International Association Of Diabetes In Pregnancy Study Group Criteria Research Articles

Prevalence of gestational diabetes mellitus, maternal obesity and associated perinatal outcomes over 10 years in an Australian tertiary maternity provider

BackgroundThe International Association of Diabetes in Pregnancy Study Groups (IADPSG) gestational diabetes mellitus (GDM) criteria have been heavily scrutinised with concerns that the consequent GDM prevalence increase has not been associated with improved perinatal outcomes. AimsAt a tertiary hospital in Melbourne, Australia we aimed to evaluate prevalence trends for GDM, type 2 diabetes (T2DM), maternal obesity and large-for-gestational age (LGA) and assess changes in perinatal outcomes following IADPSG criteria uptake in 2015. MethodsA retrospective cohort study of singleton births from 20 weeks’ gestation was conducted between 1st January 2011 and 31st December 2020. Maternal characteristics and perinatal outcomes were extracted from medical records. Results52,795 pregnancies were included. GDM prevalence increased 2.7 times from 8.9% in 2011 to 23.7% in 2020 and increased annually by 8.59% (95%CI 7.77, 9.42). The rate of T2DM increased annually by 11.69% (95%CI 7.72, 16.67). Obesity prevalence increased annually by 3.18% (95%CI 2.58, 3.78). Induction of labour (IOL) prevalence increased annually by 8.35% (95%CI 5.69, 11.06). LGA prevalence remained unchanged. Increasing maternal obesity was the major contributing factor for LGA prevalence. ConclusionsFrom 2011 to 2020 GDM, obesity and T2DM prevalence increased significantly, with associated increased IOL, without change in LGA rates. Prospective studies are required to explore interactions between GDM, obesity, LGA and obstetric interventions.

Pregnancy outcomes according to the definition of gestational diabetes

ObjectiveTo assess the frequency and perinatal outcomes of gestational diabetes mellitus (GDM) defined by the criteria according to the International Association of Diabetes in Pregnancy Study Group (IADPSG) and the National Institute for Health and Care Excellence (NICE) diagnostic criteria for GDM.DesignA retrospective cohort study.SettingSix secondary and tertiary delivery hospitals in Finland in 2009.PopulationPregnant women (N = 4,033) and their offspring.MethodsWe used data on comprehensive screening of pregnant women with a 2-h 75-g oral glucose tolerance test (OGTT), performed between gestational weeks 24 and 40. OGTT glucose concentrations were used to identify women who fulfilled IADPSG and NICE criteria. While cut-offs according to Finnish national criteria partly overlapped with both criteria, a subgroup of IADPSG- or NICE-positive GDM women remained undiagnosed by Finnish criteria and hence non-treated. They were analysed as subgroups and compared to controls who were negative with all cut-offs.Main outcome measuresGDM prevalence, birth weight SD score (BWSDS), large for gestational age (LGA) and caesarean section (CS) rates.ResultsAmong the 4,033 women screened for GDM, 1,249 (31.0%) and 529 (13.1%) had GDM according to the IADPSG and NICE criteria, respectively. The LGA rate was similar in both groups. Regardless of the diagnostic criteria, women with GDM had a higher risk of induced delivery and CSs than controls. In IADPSG-positive non-treated women, offspring’s BWSDS and CS rate were higher than in controls.ConclusionsGDM prevalence was 2.4-fold higher according to the IADPSG compared with the NICE criteria but the LGA rate did not differ. BWSDS and CS rate were increased already with mild untreated hyperglycaemia.

Incidence and Outcomes of Gestational Diabetes Mellitus Using the New International Association of Diabetes in Pregnancy Study Group Criteria in Hôpital Maisonneuve-Rosemont.

At 1 Canadian university hospital, pregnant women were routinely screened for gestational diabetes mellitus (GDM) with a 75-g oral glucose tolerance test (OGTT). Diagnostic plasma glucose thresholds were as follows: fasting: ≥5.3 mmol/L, 1 h: ≥10.6 mmol/L and 2 h: ≥9.0 mmol/L. In 2015, diagnostic thresholds were reduced to those recommended by the International Association of Diabetes in Pregnancy Study Group (IADPSG) as follows: fasting: ≥5.1 mmol/L, 1 h: ≥10.0 mmol/L and 2 h: ≥8.5 mmol/L. However, subsequent Diabetes Canada guidelines state that further evidence is required before recommending those thresholds. Our objectives were to compare pregnancy outcomes of all pregnant women who underwent a 75-g OGTT before and after the adoption of the IADPSG criteria. Pregnancy outcomes of all women (N=2,830) that had a pregnancy OGTT at the Hôpital Maisonneuve-Rosemont between July 1, 2014 and March 1, 2015 (pre-IADPSG group) were compared with women who were screened between March 1, 2015 and January 1, 2016 (post-IADPSG group). Medical files were reviewed to compare outcomes. Women in the post-IADPSG group had a higher early body mass index (26.3 vs 25.5 kg/m2, p=0.01) and more chronic hypertension (3.7% vs 1.2%, p<0.0001), respectively. OGTT results were similar, but rates of GDM were 10.8% (141 of 1,295) in the pre-IADPSG group and 17.6% (271 of 1,535) in the post-IADPSG group. In the post-IADPSG group, pre-eclampsia rates were lower (1.0% vs 2.2%, p=0.021), as was labour induction (25.6% vs 32.8%, p<0.0001) and neonatal intensive care unit admission (4.8% vs 8.5%, p<0.001), respectively. Adopting IADPSG criteria for GDM improved pregnancy outcomes in our obstetric population.

Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus.

Background: In response to concerns that the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria labeled too many women with gestational diabetes mellitus (GDM) without evidence of clinical or economic benefit, NICE recommended a change in diagnostic criteria in 2015. Aim: To compare diabetes associated maternal and neonatal complications in pregnancies complicated by GDM diagnosed using IADPSG criteria only, to those with GDM diagnosed using both IADPSG and NICE 2015 criteria. GDM screening was risk factor based. Methods: This was a secondary analysis of a trial of women with GDM diagnosed by the IADPSG criteria (fasting blood glucose (BG) ≥ 5.1 mmol/L, 1 h ≥ 10.0 mmol/L and 2 h ≥ 8.5 mmol/L). Outcomes were compared for two groups: NICE + IADPSG defined as those with GDM diagnosed by both the NICE 2015 and IADPSG criteria (fasting BG ≥ 5.6 mmol/L, 2 h ≥ 8.5 mmol/L); and IADPSG-ONLY (fasting BG 5.1 mmol/L to 5.5 mmol/L, and/or 1-hour ≥10.0 mmol/L, and 2 h ≥ 8.5 mmol/L). We were not able to obtain data for women with a 2-h value between BG 7.8–8.4 mmol/L (i.e., NICE-ONLY; NICE 2015 positive and IADPSG negative). All women were treated for GDM using targets of fasting BG < 5.3 mmol/L and 1-h post prandial BG < 7.8 mmol/L respectively. Results: Of 159 women, 65 (40.9%) were NICE + IADPSG and 94 (59.1%) IADPSG-ONLY. Hypoglycaemic medication use was similar in both groups: 52.3% NICE + IADPSG, 46.8% IADPSG-ONLY, OR 1.0 (0.5–1.9). The IADPSG-ONLY group delivered later than the NICE + IADPSG group; 39.0 weeks (sd 1.4) compared to 38.2 weeks (sd 2.5), p value 0.02. Fewer caesarean sections occurred in IADPSG-ONLY group 30.9% vs. 52.3%, OR 0.4 (0.2–0.9). Birthweight, large for gestational age, and other neonatal complications were not significantly different between groups. Conclusions: Gestational diabetes-associated perinatal complications were similar in both groups. The IADPSG criteria detect women with evidence of ongoing hyperglycaemia who may benefit from treatment during pregnancy.

Changing Glucose Tolerance during Pregnancy—Implications for Diagnosis of Gestational Diabetes Mellitus (GDM)

Background: ADA recommends testing for GDM at 24-28 weeks gestation. This recommendation is based on the assumption that glucose tolerance worsens during pregnancy and, therefore, testing earlier in pregnancy will miss many cases that develop only later. We tested this assumption in the LIFE-Moms consortium. Methods: LIFE-Moms was a consortium of randomized clinical trials of lifestyle interventions aimed at limiting gestational weight gain compared with standard care in 1,150 pregnant women with BMI ≥25 kg/m2 recruited from different racial/ethnic groups in the U.S. Women with known or probable diabetes preceding this pregnancy were excluded. As previously reported, the lifestyle interventions modestly reduced excessive gestational weight gain (the primary outcome) but had no significant effect on the prevalence of GDM at 24-31 weeks. We report here results of 75 g 2-hour OGTTs performed sequentially during pregnancy in a subset of 296 women tested at &amp;lt;16 weeks (mean 12.6 weeks) gestation and again at 24-31 weeks. Tests were interpreted by the International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria. Results: Plasma or serum glucose declined from the early to later tests by a mean of 2.5 mg/dl (fasting), 10.9 mg/dl (1-hr), and 9.3 mg/dl (2-hr), each p&amp;lt;0.0001. The prevalence of GDM by IADPSG criteria declined from 20% at &amp;lt;16 weeks gestation to 15% at 24-31 weeks (p=0.04). Only 9% of women without GDM at &amp;lt;16 weeks gestation developed it by 24-31 weeks, whereas 65% of those meeting GDM criteria at &amp;lt;16 weeks gestation did not meet GDM criteria at follow-up. None of the changes in glucose or GDM prevalence differed significantly by treatment group. Conclusions: In pregnant women with BMI ≥25 kg/m2 who are otherwise healthy, glucose tolerance improves on average rather than deteriorates during gestation. Testing for GDM early in pregnancy is needed to understand pregnancy effects on glycemia and the clinical implications of earlier detection of GDM. Disclosure W.C. Knowler: None. K. Drews: None. L. Redman: None. K.J. Joshipura: None. S. Arteaga: None. X. Pi-Sunyer: None. L. Van Horn: None. R.R. Wing: None. S. Klein: Stock/Shareholder; Self; Aspire Bariatrics. Consultant; Self; Pfizer Inc.. Research Support; Self; Merck &amp; Co., Inc., Johnson &amp; Johnson Services, Inc., REMD Biotherapeutics.

Screening for gestational diabetes mellitus in a South African population: Prevalence, comparison of diagnostic criteria and the role of risk factors.

The prevalence of gestational diabetes mellitus (GDM) is increasing. Most major world organisations now recommend universal screening for GDM based on the International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria. Currently there is a lack of consensus on the diagnostic criteria for GDM used in South Africa (SA). The Society for Endocrinology, Metabolism and Diabetes of South Africa's revised guidelines recommend the use of the IADPSG criteria for the diagnosis of GDM. To determine the prevalence of GDM in an SA population. We compared the prevalence of GDM using the various diagnostic criteria and evaluated the risk factors associated with GDM. This was a prospective cohort observational study carried out at a level 1 clinic in Johannesburg, SA. All pregnant women at &lt;26 weeks' gestation were recruited. Patients known to have GDM were excluded. At recruitment, a data questionnaire was completed and bloods were drawn for a random glucose test and measurement of the glycated haemoglobin level. A 75 g 2-hour oral glucose tolerance test (OGTT) was scheduled before 28 weeks' gestation. Five hundred and fifty-four patients (55.4%) completed the OGTT. The prevalence of GDM was 25.8% if universal screening and the IADPSG criteria were used. If universal screening and the National Institute for Health and Care Excellence (NICE) criteria were used, the prevalence was 17.0%. If selective risk factor-based screening was used, only 254 (45.8%) of the women would have had an OGTT. The prevalence of GDM in this instance would have been 15.2% with the IADPSG criteria and 3.6% with the NICE criteria. Two hundred and fifty-four patients (45.8%) had at least one risk factor for GDM. The presence of one or more risk factors had a poor sensitivity (58.7%) and specificity (58.6%) for the detection of GDM in our study population. The prevalence of GDM would be substantially increased if universal screening with the IADPSG criteria were to be employed. Risk factors are a poor screening test for GDM.

Combining the IADPSG criteria with the WHO diagnostic criteria for gestational diabetes mellitus optimizes predictability of adverse pregnancy outcome

Background: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes, yet there are no universally accepted diagnostic criteria for GDM. The International Association of Diabetes in Pregnancy Study Group (IADPSG) and World Health Organization's (WHO) diagnostic criteria are commonly used criteria, although clinical outcome data of diagnostic performance of these diagnostic criteria are limited. This study examines the IADPSG and WHO criteria for predicting adverse pregnancy outcomes. Materials and Methods: This longitudinal study involved 130 pregnant women who underwent Oral Glucose Tolerance Testing (OGTT) during 24-32 weeks of gestation. Fasting, 1-hour and 2-hour glucose were measured. Participants were classified as GDM and non-GDM women based on the IADPSG and WHO diagnostic criteria. Five pregnancy outcomes were observed, namely, pre-eclampsia, shoulder dystocia or birth injury, birth weight ≥4.0 kg, clinical neonatal hypoglycaemia and birth asphyxia. Results: Twenty-eight participants (21.5%) had GDM by the IADPSG criteria (GDM IADPSG ) and 21 (16.2%) women had GDM by the WHO criteria (GDM WHO ). Only 15 women (11.5%) met the criteria for GDM by both criteria. The association of GDM with macrosomia was stronger in GDM WHO women [Odds ratio (OR) =13.1, 95% confidence interval (CI) = 3.4-50.6] compared to the GDM IADPSG women (OR = 5.3, 95% CI 1.5-18.9). Macrosomia or at least one adverse outcome were more likely in GDM patients who met the diagnostic criteria by both the IADPSG and WHO criteria (P = 0.001). Conclusion: A diagnosis of GDM that meets both the WHO and IADPSG criteria provides stronger prediction for adverse pregnancy outcome than a diagnosis that meets only WHO or IADPSG criteria.

Case Report: Gestational Diabetes Mellitus: 2 Cases Diagnosed and Treated Using IADPSG Criteria. The Debate Goes On

Background: How best to define Gestational Diabetes Mellitus (GDM) is the object of debate, with International Association of Diabetes in Pregnancy Study Groups criteria (IADPSGc) differing from Coustan and Carpenter criteria (CCc). Cases: We present the cases histories of two patients diagnosed as having GDM using the new IADPSGc, who would not have been diagnosed using CCc. In both cases glycemic profiles revealed marked hyperglycemia. In one case, when treated according to CCc, ultrasound revealed that the fetus was large for gestation age. Conclusions: The use of IADPSG criteria permits the identification of a larger number of women at risk for the adverse maternal and fetal outcomes associated with GDM, thus permitting adequate therapy. Furthermore, given the increased risk for future metabolic disease observed in patients with a history of GDM, the detection of GDM in these women could reduce future morbidity if preventive lifestyle changes and targeted follow-up are implemented.

Comparison of different criteria for diagnosis of gestational diabetes mellitus.

Introduction:The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria for gestational diabetes mellitus (GDM) has been adopted by most associations across the world including the American Diabetes Association and World Health Organization (WHO). We conducted a study comparing the IADPSG and previous WHO criteria and their effects on neonatal birth weight.Methods:The study was carried out in Obstetrics and Gynaecology Department of a tertiary care institute in South India in collaboration with Endocrinology Department. Thousand two hundred and thirty-one antenatal cases with at least one risk factor for GDM and gestational age of more than 24 weeks were included in the study. Both criteria were compared on the basis of 75 g oral glucose tolerance test results.Results:The prevalence of GDM using IADPSG and previous WHO criteria were 12.6% and 12.4%, respectively. The prevalence of GDM was 9.9% when both criteria had to be satisfied. Both GDM criteria groups did not differ in neonatal birth weight and macrosomia rate. However, there was a significant increase in lower segment cesarean section in IADPSG criteria group. Elevated fasting plasma glucose alone picked up only one GDM in the previous WHO criteria group.Conclusions:A single 2 h plasma glucose is both easy to perform and economical. A revised WHO criterion using a 2 h threshold of ≥140 mg % can be adopted as a one-step screening and diagnostic procedure for GDM in our country.

Gestational diabetes diagnostic methods (GD2M) pilot randomized trial.

To test the feasibility of conducting a pragmatic randomized controlled trial (RCT) comparing the International Association of Diabetes in Pregnancy Study Groups (IADPSG) versus Carpenter-Coustan diagnostic criteria for gestational diabetes (GDM), and to examine patient and provider views on GDM screening. A single-blinded pragmatic pilot RCT. Participants with a singleton pregnancy between 24 and 28 weeks gestation received a 50 g oral glucose challenge test and if the value was <200 mg/dL were randomized to either the 2 h 75 g OGTT using the IADPSG criteria or the 3 h 100 g OGTT using the Carpenter-Coustan criteria. Primary outcome was the feasibility of randomization and screening. Secondary outcomes included patient and provider views (or preferences) on GDM testing. Sixty-eight women were recruited, 48 (71 %) enrolled and 47 (69 %) were randomized. Participants in both study arms identified the main challenges to GDM testing to be: drinking the glucola, fasting prior to testing, waiting to have blood drawn, and multiple venipuntures. Women in both study arms would prefer the 2 h 75 g OGTT or whichever test is recommended by their doctor in a future pregnancy. Physicians and nurse midwives endorsed screening and were comfortable with being blinded to the GDM testing strategy and results values. Both pregnant women and providers value GDM screening, and pregnant women can be recruited to a blinded, randomized GDM screening trial with minimal attrition and missing data.

The impact of adoption of the International Association of Diabetes in Pregnancy Study Group criteria for the screening and diagnosis of gestational diabetes

The objective of the study was to compare the International Association of Diabetes in Pregnancy Study Group (IADPSG) and the Canadian Diabetes Association (CDA) criteria for the diagnosis of gestational diabetes mellitus (GDM). This was a retrospective cohort study involving all pregnant women who underwent screening for GDM at a tertiary medical center between 2008 and 2011. Diagnosis of GDM during the study period was based on the CDA 2008 recommendations of universal screening with a 50 g oral glucose challenge test (GCT; threshold 140 mg/dL [7.8 mmol/L]) and a diagnostic test using a fasting 2 hour, 75 g oral glucose tolerance test (OGTT). Diagnosis of GDM required the presence of 2 or more abnormal values, whereas a single abnormal value was diagnostic of impaired glucose intolerance. Because the OGTT thresholds based on the IADPSG criteria are lower than the CDA 2008 thresholds (92 mg/dL [5.1 mmol], 180 mg/dL [10.0 mmol/L], and 153 mg/dL [8.5 mmol/L]), we identified a group of women who would have been diagnosed as GDM based on the IADPSG criteria but not the CDA 2008 criteria (OGTT-IADPSG group). The pregnancy outcome of that group as well as that of women with a positive OGTT according to the CDA 2008 criteria (OGTT-CDA group) and women with a negative OGTT (OGTT-NEGATIVE group) was compared with that of a control group consisting of women with a negative GCT (GCT-NEGATIVE group). Overall, 5429 women were eligible for the study, of which 4183 were included in the GCT-NEGATIVE group, 526 in the OGTT-NEGATIVE group, 155 in the OGTT-IADPSG group, and 385 in the OGTT-CDA group. Applying the IADPSG criteria to the study population would increase the rate of GDM from 3.2% (7.3% when including impaired glucose intolerance) to 10.3%. The majority of the increase in the rate of GDM was attributed to the use of a single abnormal value to define GDM (5.3% increase) rather than the use of lower threshold values (1.8% increase). Of the 3 threshold values, the lower 1 hour threshold was the most significant contributor to the higher GDM rate. A positive OGTT in both the OGTT-IADPSG group and the OGTT-CDA group was independently associated with a higher rate of the composite adverse outcome (odds ratio, 1.4; 95% confidence interval, 1.1-1.9). The use of the IADPSG criteria instead of the CDA criteria would result in a considerable increase in the rate of GDM, but this also appears to identify additional women at similar risk of adverse pregnancy outcome. Further studies are needed to determine whether this observation persists after controlling for confounders such as body mass index as well as whether treatment in these cases would improve perinatal outcome.

ATLANTIC-DIP: prevalence of metabolic syndrome and insulin resistance in women with previous gestational diabetes mellitus by International Association of Diabetes in Pregnancy Study Groups criteria.

Women with previous gestational diabetes (GDM) are a high-risk group for future development of diabetes, metabolic syndrome, and cardiovascular disease. The new International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria significantly increase the number of women diagnosed with GDM. The long-term metabolic outcome in these women is unknown. We set out to determine the prevalence of metabolic syndrome, using adult treatment panel-III criteria; and insulin resistance, using HOMA2-IR, in white European women with previous GDM. Using a cohort design, we invited women meeting IADPSG GDM criteria across four Irish antenatal centres between 2007 and 2010 to participate. Two hundred and sixty-five women with previous values meeting IADPSG criteria for GDM participated (44 % of the population eligible for participation). Mean age was 36.7 years (SD 5.0). These women were compared with a randomly selected control group of 378 women (mean age 37.6 years, SD 5.1) known to have normal glucose tolerance (NGT) in pregnancy during the same period. A total of 25.3 % of women with previous IADPSG-defined GDM met metabolic syndrome criteria, compared to 6.6 % of women with NGT [at 2.6 (SD 1.0) vs. 3.3 years (SD 0.7) post-partum]. The prevalence of HOMA2-IR >1.8 was higher in women with previous IADPSG-defined GDM (33.6 vs. 9.1 % with NGT, p < 0.001). Women with previous GDM by IADPSG criteria demonstrate a greater than threefold prevalence of metabolic syndrome compared to women with NGT in pregnancy. Efforts to prevent projected long-term consequences of this should focus on interventions both in the preconception and post-partum periods.

Gestational diabetes mellitus among Norwegian women with polycystic ovary syndrome: prevalence and risk factors according to the WHO and the modified IADPSG criteria

The consequences of the recently proposed International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria for gestational diabetes mellitus (GDM) in women with polycystic ovary syndrome (PCOS) are not known. We compared the prevalence rates and risk factors for GDM in PCOS women according to both the WHO and the modified IADPSG criteria. Post hoc analyses from a randomized, multicenter study were used. Fasting and 2-h plasma glucose levels were measured using a 75 g oral glucose tolerance test. GDM was diagnosed according to both the WHO and the modified IADPSG criteria. The prevalence rates of GDM according to the WHO and the modified IADPSG criteria were 9.2 and 15.0% at week 12, 18.7 and 18.7% at week 19, and 25.6 and 24.2% at week 32. Shorter stature and increased insulin levels were correlated with WHO-GDM, but not with modified IADPSG-GDM at weeks 12 and 19. Less weight gain in pregnancy predicted GDM according to both sets of criteria. GDM diagnosis was correlated with less maternal weight loss the first year post-partum. No difference was found in the prevalence of GDM between the two sets of criteria used. Less weight gain in pregnancy was associated with GDM, independent of the diagnostic criteria used. Reduced weight loss the first year post-partum in women with GDM raises the question of whether GDM diagnosis per se or the fact that these women lose less weight after pregnancy predicts later diabetes mellitus.

The Relative Contribution of Prepregnancy Overweight and Obesity, Gestational Weight Gain, and IADPSG-Defined Gestational Diabetes Mellitus to Fetal Overgrowth

OBJECTIVEThe International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria for diagnosis of gestational diabetes mellitus (GDM) identifies women and infants at risk for adverse outcomes, which are also strongly associated with maternal overweight, obesity, and excess gestational weight gain.RESEARCH DESIGN AND METHODSWe conducted a retrospective study of 9,835 women who delivered at ≥20 weeks’ gestation; had a prenatal, 2-h, 75-g oral glucose tolerance test; and were not treated with diet, exercise, or antidiabetic medications during pregnancy. Women were classified as having GDM based on IADPSG criteria and were categorized into six mutually exclusive prepregnancy BMI/GDM groups: normal weight ± GDM, overweight ± GDM, and obese ± GDM.RESULTSOverall, 5,851 (59.5%) women were overweight or obese and 1,892 (19.2%) had GDM. Of those with GDM, 1,443 (76.3%) were overweight or obese. The prevalence of large-for-gestational-age (LGA) infants was significantly higher for overweight and obese women without GDM compared with their normal-weight counterparts. Among women without GDM, 21.6% of LGA infants were attributable to maternal overweight and obesity, and the combination of being overweight or obese and having GDM accounted for 23.3% of LGA infants. Increasing gestational weight gain was associated with a higher prevalence of LGA in all groups.CONCLUSIONSPrepregnancy overweight and obesity account for a high proportion of LGA, even in the absence of GDM. Interventions that focus on maternal overweight/obesity and gestational weight gain, regardless of GDM status, have the potential to reach far more women at risk for having an LGA infant.

Screening and Diagnosis of Gestational Diabetes Mellitus

OBJECTIVETo study the implications of implementing the International Association of Diabetes in Pregnancy Study Group (IADPSG) recommendations for screening and diagnosis of gestational diabetes mellitus (GDM) in Israel and explore alternative methods for identifying women at risk for adverse pregnancy outcomes.RESEARCH DESIGN AND METHODSWe analyzed data of the Israeli Hyperglycemia and Adverse Pregnancy Outcomes study participants (N = 3,345). Adverse outcome rates were calculated and compared for women who were positive according to 1) IADPSG criteria, 2) IADPSG criteria with risk stratification, or 3) screening with BMI or fasting plasma glucose (FPG).RESULTSAdopting IADPSG recommendations would increase GDM diagnosis by ∼50%. One-third of IADPSG-positive women were at low risk for adverse outcomes and could be managed less intensively. FPG ≥89 mg/dL or BMI ≥33.5 kg/m2 at 28–32 weeks of gestation detected proportions of adverse outcomes similar to IADPSG criteria.CONCLUSIONSImplementing IADPSG recommendations will substantially increase GDM diagnosis. Risk stratification in IADPSG-positive women may reduce over-treatment. Screening with FPG or BMI may be a practical alternative.

Gestational diabetes and pregnancy outcomes--a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria.

BackgroundTwo criteria based on a 2 h 75 g OGTT are being used for the diagnosis of gestational diabetes (GDM), those recommended over the years by the World Health Organization (WHO), and those recently recommended by the International Association for Diabetes in Pregnancy Study Group (IADPSG), the latter generated in the HAPO study and based on pregnancy outcomes. Our aim is to systematically review the evidence for the associations between GDM (according to these criteria) and adverse outcomes.MethodsWe searched relevant studies in MEDLINE, EMBASE, LILACS, the Cochrane Library, CINHAL, WHO-Afro library, IMSEAR, EMCAT, IMEMR and WPRIM. We included cohort studies permitting the evaluation of GDM diagnosed by WHO and or IADPSG criteria against adverse maternal and perinatal outcomes in untreated women. Only studies with universal application of a 75 g OGTT were included. Relative risks (RRs) and their 95% confidence intervals (CI) were obtained for each study. We combined study results using a random-effects model. Inconsistency across studies was defined by an inconsistency index (I2) > 50%.ResultsData were extracted from eight studies, totaling 44,829 women. Greater risk of adverse outcomes was observed for both diagnostic criteria. When using the WHO criteria, consistent associations were seen for macrosomia (RR = 1.81; 95%CI 1.47-2.22; p < 0.001); large for gestational age (RR = 1.53; 95%CI 1.39-1.69; p < 0.001); perinatal mortality (RR = 1.55; 95% CI 0.88-2.73; p = 0.13); preeclampsia (RR = 1.69; 95%CI 1.31-2.18; p < 0.001); and cesarean delivery (RR = 1.37;95%CI 1.24-1.51; p < 0.001). Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I2 ≥ 73%). Magnitudes of RRs and their 95%CIs were 1.73 (1.28-2.35; p = 0.001) for large for gestational age; 1.71 (1.38-2.13; p < 0.001) for preeclampsia; and 1.23 (1.01-1.51; p = 0.04) for cesarean delivery. Excluding either the HAPO or the EBDG studies minimally altered these associations, but the RRs seen for the IADPSG criteria were reduced after excluding HAPO.ConclusionsThe WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes. Associations were of similar magnitude for both criteria. However, high inconsistency was seen for those with the IADPSG criteria. Full evaluation of the latter in settings other than HAPO requires additional studies.

An assessment of the international association of diabetes in pregnancy study group (IADPSG) criteria for diagnosing gestational diabetes mellitus

Following the hyperglycaemia and Adverse Pregnancy Outcome study the International Association of Diabetes in Pregnancy Study Group (IADPSG) has suggested new criteria for the diagnosis of gestational diabetes mellitus (GDM)....