miércoles, 11 de noviembre de 2009

Cambios en la Nueva Guía de Diabetes Gestacional de la IDF

Nueva Guía de diabetes Gestacional

La IDF ha actualizado su guía de la diabetes gestacional -Global Guideline on pregnancy and diabetes-, en un formato muy atractivo y con recomendaciones, que aunque no novedosas, creo deben tenerse en cuenta.
Así, entre otra cosas, nos advierte que:
Se mantiene la definición de la ADA en la que diabetes gestacional no sería más que cualquier grado de intolerancia aparecido primariamente durante la gestación, teniendo para ello en cuenta los riesgos inherentes a esta condición, tal es el caso del riesgo de morbimortalidad perinatal, de desarrollo de diabetes en la madre y de posteriores patologías en el niño.
En su diagnóstico no se distinguen niveles de riesgo como en los Standards of Medical Care in Diabetes del ADA (2009), sino que desaparece el "bajo riesgo" en las que no sería preciso el cribaje de DMG, y se mantiene la falta de consenso, utilizando sobrecargas de glucosa de 100 gr con mediciones a las 3 horas en USA o 75 gr a las dos horas, según establece la OMS.
A grandes rasgos dice:
Pregnancy and diabetes
A 1-stage oral glucose tolerance test at 26 to 28 weeks' gestation is recommended to screen all pregnant women for gestational diabetes vs the ADA recommendation for selective screening in at-risk women only.
For women at high risk for diabetes because of previous gestational diabetes, screening should be performed as soon as practical and should be repeated at 26 to 28 weeks' gestation.
For women with preexisting diabetes, glycemic control should be optimized before planned pregnancy.
Angiotensin-converting enzyme inhibitors and angiotensin-II receptor blockers should be stopped and substituted with appropriate medications in pregnant women.
Statins, fibrates, and niacin should be stopped in pregnancy.
In women with existing diabetes or gestational diabetes, risks for glucose-lowering agents should be discussed, and use of insulin and the type of insulin should be assessed and discussed.
A hemoglobin A1c target of 6.0% or lower is desired in pregnant women with diabetes.
If possible, SMBG should be done frequently in pregnant women with diabetes.
Doses of glucose-lowering agents should be adjusted according to self-monitoring results, hemoglobin A1c level, and experience of hypoglycemia.
Eyes should be examined at the first prenatal visit and at each trimester.
Breast-feeding should be encouraged.
http://www.idf.org/webdata/docs/Pregnancy_EN_RTP.pdf

1 comentario:

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