Gestational Diabetes mellitus: The evolution of diagnostic criteria
DOI:
https://doi.org/10.33448/rsd-v14i11.50245Keywords:
Translacional research, Pregnancy, Blood Glucose, Diabetes, Diagnosis.Abstract
O Diabetes mellitus (DM) é uma doença que gera hiperglicemia crônica e pode resultar em complicações secundárias. Os critérios diagnósticos para diabetes são métodos para detecção da doença e seu manejo clínico. No entanto, diferentemente dos critérios estabelecidos para mulheres diabéticas não grávidas, não há consenso atual entre os órgãos reguladores para o diagnóstico de diabetes mellitus gestacional (DMG). Portanto, foi realizada uma revisão bibliográfica com o objetivo de apresentar a evolução dos critérios diagnósticos para DMG, com foco na influência de grandes ensaios clínicos sobre os padrões atuais e explorando áreas onde ainda existem lacunas e divergências entre as diretrizes. Trata-se de uma atualização bibliográfica sobre os critérios diagnósticos para diabetes mellitus gestacional em mulheres e sua evolução nas últimas décadas. Para abranger as principais definições e abordagens, foram incluídos estudos publicados nas bases de dados PubMed, Embase, Scopus e SciELO em português, espanhol e inglês. Os estudos clínicos selecionados para análise descritiva demonstram que o diagnóstico da IADPSG, atualmente recomendado pela ADA, é o mais eficaz na identificação precoce do diabetes mellitus gestacional (DMG) e funciona como preditor de riscos materno-fetais.
References
American Diabetes Association Professional Practice Committee. (2024). Diagnosis and classification of diabetes: Standards of care in diabetes. Diabetes Care, 47(Suppl. 1), S20–S42. https://doi.org/10.2337/dc24-S002
American Diabetes Association. (2023). Standards of medical care in diabetes. Diabetes Care, 46(Suppl. 1), S1–S4. https://doi.org/10.2337/dc23-Sint
Agarwal, M. M. (2015). Gestational diabetes: Differences between the current international diagnostic criteria and implications of switching to IADPSG. Diabetes Care, 38, 9–12. https://doi.org/10.2337/dc14-1224
Abi-Abib, R., et al. (2014). Diabetes na gestação. Revista HUPE, 13, 40–47.
Balkrishna, A., Singh, S., Mishra, S., et al. (2024). Impact of biosensors and biomarkers in diabetes care: A review. Biomedical Materials & Devices. https://doi.org/10.1007/s44174-024-00230-z
Khan, R., et al. (2019). From pre-diabetes to diabetes: Diagnosis, treatments and translational research. Medicina, 55, 546. https://doi.org/10.3390/medicina55090546
Berggren, E. K., Boggess, K. A., Stuebe, A. M., & Jonsson Funk, M. (2011). National Diabetes Data Group vs. Carpenter–Coustan criteria to diagnose gestational diabetes. American Journal of Obstetrics and Gynecology, 205, 253. https://doi.org/10.1016/j.ajog.2011.06.025
Buchanan, T. A., & Xiang, A. H. (2005). Gestational diabetes mellitus. Journal of Clinical Investigation, 115, 525–534.
Castagnetti, B. (2017). “Pregnancy Complicating Diabetes” (1949), by Priscilla White. Embryo Project Encyclopedia. https://doi.org/10.25335/10776/13002
Califf, R. M. (2018). Biomarker definitions and their applications. Experimental Biology and Medicine, 243, 213–221. https://doi.org/10.1177/1535370217750088
CDC – Centers for Disease Control and Prevention. (2024). National Diabetes Statistics Report: Diabetes basics.
Committee on Practice Bulletins—Obstetrics. (2018). ACOG practice bulletin No. 190: Gestational diabetes mellitus. Obstetrics & Gynecology, 131, e49–e64. https://doi.org/10.1097/AOG.0000000000002501
O’Sullivan, J. B., & Mahan, C. M. (1964). Criteria for the oral glucose tolerance test in pregnancy. Diabetes, 13, 278–285.
Carpenter, M. W., & Coustan, D. R. (1982). Criteria for screening tests for gestational diabetes. American Journal of Obstetrics and Gynecology, 144, 768–773. https://doi.org/10.1016/0002-9378(82)90349-0
Coustan, D. R., et al. (2010). The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: Paving the way for new diagnostic criteria for gestational diabetes mellitus. American Journal of Obstetrics and Gynecology, 202, 654. https://doi.org/10.1016/j.ajog.2010.04.006
Dhawan, S., & Natarajan, R. (2019). Epigenetics and type 2 diabetes risk. Current Diabetes Reports, 19, 47. https://doi.org/10.1007/s11892-019-1168-8
Duran, A., et al. (2014). Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: The St. Carlos Gestational Diabetes Study. Diabetes Care, 37, 2442–2450. https://doi.org/10.2337/dc14-0179
Eckhardt, B. J., Holzman, R. S., Kwan, C. K., Bagdadi, J., & Aberg, J. (2012). Hemoglobina A1c glicada como triagem para diabetes mellitus em indivíduos infectados pelo HIV. Cuidados com Pacientes com AIDS, 26, 197–201. https://doi.org/10.1089/apc.2011.0379
Edelson, K. P., James, K. E., Leong, A., Arenas, J., Cayford, M., Callahan, M. J., et al. (2020). Longitudinal changes in the relationship between hemoglobin A1c and glucose tolerance across pregnancy and postpartum. The Journal of Clinical Endocrinology & Metabolism, 105, 1999–2007. https://doi.org/10.1210/clinem/dgaa053
Feig, D. S., Murphy, K., Asztalos, E., et al. (2016). Metformin in women with type 2 diabetes in pregnancy (MiTy): A multi-center randomized controlled trial. BMC Pregnancy and Childbirth, 16, 173.
Farrar, D., et al. (2017). Diagnostic criteria for gestational diabetes: A systematic review of the literature. BMJ, 359, 4875. https://doi.org/10.1136/bmj-2022-071920
FDA–NIH Biomarker Working Group. (2016). Biomarkers, endpoints, and other tools (BEST) resource.
Glechner, A., Keuchel, L., Affengruber, L., Titscher, V., Sommer, I., Matyas, N., et al. (2018). Effects of lifestyle changes on adults with prediabetes: A systematic review and meta-analysis. Primary Care Diabetes, 12, 393–408. https://doi.org/10.1016/j.pcd.2018.07.003
HAPO Study Cooperative Research Group. (2008). Hyperglycemia and adverse pregnancy outcomes. New England Journal of Medicine, 358, 1991–2002. https://doi.org/10.1056/NEJMoa0707943
Houshmand, G. (2019). Evolution of diagnostic criteria for gestational diabetes mellitus. Journal of Clinical Endocrinology & Metabolism, 104, 720–726. https://doi.org/10.1111/aogs.12152
(Obs.: O DOI informado pertence a outro periódico — Acta Obstetricia et Gynecologica Scandinavica. Posso corrigir se desejar.)
Harper, L. M., et al. (2016). Carpenter–Coustan compared with National Diabetes Data Group criteria for diagnosing gestational diabetes. Obstetrics & Gynecology, 127, 873–879. https://doi.org/10.1097/AOG.0000000000001383
IADPSG Consensus Panel. (2010). International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care, 33, 676–682. https://doi.org/10.2337/dc09-1848
Hare, J., & White, P. (1980). Gestational diabetes and the White classification. Diabetes Care, 3, 394. https://doi.org/10.2337/diacare.3.2.394
Marciano, L., Camerini, A. L., & Schulz, P. J. (2019). The role of health literacy in diabetes knowledge, self-care, and glycemic control: A meta-analysis. Journal of General Internal Medicine, 34, 1007–1017. https://doi.org/10.1007/s11606-019-04864-x
Ministério da Saúde & IBGE. (2019). Percepção do estado de saúde, estilos de vida, doenças crônicas e saúde bucal – Pesquisa Nacional de Saúde, 2019. Ministério da Saúde.
Malerbi, F., Andrade, R., Morales, P., Travassos, S., Rodacki, M., & Bertoluci, M. (2023). Manejo da retinopatia diabética. Diretriz Oficial da Sociedade Brasileira de Diabetes.
Malerbi, F. K., Andrade, R. E., Morales, P. H., Stuchi, J. A., Lencione, D., de Paulo, J. V., et al. (2021). Diabetic retinopathy screening using artificial intelligence and handheld smartphone-based retinal camera. Journal of Diabetes Science and Technology, 15, 1–9. https://doi.org/10.1177/1932296820985567
Moon, J., & Jang, H. (2022). Gestational diabetes mellitus: Diagnostic approaches and maternal–offspring complications. Journal of Maternal-Fetal & Neonatal Medicine, 35, 1951–1957. https://doi.org/10.1080/14767058.2021.1970193
Mocellin, M. C., et al. (2024). Prevalência de diabetes gestacional no Brasil: Revisão sistemática e metanálise. Revista Brasileira de Ginecologia e Obstetrícia, 46, 45–53. https://doi.org/10.1055/s-0043-1760190
Organização Pan-Americana da Saúde, Ministério da Saúde, Federação Brasileira das Associações de Ginecologia e Obstetrícia & Sociedade Brasileira de Diabetes. (2017). Rastreamento e diagnóstico de diabetes mellitus gestacional no Brasil (pp. 1–36). Sociedade Brasileira de Diabetes.
O'Sullivan, J. B., & Mahan, C. M. (1964). Criteria for the oral glucose tolerance test in pregnancy. Diabetes, 13, 278–285.
Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. [free ebook]. Santa Maria: Editora da UFSM.
Pititto, A., et al. (2023). Dados epidemiológicos do diabetes mellitus no Brasil. Sociedade Brasileira de Diabetes.
Poltavski, E., Kim, D. J., & Bang, H. (2016). Comparação das pontuações de triagem para diabetes e pré-diabetes. Diabetes Research and Clinical Practice, 118, 146–153. https://doi.org/10.1016/j.diabres.2016.06.022
Sacks, D. A., et al. (2012). Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care, 35, 526–528. https://doi.org/10.2337/dc11-2040
Silva, M. E. R., Mory, D., & Davini, E. (2008). Marcadores genéticos e autoimunes do diabetes melito tipo 1: Da teoria para a prática. Arquivos Brasileiros de Endocrinologia & Metabologia, 52, 166–180. https://doi.org/10.1590/S0004-27302008000200003
Scholtens, D. M., et al. (2019). Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS): Maternal glycemia and childhood glucose metabolism. Diabetes Care, 42, 381–392. https://doi.org/10.2337/dc18-1599
Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333–339.
Szmuilowicz, E. D., et al. (2019). Gestational diabetes mellitus. Endocrinology & Metabolism Clinics, 48, 479–493. https://doi.org/10.1016/j.ecl.2019.01.001
UKPDS Study Group. (1998). UK Prospective Diabetes Study (UKPDS). The Lancet, 352, 878–887. https://doi.org/10.1016/S0140-6736(98)02255-6
Wahabita, H. A., Fayed, A., Esmail, S., et al. (2020). Revisão sistemática e meta-análise da eficácia dos cuidados pré-gravidez para mulheres com diabetes para melhorar os resultados maternos e perinatais. PLoS ONE, 15. https://doi.org/10.1371/journal.pone.0237571
World Health Organization. (2013). Diagnostic criteria and classification of hyperglycemia first detected in pregnancy. Diabetes Research and Clinical Practice, 103, 341–363. https://doi.org/10.1016/j.diabres.2013.06.002
World Health Organization. (2014). Diagnostic criteria and classification of hyperglycemia first detected in pregnancy: A World Health Organization guideline. Diabetes Research and Clinical Practice, 103, 341–363. https://doi.org/10.1016/j.diabres.2013.12.002
White, P. (1949). Pregnancy complicating diabetes. The American Journal of Medicine, 7, 609–616. https://doi.org/10.1016/0002-9343(49)90382-4
Ye, W., et al. (2023). Gestational diabetes mellitus and adverse pregnancy outcomes: Systematic review and meta-analysis. BMJ, 382(2), e072134. https://doi.org/10.1136/bmj-2023-072134
Zajdenverg, L., et al. (2023). Rastreamento e diagnóstico da hiperglicemia na gestação. Diretriz Oficial da Sociedade Brasileira de Diabetes.
Zhang, X., Gregg, A. I., Williamson, D. F., et al. (2010). Nível de A1C e risco futuro de diabetes: Uma revisão sistemática. Diabetes Care, 33, 1665–1673. https://doi.org/10.2337/dc09-2071
Zamora-Obando, H. R., et al. (2022). Biomarcadores moleculares de doenças humanas: Conceitos fundamentais, modelos de estudo e aplicações clínicas. Química Nova, 45, 1098–1113. https://doi.org/10.21577/0100-4042.20220065
Zera, C. A., & Seely, E. W. (2021). Controversies in gestational diabetes. Touch Medical Media. https://doi.org/10.17925/EE.2021.17.2.102
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Beatriz Martins Holtz, Verônyca Gonçalves Paula, Maria Eduarda Picolo Gomes, Gustavo Tadeu Volpato, Debora Cristina Damasceno
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
