International Association Of The Diabetes And Pregnancy Study Groups Criteria Research Articles

Neonatal outcomes according to different glucose threshold values in gestational diabetes: a register-based study

BackgroundMild hyperglycaemia is associated with increased birth weight but association with other neonatal outcomes is controversial. We aimed to study neonatal outcomes in untreated mild hyperglycaemia using different oral glucose tolerance test (OGTT) thresholds.MethodsThis register-based study included all (n = 4,939) singleton pregnant women participating a 75 g 2-h OGTT in six delivery hospitals in Finland in 2009. Finnish diagnostic cut-offs for GDM were fasting ≥ 5.3, 1 h ≥ 10.0 or 2-h glucose ≥ 8.6 mmol/L. Women who did not meet these criteria but met the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria (fasting 5.1–5.2 mmol/L and/or 2-h glucose 8.5 mmol/L, n = 509) or the National Institute for Health and Clinical Excellence (NICE) criteria (2-h glucose 7.8–8.5 mmol/L, n = 166) were considered as mild untreated hyperglycaemia. Women who met both the Finnish criteria and the IADPSG or the NICE criteria were considered as treated GDM groups (n = 1292 and n = 612, respectively). Controls were normoglycaemic according to all criteria (fasting glucose < 5.1 mmol/L, 1-h glucose < 10.0 mmol/L and 2-h glucose < 8.5 mmol/L, n = 3031). Untreated mild hyperglycemia groups were compared to controls and treated GDM groups. The primary outcome – a composite of adverse neonatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, birth trauma or perinatal mortality – was analysed using multivariate logistic regression.ResultsThe risk for the adverse neonatal outcome in untreated mild hyperglycemia was not increased compared to controls (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI]: 0.71–1.44, using the IADPSG criteria; aOR: 1.05, 95% CI: 0.60–1.85, using the NICE criteria). The risk was lower compared to the treated IADPSG (aOR 0.38, 95% CI 0.27–0.53) or the treated NICE group (aOR 0.32, 95% CI 0.18–0.57).DiscussionThe risk of adverse neonatal outcomes was not increased in mild untreated hyperglycaemia compared to normoglycaemic controls and was lower than in the treated GDM groups. The OGTT cut-offs of 5.3 mmol/L at fasting and 8.6 mmol/L at 2 h seem to sufficiently identify clinically relevant GDM, without excluding neonates with a risk of adverse outcomes.

1258-P: Gestational Diabetes by IADPSG Criteria and Risk of Adverse Birth Outcomes

This study assessed risk of adverse birth outcomes (ABO) associated with GDM by Carpenter-Coustan (C&amp;C) and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) with and without abnormal fasting at OGTT screening. Data included 355,506 singletons born in a single healthcare system. Data on demographics, maternal GDM status with or without abnormal fasting, and six ABOs [caesarean section (CS), shoulder dystocia (SD), fetal distress (FD), neonatal hypoglycemia (NH), preterm birth (PTB), and large-for gestational age (LGA)] were extracted from electronic medical records. Logistic regression was used to assess associations adjusting for covariates. In this cohort, 27,990 (7.9%) were diagnosed by C&amp;C and 21,464 (6.0%) by IADPSG. In the C&amp;C group, 37.3% had abnormal fasting (C&amp;C_AF); among IADPSG, 23.3% met OGTT fasting thresholds (IADPSG_AF). Table 1 shows odds ratios (OR) of ABOs associated with GDM diagnostic types relative to no GDM. GDM by C&amp;C or IADPSG with or without abnormal fasting was associated with higher odds of CS, PTB (except IADPSG_AF), and LGA (except C&amp;C without abnormal fasting). IADPSG without abnormal fasting was associated with higher odds of SD and NH, and C&amp;C_AF was associated with higher odds of SD but lower odds FD and NH. These data suggest GDM by IADPSG was associated with risk of some ABOs; this group may benefit from diabetes care in pregnancy to reduce risk of ABOs. Disclosure S.A.Carter: None. J.C.Lin: None. T.Chow: None. M.P.Martinez: None. R.Feldman: None. K.A.Page: None. A.Xiang: None.

Comparing IADPSG and NICE Diagnostic Criteria for GDM in Predicting Adverse Pregnancy Outcomes.

OBJECTIVETo compare the performance of diagnostic criteria for gestational diabetes mellitus (GDM) proposed by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) with those endorsed by the National Institute for Health and Care Excellence (NICE) in predicting adverse pregnancy outcomes.RESEARCH DESIGN AND METHODSWe performed a secondary data analysis of the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study participants in five study centers. Logistic regression analyses were performed, and Akaike information criterion were applied for the comparison of different statistical prediction models. We further analyzed the performance by four racial/ethnic subgroups, namely, Whites, Hispanics, Asians, and Blacks.RESULTSAmong all, IADPSG criteria diagnosed 267 (4.1%) more women with GDM, but predicted primary caesarean section (CS) and large for gestational age (LGA) and neonatal adiposity better than did NICE criteria after adjustment for potential confounders. Among Whites, IADPSG criteria diagnosed 65 (2.5%) more subjects with GDM and predicted LGA and neonatal adiposity better, but predicted hypertensive disorders, primary CS and clinical neonatal hypoglycemia worse. Among Hispanics, the IADPSG criteria diagnosed 203 (12.1%) more with GDM but performed better in predicting hypertensive disorders, LGA, neonatal adiposity, and hyperinsulinemia. Among Asians, the IADPSG criteria diagnosed 34 (2.0%) fewer subjects with GDM but predicted hypertensive disorders better in the unadjusted model. In Blacks, IADPSG criteria diagnosed 34 (10.5%) more women with GDM.CONCLUSIONSIADPSG criteria appear to be more favorable than NICE for identification of adverse pregnancy outcomes among Hispanic and Asian women, while they are comparable to NICE among White women.

Gestational Diabetes Mellitus Among Pregnant Women Attending Ante-natal Clinic at a Secondary Care Health Facility in Haryana, India.

Introduction: Gestational diabetes has serious health effects during pregnancy and childbirth. We estimated the occurrence of gestational diabetes mellitus (GDM) among pregnant women in a secondary care hospital in Haryana.Methods: It was a hospital-based cross-sectional study, done in an ante-natal clinic (ANC) at a sub-district hospital (SDH), Faridabad district of Haryana, India. Eligible pregnant women attending the ANC clinic were recruited. An oral glucose tolerance test (OGTT) with 75 g of glucose was done with a collection of blood for fasting blood sugar (FBS) and two-hour post-OGTT blood glucose. A pre-tested semi-structured interview schedule was administered. Both the modified International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) and the Diabetes in Pregnancy Study Group of India (DIPSI) criteria were used. Data were presented as percentages, means, standard deviation, and 95% confidence interval (CI). Bi-variable and multi-variable logistic regressions were done. The level of significance was set at 0.05.Results: Of the 623 eligible participants, 66.1% were within the 20-25 age group. The GDM was found in 14.1% (95%CI: 11.5-17.1) participants as per modified IADPSG criteria and 6.7% (95%CI: 4.9-9.0) participants as per DIPSI criteria, respectively. Increasing age [adjusted odds ratio (AOR): 1.24 (95% CI: 1.05-1.47), p=0.008] and increasing years of schooling [AOR: 1.19 (1.01-1.41), p=0.032] were significantly associated with GDM by DIPSI criteria. Family history of DM was also found to have an increased odds with GDM using modified IADPSG criteria [AOR 2.87 (95% CI: 1.09-7.54), p=0.032]. Conclusion: Considerable proportion of pregnant women were found to have GDM in a Sub-district hospital at Ballabgarh in north India. The study highlighted the need and generated evidence about the feasibility of GDM screening utilizing routine staff in a secondary care facility.

Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols

AimsPreanalytical glycolysis in oral glucose tolerance tests (OGTT) leads to substantial underestimation of gestational diabetes mellitus (GDM) and hence risk for large-for-gestational-age (LGA) babies. This paper quantified the impact of glycolysis on identification of LGA risk in a prospective rural and remote Australian cohort. MethodsFor 495 women, OGTT results from room temperature fluoride-oxalate (FLOX) tubes were algorithmically corrected for estimated glycolysis compared to 1) the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study protocol (FLOX tubes in ice-slurry); and 2) room temperature fluoride-citrate (FC) tubes. GDM was defined by International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Unadjusted and corrected OGTT were related to LGA outcome. ResultsCorrection for FC tubes increased GDM incidence from 9.7% to 44.6%. After correction for HAPO protocol, GDM incidence was 27.7% and prediction of LGA risk (RR 1.82, [1.11–2.99]) improved compared to unadjusted rates (RR 1.12, [0.51–2.47]). To provide similar results for FC tube correction (29.3% GDM; RR 1.81, [1.11–2.96]) required + 0.2 mmol/L adjustment of IADPSG criteria. ConclusionsFC tubes present a practical alternative to the HAPO protocol in remote settings but give + 0.2 mmol/L higher glucose readings. Modification of IADPSG criteria would reduce perceived ‘overdiagnosis’ and improve LGA risk-assessment.

Prevalence and Risk Factors for Gestational Diabetes in Aswan, Egypt According to International Association of the Diabetes and Pregnancy Study Groups (IADPSG)

Background: The prevalence of diabetes in Egypt has significantly increased exceeding international rates. Egypt is now ranked ninth highest in the world in terms of the disease according to IDF, 2019. Objective: Estimation of the prevalence of gestational diabetes mellitus (GDM) in Aswan Governorate in Egypt and determination of the risk factors associated with GDM. Patients and methods: Our study was a prospective study, which carried out in the Antenatal Clinic in the Obstetrics and Gynecology Department, Aswan University Hospital from July 2016 to July 2017. The pregnant women were collected form Aswan Governorate as part of a Gestational Diabetes care in Upper Egypt project in collaboration with World Diabetes Foundation. Our study included 1000 pregnant woman. All participants were screened for GDM at 24-28 weeks of gestation. Universal screenings for GDM were performed for the participants using oral glucose tolerance test (OGTT) according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations 2017. Results: According to IADPSG criteria, 17.5% of the screened cases had GDM, 16.8% had fasting blood glucose level ≥ 92 mg/dL, 15.5% had 1-hour OGTT ≥180 mg/dL and 16.7% had ≥153 mg/dL. It was found that the age ≥ 25 years and multiparity were significantly higher in GDM than in Non-GDM. Pregnant women living in rural areas and working women were significantly protected against GDM than those from urban areas. Both family history of diabetes and previous history of GDM represented the major risk factor in our studied group (P < 0.001 & < 0.001 respectively). 40.4 % of studied group exhibited no definite risk factors. There were significant increases in systolic B.P, diastolic B.P in GDM group versus non-GDM (p < 0.001 & p < 0.001 respectively). BMI was significantly higher in GDM than non-GDM (p = 0.024). Conclusion: GDM was highly prevalent in Aswan Governorate with a rate of 17.5%. The major risk factors of GDM were family history of DM and previous history of GDM, increase in age >25 and multiparity and obesity.

Prevalence and Risk Factors for Gestational Diabetes in Aswan, Egypt According to International Association of the Diabetes and Pregnancy Study Groups (IADPSG)

Background: The prevalence of diabetes in Egypt has significantly increased exceeding international rates. Egypt is now ranked ninth highest in the world in terms of the disease according to IDF, 2019. Objective: Estimation of the prevalence of gestational diabetes mellitus (GDM) in Aswan Governorate in Egypt and determination of the risk factors associated with GDM. Patients and methods: Our study was a prospective study, which carried out in the Antenatal Clinic in the Obstetrics and Gynecology Department, Aswan University Hospital from July 2016 to July 2017. The pregnant women were collected form Aswan Governorate as part of a Gestational Diabetes care in Upper Egypt project in collaboration with World Diabetes Foundation. Our study included 1000 pregnant woman. All participants were screened for GDM at 24-28 weeks of gestation. Universal screenings for GDM were performed for the participants using oral glucose tolerance test (OGTT) according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations 2017. Results: According to IADPSG criteria, 17.5% of the screened cases had GDM, 16.8% had fasting blood glucose level ≥ 92 mg/dL, 15.5% had 1-hour OGTT ≥180 mg/dL and 16.7% had ≥153 mg/dL. It was found that the age ≥ 25 years and multiparity were significantly higher in GDM than in Non-GDM. Pregnant women living in rural areas and working women were significantly protected against GDM than those from urban areas. Both family history of diabetes and previous history of GDM represented the major risk factor in our studied group (P < 0.001 & < 0.001 respectively). 40.4 % of studied group exhibited no definite risk factors. There were significant increases in systolic B.P, diastolic B.P in GDM group versus non-GDM (p < 0.001 & p < 0.001 respectively). BMI was significantly higher in GDM than non-GDM (p = 0.024). Conclusion: GDM was highly prevalent in Aswan Governorate with a rate of 17.5%. The major risk factors of GDM were family history of DM and previous history of GDM, increase in age >25 and multiparity and obesity.

Early Screening for Gestational Diabetes Using IADPSG Criteria May Be a Useful Predictor for Congenital Anomalies: Preliminary Data from a High-Risk Population.

Background: Our aim was to investigate whether the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) glycemic thresholds used for detecting hyperglycemia in pregnancy can be predictive for malformations in women with hyperglycemia detected in early pregnancy. Methods: a single-center, retrospective observational trial of 125 mother-infant pairs from singleton pregnancies with hyperglycemia according to the IADPSG criteria diagnosed at the gestational age below 16 weeks. Glucose values obtained from 75-g OGTT (oral glucose tolerance test) were investigated as predictors for congenital malformations in newborns. Results: Characteristics of the cohort: maternal age: 31.5 ± 5.2, pre-pregnancy body mass index (BMI) ≥ 30 kg/m2: 42.0%, gestational age at diagnosis (weeks): 12.0 ± 4.0, and newborns with congenital malformations: 8.8%. Fasting blood glycemia (FBG) and HbA1c (Haemoglobin A1c) at baseline significantly predicted the outcome (expB: 1.06 (1.02–1.1), p = 0.007 and expB: 2.05 (1.24–3.38), p = 0.005, respectively). Both the fasting blood glucose (FBG) value of 5.1 mmol/dL (diagnostic for gestational diabetes mellitus (GDM)) and 5.5 mmol/dL (upper limit for normoglycemia in the general population) significantly increased the likelihood ratio (LR) for fetal malformations: 1.3 (1.1; 1.4) and 1.5 (1.0; 2.4), respectively. Conclusions: (1) Fasting glycemia diagnostic for GDM measured in early pregnancy is associated with a significantly elevated risk for congenital malformations. (2) Our data suggest that women at elevated risks of GDM/diabetes in pregnancy (DiP) should have their fasting blood glucose assessed before becoming pregnant, and the optimization of glycemic control should be considered if the FBG exceeds 5.1 mmol/dL.

OR08-01 One-Step Versus Two-Step Approach for Gestational Diabetes Mellitus Screening: Comparison of Maternal and Fetal Outcomes in a Canadian Population

Screening for gestational diabetes mellitus (GDM) is internationally recommended however there is no universal approach. Impact of the different diagnostic strategies on maternal and neonatal complications’ rates and cost-effectiveness need to be studied.ObjectiveTo compare maternal and neonatal outcomes between the two supported screening methods for GDM; the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) 75g one-step oral glucose tolerance test (OGTT) versus the 50g two-step OGTT.MethodsA retrospective cohort study was performed regrouping all deliveries between 2016 and 2018 in two centers, each using one different screening method. GDM was diagnosed in center A when meeting IADPSG odds ratio (OR) 1.75 cut-offs values after a one-step 75g-OGTT. Center B used a two-step strategy and diagnosed GDM with 50g-OGTT 1hr glycemic value ≥11.1 mmol/L or failed 50g followed by 75g-OGTT results over the IADPSG OR 2.0 cut-offs.Primary outcome was the rate of large for gestational age (LGA) babies. Outcomes were analysed for singleton pregnancies with deliveries >32 weeks.Subgroup analysis of borderline GDM women (OGTT results in between IADPSG OR 1.75 and 2.0 values) were done. Group A’s borderline patients were treated as per GDM patients. Group B’s borderline patients were not considered diabetic and had normal pregnancy care. Results were adjusted for maternal age, BMI and gestational weight gain.ResultsAt interim analysis for the year 2016, a total of 6188 pregnancies, 2664 women in center A (one-step) and 3524 in center B (two-step) were included. The prevalence of GDM was 17.1% in center A (n=456) and 14.8% in center B (n=520). Both populations were comparable in terms of risk factors for LGA except for its ethnic distribution and proportion of obese women (13.1 vs 21.6%). GDM women in center B compared to center A had significant increase in rates of LGA neonates (adjusted OR (ORa) 2.1, p=0.012); neonatal hypoglycemia (ORa 2.1, p=0.0001) and neonatal intensive care unit (NICU) admission (2.1, p=0.048). Gestational hypertension’s rate was more prevalent in center B (ORa 2.1, p=0.020) and there was a non statistical trend towards increased rate of caesareans (1.6, p=0.084).Regular prenatal care for borderline women in center B (n=94) compared to GDM care in center A (n=150) resulted in increased rate of LGA babies (ORa 3.2, p=0.049). Worse maternal outcomes were identified for gestational hypertension (9.7 vs 1.3%, p=0.035) and preeclampsia (4.3 vs 0%, p=0.021) in group B vs A, respectively.ConclusionsChoosing the one-step IADPSG criteria’s for GDM screening is associated with lower rates of LGA, neonatal hypoglycemia and NICU admissions, at the expense of increased prevalence in our population. The ongoing study will include a cost-benefit evaluation to assess if improved outcomes overbalance the increased prevalence inherent to lower diagnostic criteria.

Risk factors for abnormal postpartum glucose outcome in women with gestational diabetes mellitus diagnosed by modified The International Association of the Diabetes and Pregnancy Study Groups criteria.

To characterize postpartum glycemic outcome and related risk factors in women diagnosed with gestational diabetes mellitus (GDM) by modified The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. This is a cohort study of 583 patients with GDM diagnosed by modified IADPSG criteria for Chinese women from 2016 to 2017. According to their oral glucose tolerance tests (OGTT) results at 6-12 weeks postpartum, the subjects were categorized into normal glucose tolerance (NGT) and abnormal glucose tolerance (AGT) groups using the World Health Organization criteria. Multivariate pregestational and gestational factors were compared between the NGT and AGT groups. A total of 174 (29.9%) and 17 (2.9%) subjects were found to have AGT and diabetes, respectively. Multivariate logistic regression analysis showed that elevated 2 h postprandial plasma glucose (PPG) at the diagnosis of GDM (odds ratio [OR], 1.485; 95% confidence interval [CI], 1.253-1.760) and multigravida (OR, 2.187; 95% CI, 1.152-4.150) were independent predictors of AGT in GDM women. Subjects with elevated OGTT 2 h PPG at gestational 24-28 weeks had a 2.254-fold increased risk (95% CI, 1.439-3.530) of developing AGT. Presence of multigravida further increased the risk to 7.329 (95% CI, 2.879-18.659). Women with two or three elevated glucose levels at OGTT had higher risk for postpartum dysglycemia. There was a robust and continuous association of OGTT 2 h PPG at gestational 24-28 weeks with abnormal postpartum glycemic outcomes. In GDM women, OGTT 2 h PPG at gestational 24-28 weeks appear to confer a continuously increased risk for postpartum dysglycemia, which is further increased by the presence of multigravida. Multigravida and women with two or three elevated glucose levels during OGTT have higher risks of impaired postpartum glucose metabolism.

Pregnancy Outcomes of Women Additionally Diagnosed as Gestational Diabetes by the International Association of the Diabetes and Pregnancy Study Groups Criteria.

BackgroundWe investigated the pregnancy outcomes in women who were diagnosed with gestational diabetes mellitus (GDM) by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria but not by the Carpenter-Coustan (CC) criteria.MethodsA total of 8,735 Korean pregnant women were identified at two hospitals between 2014 and 2016. Among them, 2,038 women participated in the prospective cohort to investigate pregnancy outcomes. Diagnosis of GDM was made via two-step approach with 50-g glucose challenge test for screening followed by diagnostic 2-hour 75-g oral glucose tolerance test. Women were divided into three groups: non-GDM, GDM diagnosed exclusively by the IADPSG criteria, and GDM diagnosed by the CC criteria.ResultsThe incidence of GDM was 2.1% according to the CC criteria, and 4.1% by the IADPSG criteria. Women diagnosed with GDM by the IADPSG criteria had a higher body mass index (22.0±3.1 kg/m2 vs. 21.0±2.8 kg/m2, P<0.001) and an increased risk of preeclampsia (odds ratio [OR], 6.90; 95% confidence interval [CI], 1.84 to 25.87; P=0.004) compared to non-GDM women. Compared to neonates of the non-GDM group, those of the IADPSG GDM group had an increased risk of being large for gestational age (OR, 2.39; 95% CI, 1.50 to 3.81; P<0.001), macrosomia (OR, 2.53; 95% CI, 1.26 to 5.10; P=0.009), and neonatal hypoglycemia (OR, 3.84; 95% CI, 1.01 to 14.74; P=0.049); they were also at an increased risk of requiring phototherapy (OR, 1.57; 95% CI, 1.07 to 2.31; P=0.022) compared to the non-GDM group.ConclusionThe IADPSG criteria increased the incidence of GDM by nearly three-fold, and women diagnosed with GDM by the IADPSG criteria had an increased risk of adverse pregnancy outcomes in Korea.

Gestational diabetes mellitus: different management strategies should be adopted for different subsets of patients diagnosed by oral glucose tolerance test.

To compare women diagnosed with gestational diabetes mellitus (GDM) according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria based on the number of OGTT diagnostic criteria, which OGTT parameters are altered and the glycemic deviation from proposed diagnostic cutoffs. Cross-sectional, multicentric study of women diagnosed with GDM between 24-28 weeks of pregnancy according to the IADPSG criteria, in Portugal, between 2012-2014. Primary outcomes: large for gestational age (LGA) and maternal glucose metabolism status after delivery. Secondary outcome: small for gestational age (SGA). Three-thousand three-hundred fourteen patients were included; 67% had 1 OGTT altered value; 3.6% had LGA and 13% had SGA newborns; 7% had prediabetes/diabetes after delivery. Three diagnostic criteria in OGTT (OR 3.02; p < 0.001), a diagnostic value at 0 min (OR 2.09; p = 0.002) and 60 min (OR 1.70; p = 0.022) and glucose deviation at 0 min (OR 1.02; p = 0.014) were predictors of LGA. Having 2 (OR 1.94; p < 0.001) or 3 (OR 3.93; p < 0.001) diagnostic criteria in OGTT, a diagnostic value at 0 min (OR 1.76; p = 0.002), at 60 min (OR 1.57; p = 0.007) and at 120 min (OR 3.11; p < 0.001), the glucose deviation at 0 (OR 1.02; p = 0.017) and 120 min (OR 1.02; p < 0.001) were predictors of prediabetes/diabetes after delivery. Insufficient weight gain in pregnancy (OR 1.49; p < 0.001) and lower maternal BMI (OR 0.97; p = 0.024) were associated with SGA. IADPSG diagnostic criteria include a heterogeneous group of women, for whom different management strategies should be adopted to obtain ideal pregnancy outcomes.

Role of serum biomarkers to optimise a validated clinical risk prediction tool for gestational diabetes.

Clinical risk prediction tools for gestational diabetes (GDM) may be enhanced by measuring biomarkers in early pregnancy. To evaluate a two-step GDM risk prediction tool incorporating fasting glucose (FG) and serum biomarkers in early pregnancy. High molecular weight (HMW) adiponectin, omentin-1 and interleukin-6 (IL-6) were measured at 12-15weeks gestation in women with high risk of GDM from a randomised trial using a clinical risk prediction tool. GDM diagnosis (24-28weeks) was evaluated using 1998 Australian Diabetes in Pregnancy (ADIPS) criteria and newer International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Associations between biomarkers and development of GDM were examined using multivariable regression analysis. Area under the receiver-operator curve (AUC), sensitivity and specificity were calculated to determine classification ability of each model compared to FG and maternal characteristics. HMW adiponectin improved prediction of ADIPS GDM (AUC 0.85, sensitivity 50%, specificity 96.2%, P=0.04), compared to FG and maternal factors (0.78, 35% and, 98.1%, respectively). HMW adiponectin <1.53μg/mL further improved the model (AUC 0.87, sensitivity 75%, specificity 88.2%, P=0.01). HMW adiponectin did not improve prediction of IADPSG GDM (AUC 0.84, sensitivity 64%, specificity 97.9%, P=0.22) compared to FG and maternal factors (0.79, 56%, 93.8%). Omentin-1 and IL-6 did not significantly improve classification ability for GDM. A two-step approach combining FG and HMW adiponectin to a validated clinical risk prediction tool improved sensitivity and predictive ability for ADIPS GDM. Further research is required to enhance GDM prediction using IADPSG criteria for application in clinical practice.

Are women positive for the One Step but negative for the Two Step screening tests for gestational diabetes at higher risk for adverse outcomes?

The aim of this study was to evaluate if women meeting criteria for gestational diabetes mellitus (GDM) by the One Step test as per International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria but not by other less strict criteria have adverse pregnancy outcomes compared with GDM-negative controls. The primary outcome was the incidence of macrosomia, defined as birthweight >4000g. Electronic databases were searched from their inception until May 2017. All studies identifying pregnant women negative at the Two Step test, but positive at the One Step test for IADPSG criteria were included. We excluded studies that randomized women to the One Step vs. the Two Step tests; studies that compared different criteria within the same screening method; randomized studies comparing treatments for GDM; and studies comparing incidence of GDM in women doing the One Step test vs. the Two Step test. Eight retrospective cohort studies, including 29983 women, were included. Five study groups and four control groups were identified. The heterogeneity between the studies was high. Gestational hypertension, preeclampsia and large for gestational age, as well as in some analyses cesarean delivery, macrosomia and preterm birth, were significantly more frequent, and small for gestational age in some analyses significantly less frequent, in women GDM-positive by the One Step, but not the Two Step. Women meeting criteria for GDM by IADPSG criteria but not by other less strict criteria have an increased risk of adverse pregnancy outcomes such as gestational hypertension, preeclampsia and large for gestational age, compared with GDM-negative controls. Based on these findings, and evidence from other studies that treatment decreases these adverse outcomes, we suggest screening for GDM using the One Step IADPSG criteria.

Association Between Type of Screening for Gestational Diabetes Mellitus and Cesarean Delivery

To compare maternal and neonatal outcomes using two different testing strategies for gestational diabetes mellitus (GDM) diagnosis: the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) and Carpenter-Coustan approaches. Specifically, we wanted to compare the rates of cesarean delivery between the two epochs. This was a retrospective cohort study of women with a singleton pregnancy delivering at 37 0/7 weeks of gestation or greater, between 2010 and 2015, in a single tertiary care center. The IADPSG testing was used for GDM diagnosis from December 2010 until July 2013 when institutional guidelines changed to Carpenter-Coustan testing. Maternal and neonatal outcomes were compared between these two different epochs using bivariable and multivariable analyses. The primary outcome was the frequency of cesarean delivery. The analysis included a total of 23,509 women: 14,074 (60%) from the IADPSG epoch and 9,435 (40%) from the Carpenter-Coustan epoch. The incidence of GDM diagnosis was higher using the IADPSG compared with Carpenter-Coustan criteria (8.3% compared with 7.5%, P=.042). The total (27.0% compared with 25.5% P=.022) as well as primary cesarean delivery rates (19.1% compared with 18.0%, P=.041) were higher during the IADPSG epoch. The rates of total (39.1% compared with 37.5%, P=.594) and primary (27.3% compared with 27.0%, P=.903) cesarean delivery among women with GDM did not differ between the two epochs. Secondary outcomes of shoulder dystocia (2.5% compared with 2.1%, P=.043) and neonatal intensive care unit admission (3.2% compared with 2.0%, P<.001) also were significantly higher in women screened during the IADPSG epoch, whereas hypertensive disease of pregnancy (6.9% compared with 7.7%, P=.018) was less frequent during the IADPSG epoch. These findings persisted after adjusting for potential confounding factors. Compared with testing using the Carpenter-Coustan criteria, the IADPSG criteria for diagnosis of GDM were associated with higher rates of GDM, cesarean delivery, shoulder dystocia, and neonatal intensive care unit admission. Obstetric care provider knowledge of GDM diagnosis might have affected decision-making regarding the route of delivery.

A Comparison of Pregnancy Outcomes Using Two Diagnostic Criteria for Gestational Diabetes Mellitus-Carpenter Coustan Criteria and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) Criteria.

ObjectiveTo compare the maternal and perinatal outcomes in women with GDM diagnosed by Carpenter & Coustan (CC) criteria and by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria.MethodologyA cross-sectional comparative study was conducted using data of women who were screened and diagnosed with GDM between April 2006-March 2007 using the CC criteria and April 2013-March 2014 using IADPSG criteria. Maternal and perinatal outcomes were noted. Means and proportions were calculated for continuous and categorical variables respectively. Data were analyzed using t-test for normally distributed data and Mann-Whitney U test for those that were not normally distributed. Pearson Chi-square test was used to find an association between the various outcomes between the two groups.ResultsAmong 500 pregnant women screened, 36 were diagnosed GDM in the CC group. In the IADPSG group, 733 women were screened and 167 were diagnosed GDM. Prevalence of GDM was 7.2% in CC group and 22.78% in IADPSG group (p=0.000). There was a statistically significant difference in the number of women who developed hypertension and polyhydramnios among the two groups. Women who had an operative vaginal delivery (16.67% vs. 6.6%, p=0.085) and mean birth weight (3.10 ± 0.55 kg vs. 2.97 ± 0.48 kg, p=0.165) were higher in CC group than the IADPSG group. Among the perinatal outcomes, a statistically significant improvement was found in the number of neonates developing respiratory distress syndrome (p=0.000) and hyperbilirubinemia (p=0.000), when the IADPSG criteria were used.ConclusionsThere is a statistically significant difference between the maternal and neonatal outcomes when the newer IADPSG criteria were used for diagnosis of GDM.

Maternal and Neonatal Morbidity for Women Who Would Be Added to the Diagnosis of GDM Using IADPSG Criteria: A Secondary Analysis of the Hyperglycemia and Adverse Pregnancy Outcome Study.

To assess the frequency of adverse outcomes for women who are diagnosed with gestational diabetes mellitus (GDM) by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria using data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. This is a secondary analysis from the North American HAPO study centers. Glucose measurements from a 75-g oral glucose tolerance test were used to group participants into three nonoverlapping categories: GDM based on Carpenter-Coustan (CC) criteria (also GDM based on IADPSG criteria), GDM diagnosed based on IADPSG criteria but not CC criteria, and no GDM. Newborn outcomes included birth weight, cord C-peptide, and newborn percentage fat above the 90th percentile; maternal outcomes included primary cesarean delivery and preeclampsia. Outcome frequencies were compared using multiple logistic regression, adjusting for predefined covariates. Among 25,505 HAPO study participants, 6,159 blinded participants from North American centers were included. Of these, 81% had normal glucose testing, 4.2% had GDM based on CC criteria, and 14.3% had GDM based on IADPSG criteria but not CC criteria. Compared with women with no GDM, those diagnosed with GDM based on IADPSG criteria had adjusted odds ratios (95% CIs) for birth weight, cord C-peptide, and newborn percentage fat above the 90th percentile, as well as primary cesarean delivery and preeclampsia, of 1.87 (1.50-2.34), 2.00 (1.54-2.58), 1.73 (1.35-2.23), 1.31 (1.07-1.60), and 1.73 (1.32-2.27), respectively. Women diagnosed with GDM based on IADPSG criteria had higher adverse outcome frequencies compared with women with no GDM. These data underscore the need for research to assess the effect of treatment to improve outcomes in such women.

Is Risk Factor-based Screening Good Enough to Detect Gestational Diabetes Mellitus in High-Risk Pregnant Women? A Sri Lankan Experience.

Background:There is a long lasting dilemma over the ideal screening and diagnostic method in gestational diabetes mellitus (GDM). Even though universal screening is commonly practiced, selective screening based on risk factors is also practiced in some center. The aim of this study is to evaluate the most appropriate method to screen GDM in high-risk pregnant women in Sri Lanka.Methods:This study was a clinic-based, cross-sectional study conducted in a tertiary referral center, Sri Lanka. All women underwent 75 g oral glucose tolerance test at 24–28 weeks of gestation. Diagnosis of GDM was made according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO) criteria.Results:With universal screening using IADPSG criteria, 23.2% (105/452) were found to have GDM and with risk factor-based screening 20.1% (91/452) were detected to have GDM. The prevalence of GDM dropped to 18.1% when GDM was diagnosed using the WHO criteria with universal screening approach. It was further dropped to 15.7% when the WHO criteria were used along with risk factors-based screening approach.Conclusions:The IADPSG criteria labeled considerably higher number of women as having GDM compared to the WHO criteria. With regards to the screening methods, the risk-based screening had a lower detection rate of GDM; however, it reduced the necessity of screening of women by around 20%.

Diagnosis of gestational diabetes mellitus: falling through the net.

Aims/hypothesisGestational diabetes mellitus (GDM) is associated with increased risks to mother and child, but globally agreed diagnostic criteria remain elusive. Identification of women with GDM is important, as treatment reduces adverse outcomes such as perinatal death, shoulder dystocia and neonatal hypoglycaemia. Recently, the UK’s National Institute for Health and Care Excellence (NICE) recommended new diagnostic thresholds for GDM which are different from the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria endorsed by the WHO. The study aim was to assess neonatal and obstetric outcomes among women who would test positive for the IADPSG criteria but negative for the NICE 2015 criteria.MethodsData from 25,543 consecutive singleton live births (2004–2008) were obtained retrospectively from hospital records. Women were screened with a random plasma glucose (RPG; 12–16 weeks) and a 50 g glucose challenge test (GCT; 26–28 weeks). If RPG >7.0 mmol/l, GCT >7.7 mmol/l or symptoms were present, a 75 g OGTT was offered (n = 3,848).ResultsIn this study, GDM prevalence was 4.13% (NICE 2015) and 4.62% (IADPSG). Women who ‘fell through the net’, testing NICE-negative but IADPSG-positive (n = 387), had a higher risk of having a large-for-gestational-age (LGA) infant (birthweight >90th percentile for gestational age; adjusted OR [95% CI] 3.12 [2.44, 3.98]), Caesarean delivery (1.44 [1.15, 1.81]) and polyhydramnios (6.90 [3.94, 12.08]) compared with women with negative screening results and no OGTT (n = 21,695). LGA risk was highest among women with fasting plasma glucose 5.1–5.5 mmol/l (n = 167): the mean birthweight was 350 g above that of the reference population and 37.7% of infants were LGA.Conclusions/interpretationThe IADPSG criteria identify women at substantial risk of complications who would not be identified by the NICE 2015 criteria.

Odds, risks and appropriate diagnosis of gestational diabetes.

The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic process and criteria for gestational diabetes mellitus (GDM) have been recommended by the World Health Organization for adoption and were widely introduced into clinical practice in Australia from January 2015 - in Queensland, the Australian Capital Territory and variably across other states. The IADPSG criteria identify women at increased risk of a range of adverse pregnancy outcomes related to maternal hyperglycaemia. The relationship between maternal hyperglycaemia and adverse outcomes is continuous; however, one elevated glucose value is sufficient to impart a higher risk of pregnancy complications. We outline the background and statistical foundations of the IADPSG approach and refute the inference that invalid statistical reasoning underlies the IADPSG approach. The prevalence of GDM diagnosed by IADPSG criteria may be higher or lower than with other criteria, depending on the underlying population prevalence of fasting and post-glucose load hyperglycaemia, which in turn vary with ethnicity. Studies comparing previous Australian criteria to the IADPSG criteria suggest GDM prevalence may decrease or may increase by up to 35% in specific populations with the planned change in criteria. Pregnancy complications have multiple potential underlying causes. No set of glucose criteria will ever be able to fully separate women and babies at risk of pregnancy complications from those who are not.