Abstract
Cuban participation in and contributions to education, medical care and research on diabetes and pregnancy in Latin America dates back to the 1970s when the Latin American Diabetes Association was founded. The Cuban health system and its professionals recognized early the problems presented by diabetes during pregnancy for the health of an expectant mother and her children and assimilated and disseminated important lessons that became infl uential in the region. These included: importance of adopting a program within primary health care that offers national coverage for diabetic pregnant women, with a special focus on pre-conception monitoring of diabetic women; benefi ts of defi ning a specifi c range for application of a fasting glucose test to identify risk of gestational diabetes through selective screening for the disease; using insulin to treat gestational diabetes; controlling excessive weight at the beginning and during pregnancy; and underscoring the importance of interdisciplinary treatment of diabetes in pregnancy. The goal was to improve care and research in reproductive health for diabetic pregnant women and their children in Cuba. KEYWORDS: Gestational diabetes, pregnancy, Latin America, Cuba.
Highlights
Systematic activities in specialized medical care and research on diabetes in pregnancy were formalized in Latin America with the creation of the Latin American Diabetes Association (ALAD), founded in 1970 in Buenos Aires, Argentina
Cuban specialists have played an important role in early detection and prevention of congenital defects in children of diabetic mothers and on strict obstetric monitoring, prenatal fetal surveillance and identification of risk factors for fetal macrosomia, the most common complication in diabetic pregnancies
Cuban proposals led to new regional consensus recommendations in areas such as weight control according to initial weight and weight gain, as well as new guidelines for applying fasting blood glucose tests to screen for gestational diabetes mellitus (GDM)
Summary
Systematic activities in specialized medical care and research on diabetes in pregnancy were formalized in Latin America with the creation of the Latin American Diabetes Association (ALAD), founded in 1970 in Buenos Aires, Argentina. Cuba’s contribution to ALAD’s care recommendations for pregnant diabetics once again consisted of developing guidelines for preconception care for diabetic women.[28] The first reports on the benefits of this care were published in the early 1990s [29,30,31] and introduced in Cuba in 1992, with the founding of a preconception clinic for diabetic women in Havana, the first of this type in the country.[13] Comparing pregnancy outcomes of diabetic women who had received this specialized primary health care and those who had not showed significant differences in prevalence of congenital defects (0.9% vs 9.6%, respectively) and in perinatal mortality (0.9% vs 7.0%). Cuba remains one of the few countries in Latin America with consistent and systematic preconception care, since the PCDE provides preconception care for women with pregestational diabetes, and prenatal care for diabetic women, diagnosis of GDM, and longterm monitoring of these women and their children.[42]
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