Abstract
Introduction: While the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria is widely adopted in many countries, clinicians have questioned the applicability of these diagnostic thresholds for different races/ethnicities. We first compared the prevalence of gestational diabetes mellitus (GDM) diagnosed with different criteria including IADPSG, World Health Organization (WHO) 1999 and Sri Lankan national guidelines, and subsequently related individual guidelines-specific GDM prevalence to offspring birthweight in Sri Lanka.Materials and Methods: We retrospectively collected data on singleton pregnancies (n = 795) from two tertiary hospitals in Sri Lanka. We applied three diagnostic guidelines to define GDM, namely IADPSG criteria, the Sri Lankan national and WHO 1999 guidelines. We calculated the age- and first booking BMI-adjusted prevalence rates of GDM and assessed the association of GDM (using each guideline) with birthweight.Results: The age- and first booking BMI-adjusted GDM prevalence rates were 31.2, 28.0, and 13.1% for IADPSG criteria, Sri Lankan national and WHO 1999 guidelines, respectively. The IADPSG criteria identified 90 distinctive GDM cases at a lower cut-off of fasting glucose (from 5.1 to 5.5 mmol/L) while Sri Lankan national guideline identified 15 distinctive GDM cases at a lower cut-off for 2-h glucose (from 7.8 to 8.4 mmol/L). After adjusting for age, GDM diagnosed by IADPSG criteria was associated with higher birthweight [90.8 g, 95% CI: 10.8, 170.9], while the associations for GDM diagnosed either by Sri Lankan national or WHO 1999 guidelines were not significant.Conclusion: Adopting the IADPSG criteria for diagnosing GDM may be important in Sri Lankan pregnant population.
Highlights
While the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria is widely adopted in many countries, clinicians have questioned the applicability of these diagnostic thresholds for different races/ethnicities
After adjusting for age, gestational diabetes mellitus (GDM) diagnosed by IADPSG criteria was associated with higher birthweight [90.8 g, 95% CI: 10.8, 170.9], while the associations for GDM diagnosed either by Sri Lankan national or World Health Organization (WHO) 1999 guidelines were not significant
We found significant differences in crude and age- and first booking body mass index (BMI)-adjusted GDM prevalence using Sri Lankan national guidelines (28.0 vs. 27.2%, p < 0.01), but not in IADPSG (31.2 vs. 30.8%, p = 0.07) and WHO 1999 guidelines (13.1 vs. 13.3%, p = 0.12)
Summary
While the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria is widely adopted in many countries, clinicians have questioned the applicability of these diagnostic thresholds for different races/ethnicities. The guidelines for diagnosing GDM, as recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and adopted by the World Health Organization (WHO) in 2013 [2], include an elevation in either fasting (≥5.1 mmol/L), 1-h (≥10.0 mmol/L), or 2-h (≥8.5 mmol/L) venous plasma glucose level after a 75-gram glucose intake [1] These thresholds are based on the average glucose values at which odds for birthweight >90th percentile, cord Cpeptide >90th percentile, and percent body fat >90th percentile reached 1.75 times the estimated odds of these outcomes at mean glucose values, based on fully adjusted logistic regression models [3]. The study reported that the IADPSG criteria had classified an unmanageable number of women as having GDM who were at low risk of pregnancy complications; and subsequently diverted finite health care resources from other areas
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