Tratamiento flexible de la diabetes mellitus gestacional ajustado según el crecimiento fetal intrateurino vs tratamiento según parámetros glucémicos maternos estrictos

Resumen

Objective: To compare the conventional treatment of GDM with the treatment modified according to the measurement of the fetal abdominal circumference in our daily clinical practice. Methods: 260 pregnant women diagnosed with GDM before week 34 were randomized into two groups: a control group, treated according to maternal capillary blood glucose, and an experimental group, treated according to ultrasound parameters of fetal growth. The glycemic targets in the control group were fasting blood glucose and one hour postprandial <95/140 mg / dl. In the experimental group, glycemic targets depended on the percentile of fetal AC: if AC p <75 fasting blood glucose targets and one hour postprandial <120/180 mg / dl and if AC p> 75 glycemic targets <80/120 mg / dl. The follow-up of both groups was scheduled according to the GDM protocol of our Diabetes and Pregnancy Unit. Results: 246 pregnant women completed the study, 125 in the control group and 121 in the experimental group. In the experimental group, insulin treatment and neonatal hypoglycemia were significantly lower (p 0.018 and p 0.035 respectively). No differences were observed in large and small infants for gestational age, but macrosomic infants were less frequent in the experimental group. In pregnancy complications, the type of delivery and its complications, and the rest of neonatal complications analyzed, no significant differences were observed. In the postpartum reassessment of maternal carbohydrate metabolism there were no significant differences either. Conclusions: The treatment of GDM modified by ultrasound according to the measurement of the fetal abdominal circumference is safe for the mother and the fetus, and reduces the number of pregnant women requiring insulin treatment by almost half, without increasing the number of controls ultrasound or medical visits