RESUMO
INTRODUCTION: Early diagnosis and adequate care of gestational diabetes is of great importance for both the mother and her fetus. Although several national and international guidelines are known on the methodology for screening gestational diabetes, a not negligible part of the cases remain unrecognized when applying even the most widely used criteria recommended by the World Health Organization (1st recommendation). A connection has been found between the maternal blood glucose values and the prevalence of still-birth, preeclampsia and large for gestational age neonates in several studies, from which the Hyperglycaemia and Adverse Pregnancy Outcomes study has come into prominence. According to conclusions of this study the International Association of Diabetic Pregnancy Study Groups suggested new numeric criteria for the evaluation of the 75-gram oral glucose tolerance test (2nd recommendation), which differs from the evaluation used in the aforementioned screening system. AIMS: The aim of the study was to compare the effectiveness of the two screening systems by evaluation of the pregnancy outcomes. METHODS: By following non-twin pregnancies of 1107 pregnant mothers (831 with normal glucose tolerance, 276 with gestational diabetes based on any of the applied screening methods) the maternal (pre- and post-term birth, caesarean section, toxaemia) and newborns pregnancy outcomes (infants small and large for gestational age, hypoglycaemia) were analysed. RESULTS: With the exception of the prevalence of large for gestational age infants - which was higher among women screened by the new evaluation - no substantial difference in the efficacy of the two investigated methods was found. CONCLUSION: The decision whether the screening of gestational diabetes using the new criteria results in safer recognition of the disturbances of glucose metabolism during pregnancy requires further investigations including a large number of cases.
Assuntos
Glicemia/metabolismo , Diabetes Gestacional/diagnóstico , Teste de Tolerância a Glucose , Hiperglicemia/diagnóstico , Programas de Rastreamento/métodos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Cesárea , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Fertilização in vitro , Idade Gestacional , Teste de Tolerância a Glucose/métodos , Humanos , Hiperglicemia/sangue , Programas de Rastreamento/normas , Pré-Eclâmpsia/epidemiologia , Gravidez , Resultado da Gravidez , Gravidez de Gêmeos , Nascimento Prematuro , Natimorto , Aumento de PesoRESUMO
UNLABELLED: INTRODUCTION, OBJECT: GBS has been responsible for most cases of severe perinatal infection in the last few decades. 10-30% of women is colonised; the vertical transmission is approximately 50% with pregnant carriers. Since the bacterium is responsible for approximately 50% of perinatal sepsis's, and the same time patients may recover with severe residual symptoms, prevention is of great importance. METHOD: The authors screened 1762 out of 2214 women before giving birth at the Obst. and Gyn. Ward of the St. Jones Hosp. and the Obst. and Gyn. Ward of Semmelweis University Kútvölgyi Clinic between May. 1998 and Dec. 1999 following the recommendations issued in 1992 and modified in 1997 by the Committee on Infectious Diseases and the Committee on Fetus and Newborn. RESULTS: The rate of positive cultures was approximately 10%, and the rate of colonised newborn was 1.36%. No severe diseases with residual symptoms were recorded during the period of examination. CONCLUSIONS: On the bases of the international literature and their own experiences the authors recommend the GBS screening and prophylaxis by antibiotics based on positive cultures and risk factors.