Optimal timing for diagnosis of gestational diabetes as a determinant of pregnancy outcomes: exploring the particularities in a low-income population.

objectiveTo identify maternal and neonatal outcomes in pregnancies with early versus late gestational diabetes mellitus (GDM) diagnosis, considering healthcare access in a low- to middle-income area of Brazil. SUBJECTS AND

methodsThis retrospective study included women diagnosed with either early GDM (diagnosed before 20 weeks, based on fasting plasma glucose) or late GDM (diagnosed by 24-28 weeks, via oral glucose tolerance test), according to the IADPSG criteria, who received prenatal care at a hospital in southern Brazil. Maternal outcomes included gestational hypertension, pre-eclampsia, cesarean section or instrumented vaginal delivery, and need for intensive care after birth. Perinatal outcomes were assessed based on the adequacy of birth timing and weight for gestational age, the need for neonatal intensive care, shoulder dystocia or fractures, neonatal hypoglycemia and mortality. Logistic regression was used to adjust for possible confounders, with results presented as odds ratios (OR) and 95% confidence intervals (CI).

resultsA total of 320 women with GDM (mean age 32.9 ± 6.5 years) were included: 164 (51.2%) with early GDM and 156 (48.8%) with late GDM. The primary composite maternal outcome was more frequent in late GDM (43.6% versus 29.3%; OR 1.87; 95% CI 1.15-3.03), as well as perineal laceration (OR 2.45; 95% CI 1.22-4.84). No significant differences were found between groups in the primary composite neonatal outcome, prematurity, or macrosomia rates.

conclusionIn this low-income population in southern Brazil, early GDM diagnosis led to more prenatal consultations and pharmacological treatment, which may have contributed to reduced adverse maternal outcomes.