User Guide

GESTATIONAL DIABETES DIAGNOSIS LANDMARKS
A TIMELINE

1 - Object Name Gestational diabetes diagnosis landmarks: a timeline

2 - Knowledge Area Health Sciences, Medicine, Endocrinology, Obstetrics

3 - Keywords Gestational diabetes, timeline, diagnosis, controversies.

4 - Introduction This object describes key procedures for the diagnosis of gestational diabetes mellitus (GDM), a controversial topic that remains unresolved in the literature. GDM – an alteration in glucose metabolism that is first detected during pregnancy and may or may not persist after delivery – has an incidence rate of 7.2% among Brazilian women and may be associated with increased risk of adverse maternal and fetal outcomes, such as hypertensive disorders of pregnancy, primary cesarean section rate, and large for gestational age status or fetal macrosomia (birth weight > 4 kg)1 - 4. Several procedures have been recommended for its diagnosis, some evidence-based, others less so, which has engendered much discussion in the medical literature on this topic, particularly because the criterion most widely recommended and employed currently has the potential to increase the prevalence of GDM up to threefold. Currently, the criterion advocated by the World Health Organization1 and by the American Diabetes Association2 is that proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG)5.

5 - Objective This object presents a timeline of several diagnostic procedures, based on studies from the literature and on the recommendations of several medical professional associations with expertise in the matter. Its purpose is to train students to recognize the different diagnostic criteria and understand their origin, thus enabling critical assessment of different procedures and understanding of the advantages and limitations of each method. At the end of this study, students should be able to conduct a critical assessment of the impact of each diagnostic procedure and criterion on clinical practice.

6 - Target Audience Students of graduate and postgraduate programs in the Health Sciences, particularly those in the fields of Endocrinology and Obstetrics.

7 - Prerequisites Basic concepts related to gestational diabetes, such as its definition, its implications for pregnancy and offspring, basic notions of diagnostic procedures, and which procedures are in use in Brazil and worldwide.

8 - Suggested Activities The timeline provides a brief summary of each diagnostic recommendation (in one field) or of the major results of the studies (in another field). For each procedure, study, and recommendation, students can click on a corresponding link that leads to the article summary in PubMed. In addition, the student may access the original articles cited if in an environment with access to Periódicos Capes. Through chats or a discussion forum in the Moodle platform, the instructor may encourage discussion of the diagnostic controversy, as well as of the pros and cons of each procedure and of the limitations of employing these various procedures in different settings. For a more in-depth approach to these concepts, students may consult the full text of the articles (in a Periódicos Capes environment) and participate in the aforementioned discussions. Furthermore, this content may serve as a basis for the student’s capstone project for this discipline.

9 - Suggested Evaluation This learning object will be part of topical activities of graduate courses in Endocrinology or Obstetrics and Gynecology, and will be available to students after inclusion in the Moodle platform. The contents presented and their appropriation by the student can be evaluated during synchronous (chats) and asynchronous (discussion forum) activities, by means of discussion of the content. These activities will assess the development of a critical viewpoint on the various procedures discussed. Specifically, a forum will be available for discussion of the topic in the graduate program. In addition, students may also use the contents presented to support their capstone project for this discipline. Finally, the object itself will be subject to evaluation by each student, and the resulting feedback will serve to define whether it will be reused in later editions of this discipline.

10 - References 1. WHO Guidelines Approved by the Guidelines Review Committee. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. Geneva: World Health OrganizationCopyright (c) World Health Organization 2013.; 2013. 2. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37 Suppl 1:S81-90. 3. Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Diagnostic thresholds for gestational diabetes and their impact on pregnancy outcomes: a systematic review. Diabet Med. 2014;31(3):319-31. 4. Wendland EM, Torloni MR, Falavigna M, Trujillo J, Dode MA, Campos MA, et al. Gestational diabetes and pregnancy outcomes - a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth. 2012;12:23. 5. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676-82.

11 - Technological Specifications Recommended resolution: 800 x 600 px Browsers: Chrome, IE (version 9+), Firefox, Safari (version 5+) or Opera. Version updated in 06/2015