Gestational diabetes in the first trimester: is early testing justified?
2017; Elsevier BV; Volume: 5; Issue: 8 Linguagem: Inglês
10.1016/s2213-8587(17)30066-9
ISSN2213-8595
AutoresArianne Sweeting, Glynis P. Ross, Jon Hyett, Jencia Wong,
Tópico(s)Prenatal Substance Exposure Effects
ResumoMost studies demonstrating the risks of gestational diabetes 1 HAPO Study Cooperative Research GroupHyperglycaemia and adverse pregnancy outcomes. New Eng J Med. 2008; 358: 1991-2002 Crossref PubMed Scopus (3867) Google Scholar and the benefits of treatment 2 Alwan N Tuffnell DJ West J Treatments for gestational diabetes. Cochrane Database Syst Rev. 2009; 3 (CD003395) Google Scholar are limited to women diagnosed at 24 weeks' gestation and later. Such data have provided the rationale for universal testing for gestational diabetes from 24 weeks' gestation and the revised diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) 3 International Association of Diabetes in Pregnancy Study GroupsInternational association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33: 676-682 Crossref PubMed Scopus (3085) Google Scholar and endorsed by WHO 4 Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract. 2014; 103: 341-363 Summary Full Text PDF PubMed Google Scholar (diagnosis based on one or more of the following: fasting plasma glucose 5·1–6·9 mmol/L, 1 h post-load glucose ≥10·0 mmol/L, 2 h post-load glucose 8·5–11·0 mmol/L following a 2 h 75 g oral glucose tolerance test). 3 International Association of Diabetes in Pregnancy Study GroupsInternational association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33: 676-682 Crossref PubMed Scopus (3085) Google Scholar , 4 Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract. 2014; 103: 341-363 Summary Full Text PDF PubMed Google Scholar The IADPSG does not advise routine testing for gestational diabetes before 24 weeks' gestation, but does recommend earlier, first trimester testing for women at high risk of hyperglycaemia in pregnancy, with the intention to identify women with overt diabetes (diagnosed based on fasting plasma glucose ≥7·0 mmol/L, HbA1c ≥6·5% [41 mmol/mol], or random plasma glucose ≥11·1 mmol/L with confirmation). 3 International Association of Diabetes in Pregnancy Study GroupsInternational association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33: 676-682 Crossref PubMed Scopus (3085) Google Scholar However, early testing will also lead to increased detection of milder degrees of hyperglycaemia, below the threshold of overt diabetes, a diagnosis now referred to as gestational diabetes before 24 weeks' gestation or early gestational diabetes. One study estimated the prevalence of early gestational diabetes using pre-IADPSG criteria in a multiethnic cohort at about 30%, 5 Sweeting AN Ross GP Hyett J et al. Gestational diabetes mellitus in early pregnancy: evidence for poor pregnancy outcomes despite treatment. Diabetes Care. 2016; 39: 75-81 Crossref PubMed Scopus (141) Google Scholar and early testing nearly doubled the incidence of gestational diabetes in a Californian cohort. 6 Alunni ML Roeder HA Moore TR Ramos GA First trimester gestational diabetes screening–change in incidence and pharmacotherapy need. Diabetes Res Clin Pract. 2015; 109: 135-140 Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar Notably, however, significant uncertainties about the diagnostic criteria for early gestational diabetes and its management remain. Hyperglycaemia in pregnancy: time to ask the hard questions?We read the Comment by Arianne Sweeting and colleagues with great interest.1 The researchers highlighted the Cambridge data, which suggest that accelerated foetal growth might occur between 20 and 28 weeks of gestation, before the diagnosis of gestational diabetes. These data suggested no differences in abdominal or head circumferences at 20 weeks. Our recent study2 of babies in South India showed that foetal subcutaneous abdominal adiposity is already higher at 20 weeks of gestation in women who later developed gestational diabetes (4·7 weeks later) compared with those who did not. Full-Text PDF
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