DIABETES GESTACIONAL

DRA. YAZMIN PEREZ MARTINEZ

 HIPERINSULINEMIA
 RESISTENCIA A LA INSULINA
 ESTADO DIABETOGENICO
 CORTICOTROPINA
 HORMONA DEL CRECIMIENTO
 LACTOGENO PLACENTARIO
 PROGESTERONA

FISIOPATOGENIA
 A family history of diabetes, especially in first degree relatives [39]
 Prepregnancy weight ≥110 percent of ideal body weight or body mass index >30 kg/m2,
significant weight gain in early adulthood and between pregnancies [40], or excessive
gestational weight gain [41-43]
 Age >25 years
 Previous delivery of a baby >9 pounds [4.1 kg]
 Personal history of impaired glucose tolerance
 Member of an ethnic group with higher than the background rate of type 2 diabetes (eg,
Hispanic-American, African-American, Native American, South or East Asian, Pacific Islander). In
most populations, the background rate had been approximately 2 percent, but is rising rapidly.
 Previous unexplained perinatal loss or birth of a malformed infant
 Maternal birthweight >9 pounds [4.1 kg] or <6 pounds [2.7 kg]
 Glycosuria at the first prenatal visit
 Polycystic ovary syndrome [44-46]
 Current use of glucocorticoids
 Essential hypertension or pregnancy-related hypertension
 Metabolic syndrome

FACTORES RIESGO
 DM PREGESTACIONAL: < 20 SDG

 DM GESTACIONAL : > 20 SDG

GLUCOSA AYUNO > 92 MG

CONCENSO ACOG
 2
HORA
HORAS
> 180
> 153

CARGA GLUCOSA 75 GR 24-28 SDG

 Preeclampsia
 Hydramnios
 Fetal macrosomia
 Fetal organomegaly (hepatomegaly, cardiomegaly)
 Birth trauma
 Operative delivery
 Perinatal mortality
 Neonatal respiratory problems and metabolic complications
(hypoglycemia, hyperbilirubinemia, hypocalcemia, erythremia)

COMPLICACIONES
 DIETA

PERDIDA
EJERCICIO
DE PESO

TRATAMIENTO
  30 kcal/kg/day; ideal body weight during pregnancy
 22 to 25 kcal/kg/day; for women who are overweight
 and for morbidly obese women, the caloric requirement is 12 to
14 kcal/kg/day

DIETA
 INSULINA NPH
 12 HRS VIDA MEDIA
 .1-.3 U/Kg 2/3 AM 1/3 PM

 INSULINA RAPIDA
 INMEDIATO

 PICOS POSPRANDIO

TX
 POSPRANDIO
AYUNO < 120
< 200 MG

META TERAPEUTICA