RESUMO
OBJECTIVE: This study was aimed to identify the prevalence of gestational diabetes (GD) defined as any glucose intolerance detected in a pregnant women using the oral glucose tolerance test (OGTT) protocol, proposed by the World Health Organization (WHO) and to explore the effect of late pregnancy on the glucose tolerance test. Two groups of pregnant women > 20 years of age were evaluated with an OGTT, one group at the beginning, and the other one at the end of the third trimester, newborns weight and gestational age were recorded at the end of pregnancy. PATIENTS AND METHODS: Group A (n = 152), was studied at 24-28 weeks and group B (n = 214) was studied at 32-36 weeks, after an overnight fasting a 75 g glucose load was provided and a blood sample was taken after 2 h. Glucose levels > 140 mg/dL were diagnostic of GD, women with glucose levels in the range of 140-199 mg/dL were prescribed dietary recommendations, but women with glucose levels > 200 mg/dL were treated with insulin. Newborns were considered macrosomic if weighted > 4,000 g and large for gestational age if exceeded the 97th percentile or the Lubchenko scale, both conditions are described as macrosomia in the text. Comparisons were done using the Chi-square and Fisher exact tests. RESULTS: In group A GD was diagnosed in 27 women (17.76%), but only three of them (1.97%) had glucose levels > 200 mg/dL and in group B-GD was diagnosed in 62 women (28.97%), but only eight of them (3.73%) had glucose levels > 200 mg/dL. The difference in rates between groups A and B was significant (p < 0.01). In group A, normal women had 19 (15.2%) macrosomic newborns and women with GD had nine (33.33%) macrosomic newborns, this difference was significant (p < 0.05); however, in group B women with GD vs. normal, had 10 (16.12%) and 19 (12.5%) macrosomic newborns, respectively (p = ns). CONCLUSIONS: The new criteria for GD diagnosis increases notoriously its prevalence in our population to 17.76% at the beginning of the third trimester, comparing with 1.97% of women with glucose levels > 200 mg/dL applying the WHO criteria for diabetes in nonpregnant adults, however, comparing the newborns weight of normal women vs. GD women the prevalence of macrosomia was almost the double, reflecting the importance of this diagnosis in perinatal health. Women screened at the end of pregnancy had a significant increase in GD prevalence, but macrosomia was not different of the normal women of this group suggesting that GD at this stage of pregnancy may help to detect women with a higher risk to develop diabetes, but have no impact on perinatal health.
