Abstract
AimsQuantify the proportional increase in gestational diabetes (GDM) prevalence when implementing the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria compared to prior GDM criteria, and to assess risk factors that might affect the change in prevalence. MethodsA systematic review and meta-analysis was performed of cohort and cross-sectional studies between January 1, 2010 to December 31, 2018 among pregnant women with GDM using IADPSG criteria compared to, and stratified by, old GDM criteria. Web of science, PubMed, EMBASE, Cochrane, Open Grey and Grey literature reports were included. The relative risk for each study was calculated. Subgroup analyses were performed by maternal age, body mass index, study design, country of publication, screening method, sampling method and data stratified according to diagnostic criteria. ResultsThirty-one cohort and cross-sectional studies with 136 705 women were included. Implementing the IADPSG criteria was associated with a 75% (RR 1.75, 95% CI 1.53–2.01) increase in number of women with GDM with evidence of heterogeneity. ConclusionsThe IADPSG criteria increase the prevalence of GDM, but allow movement towards more homogeneity. More studies are needed of the benefits, harms, psychological effects and health costs of implementing the IADPSG criteria.
Highlights
Gestational diabetes mellitus (GDM) was defined by O’Sullivan as ‘‘carbohydrate intolerance of varying severity with onset or first recognition during pregnancy” [1]
The 31 studies included in the meta-analysis consisted of 136 705 pregnant women of whom 20 127 (14Á7%) had GDM according to the IADPSG criteria and 11 577 (8Á5%) using the old GDM criteria
The prevalence of GDM was 18Á8% in WP, 17.2% in AFR, 41Á4% in MENA, 16Á7% in SEA, 17Á3% EUR, 18Á0% SCA with the IADPSG criteria compared to 9Á8%, 5Á5%, 18Á1%, 9Á3%, 10Á3% and 7Á1% with the old criteria respectively
Summary
Gestational diabetes mellitus (GDM) was defined by O’Sullivan as ‘‘carbohydrate intolerance of varying severity with onset or first recognition during pregnancy” [1]. Oral glucose tolerance test (OGTT) based criteria for GDM were chosen to identify women with a high future risk of developing type 2 diabetes mellitus [2]. Since this time, a variety of diagnostic approaches to GDM have been developed across the world. GDM is associated with several long- and short-term adverse outcomes for the mother (Shoulder dystocia, preeclampsia, cesarean section, type 2 diabetes mellitus, metabolic syndrome, cardiovascular disease) [3,4,5] and child (macrosomia, birth trauma, neonatal hypoglycemia, impaired glucose tolerance, metabolic syndrome, cardiovascular disease) [5,6,7]. There is a clinical importance to finding women with GDM, since many short term adverse outcomes can be reduced with GDM treatment (lifestyle and diet, metformin, insulin) [8,9]
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