Journal Article

Gestational Diabetes Mellitus Diagnosed With a 2-h 75-g Oral Glucose Tolerance Test and Adverse Pregnancy Outcomes

Maria C. Matos, Adriana Costa e Forti, Margareth M. Teixeira, Ethel R. Spichler, Tsuyoshi Yamashita, Angela J. Reichelt, Bruce B. Duncan, Judith M.D.C. Pousada, Maria I. Schmidt, Leandro Branchtein

2001

Overview

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.

• Publisher: American Diabetes Association
• Subject: Adult / Age Factors / Biological and medical sciences / Blood Glucose - metabolism / Body Weight / Brazil / Cohort Studies / Delivery, Obstetric / Diabetes / Diabetes in pregnancy / Diabetes, Gestational - classification / Diabetes, Gestational - diagnosis / Diabetes, Gestational - physiopathology / Diagnosis / Diseases of mother, fetus and pregnancy / Educational Status / Ethnic Groups / Female / Fetal Death - epidemiology / Fetal Macrosomia - epidemiology / Glucose / Glucose Tolerance Test - methods / Gynecology. Andrology. Obstetrics / Humans / Infant, Newborn / Medical sciences / Parity / Pre-Eclampsia - epidemiology / Predictive Value of Tests / Pregnancy / Pregnancy Outcome / Pregnancy Trimester, Second / Pregnancy. Fetus. Placenta / Prenatal Care / Risk Factors / Time Factors