Risk Factors and Diagnosis of Gestational Diabetes


Introduction: The risk factors play a fundamental role in the prevention of Gestational Diabetes, and an early and timely diagnosis will considerably reduce the risk of complications of said pathology. Methodology: Virtual scientific libraries have been used as Cochane, BVS, Revista Panamericana de Salud Pública, EBSCO, and searchers of scientific information as Mendeley, UptoDate, Taylor & Francis, to find the best available evidence, subsequently the highest quality scientific bibliography has been selected, from which all those that meet the inclusion criteria and do not meet any criteria have been chosen exclusion, subsequently all scientific articles have been reviewed to acquire from them the most relevant and solid information for the creation of this systematic review. Results: We found 33 scientific articles that meet all the inclusion criteria and no exclusion criteria. Discussion: Gestational Diabetes is characterized from the pathophysiological point of view as a state of hyperglycemia, insulin resistance and decreased insulin secretion by beta-pancreatic cells, it is known that risk factors influence the genesis of disease and its prevention. Currently two diagnostic strategies are used, but the most recommended is the one-step strategy with an oral glucose load of 75 grams, which has shown better results for its diagnosis. Conclusions: Due to the complications that Gestational Diabetes can produce in both the mother and the fetus, it is important to create early diagnosis programs, active search for pregnant women and awareness of self-care during pregnancy.

Keywords: diabetes, gestational diabetes, risk factors, diagnosis.


Introducción: Los factores de riesgo juegan un papel fundamental en la prevención de la Diabetes Gestacional, y un diagnóstico temprano y oportuno reducirá considerablemente el riesgo de las complicaciones de dicha patología. Metodología: Se ha utilizado bibliotecas científicas virtuales como Cochane, BVS, Revista Panamericana de Salud Pública, EBSCO, además de buscadores de información científica como Mendeley, UptoDate, Taylor & Francis, para encontrar la mejor evidencia disponible, posteriormente se ha seleccionado la bibliografía científica de más alta calidad, de los cuales se han elegido todos los que cumplas los criterios de inclusión y no cumplan ningún criterio de exclusión, posteriormente se han revisado todos los artículos científicos para adquirir de ellos la información más relevante y sólida para la creación de esta revisión. Resultados: Se han encontrado 33 artículos científicos que cumplen con todos los criterios de inclusión y ningún criterio de exclusión. Discusión: La Diabetes Gestacional se caracteriza desde el punto de vista fisiopatológico como un estado de hiperglicemia, resistencia a la insulina y disminución de la secreción de insulina por parte de las células beta-pancreáticas, se conoce que los factores de riesgo influyen en la génesis de la enfermedad y de su prevención. Actualmente se utiliza dos estrategias diagnósticas, pero la más recomendada es la estrategia de un paso con carga oral de glucosa de 75 gramos, que ha demostrado mejores resultados para su diagnóstico. Conclusiones: Debido a las complicaciones que la Diabetes Gestacional puede producir tanto en la madre como el en feto, es importante crear programas de diagnóstico temprano, búsqueda activa de gestantes y generación de conciencia del autocuidado durante el embarazo.

Palabras clave: diabetes, diabetes gestacional, factores de riesgo, diagnóstico.

[1]Durnwald C. Diabetes mellitus in pregnancy: Screening and diagnosis. UpToDate; 2020. p. 1–20.

[2]Behboudi‐Gandevani S, Amiri M, Yarandi RB, Tehrani FR. The impact of diagnostic criteria for gestational diabetes on its prevalence: A systematic review and meta‐analysis. Diabetol Metab Syndr. 2019;11:11.

[3]Mayo K, Melamed N, Vandenberghe H, Berger H. The impact of adoption of the International Association of Diabetes in Pregnancy Study Group criteria for the screening and diagnosis of gestational diabetes. Am J Obstet Gynecol. 2015;212(2):224‐224.

[4]Scholtens DM, Kuang A, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcome follow-up study (HAPO FUS): Maternal glycemia and childhood glucose metabolism. Diabetes Care. 2019;42(3):381–92.

[5]Riskin AA, Garcia‐prats JA. Infants of women with diabetes. UpToDate [Internet]; 2020. p. 1–12. Available from: https://www.uptodate.com/contents/infants‐of‐women‐with‐diabetes/print?search=gestationaldiabetes&source=search_result&selectedTitle=4~86&usage_type

[6]Gupta Y, Kalra B, Baruah MP, Singla R, Kalra S. Updated guidelines on screening for gestational diabetes. Int J Womens Health. 2015;7:539–50.

[7]Wielgoś M, Bomba‐Opoń D, Czajkowski K, Wender‐Ożegowska E, Hod M. Towards a European consensus on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. The Polish diabetes in pregnancy study group and FIGO. Ginekol Pol. 2017;88(1):46–9.

[8]Caughey A. Gestational diabetes mellitus: Obstetrical issues and management. UpToDate; 2020. p. 1–24. Available from: https://www.uptodate.com/contents/gestational‐diabetes‐mellitus‐obstetric‐ issues‐and‐management/print?search=gestational diabetes&source=search_result&selectedTitle=2~86&usage_ type=default&display_rank=2

[9]Albright A, Allweiss P, Anderson BJP, et al. Management of diabetes in pregnancy: Standards of medical care in diabetesd2019. Diabetes Care. 2019;42:S165–72.

[10] Kapur A, Mahmood T, Hod M. FIGO’s response to the global challenge of hyperglycemia in pregnancy – toward a global consensus. Gynecol Endocrinol. 2018;34(1):1–3.

[11] Roberts V, Myatt L. Placental development and physiology. UptoDate; 2020. Available from: https://www.uptodate.com/contents/placental‐development‐and‐physiology?search=Placental development and physiology&source=search_result&selectedTitle=1~150&usage_type=

[12] American Diabetes Association. Standards of medical care in diabetes‐2020. Diabetes Care. 2020;43(January):S205–6.

[13] Wang C, Yang H‐X. Diagnosis, prevention and management of gestational diabetes mellitus. Chronic Dis Transl Med . 2016;2(4):199–203.

[14] Laafira A, White SW, Griffin CJ, Graham D. Impact of the new IADPSG gestational diabetes diagnostic criteria on pregnancy outcomes in Western Australia. Aust New Zeal J Obstet Gynaecol. 2016;56(1):36–41.

[15] Soli C, Fabricio G, Wilfrido L, et al. Diagnóstico y tratamiento de la diabetes en el embarazo (pregestacional y gestacional). Ecuador M de SP del, editor. 2014.

[16] Houlden RL, Sherifali DR, Rabi D, et al. 2018 Clinical practice guidelines of Canada. Can J Diabetes. 2018;42.

[17] Diehl K, Schneider S, Bock C, Maul H, Kleinwechter H, Görig T. German gynecologists’ experience with a universal screening for gestational diabetes mellitus in daily practice: A qualitative study. J Turkish Ger Gynecol Assoc. 2016; 17(1):10–5.

[18] Schäfer‐Graf UM, Gembruch U, Kainer F, et al. Gestational Diabetes Mellitus (GDM)‐ Diagnosis, Treatment and Follow‐Up Guideline of the DDG and DGGG (S3 Level, AWMF Registry Number 057/008, February 2018). Geburtshilfe Frauenheilkd. 2018;78(12):1219–31.

[19] McCulloch D, Robertson P. Pathogenesis of type 2 diabetes mellitus. UptoDate. 2020. Available from: https://www.uptodate.com/contents/pathogenesis‐of‐type‐2‐diabetes‐ mellitus?search=diabetes mellitus pathophysiology&source=search_result&selectedTitle=1~150&usage_ type=default&display_rank=1

[20] Padayachee C. Exercise guidelines for gestational diabetes mellitus. World J Diabetes. 2015;6(8):1033.

[21] Utz B, Delamou A, Belaid L, De Brouwere V. Detection and management of diabetes during pregnancy in low resource settings: Insights into past and present clinical practices. J Diabetes Res. 2016.

[22] Lowe WL, Scholtens DM, Kuang A, et al. Hyperglycemia and adverse pregnancy outcome follow‐up study (HAPO FUS): Maternal gestational diabetes mellitus and childhood glucose metabolism. Diabetes Care. 2019;42(3):372–80.

[23] Kennelly MA, Mcauliffe FM. Prediction and prevention of Gestational Diabetes: An update of recent literature. Eur J Obstet Gynecol Reprod Biol. 2016;202:92–8.

[24] Bhatia M, Mackillop L, Bartlett K, et al. Clinical Implications of the NICE 2015 criteria for gestational diabetes mellitus. J Clin Med. 2018;7(10):376.

[25] Caughey A, Turrentine M. ACOG practice bulletin no. 190 summary: Gestational diabetes mellitus. Obstet Gynecol. 2018;131(2):406–8.

[26] Mackillop LH, Bartlett K, Birks J, et al. Trial protocol to compare the efficacy of a smartphone‐based blood glucose management system with standard clinic care in the gestational diabetic population. BMJ Open. 2016;6(3).

[27] Albright A, Allweiss P, Anderson BJP et. al. Summary of revisions: Standards of medical care in diabetes. Diabetes Care. 2019;42:S4–6.

[28] National Insitute for Health and Care Excellence [NICE]. Diabetes in pregnancy: management from preconception to the postnatal period (NG3). NICE Guidel [NG3]. 2015;63(2008):42.

[29] Abouzeid M, Versace VL, Janus ED, et al. Socio‐Cultural disparities in GDM burden differ by maternal age at first delivery. PLoS One. 2015 [cited 2020 Mar 5]; Available from: http:// dx.doi.org/10.6084/m9.figshare.1274027.The

[30] Berger H, Gagnon R, Sermer M, et al. Diabetes in pregnancy. J Obstet Gynaecol Canada. 2016;38(7):667‐679.

[31] Daley B, Hitman G, Fenton N, Mclachlan S. Assessment of the methodological quality of local clinical practice guidelines on the identification and management of gestational diabetes. BMJ Open. 2019;9(6).

[32] Li‐zhen L, Yun X, Xiao‐Dong Z, et al. Evaluation of guidelines on the screening and diagnosis of gestational diabetes mellitus: Systematic review. BMJ Open. 2019;9(5):e023014.

[33] Kelley KW, Carroll DG, Meyer A. A review of current treatment strategies for gestational diabetes mellitus. Drugs Context. 2015;4.