The effects of implementing the International Association of Diabetes and Pregnancy Study Groups criteria for diagnosing gestational diabetes on maternal and neonatal outcomes.

Tai-Ho Hung,T’Sang-T’Ang Hsieh,Victor Sanchez-Margalet

doi:10.1371/journal.pone.0122261

Abstract

BackgroundIn 2010, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommended a new strategy for the screening and diagnosis of gestational diabetes mellitus (GDM). However, no study has indicated that adopting the IADPSG recommendations improves perinatal outcomes. The objective of this study was to evaluate the effects of implementing the IADPSG criteria for diagnosing GDM on maternal and neonatal outcomes.Methodology/Principal FindingsPreviously, we used a two-step approach (a 1-h, 50-g glucose challenge test followed by a 3-h, 100-g glucose tolerance test when indicated) to screen for and diagnose GDM. In July 2011, we adopted the IADPSG recommendations in our routine obstetric care. In this study, we retrospectively compared the rates of various maternal and neonatal outcomes in all women who delivered after 24 weeks of gestation during the periods before (P1, between January 1, 2009 and December 31, 2010) and after (P2, between January 1, 2012 and December 31, 2013) the IADPSG criteria were implemented. Pregnancies complicated by multiple gestations, fetal chromosomal or structural anomalies, and pre-pregnancy diabetes mellitus were excluded. Our results showed that the incidence of GDM increased from 4.6% using the two-step method to 12.4% using the IADPSG criteria. Compared to the women in P1, the women in P2 experienced less weight gain during pregnancy, lower birth weights, shorter labor courses, and lower rates of macrosomia (<4000 g) and large-for-gestational age (LGA) infants. P2 was a significant independent factor against macrosomia (adjusted odds ratio [OR] 0.63, 95% confidence interval [CI] 0.43–0.90) and LGA (adjusted OR 0.74, 95% CI 0.61–0.89) after multivariable logistic regression analysis.Conclusions/SignificanceThe adoption of the IADPSG criteria for diagnosis of GDM was associated with significant reductions in maternal weight gain during pregnancy, birth weights, and the rates of macrosomia and LGA.

Highlights

Women with gestational diabetes mellitus (GDM) are more likely to require operative vaginal and cesarean deliveries and are at risk for obstetrical complications, including preeclampsia, large-for-gestational age (LGA) infants, macrosomia, shoulder dystocia, and birth injury [1]
Screening and diagnostic tests for GDM are not uniform worldwide; various strategies have been endorsed by different professional organizations, such as the American College of Obstetricians & Gynecologists (ACOG) [2] and the World Health Organization (WHO) [3]
The thresholds for most of these GDM diagnostic methods are based on two standard deviations above the mean blood glucose levels or based on criteria used in non-pregnant women, which are not directly related to perinatal outcomes

Summary

Introduction

Women with gestational diabetes mellitus (GDM) are more likely to require operative vaginal and cesarean deliveries and are at risk for obstetrical complications, including preeclampsia, large-for-gestational age (LGA) infants, macrosomia, shoulder dystocia, and birth injury [1]. Following the release of the HAPO Study, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) made recommendations in an attempt to reach international uniformity and consensus on the diagnostic criteria for GDM with respect to its value in predicting adverse pregnancy outcomes [5]. The IADPSG recommends diagnosing GDM when one or more of the following plasma glucose levels (based on the 75-g, 2-h, OGTT) was met or exceeded: fasting, 92 mg/dL; 1-h, 180 mg/dL; or 2-h, 153 mg/dL. These revised, lower cut-off values were derived from the HAPO study and represent an odds ratio for adverse pregnancy outcomes of 1.75 compared with women without GDM. The objective of this study was to evaluate the effects of implementing the IADPSG criteria for diagnosing GDM on maternal and neonatal outcomes

Objectives

Methods

Results

Discussion

Conclusion