Changes in perinatal outcomes after implementation of IADPSG criteria for screening and diagnosis of gestational diabetes mellitus: A national survey.

Abstract

To compare perinatal outcomes before and after implementation of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for testing of gestational diabetes mellitus (GDM). A national, perinatal, registry-based cohort study of prospectively collected data was conducted. Patients with diabetes type 1 or 2 were excluded. Outcomes of 135 786 pregnancies before (January 1, 2004 to May 31, 2010) and 140 524 after (June 1, 2011 to December 31, 2017) the introduction of IADPSG criteria were compared using Student t test and χ2 test (P<0.05 was significant). Multivariable logistic regression was used to compare outcomes controlling for potential confounders. Prevalence of GDM increased from 2.6% to 9.7% (adjusted odds ratio 3.92; 95% confidence interval 3.78-4.08). Incidence of large-for-gestational age (LGA), macrosomia (birth weight >4500g), Erb's palsy, and hypertensive disorders in pregnancy decreased despite increasing maternal age and pre-pregnancy obesity. Rates of cesarean delivery increased in both GDM and non-GDM groups, with a less pronounced increase in GDM mothers. Incidence of small-for-gestational age (SGA) increased in GDM but not in non-GDM group. Implementation of IADPSG criteria in a country with a relatively low prevalence of GDM did not result in higher rates of cesarean delivery and was associated with reductions in LGA and hypertensive disorders in pregnancy.