2016, Number 3
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MEDICC Review 2016; 18 (3)
Controversies in screening and diagnosis of gestational diabetes: Cuba’s position
Cruz-Hernández J, Hernández-García P, Lang-Prieto J, Yanes-Quesada M, Iglesias-Marichal I, Márquez-Guillén A
Language: English
References: 35
Page: 35-38
PDF size: 136.69 Kb.
ABSTRACT
Gestational diabetes is the most common endocrine disorder affecting pregnant women and its prevalence is on the rise. Prevalence in Cuba is about 5.8%, and global prevalence ranges from 2% to 18% depending on the criteria applied. Gestational diabetes can lead to adverse gestational outcomes, such as fetal death, preterm delivery, dystocia, perinatal asphyxia and neonatal complications. Prompt, accurate diagnosis allowing early treatment can benefit both mother and child. The disease is asymptomatic, so clinical laboratory testing plays a key role in its screening and diagnosis. Cuba’s approach to diabetes screening and diagnosis differs from some international practices. All pregnant women in Cuba are screened with a fasting plasma glucose test and diagnosed using modified WHO criteria. Some international recommendations are to skip the screening step and instead follow the diagnostic criteria of the Hyperglycemia and Adverse Pregnancy Outcomes study. In Cuba, gestational outcomes for women with diabetes (including gestational diabetes) are satisfactory (preeclampsia 5%; preterm delivery 12%; neonatal macrosomia 7.5%; congenital abnormalities 4.3% and perinatal deaths 4.8%). These data do not indicate a need to change established screening and diagnostic criteria.
REFERENCES
Márquez A, Aldana D, Rodríguez BR, González ME, Lang J, Pérez J, et al. Prevalencia de diabetes gestacional en un área de salud de Ciudad de La Habana. Rev Asoc Latinoamer Diabetes. 1996;4:75–80. Spanish.
Schneider S, Bock C, Wetzel M, Maul H, Loerbroks A. The prevalence of gestational diabetes in advanced economies. J Perinat Med. 2012 Sep;40(5):511–20.
Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panelrecommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care. 2012 Mar;35(3):526–8.
International Diabetes Federation. Prólogo. In: Federación Internacional de Diabetes. Atlas de la Diabetes de la Federación Internacional de Diabetes (FID). 6th ed. Brussels: International Diabetes Federation; 2014. p. 7. Spanish.
Ferrara A. Increasing prevalence of gestational diabetes mellitus. Diabetes Care. 2007 Jul;30 Suppl 2:S141–6.
Obstetricia y perinatología. Diagnóstico y tratamiento. Havana: ECIMED; 2012. Chapter 50, Diabetes y embarazo; p. 306–21. Spanish.
Cruz HernándezJ, Hernández García P, Grandía Guzmán R, Lang Prieto J, Isla Valdés A, González Padilla K. Consideraciones acerca de la diabetes mellitus durante el embarazo. Rev Cubana Endocrinol. 2015 Jan–Apr ;26(1):47–65. Spanish.
Duperval P, Cruz J. Recién nacido de madre con diabetes. In: Valdés R, editor. Examen físico al recién nacido. Havana: ECIMED; 2016. p. 86–98. Spanish.
Coustan DR. Diagnosis of gestational diabetes. Scan J Clin Lab Invest Suppl. 2014;244:27–33.
Gabbe SG. The gestational diabetes mellitus conferences. Three are history: focus on the fourth. Diabetes Care. 1998 Aug;21 Suppl 2:B1–2.
Classifi cation and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group. Diabetes. 1979 Dec;28(12):1039–57.
Report of the Expert Committee on the Diagnosis and Classifi cation of Diabetes Mellitus. Diabetes Care. 1997 Jul;20(7):1183–97.
International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classifi cation of Hyperglycemia in Pregnancy. Diabetes Care. 2010 Mar;33(3):676– 82.
O´Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes. 1964 May–Jun;13:278–85.
Carpenter MW, Coustan DR. Criteria for screening test for gestational diabetes. Am J Obstet Gynecol. 1982 Dec 1;144(7):768–73.
O´Sullivan JB, Mahan CM, Charles D, Dandrow RV. Screening for high-risk gestational diabetic patients. Am J Obstet Gynecol. 1973 Aug 1;116:895–900.
Najimudeen M, Sachchithanantham K. An appraisal of screening methods for gestational diabetes mellitus. Br J Med Medical Res. 2014 May;4(15):2853–65.
American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2003 Jan;26 Suppl 1:S103–5.
Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care. 1998 Aug;21Suppl 2:B161–7.
American Diabetes Association. Standards of medical care in diabetes –2011. Diabetes Care. 2011 Jan;34 Suppl 1:S11–61.
American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin. Clinical management guidelines for obstetriciangynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational diabetes. Obstet Gynecol. 2001 Sep;98(3):525–38.
Ricart W, López J, Mozas J, Pericot A, Sancho MA, González N, et al. Potential impact of American Diabetes Association (2000) criteria for diagnosis of gestational diabetes mellitus in Spain. Diabetologia. 2005 Jun;48(6):1135–41.
World Health Organization. Diagnostic criteria and classifi cation of hyperglycemia fi rst detected in pregnancy. Geneva: World Health Organization; 2013. 63 p.
Blumer I, Hadar E, Hadden DR, Jovanovič L, Mestman JH, Murad MH, et al. Diabetes and pregnancy; an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2013 Nov;98(11):4227–49.
International Diabetes Federation. Recommended protocol for screening, management and follow up of women with GDM. Brussels: International Diabetes Federation; 2015.
Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management and care. Int J Gynecol Obstet. 2015 Oct;131 Suppl 3:S184–7.
Seshiah V, Banerjee S, Balaji V, Muruganathan A, Das AK; Diabetes Consensus Group. Consensus evidence-based guidelines for management of gestational diabetes mellitus in India. J Assoc Physicians India. 2014 Jul;62(7 Suppl):55–62.
Holt H. NICE´s latest guidelines on diabetes in pregnancy: getting the balance right. Practical Diabetes. 2015 Apr;32(3):87–88a.
Márquez Guillén A, Lang Prieto J, Valdés Amador L, Cruz Hernández J, Guerrero Rodríguez E. Prediabetes y diabetes gestacional. Rev Cubana Endocrinol. 2011 Jan–Apr;22(1):58–60. Spanish.
Lang Prieto J, Márquez Guillén A, Valdés Amador L. Resúmenes del XIII Congreso de las Asociación Latinoamericana de Diabetes. Estudios Clínicos. Glucemia en ayunas como instrumento en la pesquisa de la diabetes gestacional. Rev Asoc Latinoamer Diabetes. 2007;15(3):130. Spanish.
Consenso latinoamericano de diabetes y embarazo. Rev Asoc Latinoamer Diabetes. 2008;16(2):55–69. Spanish.
Pan American Health Organization. Criterios diagnósticos y clasifi cación de la hiperglucemia detectada por primera vez en el embarazo. Washington, D.C.: Pan American Health Organization; 2016. 45 p. Spanish.
Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol. 2013 Aug;122(2 Pt1):406–16.
Cruz J, Fregoso C, Lang J, Márquez A. [Pregnancy outcomes in gestational diabetes diagnosed before and after 28 weeks]. Rev Soc Argent Diabetes. 2016;50 (Special Issue Scientifi c IADPSG Meeting 2016):46. Spanish.
Pan American Health Organization. Hiperglucemia y embarazo en las Américas: Informe Final de la Conferencia Panamericana sobre Diabetes y Embarazo (Lima, Perú, September 8–10, 2015). Washington, D.C.: Pan American Health Organization; 2016. 76 p. Spanish.