Predicción de bajo peso al nacer con hipoglucemia en la prueba de tolerancia a la glucosa
DOI:
https://doi.org/10.11606/s1518-8787.2021055002543Palavras-chave:
Hipoglucemia, Prueba de Tolerancia a la Glucosa, Recién Nacido de Bajo Peso, Estudios LongitudinalesResumo
RESUMEN OBJETIVO: Determinar el valor de la combinación de la glucosa en ayunas menor que el percentil 10 (GA < p10) durante la prueba de tolerancia oral a la glucosa con 75 gramos (PTG-75g) con características maternas para predecir bajo peso al nacer (BPN) establecido mediante tablas de Intergrowth-21st. MÉTODOS: Estudio de cohorte prospectivo de mujeres embarazadas que se realizaron PTG-75g entre las 24 y 28.6 semanas. Se determinó el percentil 10 de glucosa en ayunas de la población en 65 mg/dL y fueron excluidas aquellas mujeres con factores de riesgo que pudieran modificar el peso fetal incluyendo los relacionados con la restricción del crecimiento intrauterino. Se formaron dos grupos: grupo GA < p10 y grupo con glucosa en ayunas normal. El hallazgo principal fue el diagnóstico de BPN. La asociación entre GA < p10, características maternas y BPN se estableció mediante regresión logística multivariante. El desempeño predictivo de los modelos construidos fue evaluado por el análisis de la curva característica operativa del receptor (ROC) y del área bajo la curva (ABC). RESULTADOS: Fueron elegibles para estudio 349 mujeres, de las cuales 66 (18,91%) tuvieron GA < p10; los neonatos de este grupo tuvieron pesos al nacer más bajos (2947.28 g y 3138.26 g, p = 0,001), frecuencias más altas de BPN (25% y 6,81%, p < 0,001) y de pesos < 2500 g en nacimientos de término (8,6% y 2,3%, p = 0,034). El modelo basal de predicción consistió en nuliparidad al lograr un ABC del 60%, mientras que al añadir la GA < p10 se obtuvo la mejora significativa del modelo previo (ABC 72%, DeLong: p = 0,005). CONCLUSIONES: En mujeres embarazadas sin factores que pudieran modificar el peso fetal, el modelo predictivo creado combinando GA < p10 durante la PTG-75g con nuliparidad estuvo asociado significativamente con riesgo incrementado de BPN.
Referências
. Blencowe H, Krasevec J, Onis M, Black RE, An X, Stevens GA, et al. National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health 2019;7:849-60. https://doi.org/10.1016/S2214-109X(18)30565-5 [ Links ]
Katz J, Lee AC, Kozuki N, Lawn JE, Cousens S, Blencowe H, et al. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet. 2013 Aug 3;382: 417-25. https://doi.org/10.1016/S0140-6736(13)60993-9 [ Links ]
Langer O, Levy J, Brustman L, Anyaegbunam A, Merkatz R, Divon M. Glycemic control in gestational diabetes mellitus--how tight is tight enough: small for gestational age versus large for gestational age? Am J Obstet Gynecol. 1989;161(3):646-53. https://doi.org/10.1016/0002-9378(89)90371-2 [ Links ]
Abell DA, Beischer NA. Evaluation of the three-hour oral glucose tolerance test in detection of significant hyperglycemia and hypoglycemia in pregnancy. Diabetes. 1975;24(10):874-80. https://doi.org/10.2337/diab.24.10.874 [ Links ]
Melamed N, Hiersch L, Peled Y, Hod M, Wiznitzer A, Yogev Y. The association between low 50 g glucose challenge test result and fetal growth restriction. J Matern Fetal Neonatal Med. 2013 Jul;26(11):1107-11. https://doi.org/10.3109/14767058.2013.770460 [ Links ]
Bayraktar B, Balıkoğlu M, Kanmaz AG. Pregnancy outcomes of women with hypoglycemia in the oral glucose tolerance test. J Gynecol Obstet Hum Reprod. 2020 Apr;49(4):101703. https://doi.org/10.1016/j.jogoh.2020.1017 [ Links ]
Caruso A, Paradisi G, Ferrazzani S, Lucchese A, Moretti S, Fulghesu AM. Effect of maternal carbohydrate metabolism on fetal growth. Obstet Gynecol. 1998;92(1):8-12. https://doi.org/10.1016/s0029-7844(98)00138-0 [ Links ]
Markestad T, Bergsjø P, Aakvaag A, Lie RT, Jacobsen G, Hoffman HJ et al. Prediction of fetal growth based on maternal serum concentrations of human chorionic gonadotropin, human placental lactogen and estriol. Acta Obstet Gynecol Scand Suppl.1997;165:50-5. [ Links ]
Holme AM, Roland MC, Lorentzen B, Michelsen TM, Henriksen T. Placental glucose transfer: a human in vivo study. PLoS One. 2015 Feb 13;10(2):e0117084. https://doi.org/10.1371/journal.pone.0117084 [ Links ]
Langer O, Damus K, Maiman M, Divon M, Levy J, Bauman W. A link between relative hypoglycemia-hypoinsulinemia during oral glucose tolerance tests and intrauterine growth retardation. Am J Obstet Gynecol.1986 Oct;155(4):711-6. https://doi.org/10.1016/s0002-9378(86)80004-7 [ Links ]
Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020 Jan;43(Suppl.1):14-31. https://doi.org/10.2337/dc20-S002 [ Links ]
ter Braak EWMT, Evers IM, Erkelens DW, Visser GHA. Maternal hypoglycemia during pregnancy in type 1 diabetes: maternal and fetal consequences. Diabetes Metab Res Rev. 2002;18(2):96-105. https://doi.org/10.1002/dmrr.271 [ Links ]
HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991-2002. https://doi.org/10.1056/NEJMoa0707943 [ Links ]
Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005 Jun 16;352(24):2477-86. https://doi.org/10.1056/NEJMoa042973 [ Links ]
Papageorghiou AT, Ohuma EO, Altman DG, Todros T, Cheikh-Ismail L, Lambert A, et al. International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. Lancet. 2014 Sep 6;384(9946):869-79. https://doi.org/10.1016/S0140-6736(14)61490-2 [ Links ]
Delibas IB, Tanriverdi S, Cakmak B. Does reactive hypoglycemia during the 100 g oral glucose tolerance test adversely affect perinatal outcomes? Ginekol Pol. 2018;89(1):25-9. https://doi.org/10.5603/GP.a2018.0005 [ Links ]
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics, Society for Maternal-Fetal Medicin. Practice Bulletin No. 204: Fetal Growth Restriction. Obstet Gynecol. 2019 Feb;133(2):97-109. https://doi.org/10.1097/AOG.0000000000003070 [ Links ]
Rhee J, Kim R, Kim Y, Tam M, Lai Y, Keum N, et al. Maternal Caffeine Consumption during Pregnancy and Risk of Low Birth Weight: A Dose-Response Meta-Analysis of Observational Studies. PLoS ONE. 2015 Jul 20;10(7):e0132334. https://doi.org/10.1371/journal.pone.0132334 [ Links ]
Sonek JD, Kagan KO, Nicolaides KH. Inverted Pyramid of Care. Clin Lab Med. 2016 Jun;36(2):305-17. https://doi.org/10.1016/j.cll.2016.01.009 [ Links ]
American College of Obstetricians and Gynecologists. Committee Opinion No. 548. ACOG Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol. 2013 Jan;121(1):210-2. https://doi.org/10.1097/01.aog.0000425668.87506.4c [ Links ]
Institute of Medicine, National Research Council Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines. Washington D.C.: National Academies Press, 2009. [ Links ]
Figueiredo ACMG, Gomes-Filho IS, Silva RB, Pereira PPS, Mata FAF, Lyrio AO, et al. Maternal Anemia and Low Birth Weight: A Systematic Review and Meta-Analysis. Nutrients. 2018 May 12;10(5):601. https://doi.org/10.3390/nu10050601 [ Links ]
Figueras F, Gratacós E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014;36(2):86-98. https://doi.org/10.1159/000357592 [ Links ]
Royal College of Obstetricians and Gynaecologists. The investigation and management of the small-for-gestational-age fetus: Green-top guideline No. 31. 2013. 2nd rev. ed. London: Royal College of Obstetricians and Gynaecologists, 2014. 34 p. [ Links ]
Economides DL, Nicolaides KH. Blood glucose and oxygen tension levels in small-for-gestational-age fetuses. Am J Obstet Gynecol.1989 Feb 1;160(2):385-9. https://doi.org/10.1016/0002-9378(89)90453-5 [ Links ]
Illsley NP, Baumann MU. Human placental glucose transport in fetoplacental growth and metabolism. Biochim Biophys Acta Mol Basis Dis. 2020 Feb 1;1866(2):165359. https://doi:10.1016/j.bbadis.2018.12.010 [ Links ]
Kwon H, Lee J, Lee BW, Kwon JY, Kim YH. The association between low 50 g glucosa challenge test values and adverse pregnancy outcomes. J Womens Health (Larchmt). 2018;27(6):801-7.https://doi.org/10.1089/jwh.2017.6579 [ Links ]
Naik D, Shyamasunder AH, Mruthyunjaya MD, Patil RG, Paul TV, Christina F, et al. Masked hypoglycemia in pregnancy. J Diabetes. 2017 Aug;9(8):778-86. https://doi.org/10.1111/1753-0407.12485 [ Links ]
Calfee EF, Rust OA, Bofill JA, Ross EL, Morrison JC. Maternal hypoglycemia: is it associated with adverse perinatal outcome? J Perinatol. 1999;19(5):379-82. https://doi.org/10.1038/sj.jp.7200048 [ Links ]
Pugh SK, Doherty DA, Magann EF, Chauhan SP, Hill JB, Morrison JC. Does hypoglycemia following a glucose challenge test identify a high risk pregnancy?. Reprod Health. 2009 Jul 14;6:10. https://doi.org/10.1186/1742-4755-6-10 [ Links ]
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Copyright (c) 2021 Flavio Hernández-Castro, Anaís Berlanga-Garza, Mayela Diamantina Cruz-Gutiérrez, Juan Antonio Soria-López, Gabriel Edgar Villagómez-Martínez, Iván Vladimir Dávila-Escamilla
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
