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Inicio Endocrinología y Nutrición Particularidades del tratamiento de la gestante con diabetes mellitus tipo 2
Información de la revista
Vol. 55. Núm. S2.
Guía de actualización en el tratamiento de la diabetes tipo 2 y sus complicaciones
Páginas 66-72 (Marzo 2008)
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Vol. 55. Núm. S2.
Guía de actualización en el tratamiento de la diabetes tipo 2 y sus complicaciones
Páginas 66-72 (Marzo 2008)
Guía de actualización en el tratamiento de la diabetes tipo 2 y sus complicaciones
Acceso a texto completo
Particularidades del tratamiento de la gestante con diabetes mellitus tipo 2
Special considerations in the treatment of pregnant women with type 2 diabetes mellitus
Visitas
2294
L. Sojoa,
Autor para correspondencia
h416ulsv@htrueta.scs.es

Correspondencia: Dra. L. Sojo. Servicio de Endocrinología y Nutrición. Hospital Josep Trueta. Avda. de França, s/n. 17007 Girona. España.
, R. Corcoyb
a Servicio de Endocrinología y Nutrición. Hospital Josep Trueta. Girona. España
b Servicio de Endocrinología y Nutrición. Hospital de la Santa Creu i Sant Pau. Barcelona. España
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Información del artículo

La prevalencia de diabetes mellitus tipo 2 (DM2) en la gestación está en aumento y puede superar la de la diabetes mellitus tipo 1 (DM1). En general, el tratamiento es similar, con algunas particularidades. Las pacientes con DM2 son de mayor edad, son más obesas, tienen hipertensión crónica con mayor frecuencia, reciben asistencia pregestacional específica con menor frecuencia, consultan más tarde durante la gestación y están más expuestas a fármacos potencialmente teratógenos. En contrapartida, el tiempo de evolución de la enfermedad y la frecuencia de complicaciones son inferiores y el control metabólico es mejor. Aunque hay controversia, la evolución perinatal es similar, a excepción de la prematuridad, que es inferior en DM2.

El fármaco recomendado para el tratamiento de la hiperglucemia es la insulina. Antes del embarazo, el énfasis debe ponerse en aumentar la asistencia pregestacional, mejorar el control glucémico, reforzando la educación diabetológica, y evitar la exposición a fármacos potencialmente teratógenos. Durante la gestación, los últimos objetivos continúan vigentes. Después del parto, se debe replantear el programa terapéutico teniendo en cuenta el paso de los fármacos a la leche materna.

Palabras clave:
Diabetes mellitus tipo 2
Gestación
Mortalidad perinatal
Malformaciones
Necesidades de insulina

The prevalence of type 2 diabetes mellitus (DM2) in pregnancy is increasing and can exceed that of type 1 DM (DM1). In general, treatment is similar with some special considerations. Patients with DM2 are older and heavier, more likely to have chronic hypertension, less likely to receive specific prepregnancy care, consult later in pregnancy, and are more frequently exposed to potentially teratogenic drugs. In contrast, diabetes duration and the complications rate are lower and metabolic control is better. Although there is some controversy on the topic, perinatal outcomes are similar, except for the prematurity rate, which is lower in DM2. The recommended drug for the treatment of hyperglycemia is insulin. Before pregnancy, emphasis should be placed on increasing attendance at prepregnancy care, improving glycemic control, reinforcing diabetes instruction and avoiding exposure to potentially teratogenic drugs. During pregnancy, the latter aims remain applicable. After delivery, the treatment regimen should be reconsidered, taking into account transfer of different drugs through breast milk.

Key words:
Type 2 diabetes mellitus
Pregnancy
Perinatal mortality
Congenital malformations
Insulin requirements
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