Читать книгу Gestational Diabetes - Группа авторов - Страница 67

The HAPO study clearly demonstrated that hyperglycemia-related outcomes are within a continuum, with increasing odds for morbidity in correlations with glucose values. The IADPSG tackled the nearly impossible mission of establishing a consensus threshold, based on the high-quality evidence provided by the HAPO study. This had worldwide success, excluding some organization in the United States, remaining loyal to the traditional guidelines.

The HAPO follow-up, yet to be published, released some preliminary results [84]. The follow-up study was conducted with 4,697 mothers (41.7 years old) and 4,832 children (11.4 years old). A total of 39.5 and 28.6% of the children were obese or overweight rates; 19.1 and 9.9% were obese, when comparing infants of those with GDM versus without GDM, respectively. Among the mothers, the rates of T2DM were 10.7 and 1.9%; the rates of impaired fasting glucose were 30.8 and 9.7%, for those with or without GDM, respectively. This entails that GDM has clear and proven long-term effects, for both the mother and the child. As with the original perinatal complications, the long-term effects were also with a continuous nature. This is aligned with original works of O’Sullivan and Mahan, and once published will re-ignite the debate for and against the IADPSG criteria.

However, until (and probably after) a well-designed interventional RCT will be conducted to answer what is the best threshold, not just for diagnosis but also for treatment, the debate will persist and the guidelines will evolve.