Gestational Diabetes Mellitus Diagnosed With a 2-h 75-g Oral Glucose Tolerance Test and Adverse Pregnancy Outcomes

  1. Maria I. Schmidt, MD, PHD1,
  2. Bruce B. Duncan, MD, PHD1,
  3. Angela J. Reichelt, MD, PHD2,
  4. Leandro Branchtein, MD, PHD2,
  5. Maria C. Matos, MD, PHD2,
  6. Adriana Costa e Forti, MD, PHD3,
  7. Ethel R. Spichler, MD, PHD4,
  8. Judith M.D.C. Pousada, MD, PHD5,
  9. Margareth M. Teixeira, MD, MS6,
  10. Tsuyoshi Yamashita, MD7 and
  11. For the Brazilian Gestational Diabetes Study Group
  1. 1Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre
  2. 2Postgraduate Program in Clinical Medicine, Federal University of Rio Grande do Sul, Porto Alegre
  3. 3Department of Clinical Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará
  4. 4Department of Obstetrics and Gynecology, Instituto Fernandes Figueira–Oswaldo Cruz Foundation, Rio de Janeiro
  5. 5Department of Medicine, Medical School, Federal University of Bahia, Salvador, Bahia
  6. 6Department of Medicine, Federal University of Amazonas, Manaus, Amazonas
  7. 7Hospital dos Servidores Públicos do Estado de São Paulo, São Paulo, Brazil

    Abstract

    OBJECTIVE—To evaluate American Diabetes Association (ADA) and World Health Organization (WHO) diagnostic criteria for gestational diabetes mellitus (GDM) against pregnancy outcomes.

    RESEARCH DESIGN AND 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 ≥5.3 mmol/l (fasting), ≥10 mmol/l (1 h), and ≥8.6 mmol/l (2 h). WHO criteria require a plasma glucose ≥7.0 mmol/l (fasting) 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.

    Footnotes

    • Address correspondence and reprint requests to Maria Inês Schmidt, Av. Luiz Manoel Gonzaga, 630/8, Porto Alegre, RS 90470-280 Brazil. E-mail: bbduncan{at}orion.ufrgs.br.

      Received for publication 12 October 2000 and accepted in revised form 28 February 2001.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

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