BackgroundIn August 2011, the Specialized Center for Diabetes and Pregnancy of the Botucatu Medical School/Unesp adopted a new diagnostic protocol for gestational diabetes mellitus, recommended by the American Diabetes Association and the International Association of the Diabetes and Pregnancy Study Group. The glycemic profile was evaluated using the 75-g oral glucose tolerance test (OGTT) used to diagnose mild gestational hyperglycemia, recognized and treated in our department as gestational diabetes mellitus. The cost-effectiveness of the new guidelines and the continued need for the evaluation of the glycemic profile, as part of our Service protocol, are controversial and require further investigation. We aimed to assess the impact of the new guidelines on the evaluation of mild gestational hyperglycemia and gestational diabetes mellitus, the incidence of adverse perinatal outcomes, and the association between the 75-g OGTT and the glycemic profile for the diagnosis of mild gestational hyperglycemia.MethodsThis cross-sectional study was performed identifying a convenience sample of pregnant women and their newborns. The women used our Service for diagnostic procedures, prenatal care and delivery, both before (January 2008 to August 14, 2011) and after (August 15, 2011 to December 2014) the protocol modification. The following variables were compared, following stratification according to diagnostic protocol: prevalence of gestational diabetes mellitus and mild gestational hyperglycemia, newborns large for gestational age, macrosomia, first cesarean delivery, and newborn hospital stay. Statistical analysis was performed using Poisson regression, the Student’s t test, the Chi square or Fisher’s exact test and risk estimate. The statistical significance threshold was set at 95% (p < 0.05).ResultsThe new protocol resulted in an 85% increase in the number of women with GDM, but failed to identify 17.3% of pregnant women classified as having mild gestational hyperglycemia, despite a normal 75-g OGTT. The new guidelines did not affect perinatal outcome.ConclusionsThese results support the validity of maintaining the glycemic profile as part of the diagnostic protocol at our hospital. Large multicenter studies with an adequate sample size are required for conclusive evidence on the cost-effectiveness of the new protocol.

BACKGROUND – In Brazil, the prevalence of maternal hyperglycemia is among the highest, costs are elevated and there is no evidence to recommend universal screening. OBJECTIVE – To evaluate the performance of risk factors (RF) for predicting hyperglycemia in pregnancy – Mild Gestational Hyperglycemia (MGH) or gestational Diabetes Mellitus (GDM) in public primary-care centers in Brazil. METHODS – A cohort study, including 514 women with a single pregnancy and no hyperglycemia. Study participants were evaluated at GA (gestational age) < or ≥ 20 weeks, and underwent a 75g-OGTT along with glycemic profile (GP) testing between 24 and 28 weeks. Clinical, anthropometric and laboratory data – fasting glucose (FG), glycated hemoglobin (HbA1c), basal insulin and lipid profile were obtained. The most common RF associations (OR and 95% CI and p <0.05) and different cut-off points were tested for the prediction of MGH-GDM. Predictive performance was assessed by Sensitivity/Specificity, negative predictive value NPV (negative predictive value) and false positive rates (FP; 1-Esp). RESULTS – At GA <20 weeks, age ≥25 years, WC (Waist circumference) ≥ 88 cm, BMI pre ≥25 kg/m 2 (pre gestational body mass index) and BMI gest ≥25 kg/m 2 (gestational body mass index ); at GA (gestational age) ≥20 weeks, age ≥25 years, BMI pre ≥25 kg/m 2 and TG (triglicerides) ≥150 mg/dL showed better performace for predicting MGH-GDM. Irrespective of gestational age, FG (Fasting glucose) ≥ 85 mg/dL, HbA1c ≥5.7% and HOMA-IR ≥2.71 were good predictors to rule out the risk of these complications. CONCLUSION – The results of this study should contribute to define the best diagnostic approach to MGH-GDM in our center and in others with similar characteristics.

Background: Diabetes mellitus (DM) is a public health concern spread worldwide. Maternal diabetes in pregnancy increases risk of adverse perinatal and maternal outcomes; therefore; affecting the women´s quality of life (QOL). Objective: To evaluate quality of life in pregnant women with diabetes mellitus, gestational diabetes or mild gestational hyperglycemia. Study Design: This is a prospective and longitudinal study. The sample comprised 105 pregnant women, i.e. 66 Hyperglycemic (HG) and 39 Normoglycemic (NG). The validated Whoqol-Bref/Quality of Life Assessment questionnaire was applied at the first prenatal appointment or at time of disease diagnosis; and reapplied at delivery admission or at 36-37 weeks' gestation. Results: Most pregnant women considered good QOL at early pregnancy, but not at late pregnancy. In general, they were satisfied with their quality of life. NG pregnant women were more satisfied than their HG counterparts. At the onset of the gestational period the HG group obtained lower scores in the physical domain than the NG group. At the end of the gestational period, the scores on physical, psychological and environmental domains were significant lower in pregnant women with diabetes or hyperglycemia. Conclusion: The study demonstrated that pregnant women with diabetes or hyperglycemia were compromised in certain aspects of quality of life.