Abstract
There are currently several diagnostic criteria for gestational diabetes (GDM). Both the WHO -2013 and NICE diagnose GDM based on a single step 75 g OGT; however; each uses different glucose thresholds. Previous studies have shown that the prevalence of GDM using the NICE criteria (GDM-N) is lower than that using the WHO-2013 criteria (GDM-W). Qatar has national diabetes in pregnancy program in which all pregnant women undergo OGTT screening using the WHO-2013 criteria. This study aims to define the prevalence of GDM using both criteria in a high-risk population. This retrospective study included 2000 women who underwent a 75 g (OGTT) between Jan 2016 and Apr 2016 and excluded patients with known pre-conception diabetes, multiple pregnancy, and those who did not complete the OGTT. We then classified the women into GDM-W positive, GDM-N positive but GDM-W negative, and normal glucose tolerance (NGT) population. A total of 1481 women (74%) had NGT using the NICE or the WHO-2013 criteria. The number of patients who met both criteria was 279 subjects (14%) with a good agreement (Kappa coefficient 0.67, p < 0.001). The NICE and the WHO-2013 criteria were discordant in 240 subjects (12% of the cohort); 6.7% met the WHO -2013 criteria only and only 5.3% met the NICE criteria. The frequency of pre-eclampsia, pre-term delivery, Caesarean-section, LGA and neonatal ICU admissions were significantly increased in the GDM-W group. However, the GDM-N positive but GDM-W negative had no increased risk of maternal or fetal complications apart from pregnancy-induced hypertension. The WHO-2013 and the NICE criteria classified a similar proportion of pregnant women, 21.5% and 20.1%, respectively, as having GDM; however, they were concordant in only 14% of the cases. Women who are GDM-N positive but GDM-W negative are not at increased risk of maternal and fetal pregnancy complications, except for pregnancy-induced hypertension. As the NICE criteria are more specific to the UK population, we would recommend the use of the WHO-2013 criteria to diagnose GDM in the MENA region and possibly other regions that do not have the same set-up as the UK.
Highlights
A continuous association between fasting, 1-h and 2-h blood glucose and the subsequent risk of large for gestational age (LGA), C-section and cord-serum C-peptide[7]
In 2010 the International Association of Diabetes and Pregnancy Study Groups Recommendations (IADPSG) published new diagnostic criteria for the diagnosis of GDM based on the risks of large for gestational age (LGA)[8]
The glucose threshold for the diagnosis of GDM was selected based on an odds ratio of 1.75 for LGA compared to the reference glucose levels[8]
Summary
A continuous association between fasting, 1-h and 2-h blood glucose and the subsequent risk of large for gestational age (LGA), C-section and cord-serum C-peptide[7]. In 2010 the International Association of Diabetes and Pregnancy Study Groups Recommendations (IADPSG) published new diagnostic criteria for the diagnosis of GDM based on the risks of large for gestational age (LGA)[8]. In 2013; these new diagnostic thresholds for GDM (FBG ≥ 5.1 mmol/l, 1-h post-OGTT ≥ 10.0 mmol/l or 2-h post-OGTT ≥ 8.5 mmol/l)were adopted by the WHO1 The adoption of these new criteria has resulted in an increase in the prevalence of GDM by approximately 20%9,10. The National Institute for Health and Care Excellence (NICE) recommends against the use of the IADPSG criteria based on health economic modelling using a wide range of glucose thresholds. The primary objective of this study was to investigate whether or not NICE criteria is associated with a lower prevalence of GDM compared to the WHO-2013 criteria in this high-risk population. We aimed to examine the impact of the change in the diagnostic criteria on pregnancy outcomes
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