scholarly journals Diabetes Gestacional: Serão os Atuais Critérios de Diagnóstico Mais Vantajosos?

2018 ◽  
Vol 31 (7-8) ◽  
pp. 416 ◽  
Author(s):  
Ana Filipa Ferreira ◽  
Catarina Miranda Silva ◽  
Dora Antunes ◽  
Filipa Sousa ◽  
António Carlos Lobo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Age ◽  
International Association ◽  
Study Groups ◽  
Directorate General ◽  
Group 2 ◽  
Diabetes And Pregnancy ◽  
Group 1

Introduction: There is no international consensus regarding gestational diabetes mellitus diagnostic criteria. In Portugal, the Carpenter and Coustan criteria were replaced by an adaptation of the International Association of Diabetes and Pregnancy Study Groups criteria. Our aim was to compare the incidence and outcomes of pregnancies complicated by gestational diabetes mellitus according to the current and previous criteria.Material and Methods: Retrospective analysis of 1218 singleton pregnancies complicated with gestational diabetes mellitus, with surveillance/delivery between 2008-2015. Two groups were considered: identification according to the Directorate-General of Health criteria - International Association of Diabetes and Pregnancy Study Groups (group 1); identification through Carpenter and Coustan criteria (group 2). A comparative analysis was performed.Results: The incidence of gestational diabetes mellitus doubled (9.4% vs 4.6%), and the number of consultations/year increased (~3000 vs ~2000). In Group 1, in comparison with group 2, there was a lower risk of macrosomia in newborns [RR 0.44 (IC (95%):0.26 - 0.76)] and a higher risk of small for gestational age infants [RR 1.99 (IC (95%):1.19 - 3.31)]; a 6 - fold and 4 fold higher risk in neonatal hypoglycemia [RR 6.30 (IC (95%): 3.39 - 11.71)] and hyperbilirubinemia [RR 3.89 (IC (95%): 2.25 - 6.72)] were also observed, respectively. There were no differences regarding other outcomes. Discussion: Outcomes related to the decrease in macrosomia did now show any improvement, with even an increase in Small for Gestational Age and neonatal complications. Given the increased incidence of gestational diabetes mellitus, Directorate-General of Health – International Association of Diabetes and Pregnancy Study Groups criteria may be associated with greater healthcare-related costs due to more frequent consultations, with no apparent obstetrical/neonatal benefit.Conclusion: The Directorate-General of Health – International Association of Diabetes and Pregnancy Study Groups criteria were associated with a decrease in macrosomia, not accompanied by an improvement of obstetrical/perinatal outcomes. The benefit of using these criteria is open to debate.

scholarly journals The timing of initiation of pharmacotherapy for women with gestational diabetes mellitus

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rachel K. Harrison ◽  
Meredith Cruz ◽  
Ashley Wong ◽  
Caroline Davitt ◽  
Anna Palatnik
Keyword(s):  
Diabetes Mellitus ◽  
Preterm Birth ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Neonatal Outcome ◽  
Group 2 ◽  
Nicu Admission ◽  
Group 1

Abstract Background The decision to initiate pharmacotherapy is integral in the care for pregnant women with gestational diabetes mellitus (GDM). We sought to compare pregnancy outcomes between two threshold percentages of elevated glucose values prior to initiation of pharmacotherapy for GDM. We hypothesized that a lower threshold at pharmacotherapy initiation will be associated with lower rates of adverse perinatal outcomes. Methods This was a retrospective cohort study of women with GDM delivering in a single tertiary care center. Pregnancy outcomes were compared using bivariable and multivariable analyses between women who started pharmacotherapy (insulin or oral hypoglycemic agent) after a failed trial of dietary modifications at two different ranges of elevated capillary blood glucose (CBG) values: Group 1 when 20–39% CBG values were above goal; Group 2 when ≥40% CBG values were above goal. The primary outcome was a composite GDM-associated neonatal adverse outcome that included: macrosomia, large for gestational age (LGA), shoulder dystocia, hypoglycemia, hyperbilirubinemia requiring phototherapy, respiratory distress syndrome, stillbirth, and neonatal demise. Secondary outcomes included cesarean delivery, preterm birth (< 37 weeks), neonatal intensive care unit (NICU) admission, and small for gestational age (SGA). Results A total of 417 women were included in the study. In univariable analysis, the composite neonatal outcome was statistically significantly higher in Group 2 compared to Group 1 (47.9% vs. 31.4%, p = 0.001). In addition, rates of preterm birth (15.7% vs 7.4%, p = 0.011), NICU admission (11.7% vs 4.0%, p = 0.006), and LGA (21.2% vs 9.1% p = 0.001) were higher in Group 2. In contrast, higher rates of SGA were noted in Group 1 (8.0% vs. 2.9%, p = 0.019). There was no difference in cesarean section rates. These findings persisted in multivariable analysis after adjusting for confounding factors (composite neonatal outcome aOR = 0.50, 95%CI [0.31–0.78]). Conclusions Initiation of pharmacotherapy for GDM when 20–39% of CBG values are above goal, compared to ≥40%, was associated with decreased rates of adverse neonatal outcomes attributable to GDM. This was accompanied by higher rates of SGA among women receiving pharmacotherapy at the lower threshold. Additional studies are required to identify the optimal threshold of abnormal CBG values to initiate pharmacotherapy for GDM.

scholarly journals Abnormal glucose tolerance post-gestational diabetes mellitus as defined by the International Association of Diabetes and Pregnancy Study Groups criteria

2016 ◽  
Vol 175 (4) ◽  
pp. 287-297 ◽  
Author(s):  
Eoin Noctor ◽  
Catherine Crowe ◽  
Louise A Carmody ◽  
Jean A Saunders ◽  
Breda Kirwan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Gestational Diabetes Mellitus ◽  
Cumulative Incidence ◽  
International Association ◽  
Study Groups ◽  
Abnormal Glucose Tolerance ◽  
Diabetes And Pregnancy

Objective An increase in gestational diabetes mellitus (GDM) prevalence has been demonstrated across many countries with adoption of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria. Here, we determine the cumulative incidence of abnormal glucose tolerance among women with previous GDM, and identify clinical risk factors predicting this. Design Two hundred and seventy women with previous IADPSG-defined GDM were prospectively followed up for 5years (mean 2.6) post-index pregnancy, and compared with 388 women with normal glucose tolerance (NGT) in pregnancy. Methods Cumulative incidence of abnormal glucose tolerance (using American Diabetes Association criteria for impaired fasting glucose, impaired glucose tolerance and diabetes) was determined using the Kaplan–Meier method of survival analysis. Cox regression models were constructed to test for factors predicting abnormal glucose tolerance. Results Twenty-six percent of women with previous GDM had abnormal glucose tolerance vs 4% with NGT, with the log-rank test demonstrating significantly different survival curves (P<0.001). Women meeting IADPSG, but not the World Health Organization (WHO) 1999 criteria, had a lower cumulative incidence than women meeting both sets of criteria, both in the early post-partum period (4.2% vs 21.7%, P<0.001) and at longer-term follow-up (13.7% vs 32.6%, P<0.001). Predictive factors were glucose levels on the pregnancy oral glucose tolerance test, family history of diabetes, gestational week at testing, and BMI at follow-up. Conclusions The proportion of women developing abnormal glucose tolerance remains high among those with IADPSG-defined GDM. This demonstrates the need for continued close follow-up, although the optimal frequency and method needs further study.

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