Clinical characteristics of women with gestational diabetes — comparison of two cohorts enrolled 20 years apart in southern Brazil
Keywords:
Gestational diabetes, Pregnancy, Diagnosis, Pregnancy complications, Infant, newbornAbstract
CONTEXT AND OBJECTIVE: The prevalence and characteristics of gestational diabetes mellitus (GDM) have changed over time, reflecting the nutritional transition and changes in diagnostic criteria. We aimed to evaluate characteristics of women with GDM over a 20-year interval. DESIGN AND SETTING: Comparison of two pregnancy cohorts enrolled in different periods, in university hospitals in Porto Alegre, Brazil: 1991 to 1993 (n = 216); and 2009 to 2013 (n = 375). METHODS: We applied two diagnostic criteria to the cohorts: International Association of Diabetes and Pregnancy Study Groups (IADPSG)/World Health Organization (WHO); and National Institute for Health and Care Excellence (NICE). We compared maternal-fetal characteristics and outcomes between the cohorts and within each cohort. RESULTS: The women in the 2010s cohort were older (31 ± 7 versus 30 ± 6 years), more frequently obese (29.4% versus 15.2%), with more hypertensive disorders (14.1% versus 5.6%) and at increased risk of cesarean section (adjusted relative risk 1.8; 95% confidence interval: 1.4 - 2.3), compared with those in the 1990s cohort. Neonatal outcomes such as birth weight category and hypoglycemia were similar. In the 1990s cohort, women only fulfilling IADPSG/WHO or only fulfilling NICE criteria had similar characteristics and outcomes; in the 2010s cohort, women only diagnosed through IADPSG/WHO were more frequently obese than those diagnosed only through NICE (33 ± 8 kg/m2 versus 28 ± 6 kg/m2; P < 0.001). CONCLUSION: The epidemic of obesity seems to have modified the profile of women with GDM. Despitesimilar neonatal outcomes, there were differences in the intensity of treatment over time. The IADPSG/WHO criteria seemed to identify a profile more associated with obesity.
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References
World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva: World Healt Organization; 2013. Available from: http://apps.who.int/iris/bitstream/10665/85975/1/WHO_NMH_MND_13.2_eng.pdf Accessed in 2017 (Apr 18).
Reichelt AJ, Oppermann MLR. Gestational diabetes diagnosis landmarks. A timeline. Available from: http://www.ufrgs.br/napead/repositorio/objetos/diabetes-gestacional/ Accessed in 2017 (Apr 18).
Reichelt AJ, Oppermann MLR, Schmidt MI. Recomendações da 2a reunião do grupo de trabalho em diabetes e gravidez [Guidelines of the 2nd meeting of the diabetes and pregnancy task force]. Arq Bras Endocrinol Metab. 2002;46(5):574-81.
Schmidt MI, Duncan BB, Reichelt AJ, et al. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care. 2001;24(7):1151-5.
Kanguru L, Bezawada N, Hussein J, Bell J. The burden of diabetes mellitus during pregnancy in low- and middle-income countries: a systematic review. Glob Health Action. 2014;7:23987.
Schneider S, Bock C, Wetzel M, Maul H, Loerbroks A. The prevalence of gestational diabetes in advanced economies. J Perinat Med. 2012;40(5):511-20.
Colagiuri S, Falavigna M, Agarwal MM, et al. Strategies for implementing the WHO diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Diabetes Res Clin Pract. 2014;103(3):364-72.
National Collaborating Centre for Women's and Children's Health (UK). Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period. London: RCOG Press; 2015.
American Diabetes Association. Standards of medical care in diabetes--2014. Diabetes Care. 2014;37 Suppl 1:S14-80.
Salzberg S, Alvariñas J, López G, et al. Guías de diagnóstico y tratamiento de diabetes gestacional. ALAD 2016. Revista de la ALAD. 2016;6:155-69. Available from: http://www.diabetes.org.ar/wp-content/uploads/2016/11/PUBLICACION-GUIAS-DG-alad_v6_n4_155-169-4.pdf Accessed in 2017 (Apr 18).
WHO Expert Committee on Diabetes Mellitus: second report. World Health Organ Tech Rep Ser. 1980;646:1-80.
Ministério da Educação (MEC). Secretaria de Educação Superior (SESu). Hospital de Clínicas de Porto Alegre (HCPA). Prestação de Contas Ordinárias Anual. Relatório de Gestão do Exercício de 2013. Porto Alegre; 2014. Available from: http://www.hcpa.edu.br/downloads/Publicacoes/relatorio_gestao_hcpa_2013.pdf Accessed in 2017 (Apr 18).
Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995;854:1-452.
Rasmussen KM, Yaktine AL. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington: National Academies Press; 2009.
Tranquilli AL, Dekker G, Magee L, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens. 2014;4(2):97-104.
Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol. 1996;87(2):163-8.
International Association of Diabetes in Pregnancy Study Group (IADPSG) Working Group on Outcome Definitions, Feig DS, Corcoy R, et al. Diabetes in pregnancy outcomes: a systematic review and proposed codification of definitions. Diabetes Metab Res Rev. 2015;31(7):680-90.
Human Development Report 2015. Human Development Report 2015. Work for Human Development. New York: United Nations Development Programme; 2015. Available from: https://s3.amazonaws.com/hdr2015report/2015_human_development_report.pdf. Accessed in 2017 (Apr 18).
Victora CG, Barreto ML, do Carmo Leal M, et al. Health conditions and health-policy innovations in Brazil: the way forward. Lancet. 2011;377(9782):2042-53.
NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377-96.
Godfrey KM, Reynolds RM, Prescott SL, et al. Influence of maternal obesity on the long-term health of offspring. Lancet Diabetes Endocrinol. 2017;5(1):53-64.
Catalano PM, McIntyre HD, Cruickshank JK, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care. 2012;35(4):780-6.
Zhu Y, Zhang C. Prevalence of Gestational Diabetes and Risk of Progression to Type 2 Diabetes: a Global Perspective. Curr Diab Rep. 2016;16(1):7.
Trujillo J, Vigo A, Duncan BB, et al. Impact of the International Association of Diabetes and Pregnancy Study Groups criteria for gestational diabetes. Diabetes Res Clin Pract. 2015;108(2):288-95.
Egan AM, Heerey AM, Carmody L, Dunne FP. The changing diagnosis of gestational diabetes mellitus: does anyone miss out? Diabetes Res Clin Pract. 2014;106(3):e53-5.
Zhu W, Yang H, Wei Y, et al. Comparing the diagnostic criteria for gestational diabetes mellitus of World Health Organization 2013 with 1999 in Chinese population. Chin Med J (Engl). 2015;128(1):125-7.
Sagili H, Kamalanathan S, Sahoo J, et al. Comparison of different criteria for diagnosis of gestational diabetes mellitus. Indian J Endocrinol Metab. 2015;19(6):824-8.
Meek CL, Lewis HB, Patient C, Murphy HR, Simmons D. Diagnosis of gestational diabetes mellitus: falling through the net. Diabetologia. 2015;58(9):2003-12.
Harreiter J, Simmons D, Desoye G, et al. IADPSG and WHO 2013 Gestational Diabetes Mellitus Criteria Identify Obese Women With Marked Insulin Resistance in Early Pregnancy. Diabetes Care. 2016;39(7):e90-2.
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387(10027):1513-30.
