International Association Of The Diabetes And Pregnancy Study Groups Research Articles

Gestational Outcomes Related to the Occurrence of Gestational Diabetes Mellitus: A Cohort Study

Background: Gestational diabetes mellitus (GDM) is the main cause of hyperglycemia in pregnancy and is related to complications throughout the gestational and post-partum period. Objectives: To analyze the pregnancy outcomes related to the occurrence of GDM in women and their offspring. Methods: Third-trimester pregnant women were interviewed and monitored until childbirth. The diagnosis of GDM, blood glucose ≥ 92 mg/dL, was defined by the criteria of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG). Results: A total of 138 women participated, and there were 136 births (due to 2 fetal losses); 23 (16.7%) were diagnosed with GDM. The risk of complications during childbirth was higher among pregnant women with GDM (RR 3.40; 95%CI 1.65–7.00), as was the occurrence of cesarean birth (RR 1.9; 95%CI 1.46–2.59). The occurrence of preterm birth did not show a significant difference between GDM/non-GDM groups. There was a non-significant association in adjusted analyses of macrosomia (birth weight ≥ 4000 g) among newborns born to mothers with GDM (RR 1.27; 95%CI 0.67–2.38). For newborns born to pregnant women with GDM, there was a higher risk for the following outcomes: large for gestational age (LGA) (3.29 95%CI 1.62–6.64), low Apgar (4.98 95%CI 2.32–10.69), and birth asphyxia (9.51 95%CI 3.42–26.48). Conclusions: The findings reinforce that GDM is an important risk factor for adverse pregnancy outcomes for women and their offspring.

Glycated CD59 is a potential biomarker for gestational diabetes mellitus.

To explore the diagnostic value of glycated CD59 (gCD59) in gestational diabetes mellitus (GDM). A total of 707 pregnant women who underwent the first visit in the obstetric outpatient clinic of the Affliated Suqian Hospital of Xuzhou Medical University from January 2022 to July 2023 were included, and were grouped according to the International Association of the Diabetes and Pregnancy Study Groups(IADPSG) diagnostic criteria, and finally 113 cases in the GDM group and 559 cases in the normal glucose tolerance (NGT) group were included, and the concentration of gCD59 was determined by enzyme-linked immunosorbent assay (ELISA). The baseline data characteristics of the two groups were compared, the risk factors for GDM were explored by multivariate binary logistic analysis, and the diagnostic value of gCD59 in predicting GDM was explored by receiver operating characteristic (ROC) curve analysis. The level of gCD59 in the GDM group was significantly higher than that in the NGT group (1.49 SPU vs 0.87 SPU). Multivariate regression analysis showed that gCD59, diastolic blood pressure (DBP) and thyroid stimulating hormone (TSH) were independent risk factors for GDM.The area under the curve (AUC) of gCD59 for the diagnosis of GDM was 0.681 (95% CI: 0.583-0.717), with a sensitivity of 71.7% and a specificity of 58.3%. In combination with fasting glucose, gCD59 effectively diagnosed GDM with higher AUC of 0.871 (95% CI: 0.708-1.000). gCD59 is an independent risk factor for GDM and a good biomarker for the diagnosis of GDM.

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.

184-LB: The Effect of Early Screening and Intervention for Gestational Diabetes Mellitus on Pregnancy Outcomes—The TESGO Randomized Controlled Trial

Background: Women with gestational diabetes mellitus (GDM) have excessive fetus growth weeks earlier than the recommended screening period, suggesting that earlier screening and intervention may improve pregnancy outcomes and the health of the offspring. This trial aimed to investigate if early screening and intervention could alter pregnancy outcomes, compared to the standard group. Methods: We conducted an open-label randomized controlled trial in singleton pregnant women at National Taiwan University Hospital from 2018 to 2021. GDM is diagnosed by 75g 2-hour oral glucose tolerance tests at 18-20 weeks of gestational age for the early-screening group and at 24-28 weeks for the standard-screening group. The diagnostic cutoffs are according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. The primary outcome is a composite measure of pregnancy outcomes, including primary cesarean section, birth weight &amp;gt;90th percentile, neonatal hypoglycemia, cord serum C-peptide &amp;gt;90th percentile, gestational hypertension, preeclampsia and birth trauma. Results: Total 967 subjects were enrolled, including 483 subjects in the early-screening group and 484 subjects in the standard-screening group. Primary outcome was not statistically different between the two groups (early-screening group, 34.74%; standard-screening group 30.75%, p=0.20). There was also no significant difference in each individual outcome of the primary outcome between two groups except neonatal hypoglycemia, which was significantly higher in the standard-screening group than in the early-screening group (4.14% vs. 1.71%, p=0.0278). Conclusions: Early screening and intervention of GDM by the one-step method does not improve pregnancy outcomes as compared to standard practice. Disclosure C. Kuo: None. S. Lin: None. M. Lin: None. C. Lee: None. C. Chang: None. Y. Chang: None. Y. Tai: None. S. Chen: None. I. Yen: None. K. Fan: None. C. Hsu: None. K. Huang: None. W. Hsu: None. J. Kang: None. H. Li: None.

ODP247 The Detection of Metabolic Dysfunction–Associated Fatty Liver Disease via Fibroscan® in Early–to–Mid Pregnancy is an Independent Risk Factor for the Development of Gestational Diabetes Mellitus

Abstract Aims To investigate whether the detection of metabolic dysfunction–associated fatty liver disease (MAFLD), formerly known as non–alcoholic fatty liver disease (NAFLD), in early–to–mid pregnancy is associated with the development of gestational diabetes mellitus (GDM). Methods A prospective longitudinal study was conducted on singleton pregnant women enrolled from a multiethnic obstetrics service in Sydney, Australia. A FibroScan ® was performed between 10–24 weeks to assess for hepatic steatosis in women with at least one risk factor for developing GDM, as per the Australasian Diabetes in Pregnancy Society (ADIPS) Guidelines 2014. A controlled attenuation parameter (CAP) score ≥233.5 dB/m was indicative of MAFLD, with severity graded as mild (Grade S1: CAP 233.5–267 dB/m), moderate (Grade S2: CAP 268–301 dB/m) and severe (Grade S3: CAP ≥302 dB/m). A liver stiffness measure (LSM) score ≥7. 0 kPa was indicative of hepatic fibrosis. Women were advised to fast for at least 2 hours prior to their FibroScan ® . GDM was determined by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) 2010 criteria, with a 75–gram oral glucose tolerance test (OGTT) performed between 24–28 weeks gestation. The cohort were separated by GDM status and categorical variables were compared with Pearson's chi–squared test or Fisher's exact test, and continuous variables with independent t-test or Mann–Whitney U test. Multiple logistic regression analysis was used to determine the independent predictors of GDM, reported as odds ratios (OR) and 95% confidence intervals (CI). Results Three–hundred and twenty–eight women were eligible for inclusion in our study. Of these, 135 (41.2%) had FibroScan ® –detected MAFLD, where 85 (25.9%) had Grade S1, 39 (11.9%) had Grade S2 and 11 (3.4%) had Grade S3. None of the women had hepatic fibrosis. Over 97% of women were fasting for at least 2 hours prior to their FibroScan ® . GDM was diagnosed in 87 (26.5%) women. A significantly higher rate of GDM were identified in women with MAFLD compared to those without (36.3% vs. 19.7%, p&amp;lt;0. 01). Women with MAFLD were more likely obese, with pre–pregnancy body mass index (BMI) over 27.5kg/m 2 in Asians and over 30kg/m 2 in Europeans (58.5% vs. 12.4%, p&amp;lt;0. 01), had an earlier diagnosis (prior to 24 weeks gestation) of GDM (8.1% vs. 1.6%, p&amp;lt;0. 01) and administered insulin for treatment of their GDM (12.6% vs. 4.7%, p&amp;lt;0. 01). After adjustment for ethnicity, pre–pregnancy BMI, prior history of GDM and a family history of diabetes, MAFLD remained an independent predictor of GDM development (adjusted OR 2.55, 95% CI 1.43–4.52, p&amp;lt;0. 01). Conclusions The detection of MAFLD via FibroScan ® in early–to–mid pregnancy was an independent risk factor for the development of GDM. FibroScan ® is a quick and safe measure to help screen for MAFLD and may further aid in the risk stratification of women at–risk of developing GDM. Presentation: No date and time listed

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.

Machine Learning-Derived Prenatal Predictive Risk Model to Guide Intervention and Prevent the Progression of Gestational Diabetes Mellitus to Type 2 Diabetes: Prediction Model Development Study.

BackgroundThe increasing prevalence of gestational diabetes mellitus (GDM) is concerning as women with GDM are at high risk of type 2 diabetes (T2D) later in life. The magnitude of this risk highlights the importance of early intervention to prevent the progression of GDM to T2D. Rates of postpartum screening are suboptimal, often as low as 13% in Asian countries. The lack of preventive care through structured postpartum screening in several health care systems and low public awareness are key barriers to postpartum diabetes screening.ObjectiveIn this study, we developed a machine learning model for early prediction of postpartum T2D following routine antenatal GDM screening. The early prediction of postpartum T2D during prenatal care would enable the implementation of effective strategies for diabetes prevention interventions. To our best knowledge, this is the first study that uses machine learning for postpartum T2D risk assessment in antenatal populations of Asian origin.MethodsProspective multiethnic data (Chinese, Malay, and Indian ethnicities) from 561 pregnancies in Singapore’s most deeply phenotyped mother-offspring cohort study—Growing Up in Singapore Towards healthy Outcomes—were used for predictive modeling. The feature variables included were demographics, medical or obstetric history, physical measures, lifestyle information, and GDM diagnosis. Shapley values were combined with CatBoost tree ensembles to perform feature selection. Our game theoretical approach for predictive analytics enables population subtyping and pattern discovery for data-driven precision care. The predictive models were trained using 4 machine learning algorithms: logistic regression, support vector machine, CatBoost gradient boosting, and artificial neural network. We used 5-fold stratified cross-validation to preserve the same proportion of T2D cases in each fold. Grid search pipelines were built to evaluate the best performing hyperparameters.ResultsA high performance prediction model for postpartum T2D comprising of 2 midgestation features—midpregnancy BMI after gestational weight gain and diagnosis of GDM—was developed (BMI_GDM CatBoost model: AUC=0.86, 95% CI 0.72-0.99). Prepregnancy BMI alone was inadequate in predicting postpartum T2D risk (ppBMI CatBoost model: AUC=0.62, 95% CI 0.39-0.86). A 2-hour postprandial glucose test (BMI_2hour CatBoost model: AUC=0.86, 95% CI 0.76-0.96) showed a stronger postpartum T2D risk prediction effect compared to fasting glucose test (BMI_Fasting CatBoost model: AUC=0.76, 95% CI 0.61-0.91). The BMI_GDM model was also robust when using a modified 2-point International Association of the Diabetes and Pregnancy Study Groups (IADPSG) 2018 criteria for GDM diagnosis (BMI_GDM2 CatBoost model: AUC=0.84, 95% CI 0.72-0.97). Total gestational weight gain was inversely associated with postpartum T2D outcome, independent of prepregnancy BMI and diagnosis of GDM (P=.02; OR 0.88, 95% CI 0.79-0.98).ConclusionsMidgestation weight gain effects, combined with the metabolic derangements underlying GDM during pregnancy, signal future T2D risk in Singaporean women. Further studies will be required to examine the influence of metabolic adaptations in pregnancy on postpartum maternal metabolic health outcomes. The state-of-the-art machine learning model can be leveraged as a rapid risk stratification tool during prenatal care.Trial RegistrationClinicalTrials.gov NCT01174875; https://clinicaltrials.gov/ct2/show/NCT01174875

A Cluster Randomized Noninferiority Field Trial of Gestational Diabetes Mellitus Screening

Although it is well-acknowledged that gestational diabetes mellitus (GDM) is associated with the increased risks of adverse pregnancy outcomes, the optimal strategy for screening and diagnosis of GDM is still a matter of debate. This study was conducted to demonstrate the noninferiority of less strict GDM screening criteria compared with the strict International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria with respect to maternal and neonatal outcomes. A cluster randomized noninferiority field trial was conducted on 35 528 pregnant women; they were scheduled to have 2 phases of GDM screening based on 5 different prespecified protocols including fasting plasma glucose in the first trimester with threshold of 5.1 mmol/L (92 mg/dL) (protocols A, D) or 5.6 mmol/L (100 mg/dL) (protocols B, C, E) and either a 1-step (GDM is defined if one of the plasma glucose values is exceeded [protocol A and C] or 2 or more exceeded values are needed [protocol B]) or 2-step approach (protocols D, E) in the second trimester. Guidelines for treatment of GDM were consistent with all protocols. Primary outcomes of the study were the prevalence of macrosomia and primary cesarean section (CS). The null hypothesis that less strict protocols are inferior to protocol A (IADPSG) was tested with a noninferiority margin effect (odds ratio) of 1.7. The percentages of pregnant women diagnosed with GDM and assigned to protocols A, B, C, D, and E were 21.9%, 10.5%, 12.1%, 19.4%, and 8.1%, respectively. Intention-to-treat analyses satisfying the noninferiority of the less strict protocols of B, C, D, and E compared with protocol A. However, noninferiority was not shown for primary CS comparing protocol E with A. The odds ratios (95% CI) for macrosomia and CS were: B (1.01 [0.95-1.08]; 0.85 [0.56-1.28], C (1.03 [0.73-1.47]; 1.16 [0.88-1.51]), D (0.89 [0.68-1.17]; 0.94 [0.61-1.44]), and E (1.05 [0.65-1.69]; 1.33 [0.82-2.00]) vs A. There were no statistically significant differences in the adjusted odds of adverse pregnancy outcomes in the 2-step compared with the 1-step screening approaches, considering multiplicity adjustment. The IADPSG GDM definition significantly increased the prevalence of GDM diagnosis. However, the less strict approaches were not inferior to other criteria in terms of adverse maternal and neonatal outcomes.

Effect of Different Types of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Neonatal Outcomes: A Systematic Review, Meta-Analysis, and Meta-Regression.

BackgroundEvidence supporting various diagnostic criteria for diagnose gestational diabetes mellitus (GDM) are consensus-based, needs for additional evidence related to outcomes. Therefore, the aim of this systematic-review and meta-analysis was to assess the impact of different GDM diagnostic-criteria on the risk of adverse-neonatal-outcomes.MethodsElectronic databases including Scopus, PubMed, and Web of Sciences were searched to retrieve English original, population-based studies with the universal GDM screening approach, up to January-2020. GDM diagnostic criteria were classified in seven groups and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) was considered as reference one. We used the Mantel–Haenszel method to calculate the pooled odds of events. The possibility of publication bias was examined by Begg’s test.ResultsA total of 55 population-based studies consisting of 1,604,391 pregnant women with GDM and 7,770,855 non-GDM counterparts were included. Results showed that in all diagnostic-criteria subgroups, the risk of adverse neonatal outcomes including macrosomia, hyperbilirubinemia, respiratory distress syndrome, neonatal hypoglycemia, neonatal intensive care unit admission, preterm birth, and birth-trauma were significantly higher than the non-GDM counterparts were significantly higher than non-GDM counterparts. Meta-regression analysis revealed that the magnitude of neonatal risks in all diagnostic-criteria subgroups are similar.ConclusionOur results showed that the risk of adverse-neonatal-outcome increased among women with GDM, but the magnitude of risk was not different among those women who were diagnosed through more or less intensive strategies. These findings may help health-care-providers and policy-makers to select the most cost-effective approach for the screening of GDM among pregnant women.

Screening for monogenic subtypes of gestational diabetes in a high prevalence island population - A whole exome sequencing study.

The reported frequency of monogenic defects of beta cell function in gestational diabetes (GDM) varies extensively. This study aimed to evaluate the frequency and molecular spectrum of variants in genes associated with monogenic/atypical diabetes in non-obese females of Maltese ethnicity with GDM. 50 non-obese females who met the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria for diagnosis of GDM and with a first-degree relative with non-autoimmune diabetes were included in this study. Whole exome capture and high throughput sequencing was carried out. Rare sequence variants were filtered, annotated, and prioritised according to the American College for Medical Genetics guidelines. For selected missense variants we explored effects on protein stability and structure through in-silico tools. We identified three pathogenic variants in GCK, ABCC8 and HNF1A and several variants of uncertain significance in the cohort. Genotype-phenotype correlations and post-pregnancy follow-up data are described. This study provides the first insight into an underlying monogenic aetiology in non-obese females with GDM from an island population having a high prevalence of diabetes. It suggests that monogenic variants constitute an underestimated cause of diabetes detected in pregnancy, and that careful evaluation of GDM probands to identify monogenic disease subtypes is indicated.

The role of ultrasonographic adipose tissue thickness measurement in the first trimester in predicting gestational diabetes: a prospective study.

This prospective observational study aimed to assess the association between maternal abdominal subcutaneous and visceral fat thickness measured with ultrasound scan during the first trimester and the risk of developing gestational diabetes mellitus (GDM). We recruited 43 non-diabetic women with singleton pregnancy between 11 and 14 week of gestation and evaluated ultrasonographic measurements of subcutaneous fat thickness (SFT) and preperitoneal fat (PF) above the umbilicus. During the 2nd trimester, GDM screening was performed by 75 g two-hour oral glucose tolerance test (OGTT) and diagnosis was made when one or more plasma glucose values meets or exceeds the values indicated by International Association of the Diabetes and Pregnancy Study Groups (IADPSG). Among the 43 woman, 8 developed GDM (18.6%). Of these 37,5% (N.=3) had been diagnosed with GDM during a previous pregnancy, with a statistically significant correlation (P=0.035). Mean SFT for all patients was significantly higher in the GDM group compared to non-GDM group (27.30±8.78 mm vs. 18.56±9.99 mm; P=0.049). Mean PF for all women showed a statistically significant correlation with GDM (13.27±9.07 mm for non GDM group vs. 23.52±10.24 mm for GDM group; P=0.038). Abdominal adiposity, both subcutaneous and visceral, seem to be a suitable predictor of GDM in early pregnancy and it can be easily assessed during a first trimester routine ultrasound, although further studies are needed to evaluate their role in the screening protocols.

Resolving the Gestational Diabetes Diagnosis Conundrum: The Need for a Randomized Controlled Trial of Treatment.

The diagnosis of and criteria for gestational diabetes mellitus (GDM) continue to divide the scientific and medical community, both between and within countries. Many argue for universal adoption of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria and feel that further clinical trials are unjustified and even unethical. However, there are concerns about the large increase in number of women who would be diagnosed with GDM using these criteria and the subsequent impact on health care resources and the individual. This Perspective reviews the origins of the IADPSG consensus and points out some of its less well-known limitations, particularly with respect to identifying women at risk for an adverse pregnancy outcome. It also questions the clinical and cost-effectiveness data often cited to support the IADPSG glycemic thresholds. We present the argument that adoption of diagnostic criteria defining GDM should be based on response to treatment at different diagnostic thresholds of maternal glycemia. This will likely require an international multicenter trial of treatment.

Inflammatory and Adipokine Status from Early to Midpregnancy in Arab Women and Its Associations with Gestational Diabetes Mellitus.

Objective To examine differences in maternal serum levels of adipokines (adiponectin, leptin, and resistin) and inflammatory markers (tumor necrosis factor-alpha (TNF-α) and interlukin-6 (IL-6)) from early to midpregnancy among Arab women with or without gestational diabetes mellitus (GDM), along with their links to GDM risk. Methods This is a multicenter prospective study involving 232 Saudi women attending obstetric care. Both circulating adipokine and markers of inflammation were observed at the first (eight to 12 weeks) and second trimesters (24 to 28 weeks). GDM was screened at 24 to 28 weeks using the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Results Age and body mass index- (BMI-) matched circulating TNF-α was significantly higher in women with GDM in comparison to non-GDM women (p = 0.01). Adiponectin and resistin significantly decreased from the first to second trimester in women without GDM (p = 0.002 and 0.026, respectively). Leptin presented a significant rise from the first to second trimester in both groups, with a higher increase in women with GDM (p = 0.013). Multivariate logistic regression analysis revealed that TNF-α was significantly correlated with GDM (p = 0.03). However, significance was lost after adjustments for maternal and lifestyle risk factors (OR 23.58 (0.50 to 1119.98), p = 0.11). Conclusion Inflammatory and adipocytokine profiles are altered in Arab women with GDM, TNF-α in particular. Further studies are needed to establish whether maternal inflammatory and adipocytokine profile influence fetal levels in the same manner.

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.

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.

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.

Gestational Diabetes Mellitus and Glucose Sample Handling.

Gestational diabetes mellitus (GDM) continues to provide challenges in terms of both diagnosis and management. Recent scientific discussions around the preanalytical processing of glucose samples from the glucose tolerance test (GTT) have generated considerable interest and debate (1,2). For most women, the diagnosis of GDM is based on the measurement of plasma glucose after the GTT. The observational Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study (3) and the consensus agreement about diagnostic criteria by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) (4) provided glucose thresholds for the diagnosis of GDM. The HAPO study was meticulous in the preanalytical and analytical processing of glucose samples (3). Given that our current diagnostic criteria are based on the findings of the HAPO study, if results are to be comparable, the same meticulous processing must also be applied to glucose samples processed in routine clinical care. A major source of preanalytical error in measuring glucose is loss of glucose from blood samples …

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.