International Association Of Diabetes In Pregnancy Study Group Research Articles

Anxiety and Depression in Early Gestation and the Association with Subsequent Gestational Diabetes Mellitus in a Disadvantaged Population

ObjectivesEvaluate the association between poor mental health and risk of developing gestational diabetes mellitus (GDM) in a cohort of women from a socioeconomically disadvantaged community.MethodsA total of 1363 nulliparous women with singleton pregnancies recruited to the Screening Tests to Predict Poor Outcomes of Pregnancy study in Adelaide, Australia. Women were assessed for mental health in the first trimester, including likelihood of depression, high functioning anxiety, perceived stress and risk of developing a mental health disorder. GDM was diagnosed based on the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria. Socioeconomic status was measured using the New Zealand Socioeconomic Index (NZSEI).ResultsComplete mental health data was available for 1281 participants. There was no statistically significant difference in SEI, depression, risk of mental health issues, high functioning anxiety and perceived stress between women who developed GDM and those who did not. There was no difference in history of depression nor risk of developing a high mental health disorder in first trimester after adjusting for SEI, BMI in first trimester, smoking status in first trimester and maternal age between women with a GDM pregnancy and those who did not.Conclusions for PracticeThere was no difference in markers of poor mental health in early pregnancy between women who subsequently did or did not develop GDM. Cohort participants were socioeconomically disadvantaged, potentially contributing to the lack of apparent differences in depression observed between groups. Socioeconomically disadvantaged women should be targeted in pre-conception planning to reduce risk of GDM.

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.

IDF21-0355 Puzzle and Muddle in the Guidelines for Diagnosing Gestational Diabetes Mellitus-Efforts to Solve

Background: The countries and associations introduced several guidelines to diagnose gestational diabetes mellitus (GDM). After many years, the International Association of Diabetes in Pregnancy Study Group (IADPSG) is the latest guideline. This study group suggests that anyone value of OGTT with 75 g glucose may be diagnosed as GDM based on Odds Ratio (OR) 1.75, but it does not happen on the ground. Center-to-center differences occur in GDM frequency and relative diagnostic importance of fasting, 1-hour and 2-hour glucose levels, which may impact different strategies for diagnosing GDM. In the IADPSG consensus panel, a few countries suggested OR 1.5 for diagnosing GDM. The outcome of a study found the prevalence of GDM was almost the same by following OR 1.5 whether it is in the fasting, 1 hour or 2 hours, which is the idea of suggesting anyone value to diagnose GDM. Aim: The outcome of a study found the prevalence of GDM was almost the same by following OR 1.5 whether it is in the fasting, 1 hour or 2 hours, which is the idea of suggesting anyone value to diagnose GDM. Method: Where is the problem, and What is the problem for not universally accepting IADPSG guidelines? We analyzed our data of n = 1463 antenatal women who underwent OGTT with 75g oral glucose. In this cohort, the cumulative prevalence of GDM was 14.60% based on the IADPSG methodology. Table 1:Tabled 1StepsWorking methodologyNo of GDMSTEP 1FPG > 92 mg/dl is 136 (9.30%)9.30%STEP 2Detect 136 form 1463 and the balance is 1327. Out of 1327 1hr PG > 180 mg/dl is 36 (2.46%).2.46%STEP 3Detect 36 from 1327 and the balance is 1291. Out of 1291 2hr PG > 153 mg/dl is 42 (2.87%).2.87%Total cumulative prevalence14.60% Open table in a new tab Results: Table 2:Tabled 1S.noWorking methodology N =1463No of antenatal womenPercentage1Only FPG ≥ 92 mg/dl1369.30%2Only 1hr PG ≥ 180 mg/dl654.40%3Only 2hr PG ≥ 153 mg/dl986.70%Total cumulative prevalence29920.40% Open table in a new tab The methodology of working out the prevalence of GDM by applying OR 1.5, which few countries suggested during consensus meeting at Pasadena, USA: Table 3. If IADPSG had accepted OR 1.5, the prevalence would be the same for FPG, 1 hr, and 2 hr.Tabled 1S.noWorking methodology n =1463No of antenatal womenPercentage1Only FPG ≥ 90 mg/dl18312.50%2Only 1hr PG ≥ 160 mg/dl19012.90%3Only 2hr PG ≥ 140 mg/dl19613.40% Open table in a new tab Discussion: All the diagnostic criteria require women to be in fasting, but most of the time, pregnant women do not come in the fasting state because of commutation. Many health services, especially in low-resource settings, cannot routinely perform an OGTT in pregnant women. The guidelines and diagnostic criteria which are feasible and straightforward on the ground are essential. as the procedure of following OR 1.5 is cost-effective and suitable for the population belonging to any economic status.

Early pregnancy hyperglycaemia as a significant predictor of large for gestational age neonates

AimsWe aimed to determine the effect of early pregnancy hyperglycaemia on having a large for gestational age (LGA) neonate.MethodsA prospective cohort study was conducted among pregnant women in their first trimester. One-step plasma glucose (PG) evaluation procedure was performed to assess gestational diabetes mellitus (GDM) and diabetes mellitus (DM) in pregnancy as defined by the World Health Organization (WHO) criteria with International Association of Diabetes in Pregnancy Study Group (IADPSG) thresholds. The main outcome studied was large for gestational age neonates (LGA).ResultsA total of 2,709 participants were recruited with a mean age of 28 years (SD = 5.4) and a median gestational age (GA) of eight weeks (interquartile range [IQR] = 2). The prevalence of GDM in first trimester (T1) was 15.0% (95% confidence interval [CI] = 13.7–16.4). Previously undiagnosed DM was detected among 2.5% of the participants. Out of 2,285 live births with a median delivery GA of 38 weeks (IQR = 3), 7.0% were LGA neonates. The cumulative incidence of LGA neonates in women with GDM and DM was 11.1 and 15.5 per 100 women, respectively. The relative risk of having an LGA neonate among women with DM and GDM was 2.30 (95% CI = 1.23–4.28) and 1.80 (95% CI = 1.27–2.53), respectively. The attributable risk percentage of a LGA neonate for hyperglycaemia was 15.01%. T1 fasting PG was significantly correlated with both neonatal birth weight and birth weight centile.ConclusionsThe proposed WHO criteria for hyperglycaemia in pregnancy are valid, even in T1, for predicting LGA neonates. The use of IADPSG threshold for Fasting PG, for risk assessment in early pregnancy in high-risk populations is recommended.

IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group’s Criteria

AimsThe approaches used to screen and diagnose gestational diabetes mellitus (GDM) vary widely. We generated a comparable estimate of the global and regional prevalence of GDM by International Association of Diabetes in Pregnancy Study Group (IADPSG)'s criteria. MethodsWe searched PubMed and other databases and retrieved 57 studies to estimate the prevalence of GDM. Prevalence rate ratios of different diagnostic criteria, screening strategies and age groups, were used to standardize the prevalence of GDM in individual studies included in the analysis. Fixed effects meta-analysis was conducted to estimate standardized pooled prevalence of GDM by IDF regions and World Bank country income groups. ResultsThe pooled global standardized prevalence of GDM was 14.0% (95% confidence interval: 13.97–14.04%). The regional standardized prevalence of GDM were 7.1% (7.0–7.2%) in North America and Caribbean (NAC), 7.8% (7.2–8.4%) in Europe (EUR), 10.4% (10.1–10.7%) in South America and Central America (SACA), 14.2% (14.0–14.4%) in Africa (AFR), 14.7% (14.7–14.8%) in Western Pacific (WP), 20.8% (20.2–21.4%) in South-East Asia (SEA) and 27.6% (26.9–28.4%) in Middle East and North Africa (MENA). The standardized prevalence of GDM in low-, middle- and high-income countries were 12.7% (11.0–14.6%), 9.2% (9.0–9.3%) and 14.2% (14.1–14.2%), respectively. ConclusionsThe highest standardized prevalence of GDM was in MENA and SEA, followed by WP and AFR. Among the three World Bank country income groups, high income countries had the highest standardized prevalence of GDM. The standardized estimates for the prevalence of GDM provide an insight for the global picture of GDM.

Utility of Screening Fasting Plasma Glucose and Glycated Hemoglobin to Circumvent the Need for Oral Glucose Tolerance Test in Women with Prior Gestational Diabetes.

IntroductionOur aim is to propose an evidence-based strategy for screening postpartum dysglycemia.MethodsThis study included adult non-pregnant women who were diagnosed with gestational diabetes (GDM) using International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria during their index pregnancy (2012–2019). Eligible participants underwent a concurrent oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) test. A detailed questionnaire documenting relevant personal and medical history was filled, and the relevant anthropometric parameters were recorded.ResultsWe evaluated data from 377 women at a mean (± SD) age of 32.1 ± 4.6 years and at a median duration of 15 (10–33) months following childbirth. Diabetes was diagnosed in 42 (11.1%) women. Use of a combination cutoff [fasting plasma glucose (FPG) ≥ 6.1 mmol/L or glycated hemoglobin (HbA1c) ≥ 6.0% (42 mmol/mol)] avoided OGTT in 80.9% of the study cohort, without missing the diagnosis of diabetes in any study subject. The diagnosis was missed in 2.4% of women with diabetes (and 0.3% of whole cohort) using only the FPG criterion (≥ 5.6 mmol/L) or HbA1c criterion [HbA1c ≥ 5.7% (39 mmol/mol)] alone. These tests avoided the need for an OGTT in 75.3% and 65.5% of women, respectively.ConclusionsThe proposed strategies are likely to be both patient- and physician-friendly and have the potential to address several barriers for postpartum screening among women with prior GDM.

Practice patterns among healthcare professionals for screening, diagnosis, and management of gestational diabetes mellitus (GDM) in selected countries of Asia, Africa, and Middle East

Background: Healthcare professionals (HCPs) face several challenges while treating women with gestational diabetes mellitus (GDM) and often get confused by the different diagnostic criteria recommended by different scientific organizations. A survey was carried out to understand the practices of physicians and obstetricians in South Asia, Africa, and the Middle East, to identify the screening methods and diagnostic criteria used by them for managing women with GDM in the respective countries. Materials and Methods: HCPs across three different regions including South Asia, Middle East, and Africa were contacted through professional diabetes organizations. An online survey designed with Google Forms was created. The link to the survey was shared with HCPs, and the responses were collected and stored in the Google Sheets which was later downloaded for analysis. Results: A total of 356 doctors participated in the survey. The survey covered a total of 18 countries: 3 in South Asia, 5 in Africa, and 10 in the Middle East. The vast majority of the HCPs (64.6%) screened all pregnant women for GDM. About 42.4% of them screened for GDM between 24 and 28 weeks, 21.1% screened before 12 weeks, and the rest carried out screening at different time points. With regard to the screening method, 58.5% of the HCPs responded that they followed the two-step process. However, when asked about the criteria used, the responses were inconsistent. The criteria of the International Association of Diabetes in Pregnancy Study Group (IADPSG) were used by 36.5% doctors and the 1999 criteria by the old World Health Organization (WHO) were used by 27.2%, and only 23.9% reported following the American Diabetes Association (ADA) criteria. Conclusion: This large international survey shows that there are still considerable inaccuracies in doctors following the recommended guidelines for GDM diagnosis. This reiterates the fact that more education and training will help HCPs to manage GDM better.

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.

Change in prevalence of gestational diabetes and obstetric complications when applying IADPSG screening criteria in a Belgian French speaking University Hospital. A retrospective cohort study

BackgroundIn April 2012 our institution chose to switch from a two- step criteria for Gestational Diabetes Mellitus (GDM) screening, to the International Association of Diabetes in Pregnancy Study Group (IADSPG) criteria. This shift led to an increased prevalence of GDM in our pregnant population. We designed a study in order to estimate the magnitude of the increase in GDM prevalence before and after the switch in screening strategy. As a secondary objective we wanted to evaluate if there was a significant difference between the two periods in the percentage of maternal and neonatal complications such as gestational hypertensive disorders (GHD), primary cesarean section (pCS), preterm birth, large for gestational age (LGA) newborns, macrosomia, shoulder dystocia, 5′ Apgar score less than to 7 at birth, neonatal intensive care unit (NICU) transfer and neonatal hypoglycemia.MethodsWe selected retrospectively 3496 patients who delivered between January 2009 and December 2011 who were screened with the two-step criteria (group A), and compared them to 2555 patients who delivered between January 2013 and December 2014 and who were screened with IADPSG criteria (Group B). We checked patients’ electronic files to establish GDM status, baseline characteristics (age, body mass index, nationality, parity) and the presence of maternal and neonatal complications.ResultsGDM prevalence increased significantly from group A (3.4%; 95%CI 2.8–4.06%) to group B (16.28%; 95%CI 14.8 -17.7%). In group B there were significantly more non-Belgian and primiparous patients. There was no statistically significant difference in maternal and neonatal complications between the two groups, even after adjustment for nationality and parity.There was a non-significant reduction of the proportion of macrosomic and of LGA babies.ConclusionsIn our population the introduction of IADPSG screening criteria has increased the prevalence of GDM without having a statistically significant impact on pregnancy outcomes.

Neonatal outcomes of very low birthweight infants born to mothers with hyperglycaemia in pregnancy: a retrospective cohort study in Japan

ObjectiveTo examine the mortality and morbidities of very low birthweight (VLBW, <1500 g) infants of mothers with hyperglycaemia in pregnancy.Design and settingWe conducted a retrospective cohort study using data from...

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.

39: One-step vs two-step screening for gestational diabetes: a randomized controlled trial

To assess the incidence of gestational diabetes mellitus (GDM) using the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria (one-step approach) compared to the American College of Obstetrics and Gynecology (ACOG) criteria (two-step approach) for the diagnosis of GDM. This is a prospective randomized controlled trial of women presenting for GDM screening. Patients were randomized into universal screening with either the one-step approach—a 2-hour 75g oral glucose tolerance test (OGTT as defined by IADPSG, thresholds 92mg/dl, 180mg/dl, 153 mg/dl), or with the two-step approach— a 50 glucose challenge test (GCT, threshold 135mg/dl) followed by a diagnostic 3-hour 100 g test (OGTT, as defined by Carpenter and Coustan and endorsed by ACOG, thresholds 95mg/dl, 180 mg/dl, 155mg/dl, 140mg/dl). Diagnosis of GDM required the presence of one abnormal value with the one-step approach, and two abnormal values on the second part of the two-step approach. The primary outcome was incidence of GDM. A total of 249 women were included in the trial. Of those, 123 were randomized into the one-step approach (2-hour 75g OGTT, IADPSG) and 126 into the two-step approach (1 hour GCT followed by 3 hour 100g OGTT, ACOG). GDM was diagnosed in 10 women (8.1%) in the one-step group, and 7 women (5.5%) in the two-step group (p=0.42). There was no significant difference in the rate of preeclampsia, cesarean section rate, macrosomia, shoulder dystocia, or neonatal hypoglycemia between both groups (figure). There was a significant increase in neonatal hyperbilirubinemia with the one-step approach screening (p=0.04). GDM screening with the one-step approach did not significantly increase the incidence of GDM compared with the two-step approach.

924: Prevalence of gestational diabetes after implementation of International Association of Diabetes in Pregnancy Study Group (IADPSG) screening guidelines

We sought to examine the impact on prevalence of gestational diabetes (GDM) diagnosis by adoption of international association of diabetes in pregnancy study group (IADPSG) screening guidelines. We conducted a retrospective cohort study using a natural experiment model that compared two time frames between 2009 and 2013 at a single institution. We introduced IADPSG GDM screening guidelines in 2012 and sustained that screening practice over time. Date of delivery was dichotomized by those delivering before November 1st, 2012, and those delivering after. In a population of 6,424 women with singleton, vertex, term gestations, we examined the prevalence of GDM by date of delivery and results were stratified by parity, maternal age, and BMI. Chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance. Our multivariate logistic regression model controlled for diabetes mellitus, hypertension, parity, maternal age, BMI and race/ethnicity. Overall, we found that the rate of GDM increased significantly pre- and post change in screening protocol in all women (8.3% vs. 11.8%, p<.001) and when stratified by parity, maternal age, and BMI (p<.05 for all). The most dramatic increases in GDM prevalence occurred in lower-risk groups, such as nulliparous women (odds ratio [OR] 2.09; 95% confidence interval [CI], 1.49-2.94), women less than 35 years old (OR 1.80; 95%CI, 1.39-2.33) and normal weight women (OR 2.27; 95%CI, 1.52-3.39). Implementation of the IADPSG GDM screening guidelines significantly increased GDM prevalence overall and in all analytic sub-groups. Future research should focus on the differences in perinatal outcomes in different screening cohorts.

Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya: a prospective comparison of point of care diagnostic methods

BackgroundEarly diagnosis of gestational diabetes mellitus (GDM) is crucial to prevent short term delivery risks and long term effects such as cardiovascular and metabolic diseases in the mother and infant. Diagnosing GDM in Sub-Saharan Africa (SSA) however, remains sub-optimal due to associated logistical and cost barriers for resource-constrained populations. A cost-effective strategy to screen for GDM in such settings are therefore urgently required. We conducted this study to determine the prevalence of gestational diabetes mellitus (GDM) and assess utility of various GDM point of care (POC) screening strategies in a resource-constrained setting.MethodsEligible women aged ≥18 years, and between 24 and 32 weeks of a singleton pregnancy, prospectively underwent testing over two days. On day 1, a POC 1-h 50 g glucose challenge test (GCT) and a POC glycated hemoglobin (HbA1c) was assessed. On day 2, fasting blood glucose, 1-h and 2-h 75 g oral glucose tolerance test (OGTT) were determined using both venous and POC tests, along with a venous HbA1c. The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria was used to diagnose GDM. GDM prevalence was reported with 95% confidence interval (CI). Specificity, sensitivity, positive predictive value, and negative predictive value of the various POC testing strategies were determined using IADPSG testing as the standard reference.ResultsSix hundred-sixteen eligible women completed testing procedures. GDM was diagnosed in 18 women, a prevalence of 2.9% (95% CI, 1.57% - 4.23%). Compared to IADPSG testing, POC IADPSG had a sensitivity and specificity of 55.6% and 90.6% respectively while that of POC 1-h 50 g GCT (using a diagnostic cut-off of ≥7.2 mmol/L [129.6 mg/dL]) was 55.6% and 63.9%. All other POC tests assessed showed poor sensitivity.ConclusionsPOC screening strategies though feasible, showed poor sensitivity for GDM detection in our resource-constrained population of low GDM prevalence. Studies to identify sensitive and specific POC GDM screening strategies using adverse pregnancy outcomes as end points are required.Trials registrationClinical trials.gov: NCT02978807, Registered 29 November 2016.

The Gestational Diabetes Tsunami: Can We Survive It?

(Aust N Z J Obstet Gynaecol. 2016;56(4):333–335) Sedentary lifestyles, poor diets, higher obesity levels, increasing maternal age, and migration of women of high-risk ethnicities to Australia are factors contributing to gestational diabetes mellitus (GDM). On the basis of results from various randomized controlled trials and on outcomes of the hyperglycemia and pregnancy outcomes study, the International Association of Diabetes in Pregnancy Study Groups (IADPSG) established new diagnostic criteria for GDM, which was endorsed by several organizations such as the Australasian Diabetes in Pregnancy Society (ADIPS), Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Royal College of Pathologists of Australia (RACP), and the World Health Organization (WHO).

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.

Placental lactogen, placental growth factor, insulin resistance in early pregnancy and risk for gestational diabetes

Background and aims. Placental hormones and proteins are important regulators of insulin resistance during pregnancy. However, the data concerning the assosiation between placental lactogen (PL) and placental growth factor (PLGF) level in early pregnancy and further development of gestational diabetes mellitus (GDM) are limited and incostintent. The aim of this study was to compare the level of these two placental proteins and homeostasis model assessment of insulin resistance (HOMA-IR) in early pregnancy among women diagnosed with and without GDM months later.Materials and methods. A nested case-control study was conducted in a prospective cohort of pregnant women. Among them, 78 incident GDM cases were identified and 95 women who were not diagnosed with GDM were randomly selected as a control group. Blood was sampled for measurements of PL, PLGF, fasting plasma glucose and insulin at 8-14 weeks of pregnancy. All the women underwent oral glucose tolerance test (OGTT) at 24-32 weeks. GDM was diagnosed according to the International Association of Diabetes In Pregnancy Study Groups (IADPSG) recommendations (fasting glucose ≥5.1 mmol / l and / or 1 hour ≥10.0 mmol / l and / or 2 hours ≥8.5 mmol / L). The maternal and neonatal anthropometric parameters were also measured. Statistical analysis included Student's t-test, logistic regression and Pearson's correlation.Results. There was no difference between GDM and control groups in the mean levels of PL (0,70 +/- 0,53 vs 0,81 +/- 0,58 mg/L, р =0,215 ) and PLGF (60,7 +/- 169.6 vs 46,6+105,6 pg/ml, р=0,503). Women with GDM were older (30.2 +/- 3.9 vs 28.4 +/- 4.7 years, p = 0.008), had higher first trimester body mass index (BMI) (25.2 +/- 5.2 vs 23.1 +/- 4.6 kg/m2, р = 0.006), higher levels of insulin (10.3 +/- 5.5 vs 7.9 +/- 3.9 mU/L, p = 0,007) and HOMA-IR ( 2.17 +/- 1.1 vs 1.7 +/- 0.9, p = 0,007) compared to the control group. Women with GDM also had a higher level of fasting plasma glucose (4.8 + 0.6 and 4.6 + 0,5 mmol/L, p = 0.063), although the difference did not reach statistical significance. HOMA-IR was positively associated with the development of GDM (OR: 1.62, 95% CI: 1.12 - 2.34, P = 0.01) and the association retained under a multivariable analysis controlling for age and BMI (OR: 1.59, 95% CI: 1.04 - 2.45, P = 0.033). Maternal PL and PLGF were not related to the results of OGTT, HOMA-IR or neonatal anthropometry. A positive correlation between PL level and gestational age at the time of blood sampling was observed (r = 0.657, p &lt;0.001).Conclusion. Serum concentrations of PL and PLGF in pregnant women at 8-14 weeks’ gestation were not associated with HOMA-IR and later development of GDM. Higher HOMA-IR score in early pregnancy is significantly associated with an elevated risk 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.