Diabetes y embarazo. Guía Asistencial 2006

[Preventive activities in women. PAPPS update 2022]

In the 2022 PAPPS update we present those specific preventive activities for women's health, except those related to cancer prevention (which are included in another document) and those aspects related to differential gender morbidity, a cross-cutting aspect for all working groups. Contraception is an essential preventive activity, considering basic the right to decide both the number of children and the time to have them. We must inform about the possible contraceptive methods, guaranteeing the monitoring of their safety, efficacy and effectiveness (tables are included on changing from one method to another to preserve contraceptive protection). We must inform about emergency contraception and propose it in the event of unprotected intercourse. All this will be done through opportunistic screening without requiring screening for thrombophilia or dyslipidemia, but for arterial hypertension. Pregnancy is an important life experience and the family doctor should not remain oblivious. We must be competent both in the preconception consultation (recommending the intake of folic acid, avoiding exposure to occupational and environmental risks, screening for certain pathologies and assessing the intake of drugs not indicated during pregnancy) and in the monitoring of pregnancy. Whether or not we monitor the pregnancy, we must not disregard its control, taking advantage of this period to promote healthy lifestyles and participating in the intercurrent processes that may occur. Menopause in general and osteoporosis in particular exemplify the strategy of medicalization of vital processes that has been followed from different instances and organizations. In our update we address the prevention and treatment of symptoms secondary to estrogen deprivation. We also propose the prevention of osteoporosis, including carrying out densitometry based on the risk of fracture in the next 10 years, and therefore densitometric screening is not recommended in women under 60 years of age. In risk assessment we recommend the use of the frax tool or better, the calibration of the risk of hip fracture with prevalence data from our setting. We linked the indication for treatment with the Z-Score (bone mineral density compared with women of the same age), as it is a condition associated with aging.

[Preventive activities in women's care]

A review is presented of the scientific evidence on preventive activities in women's care in relation to pregnancy follow-up, preventive activities in the planning and follow-up of contraceptive methods, preventive activities in menopause, and the prevention of osteoporotic fractures.

Citric/citrate buffer: an effective antiglycolytic agent

BACKGROUND

In order to minimize the influence of glycolysis on diabetes mellitus (DM) diagnostic tests, we have compared the behavior of citric/citrate, fluoride additives and gel-serum with plasma-heparin under careful preanalytical conditions. Subsequently, we compared the effectiveness of both fluoride and citric additives at different pre-centrifugation times. Finally, the influence of citric/citrate collection tube on diagnostic tests results was evaluated.

METHODS

The first study of 80 voluntary patients assessed the glucose bias of citric/citrate, fluoride additive tubes and gel-serum tubes versus plasma-heparin tubes at several medical decision cut-offs (MDC). The second study performed with 72 volunteers evaluated additives, simulating transport times to the laboratory and centrifugation delay periods. Final evaluation compares the proportion of positive tests in total tests carried out in two different periods.

RESULTS

When citric/citrate (n=79) and fluoride tubes (n=60) were compared with plasma-heparin under controlled preanalytical conditions, both met the bias specification for plasma glucose (±1.8%) at seven MDC. On the contrary, serum samples (n=15) did not meet it at five MDC. In the second study, differences in glucose values at distinct pre-centrifugation times were not statistically significant for citric/citrate tubes, but significant for fluoride tubes and also for comparison of fluoride and citric/citrate tubes. Hemolysis in fluoride tubes was higher. Citric/citrate tube implementation in our laboratory caused an increase in positive diagnostic tests that were only statistically significant for gestational diabetes mellitus (GDM) screening.

CONCLUSIONS

Citric/citrate additive tube is equivalent to plasma-heparin avoiding glycolysis completely and immediately under careful preanalytical conditions even with a 3-h delay in plasma separation. According to used MDC we have not statistically significantly increased the diagnoses of DM cases.