Support adequate scientific studies that support the factthe treatment of gestational diabetes reduces complicationsand perinatal death is relatively recent. The study ACHOIS (130)demonstrated that treatment of gestational diabetes reducedsignificantly (from 4 to 1%) severe perinatal complications(Death, shoulder dystocia, bone fracture and nerve injury), butwith increased neonatal care admissions, and the mother,more induction of labor, but without the necessity of increasing practicecesareans. In secondary outcomes in the newborn wasSignificantly lower birth weight, fewer large babiesfor gestational age, and fewer macrosomic infants inthe treatment group versus the control group. There is less clarityin the treatment effect in cases of gestational diabetes "lesssevere "and in this regard, some lights came with the publication of the studyLandon (131), which showed no difference in the frequency ofstillbirth or perinatal death or significant decreasecertain neonatal complications (hyperbilirubinemia, hypoglycemia,hyperinsulinemia or trauma at birth), but corroborated the findingsACHOIS in the study (130): significant reduction in birth weight, thenumber of macrosomic newborns and large for gestational age,and mother: fewer cesareans, hypertensive disorders,and less weight gain in pregnancy, in the group treatedversus the control group.
Proper treatment of gestational diabetes should haveas strict glycemic control target that leads to the reduction offetal and maternal complications in pregnancy and childbirth, withproper monitoring of weight gain in pregnancy. TheSelf-monitoring of blood glucose basal and postprandial especially figuresis crucial to guide treatment (122). The goalsglycemic capillary blood are: baseline values 90-99 mg / dL, 1 hourpostprandial <140 mg / dL, 2 hours post prandial <120-127 mg / dL (132),Although these figures are not necessarily accepted by allassociations interested in the subject.
Nutritional management is the mainstay of therapy, and at mostcases may be sufficient to achieve adequate metabolic control (132). If possible, all patients should be sent toassessment by a nutritionist (122.132). Although we will not detail theSpecific aspects of the diet should be taken into account that it mustbe individualized according to the culture, eating habits, physical activity,prepregnancy ideal weight, weight gain, etc.., making adjustmentslater needed to achieve compliance with the targets.Moderate physical activity (eg, walking 30 minutesdaily) has shown benefits in terms of reducing the numbersmaternal blood glucose in some studies. Although the impact of thisexercise in neonatal complications is not yet clear, the exerciseregularly during pregnancy is recommended by the ADA (122) and other organizations (132).As for drug therapy, it is important to mention thatalthough in recent years there has been an increase in publicationssupporting the use of oral hypoglycemic specific asglibenclamide and metformin in pregnancy (133.134), yet the weight of theno evidence to recommend its routine use.Insulin is the drug of choice in gestational diabetes, and isindicated when you can not meet and maintain glycemic targetspreviously mentioned nonpharmacologic measures. Duringpregnancy has approved the use of human insulins (NPH and regular)and short-acting analogues (lispro and aspart, but not glulisine). Notapproved the use of long-acting analogues (glargine and detemir). Themust be strictly individualized therapy.
We suggest you insulin at an average dose of 0.7 IU / kg / day. A common strategydosage is divided into two applications (2/3 in the morningand third before dinner), in the morning dose 2/3 will be NPH andThird is short-acting insulin in the evening dose half will NPHand 1/2 will short-acting insulin. This scheme will logicallyindividual settings according to BMI, the levels ofglycemia and lifestyle