Diagnostic protocol for gestational diabetes mellitus (GDM) (IADPSG/ADA, 2011): influence on the occurrence of GDM and mild gestational hyperglycemia (MGH) and on the perinatal outcomes

Abstract

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.

Incidence and risk factors for hyperglycemia in pregnancy among nulliparous women: A Brazilian multicenter cohort study

“…According to the literature, all these possibilities could mask the expected differences in perinatal outcomes. In IADPSG protocol studies, the small sample size was used to explain the increasing incidence of GDM (10 to 25%) and limited effect on perinatal results [35][36][37][38]. Overweight or obesity alone has been associated with the risk of developing GDM and Metabolic Syndrome (MetS).…”

Identifying risk effectors involved in neonatal hypoglycemia occurrence

“…Accumulated studies have shown that pregnancy complications, such as pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM) and intrahepatic cholestasis (ICP), could affect perinatal situations [7][8][9][10][11][12][13]. Glucose plays important roles in brain metabolism and brain development in newborns.…”

Risk Factors for the Prediction of Hyperglycemia during Pregnancy – A Cohort Study from a Brazilian Public Primary Care Center

“…In our study, we evaluated the value of risk factor for predicting not only GDM (using 75-g OGTT 3 as gold standard), but also MGH (using glucose profile as gold-standard). Although this approach makes comparison with other studies difficult, it is justified by the fact that the new GDM diagnostic criteria are not met by 17% of our patients, who otherwise would be left untreated to suffer maternal and perinatal consequences [4][5][6] .…”

“…Furthermore, we combine glucose profile testing (GP) with a 75g-OGTT to identify women with mild gestational hyperglycemia (MGH), who represent 17.3% of our patient population and do not meet GDM diagnostic criteria 4 . Women with MGH show the same maternal and fetal outcomes seen in those with GDM and, therefore, should be identified and treated for glycemic control during pregnancy 5,6 .…”