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|a Olmas, José María.
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|a Validación de un instrumento predictivo para la detección de la diabetes mellitus gestacional /
|c José María Olmas.
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| 260 |
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|a Córdoba RA :
|b [s.n.],
|c 2017
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|a 87 h. :
|b il.,
|c 28 cm. +
|e CD texto completo.
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| 502 |
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|a Tesis-Doctor en Medicina y Cirugía-Universidad Nacional de Córdoba. Facultad de Ciencias Médicas, 2017
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|a Los diferentes tipos de Diabetes Mellitus, y especialmente el Tipo 2, aumentan progresivamente, en la mayoría de países, y Argentina no es una excepción. La Diabetes Mellitus Gestacional (DMG), que es una forma clínica que aparece o se reconoce por primera vez durante la gesta actual, produce diferentes morbilidades en la madre y en su progenie y, ocasionalmente, mortalidad perinatal. Su incidencia varía entre 2,5% y 20% del total de gestaciones, dependiendo de las poblaciones y etnias, pero también de la presencia o ausencia de diferentes factores de riesgo que predicen, en menor o mayor grado, el posible desarrollo de DMG en una paciente en particular. El objetivo del presente trabajo de investigación es validar un instrumento predictivo para la DMG basado en el análisis de diferentes factores de riesgo. La hipótesis de trabajo es que tal instrumento permitirá la identificación de las gestantes de riesgo, evitándose la realización de pruebas de detección innecesarias. Se presenta un diseño clásico de los estudios de observación, pero realizado en dos etapas: la primera (Fase 1) es un estudio retrospectivo sobre gestantes asistidas en el Hospital Materno Provincial de la ciudad de Córdoba, para detectar la presencia de factores de riesgo y la importancia jerárquica de cada uno de ellos. La segunda etapa (Fase 2) es un análisis prospectivo sobre gestantes atendidas en el mismo Hospital, dos años después. Los factores de riesgo detectados y analizados en la Fase 1 fueron imputados a las pacientes de Fase 2 para determinar riesgos relativos, valores predictivos y razones de verosimilitud.
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|b ABSTRACT : The prevalence of diabetes mellitus (DM) is rising worldwide. This rise occurs mostly because Type 2 DM and gestational diabetes mellitus (GDM) are steadily Increasing due to a likely association to the growing rates of obesity. Argentina is no exception to this epidemiologic trend. GDM is a form of DM first appearing, or first recognized in an actual pregnancy. It produces different morbidities in mothers and offspring, and some of them are long-lasting. Rates vary between 2,5% and 20% depending on the population studied and its ethnic background. There are several risk factors (RF) that may be helpful in predicting GDM, allowing for early detection. The aim of this Thesis is to validate a predictive screening score to detect GDM based on the analysis of different RF. The working hypothesis is that such a score will allow early detection of pregnant women at risk, in order to detect which patients must undergo confirmatory blood work up such as the oral glucose tolerance test (OGTT). During Phase 1, 823 clinical records were randomly selected. Excluded were 31 (3,7%) records due to previous fasting hyperglycemia. The remaining 792 form the database for analysis. The OGTT was positive in 72 (9, 09%) women. At least one RF was found in 627 (79%) whereas no RF were found in the remaining 165 (21%). Median maternal ages were 30 [16-42] in the normal OGTT subgroup and 33 [25 43] in the positive OGTT women (p = 0.0002). The RF family history of DM in first degree relatives was more common among OGTT positive women (72%) than in normal subjects (62,6%) (p = 0.002). BMI ≥ 27 kg/m2 and age ≥ 30 years were far more common (86% each) in women with abnormal OTGG, unlike their OGTT normal counterparts who showed frequencies of 41.5% and 33,7% respectively (p = 0.0001). Logistic regression analysis showed no significant associations for other RF such as macrosomia, large for gestational infants, and perinatal or maternal mortality. Polycystic ovarian syndrome showed a high OR (3,72) despite its very low frequency (4,5%). Best predictors were the following RF: age ≥ 30 years, BMI ≥ 27 kg/m2 and polycystic ovarian syndrome, followed by a previous history of GDM.
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|x epidemiología
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|a Diabetes Mellitus
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|a estudios de validación
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|a Argentina
|9 409
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|a Factores de Riesgo
|9 77
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| 650 |
1 |
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|a Embarazo
|9 263
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| 700 |
1 |
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|a Halac, Eduardo
|e ths
|9 1488
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| 856 |
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|u http://lildbi.fcm.unc.edu.ar/lildbi/tesis/Olmas_jose_maria-2017.pdf
|z On-LINE
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