Resultados perinatales en gestantes diabéticas en instituciones prestadoras de servicios en salud de la ciudad de Bogotá

Fuentes Obando, Lina Paola

Resultados perinatales en gestantes diabéticas en instituciones prestadoras de servicios en salud de la ciudad de Bogotá

dc.contributor.advisor	Romero Infante , Ximena Carolina
dc.contributor.advisor	Sarmiento , Diana Piedad
dc.contributor.advisor	Uriel Calvo, María Montserrat
dc.contributor.advisor	Gómez Cruz , Melissa
dc.contributor.advisor	De la Hoz-Valle , José Antonio
dc.contributor.advisor	Bastidas, Karina
dc.contributor.advisor	Bonilla, Leonardo
dc.contributor.advisor	Sánchez, Sandra
dc.contributor.advisor	Beltrán, Sandra
dc.contributor.advisor	Sarmiento, Andrés
dc.contributor.advisor	Barón , Germán
dc.contributor.advisor	Reyes Skinner, Carolina
dc.contributor.advisor	Gonzalez, Ricardo
dc.contributor.advisor	Reyes , Guillermo
dc.contributor.author	Fuentes Obando, Lina Paola
dc.date.accessioned	2025-07-31T20:18:03Z
dc.date.available	2025-07-31T20:18:03Z
dc.date.issued	2025-07
dc.description.abstract	Objetivo: Evaluar los desenlaces perinatales en gestantes con diabetes gestacional (DG) según el tipo de tratamiento recibido (dieta, metformina o insulina) en cuatro instituciones de salud de Bogotá, Colombia. Materiales y métodos: Estudio de cohortes prospectivo. Se incluyeron gestantes con DG diagnosticada según los criterios de la Asociación Internacional de Grupos de Estudio sobre Diabetes y Embarazo (IADPSG) y Carpenter y Coustan. Se recolectaron variables sociodemográficas, obstétricas y desenlaces materno-perinatales. Se aplicaron pruebas de Chi-cuadrado, test exacto de Fisher y Kruskal-Wallis. Se construyó un modelo de regresión logística multivariado para identificar predictores de desenlaces perinatales adversos (p < 0,05). Resultados: Se analizaron 385 gestantes, 92.7% completó el seguimiento. Al ingreso, 42.9% recibió dieta, 27.5% metformina y 29.6% insulina. El control metabólico adecuado fue más frecuente con insulina (90.0%; p = 0.018). Se observó mayor frecuencia de ingreso a UCIN (41.4%) y SDRA (25.9%) en el grupo insulina. En el modelo ajustado, aumentaron el riesgo de desenlaces adversos: insulina (OR: 14.86) , metformina (OR: 5.11), preeclampsia (OR: 2.34), fetopatía diabética (OR: 3.78) y menor peso fetal (OR: 0.99). El tratamiento instaurado al parto fue protector (metformina OR: 0.18; insulina OR: 0.11). AUC: 0.783; sensibilidad: 64.8%; especificidad: 75.5%. Conclusiones: La frecuencia de desenlaces maternos y perinatales en mujeres con DG varió según la estrategia terapéutica. La insulina se asoció con mejor control glucémico pero mayor riesgo perinatal. La preeclampsia, signos ecográficos de fetopatía diabética, menor peso fetal al nacer y la instauración temprana de tratamiento farmacológico fueron predictores de desenlace perinatal adverso.
dc.description.abstractenglish	Objective: To evaluate perinatal outcomes in pregnant women with gestational diabetes (GD) according to the type of treatment received (diet, metformin, or insulin) in four healthcare institutions in Bogotá, Colombia. Materials and methods: Prospective cohort study. Pregnant women with GD were included based on the diagnostic criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and Carpenter and Coustan. Sociodemographic, obstetric, and maternal-perinatal outcome variables were collected. Statistical analyses included Chi-square test, Fisher's exact test, and Kruskal-Wallis test. A multivariable logistic regression model was constructed to identify predictors of adverse perinatal outcomes (p < 0.05). Results: A total of 385 pregnant women were analyzed; 92.7% completed follow-up. At inclusion, 42.9% received dietary management, 27.5% metformin, and 29.6% insulin. Adequate metabolic control was more frequent in the insulin group (90.0%; p = 0.018). Admission to NICU (41.4%) and neonatal respiratory distress syndrome (NRDS, 25.9%) were more frequent in the insulin group. In the adjusted model, the following were associated with increased risk of adverse outcomes: insulin (OR: 14.86), metformin (OR: 5.11), preeclampsia (OR: 2.34), sonographic signs of diabetic fetopathy (OR: 3.78), and lower birthweight (OR: 0.99). Pharmacological treatment initiated at delivery was protective (metformin OR: 0.18; insulin OR: 0.11). AUC: 0.783; sensitivity: 64.8%; specificity: 75.5%. Conclusions: The frequency of maternal and perinatal outcomes in women with GD varied by treatment strategy. Insulin was associated with better glycemic control but higher perinatal risk. Preeclampsia, diabetic fetopathy, low fetal weight, and early pharmacological treatment were predictors of adverse outcomes.
dc.description.degreelevel	Especialización	spa
dc.description.degreename	Especialista en Medicina Materno-Fetal	spa
dc.description.sponsorship	Hospital Universitario Clínica San Rafael
dc.description.sponsorship	Centro Policlínico del Olaya
dc.description.sponsorship	Obgyn – Centro Diagnóstico Para La Mujer
dc.description.sponsorship	Subred Sur Occidente de Kennedy
dc.format.mimetype	application/pdf
dc.identifier.instname	instname:Universidad El Bosque	spa
dc.identifier.reponame	reponame:Repositorio Institucional Universidad El Bosque	spa
dc.identifier.repourl	repourl:https://repositorio.unbosque.edu.co
dc.identifier.uri	https://hdl.handle.net/20.500.12495/15615
dc.language.iso	es
dc.publisher.faculty	Facultad de Medicina	spa
dc.publisher.grantor	Universidad El Bosque	spa
dc.publisher.program	Especialización en Medicina Materno-Fetal	spa
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dc.rights.accessrights	info:eu-repo/semantics/closedAccess
dc.rights.accessrights	http://purl.org/coar/access_right/c_14cb
dc.rights.local	Acceso cerrado	spa
dc.subject	Diabetes
dc.subject	Gestacional
dc.subject	Insulina
dc.subject	Metformina
dc.subject	Dieta
dc.subject.keywords	Gestational
dc.subject.keywords	Diabetes
dc.subject.keywords	Diet
dc.subject.keywords	Metformin
dc.subject.keywords	Insulin
dc.subject.nlm	WQ 200
dc.title	Resultados perinatales en gestantes diabéticas en instituciones prestadoras de servicios en salud de la ciudad de Bogotá
dc.title.translated	Perinatal Outcomes in Diabetic Pregnant Women in Health Care Institutions in Bogotá
dc.type.coar	https://purl.org/coar/resource_type/c_7a1f
dc.type.coarversion	https://purl.org/coar/version/c_ab4af688f83e57aa
dc.type.driver	info:eu-repo/semantics/bachelorThesis
dc.type.hasversion	info:eu-repo/semantics/acceptedVersion
dc.type.local	Tesis/Trabajo de grado - Monografía - Especialización	spa