Información del artículo
En la práctica clínica la coincidencia de diabetes y embarazo ocurre en 2 circunstancias diferentes: diabetes gestacional y la diabetes pregestacional. La hiperglucemia materna puede tener repercusiones importantes en el feto, que dependen del período de la gestación en el que está presente.
La diabetes gestacional identifica a mujeres con un riesgo sustancialmente elevado de presentar diabetes y enfermedades cardiovasculares en el futuro, lo que justifica la necesidad de establecer programas de prevención en el seguimiento posparto. En la diabetes pregestacional el control preconcepcional constituye la major oportunidad para prevenir las complicaciones maternas y neonatales. La diabetes (gestacional y pregestacional) no debe suponer un impedimento para la lactancia materna que, de hecho, puede aportar beneficios adicionales sus hijos.
Palabras clave:
Diabetes
Embarazo
Complicaciones
Tratamiento
Prevención
Lactancia
Diabetes mellitus and pregnancy cooccur in two different clinical entities: gestational diabetes and pregestational diabetes. Maternal hyperglycemia may have profound effects on the foetus, which depend on the period of pregnancy in which it is present.
Gestational diabetes identifies women at significant risk for developing diabetes and cardiovascular disease in the future, who should undergo preventive programs in the postpartum follow-up. Preconception care in women with pregestational diabetes is the best method of preventing maternal and neonatal complications.
Diabetes (gestational and pregestational) should not be an obstacle for breastfeeding, which may, in fact, provide additional benefits to the child.
Key words:
Diabetes
Pregnancy
Complications
Treatment
Prevention
Lactation
El Texto completo está disponible en PDF
Bibliografía
[1.]
D. Williams.
Pregnancy: a stress test for life.
Curr Opin Obstet Gynecol, 15 (2003), pp. 465-471
[2.]
L. Cousins, L. Rigg, D. Hollingsworth, G. Brink, J. Aurand, S.S.C. Yen.
The 24-hour excursion and diurnal rhythm of glucose insulin and C-peptide in normal pregnancy.
Am J Obstet Gynecol, 136 (1980), pp. 483-488
[3.]
L.F. Pallardo Sánchez.
Adaptaciones metabólicas en el embarazo. Clasificación de la diabetes.
Diabetes y embarazo, pp. 3-17
[4.]
P.M. Catalano, D.E. Tyzbir, N.M. Roman, S.B. Amini, E.A.H. Sims.
Longitudinal changes in insulin release and insulin resistance in non-obese pregnant women.
Am J Obstet Gynecol, 165 (1991), pp. 1667-1672
[5.]
G. Di Cianni, R. Miccoli, L. Volpe, C. Lencionci, S. Del Prato.
Intermediate metabolism in normal pregnancy and in gestational diabetes.
Diabetes Metab Res Rev, 19 (2003), pp. 259-270
[6.]
P.M. Catalano, T.A. Buchanan.
Metabolic changes during normal and diabetic pregnancies.
Diabetes in women. Adolescence, pregnancy and menopause, pp. 129-145
[7.]
F. Mimouini, R.C. Tsang.
Pregnancy outcome in insulin-dependent diabetes: temporal relationships with metabolic control during specific pregnancy periods.
Am J Perinatol, 5 (1988), pp. 334-338
[8.]
J.L. Kitzmiller, T.A. Buchanan, S. Kjos, C.A. Combs, R. Ratner.
Preconception care of diabetes, congenital malformations, and spontaneous abortions (Technical Review).
Diabetes Care, 19 (1996), pp. 514-541
[9.]
I.M. Bernstein, M.I. Goran, S.B. Amini, P.M. Catalano.
Differential growth of fetal tissues during the second half of pregnancy.
Am J Obstet Gynecol, 176 (1997), pp. 28-32
[10.]
F. Hawkins Carranza, J. Quero Jiménez, M.M. Hawkins Solis.
Complicaciones del hijo de madre diabética. Aspectos patogénicos.
Diabetes y embarazo, pp. 243-252
[11.]
Third International Workshop-Conference on Gestational Diabetes Mellitus.
Summary and recommendations, 40 (1991), pp. 197-201
[12.]
A. Ben-Haroush, Y. Yogev, M. Hod.
Epidemiology of gestational diabetes mellitus and its association with type 2 diabetes.
Diabetic Med, 21 (2004), pp. 103-113
[13.]
D. Mauricio, A. De Leiva.
Autoimmune gestational diabetes mellitus: a distinct clinical entity.
Diabetes Metab Res Rev, 17 (2001), pp. 422-428
[14.]
S. Ellard, F. Beards, Li. Allen, M. Shepherd, E. Ballantyne, R. Harvey, et al.
A high prevalence of glucokinase mutations in gestational diabetic subjects selected by clinical criteria.
Diabetologia, 43 (2000), pp. 250-253
[15.]
L.F. Pallardo Sánchez, L. Herranz de la Morena.
Diabetes gestacional.
FMC, 8 (2001), pp. 587-596
[16.]
National Diabetes Data Group.
Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance.
Diabetes, 18 (1979), pp. 1039-1057
[17.]
M.W. Carpenter, D.R. Coustan.
Criteria for screening tests for gestational diabetes.
Am J Obstet Gynecol, 144 (1982), pp. 768-773
[18.]
B.E. Metzger, D.R. Coustan, The Organizing Committee.
Summary and Recommendations of the Fourth International Workshop-Conference on gestational diabetes mellitus.
Diabetes Care, 21 (1998), pp. B161-B167
[19.]
K.G.M.M. Alberti, P.Z. Zimmet, for the WHO Consultation.
Definition, diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation.
Diabetic Med, 15 (1988), pp. 539-553
[20.]
Grupo Español de Diabetes y Embarazo (GEDE).
Diabetes mellitus y embarazo.
Guía Asistencial, (2000),
[21.]
B.E. Metzger, D.E. Bybee, N. Freinkel, R.L. Phelps, R. Radvany, N. Vaisrub.
Gestational diabetes mellitus: correlations between the phenotypic and genotypic characteristics of the mother and abnormal glucose tolerance during the first year postpartum.
Diabetes, 34 (1985), pp. 111-115
[22.]
American Diabetes Association.
Gestational diabetes mellitus.
Diabetes Care, 27 (2004), pp. S88-S90
[23.]
O. Langer, D.L. Conway, M.D. Berkus, E.M. Xenakis, O. Gonzales.
A comparison of glyburide and insulin in women with gestational diabetes.
N Engl J Med, 343 (2000), pp. 1134-1138
[24.]
L. Jovanovik, S. Ilic, D.J. Pettit, K. Hugo, M. Gutiérrez, R.R. Bowsher, E.J. Bastyr III.
Metabolic and immunologic effects of insulin lispro in gestational diabetes.
Diabetes Care, 22 (1999), pp. 1422-1427
[25.]
L.F. Pallardo Sánchez.
Insulinoterapia.
Diabetes y embarazo, pp. 157-174
[26.]
L. Herranz, A. Villaroel, G. Riesco, P. Martin-Vaquero, M. Jañez, A. González, et al.
Elective delivery in women with gestational diabetes mellitus.
Diabetologia, 46 (2003), pp. A248-A249
[27.]
F. Pallardo, L. Herranz, T. García Ingelmo, C. Grande, P. Martín Vaquero, M. Jañez, et al.
Early postpartum metabolic assessment in women with prior gestational diabetes.
Diabetes Care, 22 (1999), pp. 1053-1058
[28.]
M.C. Clark, C. Qiu, B. Amerman, B. Porter, M. Fineberg, S. Aldasouqi, A. Golichowski.
Gestational diabetes: should it be added to the syndrome of insulin resistance?.
Diabetes Care, 20 (1997), pp. 867-871
[29.]
L.F. Pallardo, L. Herranz, P. Martín Vaquero, T. García Ingelmo, C. Grande, J. Jañez.
Impaired fasting glucose and impaired glucose tolerance in women with prior gestational diabetes are associated with a different cardiovascular profile.
Diabetes Care, 26 (2003), pp. 2318-2322
[30.]
R.G. Moses.
The recurrence rate of gestational diabetes in subsequent pregnancies.
Diabetes Care, 19 (1996), pp. 1348-1350
[31.]
F.W.F. Hanna, J.R. Peters.
Screening for gestational diabetes: past, present and future.
Diabet Med, 19 (2002), pp. 351-358
[32.]
L. Herranz, M.T. García Ingelmo, M. Martín Vaquero, C. Grande, M. Jañez, L.F. Pallardo.
Follow-up of women with gestational diabetes, incidence and factors associated with later development of abnormal glucose tolerance test.
Diabetologia., 41 (1998), pp. A125
[33.]
L. Herranz de la Morena, M.T. García Ingelmo, P. Martín Vaquero, A. Villaroel Bajo, F. Fernández Martínez, C. Grande, et al.
Relación entre el grado de tolerancia glucídica postparto en mujeres con diabetes gestacional y el riesgo de diabetes a los cinco años.
Av Diabetol, 20 (2004), pp. 14-17
[34.]
N. Sattar.
Do pregnancy complications and CVD share common antecedents?.
Atheroscler Suppl, 5 (2004), pp. 3-7
[35.]
P. White, J.W. Hare.
Pregnancy in diabetes complicated by vascular disease.
Diabetes, 26 (1977), pp. 953-955
[36.]
Diabetes Control and Complications Trial Research Group.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin dependent diabetes mellitus.
N Engl J Med, 329 (1993), pp. 977-986
[37.]
L. Rossetti, A. Giaccari, R.A. DeFronzo.
Glucose toxicity.
Diabetes Care, 13 (1990), pp. 610-630
[38.]
B.M. Rosenn, M. Miodovnik, J.C. Khoury, T.A. Siddiqi.
Counter regulatory hormonal responses to hypoglycemia during pregnancy.
Obstet Gynecol, 87 (1996), pp. 70-77
[39.]
P.A.M. Weiss, H. Hofman.
Intensified conventional insulin therapy for the pregnant diabetic patient.
Obstet Gynecol, 64 (1984), pp. 629-637
[40.]
J.M. Steel, F.D. Johnstone, R. Hume, J.H. Mao.
Insulin requirements during pregnancy in women with type 1 diabetes.
Obstet Gynecol, 83 (1994), pp. 253-258
[41.]
Diabetes Control and Complications Trial Research Group.
Effect of pregnancy on microvascular complications in the diabetes control and complications trial.
Diabetes Care, 23 (2000), pp. 1084-1091
[42.]
R. Axer Siegel, M. Hod, S. Fink Cohen, M. Kramer, D. Weinberger, B. Cchinder, et al.
Diabetic retinopathy during pregnancy.
Ophtalmology, 103 (1996), pp. 1815-1819
[43.]
N. Chaturvedi, J.M. Stephenson, J.H. Fuller.
The relationship between pregnancy and long term maternal complications in the EURODIAB IDDM Complications study.
Diabet Med, 12 (1995), pp. 494-499
[44.]
L.F. Pallardo Sánchez, M.S. Calle Serrano.
Retinopatía diabética y embarazo.
Diabetes y embarazo, pp. 73-83
[45.]
J. Kitzmiller, E. Main, B. Ward, T. Theiss, D.L. Peterson.
Insulin lispro and the development of proliferative diabetic retinopathy during pregnancy.
Diabetes Care, 22 (1999), pp. 874-875
[46.]
A. Buchbinder, M. Miodovnik, S. McElvy, B. Rosenn, G. Kranias, J. Khoury, et al.
Is insulin lispro associated with the development or progression of diabetic retinopathy during pregnancy?.
Am J Obstet Gynecol, 183 (2000), pp. 1162-1165
[47.]
M.Y. Chew, J.L. Mills, B.E. Metzger, N.A. Remaley, L. Jovanovic-Peterson, R.H. Knopp, et al.
Metabolic control and progression of retinopathy. The Diabetes in Early Pregnancy Study.
Diabetes Care, 18 (1995), pp. 631-637
[48.]
L. Herranz de la Morena.
Nefropatía diabética y embarazo.
Diabetes y embarazo, pp. 85-98
[49.]
J. Diglas, C. Bali, C. Simon, D. Strassegger Böhm, K. Irsigler.
Follow-up of albumin excretion during pregnancy and postpartum in type 1 diabetic patients in comparison with health pregnant probands.
Acta Med Austriaca, 24 (1997), pp. 170-174
[50.]
G. Biesenbach, J. Zargonik, H. Stöger, P. Grafinger, R. Hubmann, W. Kaiser, et al.
Abnormal increase in urinary albumin excretion during pregnancy in women with insulin-dependent diabetes mellitus and pre-existing microalbuminuria.
Diabetologia, 37 (1994), pp. 905-910
[51.]
L.P. Purdy, C.E. Hantsch, M.E. Molitch, B.E. Metzger, R.L. Phelps, S.L. Dooley, et al.
Effect of pregnancy on renal function in patients with moderate to severe diabetic renal insufficiency.
Diabetes Care, 19 (1996), pp. 1067-1074
[52.]
V.T. Armenti, C.H. McGrory, J. Cater, J.S. Radomski, B.E. Jarrel, M.J. Moritz.
The national transplantation pregnancy register: comparison between pregnancy outcomes in diabetic cyclosporine-treated female kidney recipients and CyA treated female pancreas-kidney recipients.
Transplant Proc, 29 (1997), pp. 669-670
[53.]
T. Cundy, F. Slee, G. Gamble, L. Neale.
Hypertensive disorders of pregnancy in women with type 1 and type 2 diabetes.
Diabet Med, 19 (2002), pp. 482-489
[54.]
R. Jovanovic, L. Jovanovic.
Obstetric management when normoglicemia is maintained in diabetic women with vascular compromise.
Am J Obstet Gynecol, 149 (1984), pp. 617-623
[55.]
J.B. Bar, R. Chen, A. Schoenfeld, R. Orvieto, J. Yahav, Z. Be-Rafael, et al.
Pregnancy outcome in patients with insulin dependent diabetes mellitus and diabetic nephropathy treated with ACE inhibitors before pregnancy.
J Pediatr Endocrinol Metab, 12 (1999), pp. 659-665
[56.]
K. Rossing, P. Jacobsen, E. Hommel, E. Mathiesen, A. Svenningsen, P. Rossing, et al.
Pregnancy and progression of diabetic nephropathy.
Diabetologia, 45 (2002), pp. 36-41
[57.]
M. Delgado del Rey, L. Herranz de la Morena, P. Martín Vaquero, M. Jañez, J.J. Lozano García, R. Darias, et al.
Influencia del control metabólico preconcepcional en la evolución de la gestación de la paciente diabética.
Med Clin (Barc), 117 (2001), pp. 45-48
[58.]
American Diabetes Association.
Preconception care of women with diabetes.
Diabetes Care, 27 (2004), pp. S76-S78
[59.]
D.J. Pettitt, M.R. Forman, R.L. Hanson, W.C. Knowler, P.H. Bennett.
Breast feeding in infancy is associated with lower rates of non-insulin-dependent diabetes mellitus.
Lancet, 350 (1997), pp. 166-168
[60.]
V. Sadauskaite-Kuehne, J. Ludvigsson, Z. Padaiga, E. Jasinkiene, U. Samuelsson.
Longer breastfeeding is an independent protective factor against development of type 1 diabetes mellitus in childhood.
Diabetes Metab Res Rev, 20 (2004), pp. 150-157
[61.]
S. Tigas, A. Sunehag, M.W. Haymond.
Metabolic adaptation to feeding and fasting during lactation in humans.
Clin Endocrinol Metab, 87 (2002), pp. 302-307
[62.]
S.L. Kjos, O. Henry, R.M. Lee, T.A. Buchanan, D.R. Mishell.
The effect of lactation on glucose and lipid metabolism in women with recent gestational diabetes.
Obstet Gynecol, 82 (1993), pp. 451-455
[63.]
J.N. Oats, N.A. Beischer.
The persistence of abnormal glucose tolerance after delivery.
Obstet Gynecol, 75 (1990), pp. 397-401
[64.]
A.M. Ferris, E.A. Reece.
Nutritional consequences of chronic maternal conditions during pregnancy and lactation: lupus and diabetes.
Am J Clin Nutr, 59 (1994), pp. S465-S473
[65.]
M.A. Murtaugh, A.M. Ferris, C.M. Cappacchione, E.A. Reece.
Energy intake and glycemia in lactating women with type 1 diabetes.
J Am Diet Assoc, 98 (1998), pp. 642-648
[66.]
L. Sáez de Ibarra, R. Gapar, A. Obesso, L. Herranz.
Gycemic behaviour during lactation: postpartum practical guidelines for women with type 1 diabetes.
Practical Diabetes Int, 20 (2003), pp. 271-275
Copyright © 2005. Sociedad Española de Endocrinología y Nutrición
