FOR THE BRAZILIAN GESTATIONAL DIABETES STUDY GROUPOBJECTIVE -To evaluate American Diabetes Association (ADA) and World Health Organization (WHO) diagnostic criteria for gestational diabetes mellitus (GDM) against pregnancy outcomes. RESEARCH DESIGN AND METHODS -This cohort study consecutively enrolledBrazilian adult women attending general prenatal clinics. All women were requested to undertake a standardized 2-h 75-g oral glucose tolerance test (OGTT) between their estimated 24th and 28th gestational weeks and were then followed to delivery. New ADA criteria for GDM require two plasma glucose values Ն5.3 mmol/l (fasting), Ն10 mmol/l (1 h), and Ն8.6 mmol/l (2 h). WHO criteria require a plasma glucose Ն7.0 mmol/l (fasting) or Ն7.8 mmol/l (2 h). Individuals with hyperglycemia indicative of diabetes outside of pregnancy were excluded.RESULTS -Among the 4,977 women studied, 2.4% (95% CI 2.0 -2.9) presented with GDM by ADA criteria and 7.2% (6.5-7.9) by WHO criteria. After adjustment for the effects of age, obesity, and other risk factors, GDM by ADA criteria predicted an increased risk of macrosomia (RR 1.29, 95% CI 0.73-2.18), preeclampsia (2.28, 1.22-4.16), and perinatal death (3.10, 1.42-6.47). Similarly, GDM by WHO criteria predicted increased risk for macrosomia (1.45, 1.06 -1.95), preeclampsia (1.94, 1.22-3.03), and perinatal death (1.59, 0.86 -2.90). Of women positive by WHO criteria, 260 (73%) were negative by ADA criteria. Conversely, 22 (18%) women positive by ADA criteria were negative by WHO criteria.CONCLUSIONS -GDM based on a 2-h 75-g OGTT defined by either WHO or ADA criteria predicts adverse pregnancy outcomes.

An association between adult short stature and Type II (non-insulin-dependent) diabetes mellitus has been reported previously [1,2]. More recently, short stature has also been related to gestational diabetes (GDM) in Korea and Greece [3,4].To further evaluate the independence and magnitude of the relation between short stature and gestational diabetes, we investigated this association in 4973 women participating in the Brazilian Gestational Diabetes Study. We also examined whether the association occurs in both the fasting and post-load state and its variability across strata of adiposity. Subjects and methodsThe study was conducted in general prenatal care units in six state capitals in Brazil, from 1991 to 1995. A total of 5564 consecutive pregnant women aged 20 or more years with no diagnosis of diabetes outside pregnancy and who were approximately 21±28 weeks pregnant were enrolled. The Brazilian population can be divided for epidemiological purposes in three main groups: white (descendants of Europeans), black Abstract Aims/hypothesis. To examine the association between maternal stature and gestational diabetes mellitus. Methods. We studied a sample of 5564 consecutive Brazilian women 20 or more years old, who were pregnant for approximately 21±28 weeks, had no history of diabetes outside pregnancy and were attending general prenatal care units in six state capitals in Brazil from 1991 to 1995. We did a 2-h, 75-g oral glucose tolerance test, defining gestational diabetes by World Health Organisation criteria. Results. Those in the shortest quartile of height ( £ 151 cm) had a 60 % increase in the odds of having gestational diabetes, independently of prenatal clinic, age, global obesity, family history of diabetes, skin colour, referral pattern, waist circumference, parity, previous gestational diabetes, education, ambient temperature and gestational age compared with the tallest quartile [odds ratio (OR) = 1.60, p = 0.005]. This association was observed for those with above median values of skinfold thickness (OR = 1.74, p = 0.006) but not for those with below median values (OR = 1.22, p = 0.51). Associations of short stature with high 2-h glycaemia ( ³ 7.8 mmol/l) (OR = 1.61, p = 0.005) were essentially the same as those for gestational diabetes. There was, however, no association between short stature and gestational hyperglycaemia when the latter was defined exclusively by fasting values (OR = 0.97, p = 0.90). Conclusion/interpretation. In Brazil short stature associates with gestational diabetes, principally in women with greater fat mass. This difference in glycaemic levels is present postprandially but not in the fasting state. [Diabetologia (2000) 43: 848±851]

A cross-sectional study was performed involving epidemiological and clinical features of the metabolic syndrome (MS) in Spanish migrants to Brazil and their descendants. This included 479 subjects: Group A (Spanish migrants): n=215; Group B (descendants born in Brazil of Spanish parents): n=126, Group C (mixed descendants born in Brazil with either father or mother born in Spain): n=138. MS was defined according to the original NCEP/ATP III criteria and by the revised NCEP/ATP definition (glucose>or=100mg/dl). Overall prevalence of MS according to NCEP/ATP III criteria was 26.3%. Age/sex-adjusted prevalence was 27.4%. When the revised NCEP criteria were considered, overall prevalence was 30.1% (age/sex-adjusted 31.3%). The differences between the two criteria were 3.8% and 3.9% (CI -1.9-9.4%). When stratified by groups the MS was more prevalent in Group A (37.2%) and Group B (20.6%) than in Group C (10.9%). Environmental factors may have influenced the development of MS. Reason for the apparently protective role of genetic features due to admixture between populations in the mixed descendants needs to be explored.

RESUMO -Com o objetivo de determinar se tolerância diminuída à glicose (TDG) está associada a neuropatia vegetativa realizamos estudo transversal de que participaram 44 pacientes com intolerância a glicose (Grupo 1) os quais foram comparados com 43 indivíduos controles apresentando teste de tolerância à glicose normal (Grupo 2). Os pacientes de ambos os grupos, após aceitarem participar da pesquisa, eram submetidos a anamnese, exames clínico e laboratoriais e estudo da função vegetativa (intervalo QT, prova da arritmia sinusal, manobra de Valsalva e teste postural). Os pacientes com TDG apresentaram mais hipertensão arterial sistêmica, obesidade centrípeta, hiperglicemas de jejum e pós-prandiais e dislipidemias que os controles. O teste de arritmia sinusal estava alterado em 54,5% dos grupo 1 e em 32,5% do grupo 2. A manobra de Valsalva foi anormal em 34,1% no grupo 1 e em 7% dos controles (p=0,004). A prova postural não foi diferente nos dois grupos. O comprometimento do sistema neurovegetativo foi mais freqüente nos pacientes com TDG que nos controles. A maior freqüência de fatores de risco para doença aterosclerótica cardiovascular e o concomitante comprometimento do sistema nervoso vegetativo nos pacientes com TDG podem ser os responsáveis pelas elevadas taxas de letalidade devida a vasculopatias observadas nessa população. PALAVRAS-CHAVES: diabetes mellitus, neuropatia vegetativa, intolerância a glicose, neuropatia periférica.Autonomic neuropathy in patients with impaired glucose tolerance test ABSTRACT -Impaired glucose tolerance (1GT) is a clinical situation characterized by mild hyperglicemia, which is estimated to afflict 7.8% of the Brazilian population. Diabetic neuropathy is the most common: complication in diabetes mellitus and it is related to morbidity and lethality in this disease. The associatior between IGT and peripheral neuropathy is still a matter of great concern. Purpose and Method: In order to determine if IGT is associated with autonomic neuropathy a cross-sectional study in 44 patients with impaired glucose tolerance test (Group 1) was performed. The patients were compared to 43 control individuals (Group 2). Every patient in each group underwent anamnesis and standardized autonomic tests which consisted of hear) frequency test, Valsalva maneuver, postural test and sinus arrythmia. Routine hematologic exams as well as GTT were also made. Results: Patients in group 1 had more systemic arterial hypertension, centripetal obesity, fasting and post-feeding hyperglicemia and dyslipidemia when compared with group 2. When we analysed the autonomic tests, the sinus arrythmia test was abnormal in 54.5% of the patients in group 1 and in 32.5% in group 2 (p=0.0039) and the Valsalva maneuver was abnormal in 34.1% of group 1 and in 7% of group 2 (p=0.004). The postural test was not different in both groups (p=0.334). Conclusion: Our results show that the involvement of the autonomic nervous system was more frequent in patients with IGT when compared to controls. These findings can explair the increas...