Hiperglicemia Del Embarazo

D i a g n o s i s a n d Tre a t m e n t
of Hyperglycemia
i n P re g n a n c y
Maribeth Inturrisi, RN, MS, CNS, CDEa,b,c,*,
Nancy C. Lintner, RN, MS, ACNS, RNC-OBd, Kimberlee A. Sorem,

MD

a,e

KEYWORDS






Gestational diabetes mellitus  Type 2 diabetes
Large for gestational age  Blood glucose
Oral glucose tolerance test  Self-monitoring of blood glucose
AmericanAssociation of the College of Endocrinologists
Certified diabetes educators

Gestational diabetes mellitus (GDM) has been defined as any degree of glucose intolerance with onset or first recognition during pregnancy.1 This definition is a misnomer
in that it includes unrecognized overt diabetes that may have existed before pregnancy and hyperglycemia that is diagnosed concurrently with pregnancy.Those
with suspected type 2 diabetes mellitus (T2DM) have been referred to as “hyperglycemia in pregnancy,” despite evidence of severe hyperglycemia consistent with preexisting T2DM. Because the term “gestational diabetes mellitus” is confusing, the
authors recommend use of the term “hyperglycemia in pregnancy,” as defined by
the Endocrine Society.2
SIGNIFICANCE

The prevalence ofhyperglycemia in pregnancy varies in direct proportion to the prevalence of type 2 diabetes in a given population or ethnic group. Whereas in 1964 the
prevalence of hyperglycemia in pregnancy was 1% to 4%,3 the current estimate is 7%

The authors have nothing to disclose.
a
Region 1 & 3, California Diabetes and Pregnancy Program, San Francisco, CA, USA
b
Family Health Care Nursing, University ofCalifornia, San Francisco, CA, USA
c
Department of Maternal-Fetal Medicine, Sutter Pacific Medical Foundation at California
Pacific Medical Center, San Francisco, CA, USA
d
Diabetes and Pregnancy Program, Division of Maternal-Fetal Medicine, Department of
Obstetrics and Gynecology, University of Cincinnati College of Medicine, 231 Albert Sabin
Way, 5553, PO Box 670526, Cincinnati, OH45267–0526, USA
e
Sweet Success Program, Sutter Pacific Medical Foundation at California Pacific Medical
Center, 3700 California Street, G321, San Francisco, CA, USA
* Corresponding author. 2 Koret Way, PO Box 0606, San Francisco, CA 94143–0606.
E-mail address: maribeth.inturrisi@nursing.ucsf.edu
Endocrinol Metab Clin N Am 40 (2011) 703–726
doi:10.1016/j.ecl.2011.09.002
0889-8529/11/$ – see frontmatter Ó 2011 Elsevier Inc. All rights reserved.

endo.theclinics.com

704

Inturrisi et al

to 14%.3 In 1964, the number of adults estimated to have type 2 diabetes in the United
States was 2.3 million and in 2011 estimates were as high as 25.6 million, indicating
that type 2 diabetes in America is increasing in an epidemic pattern. Likewise, hyperglycemia in pregnancy is a silentepidemic. If current trends continue, by 2050 one in
three Americans will have diabetes.3
Hyperglycemia in pregnancy shares the pathophysiology of type 2 diabetes
(increased insulin resistance and hyperinsulinemia) and confers an increased lifetime
risk for future type 2 diabetes for both the mother and her newborn. Hyperglycemia in
pregnancy is not just a pregnancy problem. Soon after giving birth,90% to 95% of
women with hyperglycemia in pregnancy are diabetes-free by a standard 2-hour
75-g oral glucose tolerance test (OGTT). By 6 to 12 weeks, 4% to 9% are diagnosed
with T2DM. More than 20% have impaired glucose tolerance or impaired fasting
glucose or both (prediabetes). By 36 months, 30% have metabolic syndrome (dysglycemia, abnormal lipid profile, hypertension, and centraladiposity). By 5 years, 50%
have T2DM. The cumulative risk over 10 years is 2.6% to 70%.4 Fetal, neonatal,
and adult consequences of uncontrolled maternal hyperglycemia include a variety
of serious short- and long-term consequences (Table 1).
Detection and diagnosis of hyperglycemia in pregnancy provides an opportunity to
assist women to establish healthy lifestyle habits and give them tools to...