Mild gestational hyperglycaemia as a risk factor for metabolic syndrome in pregnancy and adverse perinatal outcomes

Negrato, Carlos Antônio; Jovanovič, Lois; Tambascia, Marcos Antônio; Calderon, Iracema de Mattos Paranhos; Geloneze, Bruno; Dias, Adriano; Rudge, Marilza Vieira Cunha

doi:10.1002/dmrr.815

Cited by 40 publications

(45 citation statements)

References 36 publications

(26 reference statements)

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“…Hence, in this study, the authors did not have a control group of untreated pregnant women with 2-h PG ≥ 7.8 mmol/L, as there are evidences confirming that the treatment of GDM women as defined by WHO criterion was associated with a reduced risk of pregnancy outcome (Crowther et al, 2005;Gayle et al, 2010). The policy of not treating women with 2-h PG ≥ 7.8 mmol/L amounts to deliberately exposing the pregnant mothers to unphysiological glycemic level despite our extensive knowledge of the benefits of treatment of mild hyperglycemia during pregnancy (Seshiah et al, 2008a;Landon et al, 2009;Bevier et al, 1999;Negrato et al, 2008). Wahi et al observed in their prospective study, the advantage of adhering to a cut-off level of 2-h PG ≥ 7.8 mmol/L in diagnosis and management of GDM for a significantly positive effect on pregnancy outcomes (Wahi et al, 2011).…”

Section: The Validation Of Who Criterion (Dipsi Criterion) Based On Tmentioning

confidence: 99%

Gestational Diabetes Mellitus - A Perspective

Seshiah¹,

Balaji²,

Balaji³

2011

Gestational Diabetes

217

287

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Section: The Validation Of Who Criterion (Dipsi Criterion) Based On Tmentioning

confidence: 99%

Gestational Diabetes Mellitus - A Perspective

Seshiah¹,

Balaji²,

Balaji³

2011

Gestational Diabetes

217

287

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“…A prospective observational quantitative study was conducted in the Perinatal Diabetes Center in the city of Botucatu, Southeastern Brazil, between 2007 and2008. Direct and indirect costs and disease-specifi c costs (medications and tests) were estimated.…”

Section: Methodsmentioning

confidence: 99%

“…The cutoffs used were those proposed by Carpenter & Coustan 3 for GTT, and Gilmer et al 8 for blood glucose profi le. Patients with abnormal GTT plus normal GP were diagnosed with gestational diabetes while those with normal GTT plus abnormal GP were diagnosed with mild hyperglycemia 15 and treated with diet alone as outpatients. Women with abnormal GTT plus abnormal GP, as well as those with pregestational diabetes were hospitalized for one day (24 hours) on a fortnight basis until 28 weeks of gestation, and on a weekly basis from week 28 until delivery, and were treated with diet plus insulin therapy for blood glucose control.…”

Section: Methodsmentioning

confidence: 99%

“…

ABSTRACT OBJECTIVE:To compare inpatient and outpatient care costs for pregnant/ parturient women with diabetes and mild hyperglycemia.

METHODS:A prospective observational quantitative study was conducted in the Perinatal Diabetes Center in the city of Botucatu, Southeastern Brazil, between 2007 and2008. Direct and indirect costs and disease-specifi c costs (medications and tests) were estimated.

…”

mentioning

confidence: 99%

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Care cost for pregnant and parturient women with diabetes and mild hyperglycemia

Cavassini

Lima

Calderon³

et al. 2012

Rev. Saúde Pública

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OBJECTIVE:To compare inpatient and outpatient care costs for pregnant/ parturient women with diabetes and mild hyperglycemia. METHODS:A prospective observational quantitative study was conducted in the Perinatal Diabetes Center in the city of Botucatu, Southeastern Brazil, between 2007 and2008. Direct and indirect costs and disease-specifi c costs (medications and tests) were estimated. Thirty diet-treated pregnant women with diabetes were followed up on an outpatient basis, and 20 who required insulin therapy were hospitalized. RESULTS:The cost of diabetes disease (prenatal and delivery care) was US$ 3,311.84 for inpatients and US$ 1,366.04 for outpatients. CONCLUSIONS:Direct and indirect costs as well as total prenatal care cost were higher for diabetic inpatients while delivery care costs and deliverypostpartum hospitalization were similar. Prenatal and delivery-postpartum care costs were higher for these patients compared to those paid by Brazilian National Health System. Pregnancies complicated by diabetes are associated with an increased risk of maternal and neonatal complications. The most serious maternal complication is the risk of developing type 2 diabetes within 10-12 years after birth. 21 Perinatal complications include macrosomia and increased risk of birth trauma and intrapartum hypoxia/ asphyxia, high C-section rates, delayed pulmonary maturation and consequent risk of respiratory distress syndrome, and metabolic disorders at birth including hypoglycemia, hypocalcemia and hypomagnesemia. 19All these conditions worsen neonatal prognosis and increase perinatal mortality. In addition, Rudge et al 17 demonstrated that pregnant women with mild hyperglycemia (normal 100-g glucose tolerance test [GTT] and abnormal blood glucose profi le) have perinatal outcomes comparable to those of diabetic women and should be treated following the same protocol.Perinatal outcomes with either diabetes or mild hyperglycemia are directly associated to maternal metabolic control. Maternal hyperglycemia should be carefully controlled with either diet alone or diet plus insulin therapy so that effective blood glucose normalization can be achieved and adverse perinatal outcomes prevented. Newborns of pregnant women with inadequate blood glucose control (mean blood glucose >130 mg/dL in the third trimester) are reported to show macrosomia in 52.4%, fetal death in 14.3%, and malformations in 8.2%. Over the past decades, improved maternal and perinatal outcomes of diabetic RESUMO OBJETIVO: Comparar custos de hospitalização e de atenção ambulatorial em gestantes/parturientes diabéticas e com hiperglicemia leve. MÉTODOS:Estudo observacional, prospectivo, quantitativo descritivo realizado em centro de diabete perinatal em Botucatu, SP, entre 2007 e 2008. Foram estimados os custos por absorção diretos e indiretos disponíveis na instituição e os custos específi cos para a doença (medicamentos e exames). As 30 gestantes diabéticas tratadas com dieta foram acompanhadas em ambulatório e 20 tratadas com dieta mais insulina ...

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“…with a normal 100-g glucose tolerance test (GTT) but an abnormal glycemic profile, have perinatal outcomes comparable to those of diabetic women and should, therefore, receive comparable treatment. 5,6 The principal factor responsible for this is the need for strict glycemic control to maintain blood glucose levels within the normal range throughout pregnancy. 7 To obtain such control, these women are treated with diet and/or insulin therapy, and followed up on an outpatient basis or subjected to frequent short hospitalizations.…”

Section: Introductionmentioning

confidence: 99%

Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil

Cavassini¹,

Lima

Calderon

et al. 2012

Sao Paulo Med. J.

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CONTEXT AND OBJECTIVE: Pregnancies complicated by diabetes are associated with increased numbers of maternal and neonatal complications. Hospital costs increase according to the type of care provided. This study aimed to estimate the cost-benefit relationship and social profitability ratio of hospitalization, compared with outpatient care, for pregnant women with diabetes or mild hyperglycemia. METHODS: Thirty pregnant women treated with diet were followed as outpatients, and twenty treated with diet plus insulin were managed through frequent short hospitalizations. Direct costs (personnel, materials and tests) and indirect costs (general expenses) were ascertained from data in the patients' records and the hospital's absorption costing system. The cost-benefit was then calculated. RESULTS: Successful treatment of pregnant women with diabetes avoided expenditure of US$ 1,517.97 and US$ 1,127.43 for patients treated with inpatient and outpatient care, respectively. The cost-benefit of inpatient care was US$ 143,719.16, and outpatient care, US$ 253,267.22, with social profitability of 1.87 and 5.35, respectively. CONCLUSION: Decision-tree analysis confirmed that successful treatment avoided costs at the hospital. Cost-benefit analysis showed that outpatient management was economically more advantageous than hospitalization. The social profitability of both treatments was greater than one, thus demonstrating that both types of care for diabetic pregnant women had positive benefits.

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Mild gestational hyperglycaemia as a risk factor for metabolic syndrome in pregnancy and adverse perinatal outcomes

Cited by 40 publications

References 36 publications

Gestational Diabetes Mellitus - A Perspective

Gestational Diabetes Mellitus - A Perspective

Care cost for pregnant and parturient women with diabetes and mild hyperglycemia

Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil

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