HIPERGLICEMIA Y EMBARAZO

Abstract

The HAPO study encompassed 25,505 unique pregnancies across 9 countries, which underwent a 2-hour Oral Glucose Tolerance Test (OGTT) with 75 g of glucose between weeks 24 to 32 of gestation. In 2010, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) reported that the diagnosis of hyperglycemia in pregnancy could be established using fasting values, and 1 and 2 hours post OGTT levels associated with a 1.75 times increased risk above the average of adverse effects found in the HAPO study. These levels corresponded to fasting blood sugar ≥ 92 mg/dl, 1-hour blood sugar ≥ 180 mg/dl, and 2-hour blood sugar ≥ 153 mg/dl.

Although the OGTT in the HAPO study was conducted from week 24 to 32 of pregnancy, the World Health Organization in 2013 recommended using these values for the diagnosis of hyperglycemia in pregnancy outside of this gestational period, a recommendation that was later endorsed by the International Federation of Gynecology and Obstetrics (FIGO) in 2015.

However, a retrospective cohort study of 6,035 pregnancies in Peruvian women who underwent OGTT between weeks 7 to 41 of pregnancy demonstrated that several factors including the number of fetuses, gestational age, maternal age over 24 years, body mass index over 24.9 kg/m², number of prior births, the presence of poor reproductive history, and personal or family history of cardiovascular risk diseases affected maternal blood sugar levels during pregnancy. Consequently, the Lima criteria were established, corresponding to blood sugar levels ≥ 95th percentile in 650 healthy, nulliparous women aged 18 to 24 years, with singleton pregnancies and without factors affecting maternal blood sugar. This criterion demonstrated greater sensitivity and accuracy in identifying pregnant women who underwent primary cesarean section, neonates with a weight over 4 kg, preterm neonates, neonates large for gestational age, and neonatal sepsis compared to the IADPSG criteria.