2017, Number 02
Ginecol Obstet Mex 2017; 85 (02)
Font-López KC, Gutiérrez-Castañeda MR
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ABSTRACTBackground: For more than 50 years, multiple international guidelines have been developed for the diagnosis of gestational diabetes mellitus GDM with different criteria and cut-off points; However, there is no consensus in Mexico.
Objetive: To review international diagnostic criteria and make a proposal applicable in Mexico.
Methods: We searched in MedLine, OVID, Science Direct, Practice Guidelines International Networks and scholar.google.com; from 2010 to 2016 with the following key words: diagnosis of gestational diabetes, risk factors, diagnostic criteria and glycosylated hemoglobin. Seven clinical practice guidelines and 25 articles were selected.
Results: Five questions were elaborated. Should diagnostic tests be performed on all Mexicans from the first trimester? One study indicated that Mexican women have a higher prevalence of GDM than white women, 6.1 vs. 5.4%. However, other studies did not replicate the same results. Early diagnosis of gestational diabetes. Fasting blood glucose ›92 mg/dL from the first trimester diagnoses GDM. Which women should be test in the first trimester? Patients with a history of GDM, macrosomia, glucosuria and obesity: should be tested with a glucose tolerance test before the 20th week of gestation. Which criteria and cutoffs should be used? The criteria of IADPSG have been shown lower perinatal morbidity and mortality. Utility of the glycosylated hemoglobin. A value of 4.5% or less, has a specificity of 100% but very poor sensitivity. It is not useful as a diagnostic test.
Conclusions: Fasting glycaemia ≥92 mg/dL in the first trimester diagnoses GDM. To performed glucose tolerance test in women with risk factors from the first consultation. This will be with 75 grams of glucose and the HAPO criteria will be used. Glycosylated hemoglobin is not useful for diagnosing GDM. An algorithm is proposed for applicability at all levels of care.