A fundamental fact, which showed the need to rethinkpreviously employed diagnostic criteria, was the publicationStudy HAPO (Hyperglycemia and Adverse Pregnancy Outcomes) (126), a study that sought to clarify the risk of adverse outcomesassociated with varying degrees of maternal glucose intolerance,but in any case intolerance less severe than that seen in diabetesmanifests mellitus, and wherein the relationship was clearly demonstratedcontinuously feeding glucose levels, even below thegestational diabetes diagnostic figures, with the weight increaseat birth and increased C-peptide levels in the cord bloodumbilical, unable to identify a cutoff point that clearly demarcateglucose critical level above which the risk risesfetal and maternal complications.
Derived from this study, and analyze all available evidencethen, the IADPSG launched new criteria proposedfor diagnosis of gestational diabetes, which had more to dowith fetal and maternal complications than with the probability of occurrencepost-pregnancy diabetes mellitus in the mother. These criteriawere received recently, though with some reservations, by theADA (128).
Previously, the ADA (125) recommended a selective screening inwhere should stratify patient risk for developing diabetesgestational at the first prenatal visit. The evaluation wasperformed only women who did not comply with all thefollowing criteria: age less than 25 years, normal weight, no historyfamily of diabetes (first degree), no history ofdisorders of glucose tolerance, no history of outcomesadverse obstetric and different from ethnic-racial groupshigh risk for diabetes (eg, Hispanic). Womenwho met all the criteria listed, were catalogedlow risk, and did not require further evaluation. Womenhigh risk (obesity, personal history of gestational diabetes,glycosuria, family history of diabetes) should be submitted toa test of oral glucose tolerance. If not confirmedgestational diabetes at the time, the test should be repeated betweenweeks 24 and 28 of gestation. Women of average risk (whichdid not meet the criteria for high or low risk) should be submittedto test oral glucose tolerance, between weeks 24 and 28gestation. The evaluation glucose load (100 or 75 g) couldpreceded by a load of 50 g, non-fasting, and measurementwhen glucose, which selected the patients who should receiveload of 100 g or 75.