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Fisiopatología desde la preconcepción, durante el embarazo y después
Marie-France Hivert1, Helena Backman2, Katrien Benhalima3
1Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA.
Lancet (London, England)
|June 23, 2024
Resumen
La diabetes gestacional, la complicación más común del embarazo, es más compleja de lo que se pensaba. Comprender sus subtipos y cambios metabólicos tempranos es clave para prevenir complicaciones maternas e infantiles.
Área de la Ciencia:
- Obstetricia y ginecología
- Endocrinología
- Medicina perinatal
Sus antecedentes:
- La diabetes mellitus gestacional (DMG) es la complicación médica más frecuente durante el embarazo.
- Históricamente, el manejo de GDM se centró en el control glucémico a finales del segundo trimestre.
- La evidencia emergente destaca la influencia de los factores previos al embarazo y específicos del embarazo, incluidas las funciones no glucémicas, en la etiología y los resultados de la DMG.
Objetivo del estudio:
- Desafiar la visión tradicional de la diabetes gestacional.
- Explorar la heterogeneidad de la DMG basada en el tiempo y la fisiopatología.
- Investigar el impacto de las perturbaciones metabólicas tempranas en el desarrollo materno y fetal.
Principales métodos:
- Revisión de la evidencia reciente sobre la fisiopatología de la diabetes gestacional.
- Análisis de los factores que influyen en la glucemia gestacional.
- Examen de la secreción de insulina y de los patrones de resistencia al principio y al final del embarazo.
Principales resultados:
- La diabetes gestacional exhibe heterogeneidad, con distintos subtipos tempranos y resistentes a la insulina.
- Los cambios metabólicos tempranos de la DMG pueden perjudicar el desarrollo de la placenta y afectar el crecimiento fetal.
- Los subtipos específicos de DMG están relacionados con un mayor riesgo de complicaciones durante el embarazo.
Conclusiones:
- Una comprensión más profunda de la fisiopatología y la heterogeneidad de la DMG es crucial.
- Se necesitan nuevas estrategias de manejo para prevenir complicaciones a corto y largo plazo para las madres y la descendencia.
- Las intervenciones deben abarcar los períodos previos a la concepción, el embarazo y el posparto.
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