	104	4	108
2023 March	106	6	112
2023 February	77	7	84
2023 January	94	8	102
2022 December	99	5	104
2022 November	112	12	124
2022 October	84	14	98
2022 September	81	14	95
2022 August	74	12	86
2022 July	85	13	98
2022 June	92	11	103
2022 May	112	14	126
2022 April	133	23	156
2022 March	180	19	199
2022 February	180	6	186
2022 January	198	9	207
2021 December	115	11	126
2021 November	152	13	165
2021 October	132	23	155
2021 September	123	17	140
2021 August	159	26	185
2021 July	127	12	139
2021 June	139	19	158
2021 May	144	22	166
2021 April	612	40	652
2021 March	274	14	288
2021 February	193	17	210
2021 January	170	17	187
2020 December	159	18	177
2020 November	158	15	173
2020 October	96	12	108
2020 September	107	10	117
2020 August	95	9	104
2020 July	99	11	110
2020 June	110	12	122
2020 May	90	17	107
2020 April	96	13	109
2020 March	92	5	97
2020 February	61	2	63
2020 January	59	7	66
2019 December	31	6	37
2019 November	23	4	27
2019 October	7	1	8
2019 September	17	4	21
2019 August	10	4	14
2019 July	9	30	39

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter