Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes.
OBJECTIVE
To evaluate American Diabetes Association (ADA) and World Health Organization (WHO) diagnostic criteria for gestational diabetes mellitus (GDM) against pregnancy outcomes.


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 > or = 5.3 mmol/l (fasting), > or = 10 mmol/l (1 h), and > or = 8.6 mmol/l (2 h). WHO criteria require a plasma glucose > or = 7.0 mmol/l (fasting) or > 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.
Schmidt
M I
MI
Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. bbduncan@orion.ufgrs.br
Duncan
B B
BB
Reichelt
A J
AJ
Branchtein
L
L
Matos
M C
MC
Costa e Forti
A
A
Spichler
E R
ER
Pousada
J M
JM
Teixeira
M M
MM
Yamashita
T
T
D000328:Adult; D000367:Age Factors; D001786:Blood Glucose / Q000378:metabolism*; D001835:Body Weight; D001938:Brazil; D015331:Cohort Studies; D036861:Delivery, Obstetric; D016640:Diabetes, Gestational / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005320:Fetal Macrosomia / Q000453:epidemiology*; D005951:Glucose Tolerance Test / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D010298:Parity; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011295:Prenatal Care; D012307:Risk Factors; D013997:Time Factors
D001786:Blood Glucose