A clinical guideline for diagnosis and treating of diabetes during pregnancy
Main Article Content
Keywords
Diabetes, Pregnancy, Gestational, Clinical Practice Guidelines
Abstract
Background: metabolic disturbance commonly occurs during pregnancy and perinatal outcome harms, with increased maternal-fetal morbidity. The prevalence of diabetes during pregnancy in Mexico is 7 %. Objective: to develop a guideline available to the staff of the first, second and third level of care, that includes recommendations based on the best available evidence.
Methods: clinical questions were formulated and structured. Standardized sequence was established to search for practice guidelines from the clinical questions raised on diagnosis and treatment of diabetes and pregnancy. The working group selected clinical practice guidelines. We found eleven guidelines which took many of the recommendations. For recommendations not included in the reference guides the search process was conducted in PubMed and Cochrane Library. The results were expressed as levels of evidence and grade of recommendation.
Conclusions: diabetes mellitus during pregnancy increases perinatal morbidity and mortality. The recommendations in this evidence-based guide will help to make diagnosis and treatment standardized to reduce the consequences of disease.
References
National Collaborating Centre for Women´s and Children´s Health. Diabetes in pregnancy. Management of diabetes an its complications from pre-conception to the postnatal period. NICE Clinical guideline 63. Disponible en http://www. nice. org.uk/nicemedia/pdf/CG063Guidance.pdf
Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the Fifth International Workshop Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007; 30 (Suppl 2):S251-260.
Setji T, Brown A, Feinglos M. Gestational diabetes mellitus clinical. Diabetes. 2005; 23 (1):17-24.
Duarte-Gardea M, Muñoz G, Rodríguez-Saldaña J, Escorza-Domínguez AB. Prevalencia, detección y tratamiento de la diabetes gestacional. Rev Salud Publica Nutr. 2004; 5(1). Disponible en http://www.respyn.uanl.mx/v/1/ensayos/diebetes_ gest.htm
Forsbach-Sánchez G, González-Obele E, Villanueva-Cuéllar MA, Tamez-Pérez HE, Rocha-Márquez J. Impacto del nuevo criterio para el diagnóstico de diabetes gestacional en la estimación de su prevalencia. Rev Invest Clin. 2003; 55 (5):507-510.
Ramírez M. Diabetes mellitus gestacional. Experiencia en una institución de tercer nivel de atención. Ginecol Obstet Mex. 2005; 73:484-491.
Kim C, Newton K, Knopp P. Gestational diabetes and the incidence of type 2 diabetes. A systematic review. Diabetes Care. 2002; 25 (10):1862- 1868.
Kitzmiller JL, Gavin LA, Gin GD, Jovanovic-Peterson L, Main EK, Zigrang WD. Preconception care of diabetes. Glycemic control prevents congenital anomalies JAMA. 1991; 265(6):731-736.
Pettitt DJ, Knowler WC. Long-term effects of the intrauterine environment, birth weight and breast feeding in Pima Indians. Diabetes Care. 1998; 21 (Suppl 2):B138-B141.
Silverman BL Rizzo TA, Cho NH, Metzger BE. Long-term effects of the intrauterine environment. The Northwestern University Diabetes in Pregnancy Center. Diabetes Care. 1998; 21 (Suppl 2): B142-B149.
Cheung Nw, Byth K. Population health significance of gestational diabetes. Diabetes Care. 2003; 26 (7):2005-2009.
Torres-Arreola LP, Peralta-Pedrero ML, Viniegra-Osorio A, Valenzuela-Flores A, Sandoval-Castellanos FJ, Echevarría-Zuno S. Proyecto para el desarrollo de guías de práctica clínica. Rev Med Inst Mex Seguro Soc. 2010; 48 (6):661-672.
Persson B, Hanson U. Neonatal morbidities in gestational diabetes mellitus. Diabetes Care. 1998:21 (Suppl 2):B79-B83.
Kitzmiller JL, Block JM, Brown FM et al. Managing preexisting diabetes for pregnancy. Summary off evidence and aonsensus recommentations for care. Diabetes Care. 2008; 31 (5):1060-1079.
International Diabetes Federation. Global guideline for type 2 diabetes. Clinical Guidelines Task Force, 2005. Disponible en http://www.idf.org
Lebovitz HE. Therapy for diabetes mellitus and related disorders. Fourth edition. Alexandria: American Diabetes Association; 2004.
American Diabetes Association. Standards of medical care 2008. Diabetes care. 2008; 31 (Suppl 1):S12-S54. Disponible en http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/education_2345_ENU_HTML
Ortega-González C, Ballesteros A, Casanueva E, Fonseca T, Cacique E, Parra A. Searching for alternative methods of diagnosing gestational diabetes mellitus in a Mexican urban population. Med Sci Monit. 2008; 14 (12):CR598-603. Disponible en http://www.medscimonit.com/fulltxt.php?ICID=869480
Kautzky-Willer A, Bancher-Todesca D, Weitgasser R, Prikoszovich T, Steiner H, Shnawa N, et al. The impact of risk factors and more stringent diagnostic criteria of gestational diabetes on outcomes in Central European women. J Clin Endocrinol Metab. 2008; 93 (5):1689-1695.
Di Cianni G, Seghieri G, Lencioni C, Cuccuru I, Anichini R, De Bellis A, et al. Normal glucose tolerance and gestational diabetes mellitus. What is between? Diabetes Care. 2007; 30 (7):1783-1788.
The HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358 (19):1991-2002.
Grupo Español de Diabetes y Embarazo. Guía asistencial de diabetes mellitus y embarazo. 3a edición. Av Diabetol. 2006; 22 (1):73-87.
American Diabetes Association. Nutrition recommendations and interventions for diabetes. A position statement of the American Diabetes Association. Diabetes Care. 2007; 30 (Suppl 1):S48-S65.
Jovanovic L. American Diabetes Associations’s Fourth International Workshop. Conference on Gestational Diabetes Mellitus: summary and discussion. Diabetes Care. 1998; 21 (Suppl 2):B131-B137.
Ceysens G, Rouiller D, Boulvain M. Ejercicio para las mujeres embarazadas diabéticas (Revision Cochrane Traducida). En: La Bilblioteca Cochrane Plus, Número 2. Oxford: Update Software Ltd; 2008. Disponible en http://www. update-software.com (Traducida de The Cochrane Library, 2008 Issue 2).
Hui AL, Ludwig SM, Gardiner P, Sevenhuysen G, Murray R, Morris M, et al. Community-based exercise and dietary intervention during pregnancy: a pilot study. Can J Diabetes. 2006; 30 (2):169-175.
Langer O. Oral anti-hiperglycemic agents for the management of gestational diabetes mellitus. Obstet Gynecol Clin North Am. 2007; 34 (2):255-274.
Langer O, Management of gestational diabetes: pharmacologic treatment options and glycemic control. Endocrinol Metab Clin. 2006; 35 (1):53-78.
National Collaborating Centre for Chronic Conditions. Type 1 diabetes in adults. National clinical guideline for diagnosis and management in primary and secondary care. London: Royal College of Physicians; 2004.
Royal College of Obstetricians and Gynaecologists. Tocolytic drugs for women in preterm labour. (Monografía en Internet.) London: RCOG Press; 2002. Disponible en http://www.rcog.org.uk/files/rcog-corp/uploaded-files/ GT1BTocolyticDrug2002 pdf
Farrar D, Tuffnell DJ, West J. Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes. Cochrane Database of Systematic Reviews 2007, issue 3, article CD005542.DOI:10.1002/14651858. CD005542.pub2. Disponible en http://www. cochrane.org/reviews/en/ab005542.html
Bricker I, Neilson JP. Routine Doppler ultrasound in pregnancy. (Cochrane Review.) En: Cochrane Database of Systematic Reviews. Chichester: Wile Interscience; 2001.
Kaushal K, Gibson JM, Railton A, Hounsome B, New JP, Young RJ. A protocol for improved glycaemic control following corticosteroid therapy in diabetic pregnancies. Diabet Med. 200; 20 (1):73-75.
The Diabetes Control and Complications Trial Research Group. Effect of pregnancy on microvascular complications trial. The Diabetes, Control and Complications Trial Research Group. Diabetes Care. 2000; 23 (8):1084-1091.
Rosenn BM, Miodovnik M. Diabetic vascular complications in pregnancy: nephropathy. En: Hod M, Jovanovic L, Di Renzo GC, de Leiva A, Langer O, editores. Diabetes and pregnancy. London: Taylor & Francis Group; 2003. p. 486-494.
Lean ME, Pearson DW, Sutherland HW. Insulin management during labor and delivery in mothers with diabetes. Diabetic Medicine. 1990; 7 (2):162-164.
Jovanovic L. Glucose and insulin requirements during labor and delivery: the case for normoglycemia in pregnancies complicated by diabetes. Endocr Pract. 2004; 10 (Suppl 2):40-45.
Bentley-Lewis R, Levkoff S, Stueb A Seely EW. Gestational diabetes mellitus postpartum opportunities for the diagnosis and prevention of type 2 diabetes mellitus. Nat Clin Pract Endocrinol Metab. 2008 ;4 (10):552-558.
Whorld Health Organization. Criterios médicos de elegibilidad para el uso de anticonceptivos. (Monografía en Internet.) Ginebra, Suiza: OMS; 2004. Disponible en http://www.who.int/reproductivehealth/publications/family_planning/9241562668/en/index.html
Clausen TD, Mathiesen ER, Hansen T, Pedersen O, Jensen DM, Lauenborg J, et al. High prevalence of diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia. Diabetes Care. 2008; 31 (2):340-346.
Hawking JS, Casey BM. Labor and delivery management for women with diabetes. Obstet Gynecol Clin North Am. 2007; 34 (2):323-334.