Impact of maternal hyperglycemia control perinatal outcomes: analysis of reference service protocol

• Grant number: 15/11988-2
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: October 01, 2015
• End date: September 30, 2016
• Field of knowledge: Health Sciences - Medicine - Maternal and Child Health
• Principal Investigator: Iracema de Mattos Paranhos Calderon
• Grantee: Iara Padoim e Silva
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

Gestational Diabetes Mellitus (GDM) or DM prior to pregnancy (DM 1 and DM2) are frequent complications, with important maternal-fetal repercussions the short and long term. The specialized service of Diabetes and pregnancy of Faculdade de Medicina de Botucatu-Unesp (SEDG-FMB/Unesp) associates, since 1990, Glycemic profile (PG) at TOTG, to identify pregnant women with mild gestational hyperglycemia (MGH). These pregnant women have risk factors for DMG and PG changed, but the normal TOTG. If not treated, these pregnant women present adverse perinatal outcomes (APO) comparable to those seen in pregnant women with GDM [Rudge et al., 1990; Rudge et al., 2005]. From August 15, 2011, the specialized service of Diabetes and pregnancy of Faculdade de Medicina de Botucatu-Unesp changed the GDM diagnostic Protocol, replacing the TOTG 100 g at TOTG 75 g, in accordance with the recommendations of the International Association of Diabetes and Pregnancy Study Groups [ADA, 2011], but kept the PG to identify pregnant women carriers of HGL regardless of the diagnostic criteria of DMG and, also, the same treatment protocol. In addition to the disagreements about this new diagnostic Protocol, the goals and the quality of maternal glycemic control for preventing perinatal risks, too, has been the subject of criticism and doubts. Glycemic Control Protocol used in SEDG-FMB/Unesp is based on the Mean Glycemic Level (MGL) obtained in the test 100 g-OGTT). Nonetheless, the variations in glucose levels observed throughout the day, and confirmed by the glycemic profiles, whereas APPROPRIATE control, when MG d 120 mg/dL and inadequate control, when MG > 120 mg/dL [Rudge et al., 1995]. Other services considered APPROPRIATE glycemic control when 70% of the PG had are within the limits of reference [Spaulonci et al., 2013]. There is no definition of what would be the best method to evaluate the quality of maternal glucose control. Thus, the present study is justified, in order to assess the impact of these two protocols on prediction of perinatal risk. For this, will be assessed pregnant women and newborns babies (NB) met in the service during the period from January 2008 to December 2014, classified, and treated, as carriers of Mild Gestational Hyperglycemia (MGH), GDM and prior DM. Will be assessed the prevalence of adverse perinatal outcomes (APO) and calculated performance rates of the two protocols in the prediction of risk for these APO. The data will be submitted to statistical analysis for studying the bindings (Chi-square test or Fisher's exact test) and calculation of indexes of sensitivity (Sens), specificity (Esp), positive Predictive Value (PPV) and negative (NPV) and accuracy of both maternal glycemic control protocols in relation to perinatal outcomes. For all tests, the limit of significance will be 95% (p d 0.05).