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Diabetes mellitus gestacional

  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Última revisão: 26 Sep 2025
Última atualização: 13 Aug 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presencia de factores de riesgo (generalmente asintomáticos)
Detalhes completos

Outros fatores diagnósticos

  • poliuria
  • polidipsia
  • macrosomía fetal en un embarazo anterior
Detalhes completos

Fatores de risco

  • índice de masa corporal (IMC) elevado
  • diabetes gestacional previa
  • anterior bebé macrosómico
  • antecedentes familiares de diabetes mellitus
  • ascendencia no blanca
  • edad materna avanzada (>40 años)
  • síndrome del ovario poliquístico (SOPQ)
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • test de tolerancia a la glucosa oral (PTGO)
Detalhes completos

Investigações a serem consideradas

  • glucosa en sangre (plasmática) al azar
  • HbA1c
  • glucosa plasmática en ayunas
Detalhes completos

Algoritmo de tratamento

AGUDA

glucosa plasmática en ayunas ≥7 mmol/L (≥126 mg/dL), o de 6 a 6.9 mmol/L (108-124 mg/dL) si el feto es de gran tamaño/polihidramnios

glucosa plasmática en ayunas <7 mmol/L (<126 mg/dL) sin feto grande/polihidramnios

trabajo de parto

Colaboradores

Autores

Eleanor Scott, BM, BS, MD, FRCP

Professor of Medicine (Diabetes and Maternal Health)

Leeds Institute of Cardiovascular and Metabolic Medicine

Leeds Centre for Diabetes and Endocrinology

Leeds

UK

Declarações

ES has delivered lectures and educational events for numerous organisations. She has received honoraria for talks/workshops given by Ypsomed and Lilly Diabetes Care. ES has received research grant support from the National Institute for Health and Care Research (NIHR), Abbott Diabetes Care, and the Medical Research Council (MRC) - this has gone directly to her University of Leeds employer. All of the above relate to the theme of diabetes in pregnancy. She has no contractual agreements to disseminate any product information.

Rebecca Spencer, MBChB, BSc, MRCOG, PhD

NIHR Clinical Lecturer in Obstetrics and Gynaecology

University of Leeds

Leeds

UK

Declarações

RS has received a grant from the Academy of Medical Sciences, funding from NIHR, travel and accommodation expenses from the Drug Information Association to speak at their European conference, and Tommy’s; none of these relate to the topic covered. RS has acted as an unpaid consultant to Comanche Biopharma, who are developing a novel therapy for pre-eclampsia.

Agradecimentos

Dr Scott and Dr Spencer would like to gratefully acknowledge Dr Ellen W. Seely, Dr Chloe Zera, Dr Jeremy Soule and Dr Leonard E. Egede, previous contributors to this topic.

Declarações

EWS and CZ declare that they have no competing interests. JS has undertaken research support and speakers' bureau activity for Novartis, Bristol Myers Squibb, Astra Zeneca, and Sanofi-Aventis. LEE is an author of a number of references cited in this topic.

Revisores

Helen Murphy, MBBch, BAO, FRACP, MD

Clinical Professor in Medicine (Diabetes and Antenatal Care)

University of East Anglia

Norwich

UK

利益声明

HM sits on the Medtronic (insulin pump and CGM manufacturer) European scientific advisory board. HM has received research support (CGM sensors and insulin pumps) at reduced cost from Medtronic, Dexcom, and Johnson & Johnson. MH has contributed to educational events sponsored by NovoNordisk, Medtronic, Dexcom, and Abbott Diabetes Care.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Metzger BE, Gabbe SG, Persson B, et al; International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010 Mar;33(3):676-82.全文  摘要

Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract. 2014 Mar;103(3):341-63.全文  摘要

American Diabetes Association. Standards of care in diabetes - 2025. Diabetes Care. 2025 Jan 1;48(Suppl 1):S344-52.全文

National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. Dec 2020 [internet publication].全文

Joint British Diabetes Societies for Inpatient Care Group (JBDS-IP). Managing diabetes and hyperglycaemia during labour and birth. Feb 2023 [internet publication].全文

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • 鉴别诊断

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  • 指南

    • Standards of care in diabetes - 2025
    • Diabetes in pregnancy: management from preconception to the postnatal period
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