[Basic aspects for the control of gestational diabetes].
The female population in conditions of greater demand of insulin production, as in the case of pregnancy, can develop gestational diabetes (DG); therefore, the preconceptional attention in patients with suspects of development of DG should include the confirmation that blood glucose is found within the normal range, as well as the indication of a controlled diet. Glucose posprandial determinations two hours after food intake is advisable in patients that need insulin administration, which avoids determinations four times a day. The diet should include between 35 and 40 % of carbohydrates per day, supervised by a dietitian and based on the needs of each woman and the characteristics of the gestation. The combination of ultra-rapid acting insulin associate to ultra-slow acting insulin for application as a unique dose per day has been successfully used, but it is still necessary to determine the best diet for an adequate control of glucose. Oral hypoglycemic medications are not recommended as a DG treatment, since they were traditionally described as having theratogenic activity, by maintaining long hypoglycemic periods. Vaginal delivery is not contraindicated, although to avoid obstetrical complications, a cesarean section can be practiced, taking into account the antecedents of prior birth weight and the characteristics of bone pelvis. After delivery, a monthly posprandial determination at 2 hours should be carried out, where concentrations under 140 mg/dL are considered normal and it should be repeated every year. Insulin resistance can be a physiological state of pregnancy, but the beta-cells of maternal pancreas can be altered from the fetal life and therefore, cause the impossibility to respond to such a metabolic effort as pregnancy.
Hernández-Valencia
Marcelino
M
Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social. mhernandezvalencia@prodigy.net.mx
D016640:Diabetes, Gestational / Q000517:prevention & control*; D005260:Female; D006801:Humans; D011247:Pregnancy