RESUMEN
El tratamiento con corticoides puede alterar el control metabólico de las mujeres gestantes con diabetes. El caso que se presenta corresponde al de una mujer con diabetes pregestacional en tratamiento con ISCI que, tras la inyección de 2 dosis de 12 mg betametasona vía im (cada 12 h) para maduración del pulmón fetal, necesitó una adaptación de la tasa basal de insulina de la bomba de infusión. La tasa basal de insulina fue modificada en todos los periodos previamente programados, triplicando las tasas después de aplicada la primera dosis de corticoides durante las 24 h siguientes, duplicándolas el segundo día y aumentando 0,1 UI/hora el tercer y cuarto días. El incremento de insulina que supuso la nueva pauta fue de 39,5 UI/24 h el primer día, 19,75 UI/24 h el segundo, y 2,4 UI/24 h el tercer y cuarto días. Los valores de glucemia media logrados en los 4 días siguientes de las inyecciones de corticoides fueron 152, 99, 108, y 116 mg/dl (65-206), encontrándose más del 75% de las mediciones en un rango aceptable de entre 60 a 140 mg/dl. Falta saber si los buenos resultados obtenidos son reproducibles en el resto de gestantes con diabetes tipo 1 que sigan terapia con ISCI
Corticoid treatment can alter the metabolic control of pregnant women with diabetes. The reported case describes a woman with pregestational diabetes under CSII therapy, who needed an adaptation of basal rate of the insulin pump after the i.m. injection of two doses of 12 mg beclametasone (t.i.d) administered to accelerate fetal lung maturation. The basal rate was modified in each of the previously programmed periods, increasing all of them three times during the first 24 h, twice during the second day, and 0.1 IU./h the third and the forth following days. The insulin increment was the first day 39.5 IU./24 h, the second day 19.75 IU./24 h, and 2.4 IU./24 h the ensuing third and forth days. Mean blood glucose values were achieved these days were 152, 99, 108 and 116mg/dl (range 65-206), being more than 75% of determinations in an acceptable range between 60-140 mg/dl. Our recommendation needs also to be confirmed in other type 1 diabetic women treated with CSII who receive corticoids during pregnancy
Asunto(s)
Femenino , Embarazo , Adulto , Humanos , Embarazo en Diabéticas/tratamiento farmacológico , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Corticoesteroides/farmacocinética , Sistemas de Infusión de Insulina , Interacciones Farmacológicas , Índice Glucémico , Madurez de los Órganos FetalesRESUMEN
BACKGROUND: We analysed the relationship between metabolic control parameters during the preconception stage and pregnancy outcome in diabetic patients. PATIENTS AND METHOD: We examined 69 diabetic patients who underwent a preconception control at the Diabetes and Pregnancy Unit between 1992-1998. At the end of the preconception care period, 50 women (72.6%) became pregnant. Eight out of them (16%) had an abortion. RESULTS: Women who had an abortion did not differ from those who had not an abortion with regard to HbA1c levels at the end of the preconception period, age, duration of diabetes, age at diagnosis,anti-thyroid antibodies or microvascular disease. Among 41 single age stations, fetal macrosomia was observed in 36.6% cases, neonatal hypoglycemia in 19.5% and major congenital malformations in one case. Average level of HbA1c was 7.6 +/- 1.3%and 6.5 +/- 0.7 at the beginning and at the end of the preconception period, respectively (p < 0.001). In the group with macrosomia,average HbA1c at the end of the preconception period was 6.8 +/- 0.66% as opposed to 6.3 +/- 0.7% for the non-macrosomic group (p < 0.05). A linear correlation was seen between HbA1c levels at the end of the preconception period and infant weight (r = 0,432; p = 0,014), birth weight ratio (r = 0,450; p = 0,009), and a morbidity score (r = 0,458;p = 0,007). CONCLUSIONS: A better metabolic control during the preconception period may contribute to lessen the risk of fetal macrosomia and neonatal morbidity.
Asunto(s)
Atención Preconceptiva , Embarazo en Diabéticas/metabolismo , Embarazo en Diabéticas/prevención & control , Adulto , Femenino , Humanos , EmbarazoRESUMEN
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