Gestational diabetes and overt diabetes first diagnosed in pregnancy: characteristics, therapeutic approach and perinatal outcomes in a public healthcare referral center in Brazil

Abstract

Objective: To describe the clinical characteristics, management, and fetal outcomes of patients diagnosed with gestational diabetes mellitus (GDM) or overt diabetes (OD) during pregnancy who followed up at a public healthcare referral center in Brazil. Materials and methods: A retrospective cohort study based on the medical records of women diagnosed with dysglycemia during pregnancy between January 2015 and July 2017 was conducted. Results: Out of 224 pregnant women evaluated, 70% were overweight/obese. GDM was observed in 78.6% of pregnant women, while 21.4% presented with OD. Approximately 59% of patients could be diagnosed with GDM or OD by fasting plasma glucose (FPG) alterations alone. Exclusive diet therapy was used in 50.9% of patients. The need for insulin therapy was higher in OD patients (60.4%) than in GDM patients (38.1%) (p = 0.006). Women who needed insulin (n = 96) had a mean initial dose of 0.33 IU/kg (±0.27) and a final value of 0.39 IU/kg (±0.34). The cesarean rate was 74.3%. The fetal outcomes evaluated were macrosomia (2.15%), large for gestational age (LGA) fetus (15.83%), intensive care unit (ICU) need (4.32%), Apgar score ≤7 (6.47%), hypoglycemia (14.39%) and jaundice (16.55%). Conclusions: Patients with GDM and OD presented with several similar clinical features. Approximately half of the patients presented with adequate glycemic control only with diet management. Patients with OD presented a higher need for insulin therapy. Although overweight and obesity were frequent within both groups, they could possibly explain many of our findings.

Prognosis Associated with Sub-Types of Hyperglycaemia in Pregnancy

“…Studies in various countries found similar percentages to ours of pregnant women with FPG values > 5.1 mmo/L in early pregnancy (10% in Israel [23], China [12], and Italy [11]). The percentage of women with DIP was relatively low in our series, unlike the findings in Pakistan [24] and Brazil [25], suggesting that screening for hyperglycaemia before pregnancy is probably performed more routinely in France.…”

Overt Diabetes in Pregnancy

“…Similarly, in a multi-institutional retrospective cohort study from Japan, Sugiyama et al [28] reported an earlier gestational age at diagnosis (mean 22.0 vs. 23.5 weeks), greater need for insulin therapy (85.6% vs. 34.1%), and a higher prevalence of retinopathy (1.2% vs. 0%) and pregnancy-induced hypertension (10.1% vs. 6.1%), among among Spanish women with overt diabetes (n = 50) compared to those with GDM (n = 572). In a retrospective study from Brazil, Sampaio et al [30] reported that women with overt diabetes in pregnancy (n = 48) were more likely to require insulin therapy (60.4% vs. 38.1%), and had a higher initial (mean 0.53 vs. 0.17 IU/kg) and final dose of insulin (mean 0.55 vs. 0.19 IU/kg), compared to those with GDM (n = 176). Furthermore, a higher proportion of insulin-treated women (85.9% vs. 66.0%) delivered by caesarean section.…”

Overt diabetes imposes a comparable burden on outcomes as pregestational diabetes: a cohort study

“…In a Canadian study, 2.6% of women diagnosed with gestational diabetes presented type 2 diabetes during the first year postpartum and were labelled as having had previous overt diabetes; this represents less than 0.2% of the total study sample [ 18 ]. In a Brazilian cohort of pregnant women with hyperglycemia, ~ 21.0% of 224 women presented overt diabetes [ 19 ]. The rate of undiagnosed diabetes in our cohort reflects rates described for non-pregnant adults, despite many women already presented traditional risk factors: age ≥ 35 years (~ 42%), the cutoff point for age currently recommended for diabetes screening [ 3 , 20 ]; history of gestational diabetes in previous pregnancies (~ 30.0%); and family history of diabetes (~ 61.0%) [ 3 ].…”