Protocolo de rastreio e diagnóstico do diabetes mellitus gestacional

Abstract

Gestational diabetes mellitus (GDM) is associated with severe adverse perinatal outcomes and unfavorable short- and long-term health consequences for both mother and child. Due to the increasing prevalence of GDM worldwide, the impact and importance of this medical condition in prenatal care is growing. There is no consensus on the best forms of diagnosis for GDM, different criteria are adopted worldwide which currently often leads to a late diagnosis. The aim of this study is to develop an objective and didactic clinical protocol to help general practitioners and specialists on the diagnosis of GDM, in both primary and tertiary care. The study was carried out using the method of rapid literature review, which occurred through searches in the PUBMED and Scielo databases, with the terms "GESTATIONAL DIABETES MELLITUS CLASSIFICATION", "GESTATIONAL DIABETES DIAGNOSIS", "GESTATIONAL DIABETES RISK ALGORITHM", “ALGORITHM OF COMPLICATIONS OF GESTATIONAL DIABETES MELLITUS” and its correlates in english. Repeated studies, case reports, letters to the editor, comments and studies not available in English or Portuguese were excluded. Observational, descriptive studies, literature reviews, meta-analyses and systematic reviews were included. 107 publications were carried out for this protocol, which resulted in 11 flowcharts, 9 figures and 4 tables, in addition to explanatory texts, presented in 8 topics: categorization of hyperglycemia in pregnancy (pre-gestational diabetes, overt diabetes and GDM), maternal physiology, risk factors in GDM, maternal and fetal complications, screening and diagnosis of GDM, investigation of diabetes mellitus in the puerperium and practical examples for diagnosis of GDM. This project resulted in the creation of a practical instrument, which allows medical professionals carry out the diagnosis between the different forms of hyperglycemia in pregnancy, better understanding of the pathophysiology, risk factors and maternal-fetal complications of GDM, and therefore, assist professionals in the screening and and diagnosis, in situations of total/ partial financial viability and/or technical availability, regarding both GDM and diabetes mellitus in the puerperium, in order to promote early therapeutic intervention when applicable.