Abstract
BackgroundThe World Health Organization (WHO) adopted more stringent diagnostic criteria for GDM in 2013, to improve pregnancy outcomes. However, there is no global consensus on these new diagnostic criteria, because of limited evidence. The objective of the study was to evaluate maternal characteristics and pregnancy outcomes in two cohorts in the Netherlands applying different diagnostic criteria for GDM i.e. WHO-2013 and WHO-1999.MethodsA multicenter retrospective study involving singleton GDM pregnancies in two regions, between 2011 and 2016. Women were diagnosed according to the WHO-2013 criteria in the Deventer region (WHO-2013-cohort) and according to the WHO-1999 criteria in the Groningen region (WHO-1999-cohort). After GDM diagnosis, all women were treated equally based on the national guideline. Maternal characteristics and pregnancy outcomes were compared between the two groups.ResultsIn total 1386 women with GDM were included in the study. Women in the WHO-2013-cohort were older and had a higher pre-gestational body mass index. They were diagnosed earlier (24.9 [IQR 23.3–29.0] versus 27.7 [IQR 25.9–30.7] weeks, p = < 0.001) and less women were treated with additional insulin therapy (15.6% versus 43.4%, p = < 0.001). Rate of spontaneous delivery was higher in the WHO-2013-cohort (73.1% versus 67.4%, p = 0.032). The percentage large-for-gestational-age (LGA) neonates (birth weight > 90th percentile, corrected for sex, ethnicity, parity, and gestational age) was lower in the WHO-2013- cohort, but not statistical significant (16.5% versus 18.5%, p = 0.379). There were no differences between the cohorts regarding stillbirth, birth trauma, low Apgar score, and preeclampsia.ConclusionsUsing the new WHO-2013 criteria resulted in an earlier GDM diagnosis, less women needed insulin treatment and more spontaneous deliveries occurred when compared to the cohort diagnosed with WHO-1999 criteria. No differences were found in adverse pregnancy outcomes.
Highlights
The World Health Organization (WHO) adopted more stringent diagnostic criteria for Gestational diabetes mellitus (GDM) in 2013, to improve pregnancy outcomes
A total of 1386 women with GDM were included in the study, 437 in the WHO-2013-cohort and 949 in the WHO-1999-cohort
Women in the WHO-2013-cohort were diagnosed earlier in pregnancy (24.9 [inter quartile range (IQR) 23.3–29.0] vs. 27.7 [IQR 25.9–30.7] weeks) and less women had their oral glucose tolerance test (OGTT) performed based on symptoms or signs in third trimester (15.1% vs. 28.5%) instead of screening based on predefined GDM riskfactors
Summary
The World Health Organization (WHO) adopted more stringent diagnostic criteria for GDM in 2013, to improve pregnancy outcomes. In 2008, the international prospective Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study group demonstrated a continuous association between maternal hyperglycaemia and risk of adverse pregnancy outcomes, as birth weight greater than the 90th percentile, caesarean section, premature birth, birth injury, and preeclampsia [9] Based on these findings and earlier observational studies, the International Association of Diabetes and Pregnancy Study Group (IADPSG) proposed more stringent diagnostic thresholds for GDM [10]. These new diagnostic criteria (fasting plasma glucose level ≥ 5.1 mmol/l and/or 1-h plasma glucose level ≥ 10.0 mmol/l and/or 2-h plasma glucose level ≥ 8.5 mmol/l) have been adopted by the American Diabetes Association in 2010, the World Health Organization (WHO) in 2013, and the International Federation of Gynaecology and Obstetrics in 2015 [1, 11, 12]
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