title: Diagnostic protocol for gestational diabetes mellitus (GDM) (IADPSG/ADA, 2011): influence on the occurrence of GDM and mild gestational hyperglycemia (MGH) and on the perinatal outcomes.
abstract: BACKGROUND
  In August 2011, the Specialized Center for Diabetes and Pregnancy of the Botucatu Medical School/Unesp adopted a new diagnostic protocol for gestational diabetes mellitus, recommended by the American Diabetes Association and the International Association of the Diabetes and Pregnancy Study Group. The glycemic profile was evaluated using the 75-g oral glucose tolerance test (OGTT) used to diagnose mild gestational hyperglycemia, recognized and treated in our department as gestational diabetes mellitus. The cost-effectiveness of the new guidelines and the continued need for the evaluation of the glycemic profile, as part of our Service protocol, are controversial and require further investigation. We aimed to assess the impact of the new guidelines on the evaluation of mild gestational hyperglycemia and gestational diabetes mellitus, the incidence of adverse perinatal outcomes, and the association between the 75-g OGTT and the glycemic profile for the diagnosis of mild gestational hyperglycemia.
  
  
  METHODS
  This cross-sectional study was performed identifying a convenience sample of pregnant women and their newborns. The women used our Service for diagnostic procedures, prenatal care and delivery, both before (January 2008 to August 14, 2011) and after (August 15, 2011 to December 2014) the protocol modification. The following variables were compared, following stratification according to diagnostic protocol: prevalence of gestational diabetes mellitus and mild gestational hyperglycemia, newborns large for gestational age, macrosomia, first cesarean delivery, and newborn hospital stay. Statistical analysis was performed using Poisson regression, the Student's t test, the Chi square or Fisher's exact test and risk estimate. The statistical significance threshold was set at 95% (p < 0.05).
  
  
  RESULTS
  The new protocol resulted in an 85% increase in the number of women with GDM, but failed to identify 17.3% of pregnant women classified as having mild gestational hyperglycemia, despite a normal 75-g OGTT. The new guidelines did not affect perinatal outcome.
  
  
  CONCLUSIONS
  These results support the validity of maintaining the glycemic profile as part of the diagnostic protocol at our hospital. Large multicenter studies with an adequate sample size are required for conclusive evidence on the cost-effectiveness of the new protocol.
authors.affiliation: GP Program in Gynecology, Obstetrics and Mastology (PGGOM), Botucatu Medical School/Unesp (FMB/Unesp), Botucatu, Brazil.
authors.forename: Mariana Pinto
authors.initials: MP
authors.lastname: Sirimarco
authors.affiliation: GP Program in Gynecology, Obstetrics and Mastology (PGGOM), Botucatu Medical School/Unesp (FMB/Unesp), Botucatu, Brazil.
authors.forename: Helena Maciel
authors.initials: HM
authors.lastname: Guerra
authors.affiliation: GP Program in Gynecology, Obstetrics and Mastology (PGGOM), Botucatu Medical School/Unesp (FMB/Unesp), Botucatu, Brazil.
authors.forename: Eduardo Guimarães
authors.initials: EG
authors.lastname: Lisboa
authors.affiliation: GP Program in Gynecology, Obstetrics and Mastology (PGGOM), Botucatu Medical School/Unesp (FMB/Unesp), Botucatu, Brazil.
authors.forename: Joice Monalisa
authors.initials: JM
authors.lastname: Vernini
authors.affiliation: GP Program in Gynecology, Obstetrics and Mastology (PGGOM), Botucatu Medical School/Unesp (FMB/Unesp), Botucatu, Brazil.
authors.forename: Bianca Nicolosi
authors.initials: BN
authors.lastname: Cassetari
authors.affiliation: Department of Gynecology and Obstetrics, FMB/Unesp, Botucatu, Brazil.
authors.forename: Roberto Antonio
authors.initials: RA
authors.lastname: de Araujo Costa
authors.affiliation: GP Program in Gynecology, Obstetrics and Mastology (PGGOM), Botucatu Medical School/Unesp (FMB/Unesp), Botucatu, Brazil ; Department of Gynecology and Obstetrics, FMB/Unesp, Botucatu, Brazil.
authors.forename: Marilza Vieira Cunha
authors.initials: MV
authors.lastname: Rudge
authors.affiliation: GP Program in Gynecology, Obstetrics and Mastology (PGGOM), Botucatu Medical School/Unesp (FMB/Unesp), Botucatu, Brazil ; Department of Gynecology and Obstetrics, FMB/Unesp, Botucatu, Brazil.
authors.forename: Iracema
authors.initials: I
authors.lastname: de Mattos Paranhos Calderon
keywords: Diagnosis; Gestational diabetes mellitus; Mild gestational hyperglycemia; Oral glucose tolerance test; Perinatal outcomes