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La diabetes mellitus gestacional (DMG) se asocia a un aumento de morbilidad materna y fetal, y esto se ha relacionado con el control glucémico materno. Diversos estudios han descrito que un tratamiento intensivo disminuye el riesgo perinatal, y la monitorización domiciliaria de glucemia capilar (AMGC) es uno de los principales instrumentos para controlar el tratamiento. Respecto a los objetivos del tratamiento, han disminuido en los últimos Workshop-Conferences sobre DMG acercándose al rango de normalidad, y actualmente se aconseja conseguir una glucemia capilar basal ≤ 95 mg/dl, 1 hora posprandial ≤ 140 mg/dl o 2 horas posprandial ≤ 120 mg/dl o incluso inferiores. Sin embargo, las encuestas sobre la práctica clínica habitual describen amplias diferencias en el seguimiento de las recomendaciones tanto en la AMGC como en los objetivos del control glucémico. Por otro lado, también se ha propuesto el estudio de parámetros fetales para valorar el control metabólico.
Palabras clave:
Diabetes mellitus gestacional
Morbilidad fetal
Automonitorización de la glucemia capilar
Objetivos del control metabólico
Gestational diabetes mellitus (GDM) is associated with maternal and fetal morbidity, which has been related to maternal glycemia. Various reports indicate that intensive therapy of GDM decreases the risk of perinatal morbidity. Self-monitoring of blood glucose (SMBG) provides crucial information in guiding therapy. In recent workshops and conferences on GDM, metabolic goals were lowered to those approaching the normal range. Currently recommended levels of maternal capillary blood glucose are ≤ 95 mg/dl in the fasting state, ≤ 140 mg/dl at 1 hour and/or ≤ 120 mg/dl at 2 hours after meals or even lower. However, surveys evaluating current clinical practice have described wide variations in adherence to these recommendations for SMBG, as well as in the metabolic control goals. In addition, the use of fetal measurements to guide metabolic control has been proposed.
Key words:
Gestational diabetes mellitus
Fetal morbidity
Self-monitoring of blood glucose
Metabolic control goals
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Bibliografía
[1.]
J.L. Kitzmiller, J.P. Cloherty, M.D. Younger, A. Tabatabaii, S.B. Rothchild, I. Sosenko.
Diabetic pregnancy and perinatal morbidity.
Am J Obstet Gynecol, 131 (1978), pp. 560-580
[2.]
J.A. Widness, R.M. Cowett, D.R. Coustan, M.W. Carpenter, W. Oh.
Neonatal morbidities in infants of mothers with glucose intolerance in pregnancy.
Diabetes, 34 (1985), pp. 61-65
[3.]
J.B. O'Sullivan, C.D. Mahan, R.V. Dandrow.
Gestational diabetes and perinatal mortality.
Am J Obstet Gynecol, 116 (1973), pp. 901-904
[4.]
M.T. Gyves, H.M. Rodman, A.B. Little, A.A. Fanaroff, I.R. Merkatz.
A modern approach to management of pregnant diabetics: a two year analysis of perinatal outcomes.
Am J Obstet Gynecol, 128 (1977), pp. 606-612
[5.]
J.B. O'Sullivan.
Diabetes after Gestational Diabetes Mellitus.
Diabetes, 40 (1991), pp. 131-135
[6.]
J.H. Mestman.
Follow-up studies in women with gestational diabetes mellitus: the experience at Los Angeles County/University of Southern California Medical Center.
Gestational Diabetes, pp. 191-198
[7.]
N. Freinkel.
Banting Lecture 1980 Of pregnancy and progeny.
Diabetes, 29 (1980), pp. 1023-1035
[8.]
D.J. Pettitt, P.H. Bennett, M.F. Saad, M.A. Charles, R.G. Nelson, W.C. Knowler.
Abnormal glucose tolerance during pregnancy in Pima Indian women. Long-term effects on offspring.
Diabetes, 40 (1991), pp. 126-130
[9.]
B.L. Silverman, T.A. Rizzo, N.H. Cho, B.E. Metzger.
Long-term effects of the intrauterine environment: the Northwestern University Diabetes in Pregnancy Center.
Diabetes Care, 21 (1998), pp. 142-149
[10.]
M. De Veciana, C.A. Major, M.A. Morgan, T. Asrat, J.S. Toohey, J.M. Lien, et al.
Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy.
N Engl J Med, 333 (1995), pp. 1237-1241
[11.]
D.J. Pettitt, R.G. Nelson, M.F. Saad, P.H. Bennett, W.C. Knowler.
Diabetes and obesity in the offspring of Pima Indian women with diabetes during pregnancy.
Diabetes Care, 16 (1993), pp. 310-314
[12.]
O. Langer, R. Mazze.
The relationship between large-for-gestational-age infants and glycemic control in women with gesta-tional diabetes.
Am J Obstet Gynecol, 159 (1988), pp. 1478-1483
[13.]
L. Jovanovic.
American Diabetes Association's Fourth International Workshop-Conference on Gestational Diabetes Mellitus: Summary and discussion.
Diabetes Care, 21 (1998), pp. 131-137
[14.]
L. Cousins, L. Rigg, D. Hollingsworth, G. Brink, J. Aurand.
Yen SSC. 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
[15.]
M. Stangenberg, B. Persson, E. Nordlander.
Random capillary blood glucose and conventional selection criteria for glucose tolerance testing during pregnancy.
Diabetes Res, 2 (1985), pp. 29-33
[16.]
M.D.M.G. Gillmer, R.W. Beard, F.M. Brooke, N.W. Oakley.
Carbohydrate metabolism in pregnancy. Part I-Diurnal plasma glucose profile in normal and diabetic women.
BMJ, 2 (1975), pp. 399-402
[17.]
W.L. Fitch, J.C. King.
Plasma amino acid, glucose and insulin responses to moderate-protein and high-protein test meals in pregnant, nonpregnant and gestational diabetic women.
Am J Clin Nutr, 46 (1987), pp. 243-249
[18.]
N. Freinkel, R.L. Phelps, B.E. Metzger.
Intermediary metabolism during normal pregnancy.
Carbohydrate metabolism in pregnancy and the newborn, 1978, pp. 1-31
[19.]
A. Victor.
Normal blood sugar variation during pregnancy.
Acta Obstet Gynecol Scand, 53 (1974), pp. 37-40
[20.]
L. Tallarigo, O. Giampietro, G. Penno, R. Miccoli, G. Gregori, R. Navalesi.
Relation of glucose tolerance to complications of pregnancy in nondiabetic women.
N Engl J Med, 315 (1986), pp. 989-992
[21.]
E.L. Leikin, J.H. Jenkins, G.A. Pomerantz, L. Klein.
Abnormal glucose screening tests in pregnancy: a risk factor for fetal macrosomia.
Obstet Gynecol, 69 (1987), pp. 570-573
[22.]
O. Langer, L. Brustman, A. Anyaegbunam, R. Mazze.
The significance of one abnormal glucose tolerance test value on adverse outcome in pregnancy.
Am J Obstet Gynecol, 157 (1987), pp. 758-763
[23.]
M. Sermer, C.D. Naylor, D. Farine, A.B. Kenshole, J.W.K. Ritchie, D.J. Gare, et al.
for The Toronto Tri-Hospital Gestational Diabetes Investigators. The Toronto Tri-Hospital Gestational Diabetes Mellitus Project: a preliminary review.
Diabetes Care, 21 (1998), pp. 33-42
[24.]
D.A. Sacks, J.S. Greenspoon, S. Abu-Fadil, H.M. Henry, G. Wolde-Tsadik.
Yao JFF. Toward universal criteria for gestational diabetes: The 75-gram glucose tolerance test in pregnancy.
Am J Obstet Gynecol, 172 (1995), pp. 607-614
[25.]
O. Langer.
Is normoglycemia the correct threshold to prevent complications in the pregnant diabetic patient?.
Diabetes Rev, 4 (1996), pp. 2-10
[26.]
O. Langer, J. Levy, L. Brustman, A. Anyaegbunam, R. Merkatz, M.Y. Divon.
Glycemic control in gestational diabetes mellitus: how tight is tight enough: small for gestational age versus large for gestational age?.
Am J Obstet Gynecol, 161 (1989), pp. 646-653
[27.]
D.J. Pettitt, W.C. Knowler, H.R. Baird, P.H. Bennett.
Gestational diabetes: Infant and maternal complications of pregnancy in relation to third-trimester glucose tolerance in the Pima Indians.
Diabetes Care, 3 (1980), pp. 458-464
[28.]
K. Karlsson, I. Kjellmer.
The outcome of diabetic pregnancies in relation to the mother's blood sugar levels.
Am J Obstet Gynecol, 112 (1979), pp. 213-220
[29.]
D.R. Coustan, J. Imarah.
Prophylactic insulin treatment of gestational diabetes reduces the incidence of macrosomia, operative delivery, and birth trauma.
Am J Obstet Gynecol, 150 (1984), pp. 836-842
[30.]
B. Persson, M. Stangenberg, U. Hansson, E. Nordlander.
Gestational diabetes mellitus (GDM): comparative evaluation of two treatment regimens, diet versus insulin and diet.
Diabetes, 34 (1985), pp. 101-105
[31.]
E. Leikin, J.H. Jenkins, W.L. Granes.
Prophylactic insulin in gestational diabetes.
Obstet Gynecol, 71 (1988), pp. 951
[33.]
H. Drexel, A. Bichler, S. Sailer, C. Breier, H.J. Lisch, H. Braunsteiner, et al.
Prevention of perinatal morbidity by tight metabolic control in gestational diabetes mellitus.
Diabetes Care, 11 (1988), pp. 761-768
[34.]
D.J. Thompson, K.B. Porter, D.J. Gunnells, P.C. Wagner, J.A. Spinnato.
Prophylactic insulin in the management of GDM.
Obstet Gynecol, 75 (1990), pp. 960-964
[35.]
M.B. Landon, S.G. Gabbe, R. Piana, M.T. Mennuti, E.K. Main.
Neonatal morbidity in pregnancy complicated by pregestational diabetes mellitus.
Am J Obstet Gynecol, 156 (1987), pp. 1089-1095
[36.]
E. Nord, U. Hanson, B. Persson.
Blood glucose limits in the diagnosis of impaired glucose tolerance during pregnancy: relation to morbidity.
Acta Obstet Gynecol Scand, 74 (1995), pp. 589-593
[37.]
L. Jovanovic, M. Druzin, C.M. Peterson.
Effect of euglycemia on the outcome of pregnancy in insulin-dependent diabetic women as compared to normal controls.
Am J Med Genet, 71 (1981), pp. 921-927
[38.]
C.A. Combs, E. Gunderson, J.L. Kitzmiller, L.A. Gavin, E.K. Main.
Relationship of fetal macrosomia to maternal postprandial glucose control during pregnancy.
Diabetes Care, 15 (1992), pp. 1251-1257
[39.]
O. Langer, D.A. Rodriguez, E.M.J. Xenakis, M.B. McFarland, M.D. Berkus, F. Arredondo.
Intensified versus conventional management of gestational diabetes.
Am J Obstet Gynecol, 170 (1994), pp. 1036-1047
[40.]
P. Garner, N. Okun, E. Keely, G. Wells, S. Perkins, J. Sylvain, et al.
A randomized controlled trial of strict glycemic control and tertiary level obstetric care versus routine obstetric care in the management of gestational diabetes: A pilot study.
Am J Obstet Gynecol, 177 (1997), pp. 190-195
[41.]
N. Roncaglia, P. Bellini, A. Arreghini, A. Zanini, H. Cepparo, C. Patregnani.
Gestational diabetes mellitus: intensive versus mild treatment.
Clin Exp Obstet Gynecol, 26 (1999), pp. 95-97
[42.]
K. Bancroft, D.J. Tuffnell, G.C. Mason, L.J. Rogerson, M. Mansfield.
A randomised controllet pilot study of the management of gestational impaired glucose tolerance.
BJOG, 107 (2000), pp. 959-963
[43.]
R. Corcoy, M. Codina, M.J. Cerqueira, G. Rectoret, T. Cervera, L. Cabero, et al.
Tratamiento intensivo de la diabetes gestacional: evolución de 100 pacientes.
Rev Clin Esp, 183 (1988), pp. 344-348
[44.]
J.D. Golberg, B. Franklin, D. Lasser, D.L. Jornsay, R.U. Hausknecht, F. Gindberg-Fellner, et al.
Gestational diabetes: Impact of home glucose monitoring on neonatal birth weight.
Am J Obstet Gynecol, 154 (1986), pp. 546-550
[45.]
N. Freinkel.
Summary and Recommendations of the Second International Workshop-Conference on Gestational Diabetes Mellitus.
Diabetes, 34 (1985), pp. 123-126
[46.]
Metzger BE and the Organizing Committee.
Summary and Recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus.
Diabetes, 40 (1991), pp. 197-201
[47.]
American Diabetes Association.
Position statement: Gestational diabetes mellitus.
Diabetes Care, 19 (1996), pp. 29
[48.]
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. 161-167
[49.]
D.J. Wechter, R.C. Kaufmann, K.S. Amankwah, D.A. Rightmire, S.P. Eardley, S. Verhulst, et al.
Prevention of neonatal macrosomia in gestational diabetes by the use of intensive dietary therapy and home glucose monitoring.
Am J Perinatol, 8 (1991), pp. 131-134
[50.]
L. Jovanovic-Peterson, C.M. Peterson, G.F. Reed, B.E. Metxger, J.L. Mills, R.H. Knopp, et al.
and the National Institute of Child Health and Human Development-Diabetes in Early Pregnancy Study. Maternal postprandial glucose levels and infant birth weight: The Diabetes in Early Pregnancy Study.
Am J Obstet Gynecol, 164 (1991), pp. 103-111
[51.]
J.F. Huddleston, M.K. Cramer, D.H. Vroon.
A rationale for omitting two-hour postprandial glucose determinations in gestational diabetes.
Am J Obstet Gynecol, 169 (1993), pp. 257-264
[52.]
S.G. Gabbe.
Discussion: a rationale for omitting two-hour postprandial glucose determinations in gestational diabetes.
Am J Obstet Gynecol, 169 (1993), pp. 262-263
[53.]
R.G. Moses, E.M. Lucas, S. Knights.
Gestational diabetes mellitus at what time should the postprandial glucose level be monitored?.
Aust NZ J Obstet Gynaecol, 39 (1999), pp. 457-460
[54.]
R.D.M.G. Neely, J.B. Kiwanuka, D.R. Hadden.
Influence of sample type on the interpretation of the oral glucose tolerance test for gestational diabetes.
Diabetic Med, 8 (1990), pp. 129-134
[55.]
N.J. Murphy, B.A. Meyer, R.T. O'Kell, M.E. Hogard.
Screening for gestational diabetes mellitus with a reflectance photometer: Accuracy and precision of the single-operator model.
Obstet Gynecol, 83 (1994), pp. 1038-1042
[56.]
P.E. Baurreau, J.E. Buttery.
Effect of hematocrit concentration on blood glucose value determined on Glucometer II.
Diabetes Care, 11 (1988), pp. 116-118
[57.]
S.R. Carr, D.R. Coustan, P. Martelly, F. Brosco, L. Rotondo.
Precission of reflectance meters in screening for gestational diabetes.
Obstet Gynecol, 73 (1989), pp. 727-731
[58.]
R. Corcoy, M. Balsells, A. de Leiva.
Tratamiento sustitutivo de la función beta-pancreática en la gestante diabética.
Av Diabetol, 5 (1992), pp. 49-60
[59.]
P. Stenger, M.e. Allen, L. Lisiu.
Accuracy of blood glucose meters in pregnant subjects with diabetes.
Diabetes Care, 19 (1996), pp. 268-269
[60.]
R. Moses, G. Schier, J. Matthews, W. Davis.
The accurancy of home glucose meters for the glucose range anticipated in pregnancy.
Aust NZ J Obstet Gynaecol, 37 (1997), pp. 282-286
[61.]
S.R. Carr, J. Slocum, L. Tefft, B. Haydon, M.W. Carpenter.
Precision of office-based blood glucose meters in screening for gestational diabetes.
Am J Obstet Gynecol, 173 (1995), pp. 1267-1272
[62.]
M.E. Molitch, J. Barr, R.L. Callahan, R.K. Campbell, L.M. Delahanty, R. Rizza, et al.
American Diabetes Association: Consensus statement: Self-monitoring of blood glucose.
Diabetes Care, 19 (1996), pp. 62-66
[63.]
E.A. Ryan, G. Nguyen.
Accuracy of glucose meter use in gestational diabetes.
Diabetes Technol Ther, 3 (2001), pp. 91-97
[64.]
R.S. Mazze, H. Shamson, R. Pasmantier, D. Lucido, J. Murphy, K. Hartmann, et al.
Reliability of blood-glucose monitoring by patients with diabetes mellitus.
Am J Med, 77 (1984), pp. 211-217
[65.]
O. Langer, R.S. Mazze.
Diabetes in pregnancy: evaluating self-monitoring performance and glycaemic control with memory-based reflectance meters.
Am J Obstet Gynecol, 155 (1986), pp. 635-637
[66.]
R. Corcoy, M. Codina, A. Pérez, W. De la Torre, J.R. Urgellés, J.M. Pou, et al.
Self-monitoring of blood glucose in women attending a diabetes and pregnancy clinic: Accuracy in reporting blood glucose values and fulfilment of scheduled timing.
Diab Nutr Metab, 4 (1991), pp. 23-38
[67.]
R.G. Moses.
Assessment of reliability of patients performing SMBG with a portable reflectance meter with memory capacity (M-Glucometer).
Diabetes Care, 9 (1986), pp. 670-671
[68.]
O. Langer, N. Langer, J.M. Piper, B. Elliott, A. Anyaebunam.
Cultural diversity as a factor in self-monitoring blood glucose in gestational diabetes.
J Assoc Acad Min Phys, 6 (1995), pp. 73-77
[69.]
L. Jovanovic.
The role of continuous glucose monitoring in gestational diabetes mellitus.
Diabetes Technol Ther, 2 (2000), pp. 67-71
[70.]
J.W. Hare.
Gestational diabetes mellitus: levels of glycemia as management goals.
Diabetes, 40 (1991), pp. 193-196
[71.]
ACOG Practice Bulletin.
Clinical management guidelines for obstetrician-gynecologists. N° 30.
Obstet Gynecol, 98 (2001), pp. 525-538
[72.]
M.B. Landon, S.G. Gabbe, L. Sachs.
Management of diabetes mellitus and pregnancy: a survey of obstetricians and maternal-fetal specialists.
Obstet Gynecol, 75 (1990), pp. 635-640
[73.]
J. Owen, S.T. Phelan, M.B. Landon, S.G. Gabbe.
Gestational diabetes survey.
Am J Obstet Gynecol, 172 (1995), pp. 615-620
[74.]
B.J. Burke, R.J. Sherriff, P.E. Savage, H.G. Dixon.
Diabetic twin pregnancy: an unequal result.
Lancet, 1 (1979), pp. 1372-1373
[75.]
J. Pedersen.
The pregnant diabetic and her newborn: Problems and management 2nd ed.
pp. 191-197
[76.]
B.L. Silverman, T. Rizzo, O.C. Green, N. Cho, R.J. Winter, E.S. Ogata, et al.
Long-term prospective evaluation of offspring of diabetic mothers.
Diabetes, 40 (1991), pp. 121-125
[77.]
W.N. Spellacy, S. Miller, A. Winegar, P.Q. Peterson.
Macrosomia-maternal characteristics and infant complications.
Obstet Gynecol, 66 (1985), pp. 158-161
[78.]
J.B. Susa, O. Langer.
Macrosomia: lessons from animal and clinical studies.
Diabetes Rev, 4 (1996), pp. 11-20
[79.]
P.A.M. Weiss, H.M.H. Hofmann, F. Kainer, J.G. Haas.
Fetal outcome in gestational diabetes with elevated amniotic fluid insulin levels: dietary vs insulin treatment.
Diabetes Res Clin Pract, 5 (1988), pp. 1-7
[80.]
T.A. Buchanan, S.L. Kjos, U. Schafer, R. Peters, A. Xiang, J. Byrne, et al.
Utility of fetal measurements in the management of gestational diabetes mellitus.
Diabetes Care, 21 (1998), pp. 99-106
[81.]
R.K. Kalkhoff.
Impact of maternal fuels and nutritional state on fetal growth.
Diabetes, 40 (1991), pp. 61-66
[82.]
R.H. Knopp, M.S. Magee, C.E. Walden, B. Bonet, T.J. Benedetti.
Prediction of infant birth weight by GDM screening: importance of plasma triglyceride.
Diabetes Care, 15 (1992), pp. 1605-1613
[83.]
R.D.M.G. Milner, M.A. Ashworth, A.J. Barson.
Insulin release from human foetal pancreas in response to glucose, leucine, and arginine.
J Endocrinol, 52 (1972), pp. 497-505
[84.]
F. Stoz, R.A. Schuhmann, B. Hass.
Morphometric investigations in placentas of gestational diabetes.
J Perinatol Med, 16 (1988), pp. 205-209
[85.]
C. Jones, H. Fox.
Placental changes in gestational diabetes.
Obstet Gynecol, 48 (1976), pp. 274-280
[86.]
U. Nicolini, C. Hubinont, J. Santolaya, N.M. Fisk, A.M. Coe, C.H. Rodeck.
Maternal-fetal glucose gradient in normal pregnancies and in pregnancies complicated by alloimmunization and fetal growth redardation.
Am J Obstet Gynecol, 161 (1989), pp. 924-927
[87.]
S.L. Dooley, B.E. Metzger, N. Cho.
Gestational diabetes: influence of race on disease prevalence and perinatal outcome in a U.S. population.
Diabetes, 40 (1991), pp. 25-29
[88.]
C.J. Homko, E. Sivan, P. Nyirjesy.
The interrelationship between ethnicity and gestational diabetes in fetal macrosomia.
Diabetes Care, 18 (1995), pp. 1442-1445
[89.]
F. Gloria-Bottini, G. Gerlin, N. Lucarini, A. Amante, P. Lucarelli, P. Borgiani, et al.
Both maternal and foetal genetic factors contribute to macrosomia in diabetic pregnancy.
Hum Hered, 44 (1994), pp. 24-30
[90.]
F.D. Johnstone, J.D. West, J. Steel, D.B. Whitehouse, G.A. Deago, I.A. Greer, et al.
Lack of association between maternal phosphoglucomutase-1 phenotype and fetal macrosomia in diabetic pregnancy.
Br J Obstet Gynecol, 101 (1994), pp. 239-245
[91.]
P.A.M. Weiss, H.M. Hofmann, R.R. Winter, W. Lichtenegger, P. Purstner, J. Haas.
Diagnosis and treatment of gestational diabetes according to amniotic fluid insulin levels.
Arch Gynecol, 239 (1986), pp. 81-91
[92.]
H.M.H. Hofmann, P.A.M. Weiss, P. Purstner, J. Haas, G. Gmoser, K. Tamussino, et al.
Serum fructosamine and amniotic fluid insulin levels in patients with gestational diabetes and healthy control subjects.
Am J Obstet Gynecol, 162 (1990), pp. 1174-1177
[93.]
G. Rossi, E. Somigliana, M. Moschetta, B. Bottani, M. Barbieri, M. Vignali.
Adequate timing of fetal ultrasound to guide metabolic therapy in mild gestational diabetes mellitus. Results from a randomized study.
Acta Obstet Gynecol Scand, 79 (2000), pp. 649-654
[94.]
S.P. Chauhan, N.W. Hendrix, E.F. Magann, J.C. Morrison, S.P. Kenney, L.D. Devoe.
Limitations of clinical and sonographic estimates of birth weight: experience with 1034 parturients.
Obstet Gynecol, 91 (1998), pp. 72-77
[95.]
S. Lurie, Y. Zalel, Z.J. Hagay.
The evaluation of accelerated fetal growth.
Curr Opin Obstet Gynecol, 7 (1995), pp. 477-481
[96.]
R.A. McLaren, J.L. Puckett, S.P. Chauhan.
Estimators of birth weight in pregnant women requiring insulin: a comparison of seven sonographic models.
Obstet Gynecol, 85 (1995), pp. 565-569
[97.]
R. Gonen, D. Spiegel, M. Abend.
Is macrosomia predictable, and are shoulder dystocia and birth trauma preventable?.
Obstet Gynecol, 88 (1996), pp. 526-529
[98.]
L.J. Grylack, S.S. Chu, J.W. Scanlon.
Use of intravenous fluids before cesarean section: effects on perinatal glucose, insulin and sodium homeostasis.
Obstet Gynecol, 63 (1984), pp. 654-658
[99.]
S. Singhi, S. Sharma.
Neonatal hypoglycemia following maternal glucose infusion prior to delivery.
Indian J Pediatr, 58 (1991), pp. 43-49
[100.]
J. Meindiola, L.J. Grylack, J.W. Scanlon.
Effects of intrapartum glucose infusion on the normal fetus and newborn.
Anesth Analg, 61 (1982), pp. 32-35
[101.]
M. Balsells, R. Corcoy, J.M. Adelantado, A. García-Patterson, O. Altirriba, A. de Leiva.
Gestational diabetes mellitus. Metabolic control during labour.
Diab Nutr Metab, 13 (2000), pp. 257-262
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