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Objective To describe the frequency and types of congenital anomalies and associated risk factors in Brazilian women with type 2 diabetes. Methods In this retrospective cohort study between 2005 and 2021, we included all pregnant participants with type 2 diabetes from the two major public hospitals in southern Brazil. We collected data from the electronic hospital records. Congenital anomalies were classified by the 10 th revised International Classification of Diseases, Q chapter, enhanced by the EUROCAT registry classification, and categorized by type and gravity. We used multiple Poisson regression with robust estimates to estimate risks. Results Among 648 participants, we excluded 19, and 62 were lost to follow-up; therefore, we included 567 participants. Overt diabetes arose in 191 participants (33.7%, 95% CI 30.0% – 38.0%). Less than 20% of the participants supplemented folate. Congenital anomalies occurred in 78 neonates (13.8%, CI 11.0 − 16.9%), 73 babies (93.6%) presented major anomalies, and 20 (10.5%) cases occurred in participants with overt diabetes. Cardiac anomalies were the most frequent (43 isolated and 12 combined). Pre-eclampsia was associated with an increased risk in the analyses including all women (adjusted RR 1.87 (95% CI 1.23–2.85), p  = 0.003), but not in analyses including only women with an HbA1c measured up to the 14 th gestational age. HbA1c, either measured at any time in pregnancy (adjusted RR 1.21 (95% CI 1.10–1.33), p  < 0.001) or up to the first 14 weeks (adjusted RR 1.22, 95% CI 1.10–1.35, p  < 0.001) was the only sustained risk factor. Risk factors such as maternal age, obesity, diabetes diagnosis, or use of antidiabetic medications were not associated with congenital anomalies. Conclusion We found a high frequency of congenital anomalies associated with poor maternal glycemic control and revealed an almost universal lack of preconception care. An urgent call to action is mandatory for the reversal of this gray scenario.

Background During the COVID-19 pandemic, some studies describing different aspects of the infection included very similar participants, rising suspicion about double reporting. We aimed to evaluate the Gantt chart as a tool to highlight possible double reporting. The chart is routinely used in business applications to depict tasks of a project, by plotting horizontal bars against time, showing their time span and overlaps. Methods All case reports and case series of pregnant women with COVID-19, published by July 15, 2020, were included. Initial and final dates of participants’ enrollment, country, city, hospital, and number of pregnancies were plotted in the Gantt chart. Bars stand for enrollment dates of each study, according to hospital and city, thus allowing comparisons. Results We included 116 articles in the present analysis. The Gantt chart highlighted papers in which some participants were likely the same, thus allowing easier identification of double reporting of cases. Combining all information and pregnancy characteristics and outcomes helped to recognize duplications when the authors did not acknowledged the previous publication. Conclusions Unintended double reporting may occur, especially in exceptional times. The Gantt chart may help researchers to visually identify potential duplications, thus avoiding biased estimates in systematic reviews or meta-analysis.

BACKGROUND Vitamin D deficiency in pregnancy has been associated with an increased risk of preeclampsia. However, the association between serum vitamin D and blood pressure in pregnant women has been scarcely evaluated, particularly in women with a high risk of developing hypertensive disorders of pregnancy. We sought to evaluate the association between serum 25-hydroxyvitamin D and blood pressure in pregnant women with gestational diabetes mellitus (GDM). METHODS A cohort of 184 pregnant women with GDM was followed during the third trimester of pregnancy and early puerperium. Blood pressure was recorded in all prenatal visits, and serum vitamin D was measured by chemiluminescence immunoassay. Pearson's coefficients and multiple linear regressions were used to study predictors of blood pressure levels. RESULTS Women with vitamin D insufficiency (<30ng/mL; n = 159) had higher systolic and diastolic blood pressure than the remaining participants. In white women (n = 136), serum vitamin D levels presented a significant negative correlation with systolic blood pressure at the beginning (r = −0.268; P = 0.002) and at the end of the third trimester (r = −0.203; P = 0.02), and vitamin D significantly affected systolic blood pressure after adjusting for confounders. This was not observed in women of other ethnicities. CONCLUSIONS In this cohort of pregnant women with GDM, vitamin D insufficiency was associated with higher blood pressure, and in white women, serum vitamin D was an independent predictor of systolic blood pressure during pregnancy.

Gestational Diabetes Mellitus Diagnosed With a 2-h 75-g Oral Glucose Tolerance Test and Adverse Pregnancy Outcomes Maria I. Schmidt , MD, PHD 1 , Bruce B. Duncan , MD, PHD 1 , Angela J. Reichelt , MD, PHD 2 , Leandro Branchtein , MD, PHD 2 , Maria C. Matos , MD, PHD 2 , Adriana Costa e Forti , MD, PHD 3 , Ethel R. Spichler , MD, PHD 4 , Judith M.D.C. Pousada , MD, PHD 5 , Margareth M. Teixeira , MD, MS 6 , Tsuyoshi Yamashita , MD 7 and For the Brazilian Gestational Diabetes Study Group 1 Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre 2 Postgraduate Program in Clinical Medicine, Federal University of Rio Grande do Sul, Porto Alegre 3 Department of Clinical Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará 4 Department of Obstetrics and Gynecology, Instituto Fernandes Figueira–Oswaldo Cruz Foundation, Rio de Janeiro 5 Department of Medicine, Medical School, Federal University of Bahia, Salvador, Bahia 6 Department of Medicine, Federal University of Amazonas, Manaus, Amazonas 7 Hospital dos Servidores Públicos do Estado de São Paulo, São Paulo, Brazil Abstract OBJECTIVE —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 enrolled Brazilian 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 ≥5.3 mmol/l (fasting), ≥10 mmol/l (1 h), and ≥8.6 mmol/l (2 h). WHO criteria require a plasma glucose ≥7.0 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 1.29, 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. ADA, American Diabetes Association GDM, gestational diabetes mellitus OGTT, oral glucose tolerance test RR, relative risk WHO, World Health Organization Footnotes Address correspondence and reprint requests to Maria Inês Schmidt, Av. Luiz Manoel Gonzaga, 630/8, Porto Alegre, RS 90470-280 Brazil. E-mail: bbduncan{at}orion.ufrgs.br . Received for publication 12 October 2000 and accepted in revised form 28 February 2001. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

To evaluate fasting plasma glucose as a screening test for states of gestational diabetes. Baseline data of a cohort conducted in general prenatal care units in Brazil, enrolling 5,579 women aged > or = 20 years with gestational ages of 24-28 weeks at the time of testing and no previous diagnosis of diabetes. A standardized 2-h 75-g oral glucose tolerance test was performed in 5,010 women. Gestational diabetes and its subcategories--diabetes and impaired glucose tolerance--were defined according to the 1994 World Health Organization panel recommendations. We evaluated screening properties of calculated sensitivity and specificity for fasting plasma glucose with receiver operator characteristic curves. For detection of the subcategory diabetes, a fasting plasma glucose of 89 mg/dl jointly maximizes sensitivity (88%) and specificity (78%), identifying 22% of the women as test-positive. For detection of impaired glucose tolerance, a value of 85 mg/dl jointly maximizes sensitivity and specificity (68%), identifying as test-positive 35% of the women. Lowering the cut point to 81 mg/dl increases sensitivity to 81%, but decreases specificity to 54%, labeling as test-positive 49% of the women. Fasting plasma glucose is a useful test for the screening of both subcategories of gestational diabetes, a threshold of 85 mg/dl being an acceptable option. Effective screening for the subcategory diabetes can be achieved using a cut point of 89 mg/dl. If greater emphasis is placed on the detection of impaired glucose tolerance, a lower value, 81 mg/dl, may be needed.

Total Sialic Acid and Associated Elements of the Metabolic Syndrome in Women With and Without Previous Gestational Diabetes Mohanaluxmi Sriharan , BSC 1 , Angela J. Reichelt , MD, PHD 2 , Maria Lúcia R. Opperman , MD 3 , Bruce B. Duncan , MD, PHD 4 , Sotero S. Mengue , PHD 4 , Martin A. Crook , MB, PHD 5 and Maria I. Schmidt , MD, PHD 4 1 Guy’s, King’s, and St. Thomas’ Hospitals School of Medicine, King’s College London, London, U.K. 2 Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil 3 Department of Obstetrics and Gynecology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil 4 Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil 5 Department of Chemical Pathology, St. Thomas’ Hospital, London, U.K Abstract OBJECTIVE —Inflammatory markers predict type 2 diabetes and relate to the metabolic syndrome. Gestational diabetes mellitus (GDM) predicts type 2 diabetes and may be part of this syndrome. To examine the association of inflammatory markers with GDM, we investigated total sialic acid (TSA) in women with and without previous GDM. RESEARCH DESIGN AND METHODS —All women with GDM and a random sample of women from one center of the Brazilian Study of Gestational Diabetes were invited to return 7 years after their index pregnancy. After an interview, an oral glucose tolerance test and anthropometry were performed. A total of 46 women with and 50 women without previous GDM completed the protocol. RESULTS —Mean TSA was significantly higher in women with (71.8 ± 11.1 mg/dl) than without (67.5 ± 9.8 mg/dl) previous GDM ( P < 0.05). In a linear regression model, TSA was 4 mg/dl ( P < 0.05) higher in women with previous GDM, after adjustment for BMI, fasting insulin sensitivity, and number of years spent in school. In a similar model, current 2-h plasma glucose levels were associated with higher TSA levels after adjustment for waist-to-hip ratio and the log of triglycerides. TSA was strongly correlated with individual components and aggregates ( r = 0.55, P < 0.001) of the metabolic syndrome. CONCLUSIONS —Increased TSA levels are associated with previous GDM and are strongly linked to the metabolic syndrome. These findings in young women suggest that a chronic mild systemic inflammatory response is an early feature of the metabolic syndrome and that GDM may be a window for its investigation. GDM, gestational diabetes mellitus OGTT, oral glucose tolerance test TSA, total sialic acid WHO, World Health Organization Footnotes Address correspondence and reprint requests to Dr. Maria I. Schmidt, Department of Social Medicine, School of Medicine, UFRGS, Rua Ramiro Barcelos 2600/414, Porto Alegre, RS 90035–003, Brazil. E-mail: bbduncan{at}orion.ufrgs.br . Received for publication 19 February 2002 and accepted in revised form 24 April 2002. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. DIABETES CARE

Waist circumference and waist-to-hip ratio are related to gestational glucose tolerance. L Branchtein , M I Schmidt , S S Mengue , A J Reichelt , M C Matos and B B Duncan Department of Internal Medicine, School of Medicine, Pontificial Catholic University of Rio Grande do Sul, Porto Alegre, Brazil. Abstract OBJECTIVE: To evaluate the relationship of central fat distribution with gestational glucose tolerance during the usual time for screening gestational diabetes. RESEARCH DESIGN AND METHODS: This cross-sectional study investigated 1,113 consecutive women, > or = 20 years old, pregnant for approximately 21 to 28 weeks, without history of previous diabetes outside pregnancy, who attended two general prenatal care units in Porto Alegre, Brazil, from 1991 to 1993. Weight, height, waist and hip circumferences, and skinfolds were measured, and a 2-h, 75-g glucose tolerance test was performed. Data were analyzed using multiple linear regression models. RESULTS: Waist-to-hip ratio (WHR) and waist circumference were independently associated with higher 2-h glycemia. Glycemic level was 0.11 and 0.13 mmol/l greater for each standard deviation increase in WHR (0.06) and waist circumference (8.0 cm), respectively (P < 0.02). Restricting analyses to the subset of women with uterine height < or = 26 cm improved the association (0.13 and 0.19 mmol/l, respectively, P < 0.02); differences of 0.22 and 0.19 mmol/l were observed for 1 SD changes in the sum of skinfold thicknesses (24.7 mm) and in age (5.5 years), respectively. CONCLUSIONS: Central fat distribution measured in pregnancy is an independent predictor of gestational glucose intolerance. This finding supports the concept that NIDDM and gestational diabetes are parts of the same disease, differing basically in their moment of detection. The usefulness of these anthropometric measurements in identifying pregnant women at high risk of having gestational glucose intolerance merits further investigation.

Ambient temperature may affect venous glucose concentration after glucose tolerance tests. We analysed 1030 standardised 75 g tests. Although mean fasting values did not differ, post-load values did: adjusted mean 2 h glucose concentration was 1·03 mmol/L lower at lower (5-14°C) than at higher (25-31°C) temperatures (p<0·001). The occurrence of abnormal glucose tolerance doubled on warmer days. The diagnostic accuracy of the glucose tolerance test showed clinically significant temperature-associated variation. These variations, if confirmed, call for temperature standardisation during glucose tolerance testing and/or alternative strategies for use when standardisation is not feasible.