Dysglycemias in pregnancy: from diagnosis to treatment. Brazilian consensus statement (original) (raw)
Related papers
2020
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, nega...
2018
AIMS OF THE STUDY We describe the impact of different forms of dysglycemia on maternal and neonatal health. This research is a part of the PEARL-Peristat Maternal and newborn registry, funded by Qatar National Research Fund (QNRF) Doha, Qatar. METHODS A population-based retrospective data analysis of 12,255 women with singleton pregnancies screened during the year 2016-2017, of which 3,027 women were identified with gestation diabetes mellitus (GDM) during pregnancy and 233 were diabetic before pregnancy. Data on maternal outcome was collected from the PEARL-Peristat Maternal and newborn registry. RESULTS The prevalence of GDM and diabetes mellitus (DM) was 24.7 % and 1.9%, respectively. 55% of DM, 38% of GDM and 25.6% of controls were obese (p<0.001). 71% of pregnant women with DM and 57.8% of those with GDM were older than 30 years versus 44.2% of controls. Pregnant women with DM or GDM had higher prevalence of hypertension versus normal controls (9.9%, 5.5% and 3.5%, respectiv...
Diabetes and Pregnancy: an Update of the Problem
Annual Review of Biomedical Sciences, 2007
. Pregnancies complicated by diabetes account for about 7% of all pregnancies attended by the Brazilian Unified Healthcare System (SUS) and are one of the main causes of maternal/perinatal morbidity and mortality in Brazil. Considering the importance of this topic, this article presents an update of diabetes classification, diagnostic criteria, maternal/perinatal outcomes, and both clinical and obstetric prenatal care. Even though there is no consensus about screening and diagnostic standards, the investigation of hyperglycemia in all risk pregnancies is recommended. The importance of adequate metabolic control is emphasized in order to improve maternal and neonatal outcomes. Finally, the development of educational programs is encouraged, viewing not only good gestational outcome but also long-term changes in the lifestyle of these women.
Diabetology & Metabolic Syndrome, 2020
Background While sufficient evidence supporting universal screening is not available, it is justifiable to look for specific risk factors for gestational diabetes mellitus (GDM) or hyperglycemia in pregnancy (HIP). The objective of this study is to identify independent risk factors for HIP and its adverse perinatal outcomes in a Brazilian public referral center. Methods We included 569 singleton pregnant women who were split into three groups by glucose status: GDM (n = 207), mild gestational hyperglycemia (MGH; n = 133), and control (n = 229). Women who used corticosteroids or had a history of DM were excluded. HIP comprised both GDM and MGH, diagnosed by a 100 g- or 75 g-oral glucose tolerance test (OGTT) and a glucose profile at 24–28 weeks. Maternal characteristics were tested for their ability to predict HIP and its outcomes. Bivariate analysis (RR; 95% CI) was used to identify potential associations. Logistic regression (RRadj; 95% CI) was used to confirm the independent risk ...
A new diagnostic perspective – hyperglycemia in pregnancy – as of the year, 2014
Current Issues in Pharmacy and Medical Sciences, 2014
Gestational Diabetes Mellitus (GDM) is a growing epidemiological problem, and it is currently the most common metabolic disorder in pregnancy, as it affects approximately 2-6% of all pregnant women. In 2014, the Polish Diabetic Association introduced significant changes in the diagnosis of hyperglycemia as first diagnosed in pregnancy, based on the recommendations of the IADPSG of 2010 and WHO of 2013. There are now two categories: diabetes in pregnancy, and GDM. These involve different degrees of severity of metabolic complications for the mother and the growing fetus. Establishing a new diagnostic criterion is significant because of the negative impact of hyperglycemia on the fetus (especially in the first trimester), the increased prevalence of malformations or the possibility of spontaneous abortions in early pregnancy.
medRxiv (Cold Spring Harbor Laboratory), 2022
Objective: To analyze the maternal-fetal characteristics of patients with gestational diabetes mellitus (GDM) attended in a private service. Materials and Methods: This is a cross-sectional study. Data collection was carried out from the medical records of patients diagnosed with GDM at Centro Hospitalar UNIMED, in Joinville city, between 2011 and 2017. Maternal-fetal characteristics, therapeutics and complications of pregnant women diagnosed with GDM were analyzed. Results: 515 patients with GDM were reported. Of the maternal characteristics, the mean age was (31.77), BMI (27.82). The proportion of obese pregnant women was (55.6%), normal (42.4%) and low weight (2%). The preference for cesarean section was (81.4%) and Gestational Age (GA) of GDM diagnosis (26.85), with higher diagnosis in the third trimester (65.2%) than second (29.3%) and first (5.3%). Incidences of hypertension (7.4%), preeclampsia (0.6%) and pregnant women with previous abortions (16.5%) were found. The mean glycemic profile showed HbA1C (5.26), estimated glucose (104.30) and FPG fasting (86.38), in the first hour (144.46) and in the second hour (64.15). Treatment with diet and exercise (38.3%), metformin (40%), insulin (14.5%) and combined (7.8%). Regarding newborns, the mean weight was (3.123.46) and the GA at birth (37.46). Regarding the percentile, AGP (71.8%), SGP (28.2%) and no cases of LGP. In terms of adverse outcomes, hyperbilirubinemia was evidenced in (25.6%), prematurity (10.9%) and fetal hypoglycemia (9.9%). Conclusion: Pregnant women diagnosed with GDM had a higher GA at diagnosis in the third trimester and more cesarean sections. Among the adverse outcomes related to newborns, there were more cases of hyperbilirubinemia, prematurity and fetal hypoglycemia.
GESTATIONAL DIABETES MELLITUS: A SILENT AND GROWING PROBLEM IN BRAZIL'S HEALTH - A LITERATURE RESCUE (Atena Editora), 2022
INTRODUCTION: Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder in the pregnancy cycle. In recent years, the number of cases has increased, mainly due to the increase in obesity. GOAL: Discuss in the light of the literature on the topic of Gestational Diabetes in Brazilian women from 2019 to 2021. METHODOLOGY:The present study carries out an exploratory bibliographic research on Scielo platforms; Virtual Health Library and the Report on Screening and Diagnosis of Gestational Diabetes Mellitus in Brazil; in addition to databases such as Associação Brazileira de Diabetes in a period of 3 years, between 2019 and 2021. As inclusion criteria, articles in Portuguese, published between 2019 and 2021 were used. The exclusion criteria were English language, dissertations and TCCs. 16 articles were located, and after analysis, 13 were excluded, finally, the study consisted of 3 publications. RESULT: Of the studies surveyed, the largest number were those from the year 2019, totaling 10 (63%); followed by 2019, totaling 04 (25%). The others dated from 2020 and 2021, 01 (6%) in each year. However, only 3 (18.7%) referred to the importance of the topic addressed, therefore, used. GDM is understood as the inability of the maternal body to secrete insulin at levels necessary to meet the needs of the pregnancy-puerperal cycle. GDM is liable to develop in any woman, but it is common in those with risk factors such as advanced age, a history of gestational diabetes, polycystic ovary syndrome or obesity. It can cause complications such as preeclampsia, preterm birth, macrosomia, fetal malformations and fetal death. According to the class, DMG can be controlled only with lifestyle change (SEM). CONCLUSION: GDM, a relevant public health problem, is influenced by several factors. However, the cases can decrease when associating an adequate work of the multiprofessional team in the prenatal and SEM follow-up.
2016
nization (WHO) diagnostic criteria for gestational diabetes mellitus (GDM) against pregnancy outcomes. RESEARCH DESIGN AND METHODS — This cohort study consecutively enrolled Brazilian adult women attending general prenatal clinics. All women were requested to under-take 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 5.3mmol/l(fasting),5.3 mmol/l (fasting), 5.3mmol/l(fasting),10 mmol/l (1 h), and 8.6mmol/l(2h).WHOcriteriarequireaplasmaglucose8.6 mmol/l (2 h). WHO criteria require a plasma glucose 8.6mmol/l(2h).WHOcriteriarequireaplasmaglucose7.0 mmol/l (fasting) or $7.8 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 1.2...
Diabetes Research and Clinical Practice, 2014
The high prevalence of diabetes globally and its increasing frequency in women of gestational age have generated new research data on the relationship between glycaemia and pregnancy outcomes. The diagnostic criteria for hyperglycaemia in pregnancy recommended by the World Health Organization (WHO) in 1999 were not evidence-based and needed to be updated in the light of previously unavailable data. The update follows the WHO procedures for guidelines development. Systematic reviews were conducted for key questions, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess the quality of the evidence and to determine the strength of the recommendation on the diagnostic cutoff values for gestational diabetes. Where evidence was absent (diagnosis of diabetes in pregnancy) or GRADE was not deemed suitable (classification), recommendations were based on consensus. The systematic review of cohort studies showed that women with hyperglycaemia detected during pregnancy are at greater risk for adverse pregnancy outcomes, notably, macrosomia of newborn and pre-eclampsia, even after excluding the more severe cases of hyperglycaemia that required treatment. Treatment of gestational diabetes (GDM) is effective in reducing macrosomia, large for gestational age, shoulder dystocia and pre-eclampsia/hypertensive disorders in pregnancy. The risk reduction for these outcomes is in general large, the number need to treat is low, and the quality of evidence is adequate to justify treatment of GDM. Quality of evidence: not graded Strength of recommendation: not evaluated Diagnostic criteria for diabetes in non-pregnant individuals are based on the relationship between plasma glucose values
2014
Objective: To assess the relationship between nutritional status and glycemic control in pregnant women with diabetes hospitalized in a public maternity hospital in Fortaleza-CE. Methods: Observational, descriptive and cross-sectional study conducted with 11 diabetic pregnant women hospitalized in a reference maternity hospital between July and November 2012. Clinical, obstetric, pre-natal, weight gain, insulin and glucose data were obtained from records and prenatal care cards; socioeconomic data and obstetric and nutritional history data were obtained through direct interviews. Qualitative variables were presented in absolute numbers and simple frequency, and quantitative variables were presented using mean and standard deviation. Results: The participants were aged 31.4±4.2 years. The majority (81.9%, n=9) started pregnancy with weight deviation such as overweight (27.3%; n=3) and obesity (54.5%; n=6) and used a greater amount of insulin per day, mean of 39.5±16.8 International U...