Glucemia basal en el primer trimestre como acercamiento inicial al diagnóstico de la diabetes en el embarazo / Fasting glucose in the first trimester: An initial approach to diagnosis of gestational diabetes

Objetivos: 1) Determinar si una glucemia basal en el primer trimestre (GBPT) del embarazo ≥ 92 mg/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). Métodos: Estudio retrospectivo de 1.425 embarazos con GBPT y test de ÓSullivan (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. Resultados: La 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 <92 mg/dl, las gestantes con GBPT ≥ 92 mg/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 ± 31 g; p < 0,05; porcentaje de macrosomía: 7,2% versus 3,4%; p < 0,05). Conclusiones: 1) La GBPT no es un buen sustituto del diagnóstico clásico de DMG en el segundo trimestre. 2) Las gestantes con GBPT ≥ 92 mg/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

Objectives: To establish whether fasting glucose levels in the first trimester (FGFT)of pregnancy ≥ 92 mg/dL (5.1 mmol/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). Methods: A 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. Results: Sensitivity 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 ≥ 92 mg/dL and newborn weight (3228±86 versus 3123±31g; P<.05), as well as a higher rate of macrosomia (6.9% versus 3.5%; P<.05). This association persisted after excluding patients diagnosed with and treated for GDM (weight: 3235±98 versus 3128±31 g; P<.05; percentage of macrosomia: 7.2% versus 3.4%; P<.05). Conclusions: FGFT is not a good substitute for conventional diagnosis of GDM in the second trimester. Pregnant women with FGFT levels ≥ 92 mg/dL, even with no subsequent diagnosis of GDM, are a risk group for fetal macrosomia and could benefit from dietary measures and physical exercise

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.

OBJECTIVES: To establish whether fasting glucose levels in the first trimester (FGFT)of pregnancy ≥ 92 mg/dL (5.1 mmol/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). METHODS: A 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. RESULTS: Sensitivity 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 ≥ 92 mg/dL and newborn weight (3228±86 versus 3123±31g; P<.05), as well as a higher rate of macrosomia (6.9% versus 3.5%; P<.05). This association persisted after excluding patients diagnosed with and treated for GDM (weight: 3235±98 versus 3128±31 g; P<.05; percentage of macrosomia: 7.2% versus 3.4%; P<.05). CONCLUSIONS: FGFT is not a good substitute for conventional diagnosis of GDM in the second trimester. Pregnant women with FGFT levels ≥ 92 mg/dL, even with no subsequent diagnosis of GDM, are a risk group for fetal macrosomia and could benefit from dietary measures and physical exercise.