Identificación De Grupos Funcionales Ii (Ácidos Carboxílicos Y Derivados Y Marcha Analítica)

Wendland et al. BMC Pregnancy and Childbirth 2011, 11:92
http://www.biomedcentral.com/1471-2393/11/92

RESEARCH ARTICLE

Open Access

Lesser than diabetes hyperglycemia in pregnancy
is related to perinatal mortality: a cohort study in
Brazil
Eliana M Wendland*, Bruce B Duncan, Sotero S Mengue and Maria I Schmidt

Abstract
Background: Gestational diabetes related morbidity increasesalong the continuum of the glycemic spectrum.
Perinatal mortality, as a complication of gestational diabetes, has been little investigated. In early studies, an
association was found, but in more recent ones it has not been confirmed. The Brazilian Study of Gestational
Diabetes, a cohort of untreated pregnant women enrolled in the early 1990’s, offers a unique opportunity to
investigate thisquestion. Thus, our objective is to evaluate whether perinatal mortality increases in a continuum
across the maternal glycemic spectrum.
Methods: We prospectively enrolled and followed 4401 pregnant women attending general prenatal care clinics in
six Brazilian state capitals, without history of diabetes outside of pregnancy, through to birth, and their offspring
through the early neonatalperiod. Women answered a structured questionnaire and underwent a standardized 2hour 75-g oral glucose tolerance test (OGTT). Obstetric care was maintained according to local protocols. We
obtained antenatal, delivery and neonatal data from hospital records. Odds ratios (OR) were estimated using
logistic regression.
Results: We ascertained 97 perinatal deaths (67 fetal and 31 early neonatal). Oddsof dying increased according to
glucose levels, statistically significantly so only for women delivering at gestational age ≥34 weeks (p < 0.05 for
glycemia-gestational age interaction). ORs for a 1 standard deviation difference in glucose, when analyzed
continuously, were for fasting 1.47 (95% CI 1.12, 1.92); 1-h 1.55 (95% CI 1.15, 2.07); and 2-h 1.53 (95% CI 1.15, 2.02).
The adjusted OR forIADPSG criteria gestational diabetes was 2.21 (95% CI 1.15, 4.27); and for WHO criteria
gestational diabetes, 3.10 (95% CI 1.39, 6.88).
Conclusions: In settings of limited detection and treatment of gestational diabetes mellitus, women across a
spectrum of lesser than diabetes hyperglycemia, experienced a continuous rise in perinatal death with increasing
levels of glycemia after 34 weeks ofpregnancy. Current GDM diagnostic criteria identified this increased risk of
mortality.

Background
Gestational diabetes is generally defined as a state of
glucose intolerance detected during pregnancy, but the
level of hyperglycemia used in its definition varies
remarkably around the world, as does its prevalence [1].
Gestational diabetes is an established risk factor for
adverse maternaloutcomes such preeclampsia and
future type 2 diabetes, as well as neonatal outcomes
* Correspondence: elianawend@gmail.com
Post-Graduate Program in Epidemiology, Federal University of Rio Grande do
Sul, Porto Alegre, Brazil

such as macrosomia, hypoglycemia and birth injuries
[2-6].
Perinatal mortality was reported to be higher among
women with gestational diabetes in some initial studies[7,8]. However, the HAPO Study, a large multi-country
cohort study conducted between 2000 and 2006, found
no association between glucose levels and perinatal mortality [6]. In fact, this association was also not found in
an additional large, retrospective cohort study conducted
in a developing country [9].
Worldwide, an estimated 6.3 million perinatal deaths,
of which 57% are fetal deaths,occur annually [10]. The

© 2011 Wendland et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.

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