Impact of the new potocol for diagnosis of Gestational Diabetes Mellitus (GDM), developed by ADA (2011), on the occurrence of GDM, gestational mild hyperglycemia and perinatal outcomes

• Grant number: 14/22608-3
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: July 01, 2015
• End date: June 30, 2016
• Field of knowledge: Health Sciences - Medicine - Maternal and Child Health
• Principal Investigator: Iracema de Mattos Paranhos Calderon
• Grantee: Helena Maciel Guerra
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

Gestational Diabetes Mellitus (GDM) is a frequent complication with significant maternal and fetal repercussions in the short and long term. In 2011, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) developed a new diagnostic protocol establishing universal screening of pregnant women using the oral glucose tolerance test (OGTT 75g) between 24 and 28 weeks of gestation. According to this protocol, the maternal glycemia is evaluated in three blood samples (fasting, 1 hour and 2 hours after glucose load) and only an altered result is sufficient for the diagnosis of GDM (ADA, 2011). The Specialized Diabetes and Pregnancy Service of Botucatu Medical School - Unesp associates since 1990, the glycemic profile (GP) to the OGTT to identify pregnant women with mild gestational hyperglycemia (MGH). These pregnant women have risk factors for GDM and abnormal GP, but OGTT is normal. If untreated, these women have adverse perinatal outcomes (APO) comparable to those seen in women with GDM (Rudge et al., 1990; Rudge et al., 2005). From August 15, 2011, the Specialized Service of Diabetes and Pregnancy Botucatu Medical School - Unesp changed the diagnostic protocol of DMG, replacing the 100g OGTT by 75g OGTT, according to IADPSG recommendations, but kept the GP to identify pregnant women with MGH, regardless of GDM diagnostic criteria. So far, the new protocol proposed by the ADA in 2011, has been the subject of criticism and doubts. Literature findings highlight increase in the prevalence of GDM, reaching figures of 10-25%, little impact on perinatal outcomes, yet with significant inconsistencies and the need for more studies to define the cost-effectiveness of these new recommendations (Holt et al ., 2011; Falavigna et al, 2013). This justifies the need to assess the impact of the new Protocol on this Service, comparing the periods relating to the old [OGTT 100g + PG] and the new diagnostic protocols [OGTT 75g + PG] regarding the prevalence of MGH and GDM, the APO and the risks for their occurrences. For this purpose, pregnant women and their newborns (RN) attending the service in two specific periods will be evaluated regarding both the NEW PROTOCOL, August 15, 2011 to December 31, 2014, and the OLD PROTOCOL, January 1, 2008 to August 14, 2011. The data will be analyzed statistically using association tests (chi-square test or Fisher's exact test), and also logistic regression analysis and risk estimate (odds ratio and confidence interval - CI-95) to the occurrence of the outcomes assessed. For all tests, the significance limit will be 5% (p d 0.05).