Original article
Predictors of postpartum diabetes mellitus in patients with gestational diabetes
Factores predictores de diabetes mellitus posparto en pacientes con diabetes gestacional
Soralla Civantosa,b,
, María Duránc, Beatriz Flándezc, María Merinoc, Cristina Naveac, Guadalupe Guijarroc, Nieves Martelld, Susana Monereoe
Corresponding author
a Sección de Endocrinología y Nutrición, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
b Servicio de Endocrinología y Nutrición, Hospital Universitario Quirón, Madrid, Spain
c Servicio de Endocrinología y Nutrición, Hospital Universitario de Getafe, Getafe, Madrid, Spain
d Unidad de Hipertensión, Hospital Universitario Clínico San Carlos, Madrid, Spain
e Servicio de Endocrinología y Nutrición, Hospital Universitario Gregorio Marañón, Madrid, Spain
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"aff0015" ] 3 => array:3 [ "entidad" => "Unidad de Hipertensión, Hospital Universitario Clínico San Carlos, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Endocrinología y Nutrición, Hospital Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores predictores de diabetes mellitus posparto en pacientes con diabetes gestacional" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 817 "Ancho" => 1084 "Tamanyo" => 60879 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Blood glucose values at the different measurement points in the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g of glucose according to postpartum reassessment (normal, IFG, CHI or DM).</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 (GD) is defined as carbohydrate intolerance of variable intensity diagnosed for the first time during pregnancy, regardless of the treatment used to control it or its postpartum course.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of GD in Spain ranges from 4.5% to 11.6% of all pregnancies, depending on the study and the criteria used to diagnose the condition.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Gestational diabetes is related to metabolic syndrome, high blood pressure, dyslipidemia and obesity in the future, and the literature indicates that over 50% of all affected patients develop type 2 diabetes mellitus (DM) in the course of follow-up.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a> The current clinical practice guidelines<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a> therefore recommend early patient reassessment after delivery. However, in routine practice it is difficult to ensure patient compliance once pregnancy has ended.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There is evidence that the incidence of DM can be reduced by the adoption of healthy lifestyle habits. Despite this, some studies have found that less than half of all patients with GD undergo postpartum reassessment.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The reporting of factors implicated in the development of DM may help increase the number of patients adhering to prevention programs.</p><p id="par0030" class="elsevierStylePara elsevierViewall">However, the lack of data for individual risk estimation means that the healthcare professionals involved in the care of women with GD fail to optimize patient counseling in this regard.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">We therefore conducted a study with the primary aim of analyzing the factors related to postpartum diabetes in a sample of patients with GD.</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 observational study was made, using information collected from the specialist GD unit of Hospital Universitario de Getafe (Madrid, Spain). We selected a total of 1765 single pregnancy women diagnosed with GD according to the criteria of the National Diabetes Data Group (NDDG) between 1993 and 2013. The study was carried out with the approval of the hospital Ethics Committee.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We evaluated the women with no history of diabetes between 24 and 28 weeks of pregnancy based on the O'Sullivan test after a 12-h fasting period. If any known risk factor for GD was detected (age<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>35 years, a body mass index [BMI]<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, previous GD or a family history of DM), the screening test was performed in the first trimester of pregnancy. When the plasma glucose levels recorded 1<span class="elsevierStyleHsp" style=""></span>h after an oral glucose tolerance test (OGTT) with 50<span class="elsevierStyleHsp" style=""></span>g were ≥140<span class="elsevierStyleHsp" style=""></span>mg/dl, the OGTT was repeated with 100<span class="elsevierStyleHsp" style=""></span>g, and the fasting plasma glucose levels were measured 1, 2 and 3<span class="elsevierStyleHsp" style=""></span>h after intake, with the recording of glycosylated hemoglobin (HbA<span class="elsevierStyleInf">1c</span>) (DCCT). Gestational diabetes was diagnosed according to the NDDG criteria: two or more plasma glucose values above the following limits: 105<span class="elsevierStyleHsp" style=""></span>mg/dl basal: 190<span class="elsevierStyleHsp" style=""></span>mg/dl in 1<span class="elsevierStyleHsp" style=""></span>h, 165<span class="elsevierStyleHsp" style=""></span>mg/dl in 2<span class="elsevierStyleHsp" style=""></span>h and 145<span class="elsevierStyleHsp" style=""></span>mg/dl in 3<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0050" class="elsevierStylePara elsevierViewall">If GD was diagnosed, we prescribed dietary measures (50% carbohydrate, 20% protein and 30% fat) with a calorie supply of 35<span class="elsevierStyleHsp" style=""></span>kcal/kg in low-weight patients, 30<span class="elsevierStyleHsp" style=""></span>kcal/kg in patients with normal weight, 25<span class="elsevierStyleHsp" style=""></span>kcal/kg in overweight women and 15<span class="elsevierStyleHsp" style=""></span>kcal/kg in obese patients. In addition, recommendations for moderate and regular physical activity (brisk walking for at least 1<span class="elsevierStyleHsp" style=""></span>h a day) were made. Insulin therapy was started if optimal glycemia targets were consistently not met (fasting capillary blood glucose<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>95<span class="elsevierStyleHsp" style=""></span>mg/dl or 1<span class="elsevierStyleHsp" style=""></span>h postprandial<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>140<span class="elsevierStyleHsp" style=""></span>mg/dl).</p><p id="par0055" class="elsevierStylePara elsevierViewall">Three months after delivery, an OGTT was performed with 75<span class="elsevierStyleHsp" style=""></span>g and HbA<span class="elsevierStyleInf">1c</span> (DCCT) was measured in order to reassess postpartum altered glucose. Normal fasting glycemia was defined as <100<span class="elsevierStyleHsp" style=""></span>mg/dl and 2<span class="elsevierStyleHsp" style=""></span>h <140<span class="elsevierStyleHsp" style=""></span>mg/dl; impaired fasting glucose (IFG) was defined as fasting glycemia between 100 and 125<span class="elsevierStyleHsp" style=""></span>mg/dl; carbohydrate intolerance (CHI) was defined as blood glucose after 2<span class="elsevierStyleHsp" style=""></span>h between 140 and 199<span class="elsevierStyleHsp" style=""></span>mg/dl; and DM was defined as fasting glycemia<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>126<span class="elsevierStyleHsp" style=""></span>mg/dl and/or 2<span class="elsevierStyleHsp" style=""></span>h ≥200<span class="elsevierStyleHsp" style=""></span>mg/dl.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The exclusion criteria were multiple pregnancies, delivery <20 weeks and incomplete follow-up to delivery.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The following data were analyzed.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Clinical data</span><p id="par0070" class="elsevierStylePara elsevierViewall">Maternal age, maternal origin and maternal pregestational body weight (kg) and the BMI (kg/m<span class="elsevierStyleSup">2</span>), obesity being defined as a BMI<span class="elsevierStyleHsp" style=""></span>≥30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, together with weight gain during pregnancy, a history of DM in first-degree relatives, and a history of GD in the patient.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Laboratory test data</span><p id="par0075" class="elsevierStylePara elsevierViewall">Plasma glucose in GD diagnostic testing after an OGTT with 100<span class="elsevierStyleHsp" style=""></span>g (basal: 1, 2 and 3<span class="elsevierStyleHsp" style=""></span>h). The number of points with pathological blood glucose values among the four measurements (2, 3 or 4 pathological points in the OGTT). The glycemic response to reassessment testing three months after delivery using an OGTT with 75<span class="elsevierStyleHsp" style=""></span>g. Glycosylated hemoglobin at the time of the diagnosis of GD and three months after delivery. Insulin use during pregnancy in order to secure good blood glucose control.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Qualitative variables were reported as frequency distributions, and quantitative variables as the mean and standard deviation (SD) (data exhibiting a normal distribution).</p><p id="par0085" class="elsevierStylePara elsevierViewall">The behavior of the quantitative parameters was analyzed for each of the independent variables based on the Student t-test (for comparisons of a variable with two categories) or analysis of variance (ANOVA).</p><p id="par0090" class="elsevierStylePara elsevierViewall">Diagnostic performance curves (receiver operating curves [ROCs]) were used for the parameters of the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g in order to detect the points discriminating the presence of postpartum DM, with the calculation of sensitivity and specificity.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Linear regression models were fitted to assess factors associated with the development of postpartum DM.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Statistical significance was considered for <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05. The SPSS<span class="elsevierStyleSup">®</span> version 15.0 statistical package for MS Windows<span class="elsevierStyleSup">®</span> was used throughout.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0105" class="elsevierStylePara elsevierViewall">A total of 1765 patients were included in the study, with an age of 32.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.3 years (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD). Of these patients, 14.2% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>251) were foreigners. The pregestational BMI was 26.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.4<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, and 21.6% of the patients had pregestational obesity. A total of 60.6% of the sample had a history of first-degree relatives with DM, and 13.1% had experienced at least one episode of GD in previous pregnancies.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The diagnosis of GD leading to the start of treatment (based on dietary and physical activity recommendations) was established at 29.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.9 weeks of pregnancy on average. During pregnancy, insulin therapy was required by 20.1% of the patients to improve blood glucose control (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">With regard to the neonatal and delivery characteristics, 10.1% of the infants presented macrosomia (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>171). In turn, 27.1% of the deliveries were by cesarean section (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>474), and the mean gestational age at delivery was 38.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.1 weeks.</p><p id="par0120" class="elsevierStylePara elsevierViewall">At an average of 3.5 months (±0.4) after delivery, the OGTT was performed with 75<span class="elsevierStyleHsp" style=""></span>g of glucose to determine whether any postpartum glucose alterations persisted. This reassessment found that 77.8% of the women had a normal OGTT, 9.5% presented IFG, 10.8% had CHI, and 2.1% were diagnosed with DM after pregnancy. A total of 524 patients (29.7%) were lost over postpartum follow-up. Thus, a total of 1241 patients (70.3%) were followed-up on until reassessment after delivery. Analysis of the baseline characteristics of the patients lost to follow-up revealed no statistically significant differences versus the other patients.</p><p id="par0125" class="elsevierStylePara elsevierViewall">In the analysis of predictors of DM after delivery, we took into consideration the clinical and laboratory test parameters, focusing mainly on blood glucose levels in the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g and HbA<span class="elsevierStyleInf">1c</span> during pregnancy (DCCT).</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Clinical data</span><p id="par0130" class="elsevierStylePara elsevierViewall">The study of the clinical parameters showed differences according to a history of GD in previous pregnancies. In this regard, 25% of the patients who finally had postpartum DM presented a history of GD in previous pregnancies, versus only 12.9% of the patients who did not have DM after delivery (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="par0135" class="elsevierStylePara elsevierViewall">In the patients of other origin (i.e., not Spanish), the probability of postpartum DM was higher than among the Spanish patients (6.8% versus 1.3%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01).</p><p id="par0140" class="elsevierStylePara elsevierViewall">Differences were also found in relation to pregestational obesity, with the percentage of DM in obese patients being 20.8% versus 14.9% in the non-obese women (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="par0145" class="elsevierStylePara elsevierViewall">Statistically significant differences were observed in relation to insulin use: of the patients who finally had DM after delivery, 79.2% required insulin treatment to improve their blood glucose control, while only 20% of the women with no DM at reassessment required insulin treatment (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01).</p><p id="par0150" class="elsevierStylePara elsevierViewall">There were no significant differences in the postpartum reassessment results after the family history of DM was taken into consideration (59.2% versus 61.3% of the patients with postpartum DM) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="par0155" class="elsevierStylePara elsevierViewall">Likewise, no differences were found in maternal weight gain during pregnancy, with the patients with no DM after delivery presenting a weight gain of 8.1.<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.3<span class="elsevierStyleHsp" style=""></span>kg versus 8.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.9<span class="elsevierStyleHsp" style=""></span>kg in those with postpartum DM (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Laboratory test data</span><p id="par0160" class="elsevierStylePara elsevierViewall">On analyzing the laboratory test data, we focused on the OGTT glycemia measurements with 100<span class="elsevierStyleHsp" style=""></span>g of glucose and the HbA<span class="elsevierStyleInf">1c</span> levels during pregnancy.</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Oral glucose tolerance test with 100<span class="elsevierStyleHsp" style=""></span>g</span><p id="par0165" class="elsevierStylePara elsevierViewall">The mean glycemia values recorded in the diagnostic OGTT with 100<span class="elsevierStyleHsp" style=""></span>g were as follows: mean basal blood glucose: 91.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16.0<span class="elsevierStyleHsp" style=""></span>mg/dl; after 1<span class="elsevierStyleHsp" style=""></span>h: 210.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>27.7<span class="elsevierStyleHsp" style=""></span>mg/dl; after 2<span class="elsevierStyleHsp" style=""></span>h: 187.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>27.7<span class="elsevierStyleHsp" style=""></span>mg/dl; and after 3<span class="elsevierStyleHsp" style=""></span>h: 138.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>37.0<span class="elsevierStyleHsp" style=""></span>mg/dl.</p><p id="par0170" class="elsevierStylePara elsevierViewall">In the above-mentioned OGTT with 100<span class="elsevierStyleHsp" style=""></span>g of glucose, 15.5% of the global patients presented pathological glycemia at baseline, 82.6% showed impaired glycemia in the measurement obtained after 1<span class="elsevierStyleHsp" style=""></span>h, 91.6% in the measurement after 2<span class="elsevierStyleHsp" style=""></span>h, and 42.5% in the measurement after 3<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0175" class="elsevierStylePara elsevierViewall">The percentage of patients with pathological findings at the different points of the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g of glucose according to postpartum reassessment is given in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">Independently of postpartum reassessment, the blood glucose values most often found to be altered in the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g of glucose were those corresponding to one and 2<span class="elsevierStyleHsp" style=""></span>h after glucose intake in all the groups (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01). Statistically significant differences were observed on comparing the values 1 and 2<span class="elsevierStyleHsp" style=""></span>h after glucose intake versus baseline and the 3<span class="elsevierStyleHsp" style=""></span>h point (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01). By contrast, no significant differences were recorded between the measurements after 1 and 2<span class="elsevierStyleHsp" style=""></span>h (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05) or at baseline versus the measurement after 3<span class="elsevierStyleHsp" style=""></span>h (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><p id="par0185" class="elsevierStylePara elsevierViewall">In relation to the percentage of patients presenting alterations of the different points of the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g of glucose, the postpartum reassessment showed the group with IFG to include a larger proportion of women with pathological glucose values at baseline (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><p id="par0190" class="elsevierStylePara elsevierViewall">No statistically significant differences were found for the remaining measurement points.</p><p id="par0195" class="elsevierStylePara elsevierViewall">Since the diagnosis of GD according to the NDDG is based on the recording of two or more pathological points in the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g, we studied the percentage of patients with 2, 3 or 4 pathological points (baseline: 1, 2 or 3<span class="elsevierStyleHsp" style=""></span>h).</p><p id="par0200" class="elsevierStylePara elsevierViewall">We found that 76% of the patients had two pathological points, 25.6% three points, and 2.4% four pathological points.</p><p id="par0205" class="elsevierStylePara elsevierViewall">With regard to the number of pathological points according to the situation at postpartum reassessment, differences were found between patients who finally had DM after delivery (3.18<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.69) versus those without (2.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.45) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). The fact of yielding pathological glycemia values at all four points of the OGTT was related to postpartum DM: 12% of these patients presented postpartum DM versus only 1.1% of those with two or three pathological points (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01).</p><p id="par0210" class="elsevierStylePara elsevierViewall">On considering the glycemia values in the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g of glucose according to postpartum reassessment, we found that the women with postpartum DM had significantly higher values at baseline and after 1, 2 and 3<span class="elsevierStyleHsp" style=""></span>h versus the other groups (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0215" class="elsevierStylePara elsevierViewall">We found no statistically significant differences on comparing the values of the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g of glucose among the groups with normal values at reassessment, IFG or CHI at postpartum (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0220" class="elsevierStylePara elsevierViewall">Taking the above into account, we analyzed the data based on the ROC curves for each of the points of the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g of glucose, and found the most representative point in relation to postpartum DM to be the measurement obtained 2<span class="elsevierStyleHsp" style=""></span>h after glucose intake (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01; with AUC: 0.85). Within this setting, the most sensitive and specific glycemia value for predicting postpartum DM was seen to be 189<span class="elsevierStyleHsp" style=""></span>mg/dl (sensitivity: 86.2%; specificity: 72%) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">HbA<span class="elsevierStyleInf">1c</span></span><p id="par0225" class="elsevierStylePara elsevierViewall">The mean HbA<span class="elsevierStyleInf">1c</span> concentration at the time of the diagnosis of GD was 5.3%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4, versus 5.2%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.6 at postpartum reassessment.</p><p id="par0230" class="elsevierStylePara elsevierViewall">On examining the HbA <span class="elsevierStyleInf">1c</span> levels during pregnancy and after delivery in relation to postpartum reassessment, we observed significant differences in HbA <span class="elsevierStyleInf">1c</span> on comparing the patients with DM after delivery versus the other groups (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0235" class="elsevierStylePara elsevierViewall">In relation to the above, we explored the possible existence of an association between HbA<span class="elsevierStyleInf">1c</span> measured during pregnancy and the development of postpartum DM. We found an HbA<span class="elsevierStyleInf">1c</span> concentration of 5.9% or higher to be very specific in predicting postpartum DM (specificity: 95.9%; sensitivity: 69%; area under the ROC curve: 0.77) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01).</p><p id="par0240" class="elsevierStylePara elsevierViewall">The multivariate analysis adjusted for age, the maternal BMI, maternal origin and fasting glucose showed a statistically significant relationship between blood glucose measured 2<span class="elsevierStyleHsp" style=""></span>h after the OGTT and a diagnosis of DM after delivery (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02), and between HbA<span class="elsevierStyleInf">1c</span> determined at the diagnosis of pregnancy and postpartum DM (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03).</p></span></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0245" class="elsevierStylePara elsevierViewall">The risk of DM in patients with a history of GD is clearly high, with over 50% of such patients developing DM over the years.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">The incidence reported in the literature is highly variable, ranging from 3% at early postpartum assessment (3–6 months)<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> to 50–70% at 15–25 years postpartum.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">For this reason, the clinical guidelines recommend assessment following delivery at intervals of approximately 4–12 weeks using the OGTT with 75<span class="elsevierStyleHsp" style=""></span>g of glucose.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a> However, in this phase a considerable percentage of patients are lost to follow-up, and the test is not performed. Studies of GD analyzing data based on postpartum reassessment usually assume a loss to follow-up of over 50%.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10,11</span></a> In our study, we were able to follow-up on over 70% of the women in postpartum reassessment, so giving an added value to the results obtained.</p><p id="par0260" class="elsevierStylePara elsevierViewall">The early identification of patients with a greater probability of postpartum DM is very important. In this regard, and based on objective data, we should insist on the need for a reassessment of blood glucose alterations after delivery, with the OGTT being given early when required.</p><p id="par0265" class="elsevierStylePara elsevierViewall">A comprehensive review of the risk factors for DM in patients with GD shows clinical data such as pregestational overweight or obesity to be the most commonly analyzed factors,<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">12–14</span></a> along with insulin use during pregnancy<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">3,15</span></a> or a history of GD in previous pregnancies.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">16,17</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">A meta-analysis conducted in 2016 by Rayanagoudar et al.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> showed that women requiring insulin to improve the control of GD are at a greater risk of developing future DM, with a relative risk (RR) of 3.66 as compared to those not requiring insulin. In obese patients the RR was 3.18. There is strong evidence of an association between these factors and DM in women with a history of GD,<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">19–21</span></a> which is consistent with the data obtained in our study.</p><p id="par0275" class="elsevierStylePara elsevierViewall">In studies examining laboratory test data as predictors of DM after delivery, the most widely analyzed parameter is fasting blood glucose, which appears to be related to the development of future DM.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10,22–24</span></a></p><p id="par0280" class="elsevierStylePara elsevierViewall">However, fewer studies have analyzed the remaining measurement points in the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g of glucose. The meta-analysis conducted by Rayanagoudar et al.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> suggests that the blood glucose levels at baseline and recorded at 1, 2 and 3<span class="elsevierStyleHsp" style=""></span>h in the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g may be related to the occurrence of postpartum DM (RR: 3.5, 3.05, 3.46 and 3.2, respectively), though the supporting studies are very few and the level of evidence is therefore very low.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a></p><p id="par0285" class="elsevierStylePara elsevierViewall">A number of studies have been carried out in the Spanish population, such as that published by Albareda et al.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a> These authors identified the pregestational BMI, glycemia<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>210<span class="elsevierStyleHsp" style=""></span>mg/dl at 2<span class="elsevierStyleHsp" style=""></span>h and the presence of four pathological points in the OGTT as predictors of diabetes. Mention should also be made of a recent study carried out by Monroy et al.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a> in which an association was recorded between glycemia at each OGTT measurement point and the risk of postpartum glycemia disorders (RR between 1.0 and 1.4).</p><p id="par0290" class="elsevierStylePara elsevierViewall">In our study we focused on the data which could be afforded by the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g of glucose. We found a large proportion of the patients to be diagnosed with GD on the basis of only two altered points on the curve (76% of the women versus 25.6% with 3 altered points and 2.4% with 4 altered points). The most frequently altered measurements were those obtained one and 2<span class="elsevierStyleHsp" style=""></span>h after glucose intake; these were therefore the two most relevant points in diagnosing GD.</p><p id="par0295" class="elsevierStylePara elsevierViewall">In patients with postpartum DM, the blood glucose levels in the above-mentioned OGTT were higher. We thus sought to determine the most significant measurement point and the glycemia threshold above which a diagnosis of DM proves more likely in postpartum reassessment. We found glycemia<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>189<span class="elsevierStyleHsp" style=""></span>mg/dl recorded after 2<span class="elsevierStyleHsp" style=""></span>h in the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g of glucose to be related to a greater probability of postpartum DM. The multivariate analysis adjusted for factors related to postpartum diabetes confirmed its association independently.</p><p id="par0300" class="elsevierStylePara elsevierViewall">With regard to HbA<span class="elsevierStyleInf">1c</span> determined during pregnancy, the literature describes an association with postpartum DM (RR: 2.56), but the evidence is weak.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> In our study we found that patients who were finally diagnosed with DM in the postpartum period had higher HbA<span class="elsevierStyleInf">1c</span> concentrations during pregnancy than the other women. Our analysis found an HbA<span class="elsevierStyleInf">1c</span> concentration of 5.9% or more at the diagnosis of GD to be very specific (95.9%) in predicting postpartum DM.</p><p id="par0305" class="elsevierStylePara elsevierViewall">We consider our findings to be very important, since they may allow us to identify those women at an increased risk of developing DM after delivery, based on objective information drawn from the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g and HbA<span class="elsevierStyleInf">1c</span> measurements during pregnancy. This may allow us to provide more firm recommendations for those patients at increased risk. On the one hand, adherence to testing in postpartum reassessment is indicated, and on the other hand adherence to the provided recommendations is needed in order to lessen the risk of future DM as far as possible.</p><p id="par0310" class="elsevierStylePara elsevierViewall">It may therefore be concluded that in our sample of patients with GD, certain laboratory test parameters such as blood glucose at 2<span class="elsevierStyleHsp" style=""></span>h in the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g or HbA<span class="elsevierStyleInf">1c</span> measurements performed during pregnancy are related to the diagnosis of postpartum DM.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0315" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1164614" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1089926" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1164615" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1089925" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Clinical data" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Laboratory test data" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] 7 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Clinical data" ] 1 => array:3 [ "identificador" => "sec0040" "titulo" => "Laboratory test data" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Oral glucose tolerance test with 100 g" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "HbA" ] ] ] ] ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-21" "fechaAceptado" => "2018-08-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1089926" "palabras" => array:5 [ 0 => "Gestational diabetes" 1 => "Risk factor" 2 => "Diabetes mellitus" 3 => "Postpartum" 4 => "Oral glucose tolerance test" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1089925" "palabras" => array:5 [ 0 => "Diabetes gestacional" 1 => "Factor de riesgo" 2 => "Diabetes mellitus" 3 => "Posparto" 4 => "Sobrecarga oral de glucosa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Gestational diabetes (GD) is related to development of diabetes mellitus (DM) after delivery. The predictive factors in this association are not yet well defined. Objective: to study the predictive factors of dysglucosis in the postpartum period in a sample of patients with GD.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 1765 women with DG were studied. Variables analyzed: anthropometric data and maternal history. Glycemia in OGTT with 100<span class="elsevierStyleHsp" style=""></span>g (basal: 1, 2 and 3<span class="elsevierStyleHsp" style=""></span>h) and HbA<span class="elsevierStyleInf">1c</span>. Use of insulin in pregnancy. The OGTT with 75<span class="elsevierStyleHsp" style=""></span>g and HbA<span class="elsevierStyleInf">1c</span> at 3 months after delivery.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Postpartum DM prevalence 2.1%. Among these patients, there was a higher percentage of patients with a history of GD (25.9 vs. 12.9%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05), pre-pregnancy obesity (20.8 vs. 14.9%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) and insulin use during pregnancy (79.2 vs. 20%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01). In the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g, the number of pathological points was higher (3.18<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.69 in DM vs. 2.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.28 normal, 2.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.47 IFG, 2.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.32 IGT; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). In the OGTT 100<span class="elsevierStyleHsp" style=""></span>g, the blood glucose level above which the diagnosis of postpartum DM is most likely is 189<span class="elsevierStyleHsp" style=""></span>mg/dl in the 2<span class="elsevierStyleHsp" style=""></span>h determination (S: 86.2%, E: 72%). A level of HbA<span class="elsevierStyleInf">1c</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>5.9% during pregnancy has a specificity of 95.9% for the diagnosis of postpartum DM in our sample.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We show factors associated with the diagnosis of postpartum DM, among which are quantitative determinations such as glycemia at 2<span class="elsevierStyleHsp" style=""></span>h of the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g and HbA<span class="elsevierStyleInf">1c</span> during pregnancy in patients with DG.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La diabetes gestacional (DG) está relacionada con el desarrollo de la diabetes mellitus (DM) tras el parto. Los predictores en esta asociación aún no están bien definidos. El objetivo de nuestro trabajo es estudiar los factores predictores de disglucosis en el posparto en una muestra de pacientes con DG.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Un total de 1.765 mujeres con DG fueron estudiadas. Variables analizadas: datos antropométricos y antecedentes maternos. Glucemia en sobrecarga de glucosa (SOG) con 100<span class="elsevierStyleHsp" style=""></span>g (basal: 1, 2 y 3<span class="elsevierStyleHsp" style=""></span>h) y HbA<span class="elsevierStyleInf">1c</span>. Uso de insulina en la gestación. La SOG con 75<span class="elsevierStyleHsp" style=""></span>g y HbA<span class="elsevierStyleInf">1c</span> a los 3 meses tras el parto.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Prevalencia DM posparto: 2,1%. Entre estas pacientes hubo mayor porcentaje de pacientes con antecedentes de DG (25,9 vs. 12,9%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05), obesidad pregestacional (20,8 vs. 14,9%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05) y uso de insulina durante el embarazo (79,2 vs. 20%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,01). En la SOG con 100<span class="elsevierStyleHsp" style=""></span>g, el número de puntos patológicos fue mayor (3,18<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,69 en DM vs. 2,3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,28 normal, 2,6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,47 GBA, 2,5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,32 IHC; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001). En la SOG con 100<span class="elsevierStyleHsp" style=""></span>g, el nivel de glucemia por encima del cual es más probable el diagnístico de DM posparto es 189<span class="elsevierStyleHsp" style=""></span>mg/dl en la determinación a las 2<span class="elsevierStyleHsp" style=""></span>h (S: 86,2%; E: 72%). Un nivel de HbA<span class="elsevierStyleInf">1c</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>5,9% durante la gestación tiene una especificidad del 95,9% para el diagnóstico de DM posparto en nuestra muestra.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Evidenciamos factores asociados al diagnóstico de DM posparto entre los que se encuentran determinaciones cuantitativas como la glucemia a las 2<span class="elsevierStyleHsp" style=""></span>h de la SOG con 100<span class="elsevierStyleHsp" style=""></span>g y la HbA<span class="elsevierStyleInf">1c</span> durante la gestación en pacientes con DG.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Civantos S, Durán M, Flández B, Merino M, Navea C, Guijarro G, et al. Factores predictores de diabetes mellitus posparto en pacientes con diabetes gestacional. Endocrinol Diabetes Nutr. 2019;66:83–89.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 817 "Ancho" => 1084 "Tamanyo" => 60879 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Blood glucose values at the different measurement points in the OGTT with 100<span class="elsevierStyleHsp" style=""></span>g of glucose according to postpartum reassessment (normal, IFG, CHI or DM).</p>" ] ] 1 => 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 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">GD: gestational diabetes; DM: diabetes mellitus; BMI: body mass index.</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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.3 \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">Family history of DM (%) (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1070) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60.6 \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">History of GD (%) (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>231) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.1 \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">Mean pregestational weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14.7 \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">Mean height (m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.59<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.06 \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">Pregestational BMI (kg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.4 \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">Obesity (%) (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>381) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21.6 \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">GD diagnosis week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.9 \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">Insulin (%) (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>354) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20.1 \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">Weight at start of third trimester (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14.1 \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">Total weight gain (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1987820.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Maternal characteristics of the study sample: personal history, family history, anthropometric measurements and percentage of patients treated with insulin.</p>" ] ] 2 => 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:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">DM: diabetes mellitus; IFG: impaired fasting glucose; CHI: carbohydrate intolerance; OGTT: oral glucose tolerance test.</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="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Postpartum reassessment</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">Normal% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>965) \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">IFG% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>118) \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">CHI% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>134) \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">DM% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>261) \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">Basal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.6 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.5 (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.5 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.5 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>38) \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">1<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.3 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>785) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>106) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.4 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>118) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.2 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>230) \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">2<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.1 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>889) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.8 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.4 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>129) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>261) \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">3<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.9 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>385) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.6 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.5 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>66.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.4 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>186) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1987819.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Percentage of patients with pathological blood glucose levels at the different OGTT 100<span class="elsevierStyleHsp" style=""></span>g measurement points according to the postpartum reassessment groups (normal, IFG, CHI and DM).</p>" ] ] 3 => 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:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">DM: diabetes mellitus; 95%CI: 95% confidence interval; OGTT: oral glucose tolerance test.</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">OGTT 100<span class="elsevierStyleHsp" style=""></span>g \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">Glycemia (mg/dl) \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">Sensitivity (%) \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">Specificity (%) \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">Area ROC curve \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%CI \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">Basal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.65–0.89 \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">1<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">222 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52–0.84 \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">2<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">189 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.72–0.92 \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">3<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52–0.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1987817.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Sensitivity, specificity and ROC curve corresponding to blood glucose at each OGTT 100<span class="elsevierStyleHsp" style=""></span>g measurement point in patients with postpartum DM.</p>" ] ] 4 => 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:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">DM: diabetes mellitus; IFG: impaired fasting glucose; CHI: carbohydrate intolerance.</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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Postpartum reassessment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Normal \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">IFG \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">CHI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">DM \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>-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">HbA<span class="elsevierStyleInf">1c</span> pregnancy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.6 \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></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1987818.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Relationship between HbA<span class="elsevierStyleInf">1c</span> concentration during pregnancy and postpartum reassessment.</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" => "Asistencia a la gestante con diabetes. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 0 | 4 |
| 2024 October | 16 | 9 | 25 |
| 2024 September | 32 | 8 | 40 |
| 2024 August | 20 | 5 | 25 |
| 2024 July | 27 | 7 | 34 |
| 2024 June | 23 | 0 | 23 |
| 2024 May | 25 | 5 | 30 |
| 2024 April | 19 | 3 | 22 |
| 2024 March | 9 | 4 | 13 |
| 2024 February | 10 | 1 | 11 |
| 2024 January | 30 | 4 | 34 |
| 2023 December | 48 | 9 | 57 |
| 2023 November | 28 | 3 | 31 |
| 2023 October | 42 | 5 | 47 |
| 2023 September | 24 | 1 | 25 |
| 2023 August | 17 | 2 | 19 |
| 2023 July | 25 | 3 | 28 |
| 2023 June | 39 | 5 | 44 |
| 2023 May | 49 | 5 | 54 |
| 2023 April | 41 | 0 | 41 |
| 2023 March | 33 | 3 | 36 |
| 2023 February | 23 | 12 | 35 |
| 2023 January | 26 | 3 | 29 |
| 2022 December | 45 | 18 | 63 |
| 2022 November | 19 | 6 | 25 |
| 2022 October | 27 | 8 | 35 |
| 2022 September | 26 | 7 | 33 |
| 2022 August | 13 | 9 | 22 |
| 2022 July | 14 | 10 | 24 |
| 2022 June | 18 | 4 | 22 |
| 2022 May | 31 | 9 | 40 |
| 2022 April | 24 | 5 | 29 |
| 2022 March | 66 | 9 | 75 |
| 2022 February | 41 | 6 | 47 |
| 2022 January | 55 | 6 | 61 |
| 2021 December | 30 | 8 | 38 |
| 2021 November | 38 | 8 | 46 |
| 2021 October | 29 | 10 | 39 |
| 2021 September | 35 | 8 | 43 |
| 2021 August | 40 | 8 | 48 |
| 2021 July | 40 | 17 | 57 |
| 2021 June | 15 | 11 | 26 |
| 2021 May | 29 | 11 | 40 |
| 2021 April | 65 | 8 | 73 |
| 2021 March | 48 | 12 | 60 |
| 2021 February | 29 | 14 | 43 |
| 2021 January | 19 | 8 | 27 |
| 2020 December | 19 | 7 | 26 |
| 2020 November | 23 | 4 | 27 |
| 2020 October | 13 | 7 | 20 |
| 2020 September | 25 | 12 | 37 |
| 2020 August | 25 | 9 | 34 |
| 2020 July | 32 | 11 | 43 |
| 2020 June | 26 | 10 | 36 |
| 2020 May | 29 | 8 | 37 |
| 2020 April | 14 | 0 | 14 |
| 2020 March | 34 | 2 | 36 |
| 2020 February | 24 | 2 | 26 |
| 2020 January | 32 | 6 | 38 |
| 2019 December | 29 | 6 | 35 |
| 2019 November | 12 | 8 | 20 |
| 2019 October | 21 | 5 | 26 |
| 2019 September | 9 | 7 | 16 |
| 2019 August | 6 | 8 | 14 |
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