Prevalência de mulheres com pré-diabetes no primeiro trimestre da gestação e seu impacto na incidência de diabetes mellitus gestacional
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Data
2022-02-18
Autores
Cabral, Rayanne Pereira
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O pré-diabetes (PD) é uma condição de perda da tolerância à glicose e que em sua maioria antecede os quadros de diabetes mellitus (DM). No período gestacional, as pacientes com hemoglobina glicada (HbA1C) igual ou maior que 5,7% e menor que 6,5% não recebem a mesma atenção que as gestantes que foram diagnosticadas com diabetes mellitus gestacional (DMG). Método: Estudo de prevalência retrospectivo para determinar, no primeiro trimestre, o número de gestantes com rastreamento negativo para DMG e HbA1C igual ou maior que 5,7% e menor que 6,5%. Também foi estudada uma coorte retrospectiva para avaliação do risco das gestantes com rastreamento negativo para diabetes e HbA1C entre 5,7 e menor que 6,5%, verificados até a 14ª semana de gestação, desenvolver DMG quando comparadas àquelas com HbA1C normal. As prevalências e incidências dos diagnósticos identificados pela associação de GJ e HbA1c e pelo teste de tolerância oral à glicose 75g (TOTG-75g), respectivamente, foram apresentadas em forma de porcentagem e intervalo de confiança (IC) 95%, sendo calculado o risco relativo com IC 95%. Resultados: A prevalência de gestantes com rastreamento negativo para diabetes e HbA1C ≥ 5,7 e < 6,5% foi de 5,6% (IC95% 4,5–6,9). Também identificamos que 12,2% (IC95% 10,6–14,0) foram diagnosticadas com DMG e 1,7% (IC95% 1,1–2,4) apresentaram diagnóstico de diabetes pré-existente. A HbA1C ≥ 5,7% e <6,5 e idade acima de 30 anos são fatores de risco independente para desenvolvimento de DMG nas gestações com rastreamento negativo para diabetes, com razões de chance de 3,241 (IC95% 1,242 – 8,457) e 2,175 (IC95% 0,968 – 4,883), respectivamente. Conclusão: As gestantes que desenvolvem DMG podem ter alterações do metabolismo da glicose previamente à gestação, conforme indicado por sua HbA1c elevada no primeiro trimestre. A HbA1c do primeiro trimestre pode ajudar na identificação precoce de mulheres em risco para possível acompanhamento e tratamento durante a gestação e após o parto.
Introduction: Prediabetes (PD) is a condition of loss of glucose tolerance and that mostly precedes diabetes mellitus (DM). During pregnancy, patients with glycated hemoglobin (HbA1C) equal to or greater than 5.7% and less than 6.5% do not receive the same attention as pregnant women diagnosed with gestational diabetes mellitus (GDM). Method: Retrospective prevalence study to determine, in the first trimester, the number of pregnant women with negative screening for GDM and HbA1C equal to or greater than 5.7% and less than 6.5%. A retrospective cohort was also studied to assess the risk of pregnant women with negative screening for diabetes and HbA1C between 5.7% and less than 6.5%, verified up to the 14th week of gestation, to develop GDM when compared to those with normal HbA1C. The prevalences and incidences of diagnoses identified by the association of FG and HbA1c and by the oral glucose tolerance test 75g (OGTT-75g), respectively, were presented as percentages and 95% confidence interval (CI), and the relative risk was calculated with 95% CI. Results: The prevalence of pregnant women with negative screening for diabetes and HbA1C ≥ 5.7% and < 6.5% was 5.6% (95%CI 4.5–6.9). We also identified that 12.2% (95%CI 10.6–14.0) were diagnosed with GDM and 1.7% (95%CI 1.1–2.4) had a diagnosis of pre-existing diabetes. HbA1C ≥ 5.7% and <6.5 and age over 30 years are independent risk factors for the development of GDM in pregnancies with negative screening for diabetes, with odds ratios of 3.241 (95%CI 1.242 – 8.457) and 2.175 (95%CI 0.968 - 4.883), respectively. Conclusion: Pregnant women who develop GDM may have alterations in glucose metabolism prior to pregnancy, as indicated by their elevated HbA1c in the first trimester. First trimester HbA1c may help early identification of women at risk for possible follow-up and treatment during pregnancy and after childbirth.
Introduction: Prediabetes (PD) is a condition of loss of glucose tolerance and that mostly precedes diabetes mellitus (DM). During pregnancy, patients with glycated hemoglobin (HbA1C) equal to or greater than 5.7% and less than 6.5% do not receive the same attention as pregnant women diagnosed with gestational diabetes mellitus (GDM). Method: Retrospective prevalence study to determine, in the first trimester, the number of pregnant women with negative screening for GDM and HbA1C equal to or greater than 5.7% and less than 6.5%. A retrospective cohort was also studied to assess the risk of pregnant women with negative screening for diabetes and HbA1C between 5.7% and less than 6.5%, verified up to the 14th week of gestation, to develop GDM when compared to those with normal HbA1C. The prevalences and incidences of diagnoses identified by the association of FG and HbA1c and by the oral glucose tolerance test 75g (OGTT-75g), respectively, were presented as percentages and 95% confidence interval (CI), and the relative risk was calculated with 95% CI. Results: The prevalence of pregnant women with negative screening for diabetes and HbA1C ≥ 5.7% and < 6.5% was 5.6% (95%CI 4.5–6.9). We also identified that 12.2% (95%CI 10.6–14.0) were diagnosed with GDM and 1.7% (95%CI 1.1–2.4) had a diagnosis of pre-existing diabetes. HbA1C ≥ 5.7% and <6.5 and age over 30 years are independent risk factors for the development of GDM in pregnancies with negative screening for diabetes, with odds ratios of 3.241 (95%CI 1.242 – 8.457) and 2.175 (95%CI 0.968 - 4.883), respectively. Conclusion: Pregnant women who develop GDM may have alterations in glucose metabolism prior to pregnancy, as indicated by their elevated HbA1c in the first trimester. First trimester HbA1c may help early identification of women at risk for possible follow-up and treatment during pregnancy and after childbirth.
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Palavras-chave
Estado pré-diabético, Gravidez, Hemoglobina A glicada, Pre-diabetic state, Pregnancy, Glycated hemoglobin A