Comparação entre dois testes de rastreamento do diabetes gestacional e o resultado perinatal
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Data
2010-05-01
Autores
Ayach, Wilson
Calderon, Iracema de Mattos Paranhos [UNESP]
Rudge, Marilza Vieira Cunha [UNESP]
Costa, Roberto Antonio de Araújo [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
Resumo
OBJETIVO: comparar dois testes de rastreamento para diabetes e seus resultados com o resultado da gestação. MÉTODOS: no total, 279 pacientes foram submetidas a dois testes de rastreamento do diabetes gestacional - associação glicemia de jejum e fatores de risco (GJ + FR) e o teste de tolerância à glicose simplificado (TTG50g). O rastreamento pela associação GJ + FR caracterizou-se pela dosagem da glicemia de jejum e anamnese para identificação dos fatores de risco na primeira consulta de pré-natal. O TTG50g foi realizado entre a 24ª e a 28ª semana de gestação e caracterizou-se pela dosagem das glicemias plasmáticas em jejum e uma hora após a sobrecarga oral com 50 g de glicose. Os resultados, positivo e negativo, foram relacionados ao resultado da gestação. Foram consideradas variáveis dependentes: via de parto, idade gestacional, peso e índice ponderal ao nascimento, índices de Apgar <7 no 1º e 5º minutos, necessidade de Unidade de Terapia Intensiva (UTI), tempo de permanência hospitalar e óbito neonatal. Empregou-se o teste t de Student, admitindo-se 5% como limite de significância para calcular a diferença de proporção de das médias. RESULTADOS: apenas dois resultados perinatais estudados foram diferenciados pelos testes. O TTG50g alterado esteve associado à maior proporção de cesárea (58,7 versus 34,3%) e a associação GJ + FR positiva, maior taxa de prematuridade (15,4 versus 5,4%). As demais variáveis não foram diferentes nas pacientes com testes de rastreamento positivo e negativo. CONCLUSÕES: Apesar da relação entre a prematuridade e associação GJ + FR positiva e aumento de cesárea e TTG50g alterado, seria falha crítica aceitá-los como definitivos. Entre outras explicações, múltiplos fatores intercorrentes e as características próprias dos testes de rastreamento devem ser consideradas.
PURPOSE: to compare two screening tests for diabetes and their results to pregnancy outcomes. METHODS: in total, 279 pregnant women were submitted to two screening tests for gestational diabetes - fasting glycemia plus risk factors (FG + RF) and to the simplified glucose tolerance test (GTT50g). Screening by FG + RF consisted of the determination of fasting glycemia and anamnesis for the identification of risk factors on the occasion of the first prenatal visit. The GTT50g was performed between the 24th and the 28th week of pregnancy and consisted of the determination of plasma glycemia under fasting conditions and one hour after an oral overload with 50 g glucose. Positive and negative results were compared to pregnancy outcome. The dependent variables were: type of delivery, gestational age, weight and ponderal index at birth, Apgar indexes <7 in the 1st and 5th minutes, need for admission to the Intensive Care Unit (ICU), duration of hospitalization, and neonatal death. Data were analyzed statistically through the Students t-test, and the level of significance was set at 5%. RESULTS: only two of the perinatal variables studied were distinguished by the tests. An abnormal GTT50g was associated with a greater proportion of cesarean deliveries (58.7 versus 34.3%) and a positive FG + RF association was related to a higher rate of premature births (15.4 versus 5.4%). The other dependent variables did not differ among patients with positive and negative results of the two screening tests. CONCLUSIONS: despite the relation between prematurity and a positive FG + RF association, the increase of caesarean sections and the abnormal GTT50g, it would be a critical failure to accept these associations as definitive. Among others explanations, multiple intercurrent factors and the characteristics of the screening tests themselves should be considered.
PURPOSE: to compare two screening tests for diabetes and their results to pregnancy outcomes. METHODS: in total, 279 pregnant women were submitted to two screening tests for gestational diabetes - fasting glycemia plus risk factors (FG + RF) and to the simplified glucose tolerance test (GTT50g). Screening by FG + RF consisted of the determination of fasting glycemia and anamnesis for the identification of risk factors on the occasion of the first prenatal visit. The GTT50g was performed between the 24th and the 28th week of pregnancy and consisted of the determination of plasma glycemia under fasting conditions and one hour after an oral overload with 50 g glucose. Positive and negative results were compared to pregnancy outcome. The dependent variables were: type of delivery, gestational age, weight and ponderal index at birth, Apgar indexes <7 in the 1st and 5th minutes, need for admission to the Intensive Care Unit (ICU), duration of hospitalization, and neonatal death. Data were analyzed statistically through the Students t-test, and the level of significance was set at 5%. RESULTS: only two of the perinatal variables studied were distinguished by the tests. An abnormal GTT50g was associated with a greater proportion of cesarean deliveries (58.7 versus 34.3%) and a positive FG + RF association was related to a higher rate of premature births (15.4 versus 5.4%). The other dependent variables did not differ among patients with positive and negative results of the two screening tests. CONCLUSIONS: despite the relation between prematurity and a positive FG + RF association, the increase of caesarean sections and the abnormal GTT50g, it would be a critical failure to accept these associations as definitive. Among others explanations, multiple intercurrent factors and the characteristics of the screening tests themselves should be considered.
Descrição
Palavras-chave
Glicemia, Fatores de risco, Teste de tolerância à glucose, Diabetes gestacional, Resultado da gravidez, Blood glucose, Risk factors, Glucose tolerance test, Diabetes, gestational, Pregnancy outcome
Como citar
Revista Brasileira de Ginecologia e Obstetrícia. Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, v. 32, n. 5, p. 222-228, 2010.