National Diabetes Data Group Criteria Research Articles

MiR-24-3p and Body Mass Index as Type 2 Diabetes Risk Factors in Spanish Women 15 Years after Gestational Diabetes Mellitus Diagnosis.

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that is diagnosed for the first time during pregnancy. The objective of this study is to know the glucose tolerance status after 15 years of pregnancy in patients diagnosed with gestational diabetes and to assess the long-term effect of GDM on the circulating miRNA profile of these women. To answer these, 30 randomly selected women diagnosed with GDM during 2005-2006 were included in the study, and glucose tolerance was measured using the National Diabetes Data Group criteria. Additionally, four miRNAs (hsa-miR-1-3p, hsa-miR-24-3p, hsa-miR-329-3p, hsa-miR-543) were selected for their analysis in the plasma of women 15 years after the diagnosis of GDM. In our study we discovered that, fifteen years after the diagnosis of GDM, 50% of women have some degree of glucose intolerance directly related to body weight and body mass index during pregnancy. Dysglycemic women also showed a significantly increased level of circulating hsa-miR-24-3p. Thus, we can conclude that initial weight and BMI, together with circulating expression levels of hsa-miR-24-3p, could be good predictors of the future development of dysglycemia in women with a previous diagnosis of GDM.

Cohort Study of Maternal Gestational Weight Gain, Gestational Diabetes, and Childhood Asthma.

Data on the association of maternal gestational weight gain (GWG) and gestational diabetes mellitus (GDM) with childhood asthma are limited and inconsistent. We aimed to investigate these associations in a U.S. pre-birth cohort. Analyses included 16,351 mother-child pairs enrolled in the Massachusetts General Hospital Maternal-Child Cohort (1998-2010). Data were obtained by linking electronic health records for prenatal visits/delivery to determine BMI, GWG, and GDM (National Diabetes Data Group criteria) and to determine asthma incidence and allergies (atopic dermatitis or allergic rhinitis) for children. The associations of prenatal exposures with asthma were evaluated using logistic regression adjusted for maternal characteristics. A total of 2306 children (14%) developed asthma by age 5 years. Overall, no association was found between GWG and asthma. GDM was positively associated with offspring asthma (OR 1.46, 95% CI 1.14-1.88). Associations between GDM and asthma were observed only among mothers with early pregnancy BMI between 20 and 24.9 kg/m2 (OR 2.31, CI 1.46-3.65, p-interaction 0.02). We report novel findings on the impact of prenatal exposures on asthma, including increased risk among mothers with GDM, particularly those with a normal BMI. These findings support the strengthening of interventions targeted toward a healthier pregnancy, which may also be helpful for childhood asthma prevention.

A comparative study of prevalence of Gestational Diabetes Mellitus between urban and rural women in kut city

This study was carried out to show the prevalence of gestational diabetes mellitus(GDM) between urban and rural pregnant women in kut city of Iraq .A total of one thousand pregnant women (divided into 500 from urban areas and 500 rural areas),who had attended various antenatal clinics were screened for GDM by (one hour post 50 gm glucose load) oral glucose challenge test. Women who had an abnormal screening test proceeded to oral glucose tolerance testing by had a 3 hr. 100 gram oral glucose tolerance test (OGTT) and National diabetes data group criteria applied for diagnosis of GDM. This study showed the overall prevalence of GDM to be 3.2% (3.8% in urban women versus 2.6% in suburban women)

The NDDG criteria versus the IADPSG or the ADA criteria for diagnosing early-onset gestational diabetes mellitus or abnormal glucose tolerance.

To analyze the effects of substituting the National Diabetes Data Group (NDDG) criteria with the International Association of Diabetes and Pregnancy Study Groups (IADPSG) or American Diabetes Association (ADA) criteria for the diagnosis of early-onset gestational diabetes mellitus (Early-GDM) or first trimester abnormal glucose tolerance (1t-AGT). A retrospective cohort study was conducted of 3200 women: 400 with Early-GDM, 800 with GDM, and 2000 with Non-GDM, according to the NDDG criteria. Rates of women with missed and new Early-GDM according to the IADPSG or ADA criteria were calculated. Multivariate logistic regression analysis was used to compare perinatal outcomes between groups. Using the IADPSG criteria, 61.6% of women with Early-GDM according to the NDDG were undiagnosed (Missed-Early-GDM group), and 25.9% of women with GDM and 15.7% of women with Non-GDM were diagnosed with Early-GDM (New-Early-GDM groups). Perinatal outcomes were worse in Missed-Early-GDM than in Non-GDM and better in New-Early-GDM groups than in the Early-GDM group. According to the ADA recommendations, only 11.8% of women with Early-GDM according to the NDDG criteria were diagnosed. Replacing the NDDG recommendations for the diagnosis of Early-GDM with the IADPSG or ADA criteria would mean depriving a large number of women with AGT and higher risk of adverse perinatal outcomes from early treatment and treating others with lower risk.

Obstetric and neonatal outcomes of gestational diabetes mellitus in twin pregnancies according to changes in its diagnostic criteria from National Diabetes Data Group criteria to Carpenter and Coustan criteria: a retrospective cohort study

BackgroundTo compare obstetric and neonatal outcomes in twin pregnancies with or without gestational diabetes mellitus (GDM) before and after changes in GDM diagnostic criteria.MethodsThis was a retrospective cohort study of 1,764 twin pregnancies including 130 women with GDM (GDM group) and 1,634 women without GDM (non-GDM group). Patients with pregestational diabetes, unknown GDM status, and fetal death at < 24 gestational weeks were excluded. Obstetric and neonatal outcomes were compared between the two groups by two periods: period 1 (1995–2005) and period 2 (2005–2018) when National Diabetes Data Group criteria and Carpenter and Coustan criteria were used for diagnosis of GDM, respectively.ResultsThe incidence of GDM in twin pregnancies increased from 4.0% in period 1 to 9.3% in period 2. Composite obstetric complications rate was significantly higher in the GDM group than that in the non-GDM group during period 1 (72.0% vs. 45.5%, P = 0.009). However, it became comparable during period 2 (60.0% vs. 57.4%, P = 0.601). Interaction between GDM and period indicated a significant differential effect of GDM by period on the rate of composite obstetric complications. The rate of composite neonatal complications was similar between the two groups during both periods. The interaction between GDM and period was not significant.ConclusionAfter changes of GDM diagnostic criteria, the incidence of GDM increased more than twice, and the rate of composite obstetric complications decreased, but the rate of composite neonatal complications did not change significantly.

Diagnostic Accuracy of Diabetes in Pregnancy Study Group of India with Carpenter-Coustan and National Diabetes Data Group Criteria for Diagnosis of Gestational Diabetes Mellitus and Correlation with Fetomaternal Outcome.

No previous study compared ACOG and DIPSI criteria for diagnosing gestational diabetes (GDM). This study compared diagnostic accuracy of Diabetes in pregnancy study group of India (DIPSI) with Carpenter-Coustan (CC) and National Diabetes Data Group (NDDG) criteria for diagnosis of GDM and correlation with fetomaternal outcome. A total of 1029 pregnant women underwent 2h 75g OGTT in non-fasting state. After 3-7days, women were called in fasting state and subjected to 100g OGTT and fasting, 1, 2, 3h samples were taken. GDM was diagnosed using DIPSI, CC and NDDG criteria. All women were followed till delivery, and fetomaternal outcome was noted. 10.4% (107) women were diagnosed as GDM by DIPSI, 6.4% (66) by CC and 3.1% (32) by NDDG criteria. Sensitivity of DIPSI with CC was 98.48%, specificity was 95.64%, and diagnostic accuracy was 95.82%. Sensitivity of DIPSI with NDDG was 99.89%, specificity was 92.38%, and diagnostic accuracy was 95.52%. Sensitivity of NDDG with CC was 48.48%, specificity was 100%, and diagnostic accuracy was 96.7%. Women with GDM by all three criteria were seen to have a significantly higher proportion of LSCS, higher birth weight and macrosomia compared to normoglycemic women (p value < 0.001). Diagnostic accuracy, sensitivity and specificity of DIPSI are comparable to CC and NDDG criteria; therefore, DIPSI can be recommended for diagnosing GDM with added advantage of low cost, simplicity and convenience. Women diagnosed as GDM by DIPSI, CC and NDDG had significantly higher rate of cesarean delivery, higher birth weight and macrosomia as compared to women with normoglycemia.

One elevated oral glucose tolerance test value in pregnancy increases the risk for future diabetes mellitus type 2.

Women with only one elevated 100g OGTT value are not considered as having gestational diabetes mellitus (GDM) and therefore there are no recommendations to address this population as a risk group for type 2 diabetes mellitus (T2DM). We aimed to elucidate whether one elevated OGTT value increases the risk for T2DM. A retrospective population-based cohort study of women with a first diagnosis of GDM who delivered between 1991 and 2011 was conducted. Women were divided according to GDM diagnosis criteria into three groups: (1) at least two elevated values of Carpenter and Coustan criteria (C&C; N = 209), (2) At least two elevated values of the National Diabetes Data Group (NDDG) criteria (NDDG2; N = 290) and (3) only one elevated value of the NDDG criteria (NDDG1; N = 226). A fourth group comprising women without GDM was included (control; N = 352). The primary outcome was the development of T2DM. The mean follow-up was 12.4 ± 5.3years and the mean age at follow-up was 43.0 ± 5.7years. The rate of T2DM in the control, C&C, NDDG1 and NDDG2 groups were 5%, 18%, 19% and 31%, respectively. All GDM diagnoses were independent risk factors for T2DM in multivariable Cox regression when compared to controls, adjusted hazard ratio and 95% CI: C&C 7.8 [95% CI 3.7-16.4], NDDG1 5.5 [2.6-11.6], and NDDG2 10.5 [5.2-21.4]. Additional independent risk factors were parity, fasting and 1-h post-glucose load of the OGTT and insulin use. Women with one elevated OGTT value using the NDDG criteria are at increased risk for T2DM. Further studies are needed to decide whether those women should be considered a focus group for long-term surveillance and T2DM prevention interventions.

188-OR: Assessing the Validity of Diagnosis Codes for Gestational Diabetes Ascertainment

Background: Researchers often rely on diagnosis codes from billing/administrative data to ascertain diagnoses, including gestational diabetes (GDM). We assessed the validity of relying on these diagnosis codes for GDM ascertainment, using laboratory criteria for GDM as the reference. Methods: We studied women seen at our hospital for prenatal care between 1998-2016. Women underwent GDM screening using a 50-gram glucose loading test (GLT) followed by a diagnostic 100-gram 3-hour oral glucose tolerance test (GTT) if the GLT result was ≥140 mg/dl. We defined GDM using National Diabetes Data Group (NDDG) criteria, which was in clinical use during the study period. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for ICD code-based ascertainment of GDM using codes for GDM (ICD-9: 648.8; ICD-10: O24.4) recorded in administrative data from inpatient and outpatient encounters. In a sensitivity analysis we included additional codes that broadly represent diabetes and abnormal glucose diagnoses (ICD-9: 249, 250, 648.0, 790.2; ICD-10: O24.0-3, O24.8-9, E08-E13, R73.0, R73.9). In a secondary analysis, we defined GDM using Carpenter-Coustan (CC) criteria. Results: Out of 49195 pregnancies, 1258 (2.6%) met NDDG criteria and 2039 (4.1%) met CC criteria based on GLT and GTT values. In the same cohort, 589 (1.2%) had GDM ICD-9/10 codes. Using NDDG criteria as the reference, we observed sensitivity of 35.2% and specificity of 99.7% for these codes. This resulted in a PPV of 75.2% and an NPV of 98.3%. In our sensitivity analysis, 700 (1.4%) pregnancies had at least one of the codes on the expanded list. The sensitivity (37.4%) and specificity (99.5%) of this set of codes was similar to the more restricted set. Results were similar for GDM defined by CC criteria. Conclusion: Using diagnosis codes from administrative data to ascertain GDM resulted in underestimation of cases. One in 4 cases identified by these codes could not be confirmed with laboratory data. Disclosure S. Hsu: None. K. Mathieu: None. A. Kaimal: None. R. Thadhani: None. K. James: None. C.E. Powe: None. Funding Massachusetts General Hospital

Evaluation of the gestational diabetes mellitus diagnostic criteria recommended by the international association of diabetes and pregnancy study group for long-term maternal postpartum outcomes in mainland China.

The gestational diabetes mellitus (GDM) diagnostic criteria recommended by the International Association of Diabetes and Pregnancy Study Group (IADPSG) were established based on the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study and have been the most commonly used criteria for determining GDM worldwide. Although individuals from mainland China were not included in the HAPO study, the IADPSG criteria have been used in China since 2011. However, the appropriateness of the criteria for evaluating maternal postpartum outcomes in mainland China are unknown. We conducted this study to determine whether the IADPSG criteria are appropriate for Chinese patients for evaluating long-term maternal postpartum outcomes.Eighty-four patients who were diagnosed with hyperglycemia during pregnancy and had delivery in Peking University First Hospital from February 2007 to December 2009 were enrolled in the study. For patients in Group A, GDM was diagnosed using both the National Diabetes Data Group (NDDG) and the IADPSG criteria, while patients in Group B, gestational impaired glucose tolerance (GIGT) was diagnosed using the NDDG criteria while GDM was diagnosed based on the IADPSG criteria. Anthropometric data, glucose metabolism, lipid profiles, β cell function, and insulin resistance index were evaluated and compared to baseline after 5- to 6-year postpartum period.Patients in group A had significantly higher oral glucose tolerance test (OGTT) fasting, 2-hour and 3-hour plasma glucose levels compared to patients in group B at 24 to 28 weeks of gestation (P < .05). No significant differences were observed between the groups for anthropometric data, postpartum abnormal glucose metabolism (50.91% vs 44.83%, P = .596), type 2 diabetes mellitus (T2DM) (16.36% vs 3.45%, P = .167), lipid profiles, β cell function (homeostasis model assessment β-cell function index (HOMA-β) 1.04 vs 0.99, P = .935) and insulin resistance (homeostasis model assessment insulin resistance index (HOMA-IR) 2.01 vs 1.69, P = .583).Patients diagnosed with GDM using either the NDDG or IADPSG criteria had abnormal glucose levels and lipid metabolism after delivery. Patients with mild hyperglycemia had similar postpartum β-cell functional impairment and insulin resistance to those with moderate hyperglycemia during pregnancy. Hence, with respect to maternal long-term postpartum outcomes, the IADPSG diagnostic criteria for GDM could be appropriate for patients in mainland China.

Implication of gestational diabetes treatment on maternal weight gain and low neonatal weight: a large retrospective cohort study.

Objective: the treatment for gestational diabetes is based on diet, and this may modify maternal weight gain. The limited maternal weight gain is related to newborns with small weight for their gestational age (SGA), and many studies have found an increase of SGA in women with gestational diabetes (GD), but the reason for this is not clear. The objective of this study is to evaluate the effects of gestational diabetes treatment on maternal weight gain and neonatal weight. Methods: a retrospective cohort study of 1,765 patients with GD, according to the National Diabetes Data Group (NDDG) criteria. We assessed: pre-pregnancy BMI, total maternal weight gain (MWG), weight gain during the third trimester, gestational week of starting the treatment, and treatment modality (diet or diet plus insulin). Birth weight was adjusted by gestational age and gender: SGA (≤ 10th) and large for gestational age (LGA) (> 90th). Results: the percentage of newborns with weight ≤ 10 was 14.8 %. The diet and the time of initiation of the treatment were related to maternal weight gain (MWG) in the third trimester. For every 1 kcal/kg of variation in the diet (increase or decrease), a MWG variation of 0.03 (0.001-0.06) kg occurred (p < 0.01). For each week before the beginning of treatment, the mother did not gain 0.13 ± [(-0.15) - (-0.11)] kg in the third trimester (p < 0.01). The SGA was related to the lowest MWG in total gestation: 7.0 (IQR 3.0-10.4) kg vs 8.4 (IQR 5.0-11.6) kg (p < 0.01), and in the third trimester: 0.3 (IQR -0.9-1.5) kg vs. 0.9 (IQR -0.3-2.2) kg (p < 0.01). Conclusion: the dietary treatment for gestational diabetes leads to a lower maternal weight gain and induces an impact on neonatal weight.

Screening for Gestational Diabetes Mellitus by Measuring Glycated Hemoglobin Can Reduce the Use of the Glucose Challenge Test.

BackgroundPhysiological changes during pregnancy, such as dilutional anemia and a reduced half-life of red blood cells, have prevented the use of glycated Hb (HbA1c) as a biomarker for gestational diabetes mellitus (GDM). Nevertheless, increasing evidence supports the use of HbA1c in GDM diagnostic strategies.We studied HbA1c as a biomarker of GDM and its possible use as a screening test to avoid the use of the glucose challenge test (GCT).MethodsThis case-control study involved 607 pregnant women between the 24th and 28th week of gestation. HbA1c level was determined, and GDM was diagnosed according to the National Diabetes Data Group criteria. The area under the ROC curve (AUC) was determined; two low and two high cut-off points were established to rule out GDM and classify high-risk pregnant women, respectively. For each cut-off, sensitivity (S), specificity (SP), and total number and percentage of GCTs avoided were determined.ResultsThe AUC for HbA1c diagnostic performance was 0.68 (95% confidence interval 0.57–0.79). Using 4.6% HbA1c (27 mmol/mol) as the lower cut-off (S=100%), 14% of participants could avoid the GCT. Using 5.5% HbA1c (36 mmol/mol) as the upper cut-off (SP =94.5%), 6% of participants would be considered at high risk.ConclusionsHbA1c can be used as a screening test prior to the GCT, thereby reducing the need for the GCT among pregnant women at a low risk of GDM.

Evidence in support of the International Association of Diabetes in Pregnancy study groups’ criteria for diagnosing gestational diabetes mellitus worldwide in 2019

Gestational diabetes mellitus, the most frequent medical complication of pregnancy, affects 5-6% of women in the United States with the use of the currently predominant Carpenter-Coustan criteria, which still represent the preferred approach of the American College of Obstetricians and Gynecologists. Alternative criteria proposed by the International Association of Diabetes in Pregnancy Study Groups would likely increase gestational diabetes mellitus prevalence to 15-20%, because of both a 1-step testing policy and the requirement for only 1 elevated glucose value for diagnosis. Increasing gestational diabetes mellitus prevalence relates to older maternal age and the increasing prevalence of overweight and obesity. This increased gestational diabetes mellitus prevalence is consistent with 29.3% prevalence of prediabetes and 4.5% prevalence of known diabetes outside pregnancy in US adults from 20-44 years of age. Gestational diabetes mellitus according to the International Association of Diabetes in Pregnancy Study Groups criteria is associated with almost twice the risk of large-for-gestational-age babies, increased fetal adiposity, neonatal hyperinsulinemia and preeclampsia, and a 50% higher risk of preterm delivery and shoulder dystocia. The recent publication of the Hyperglycemia and Adverse Pregnancy Outcome Follow Up Study provides further evidence regarding the influence of gestational diabetes mellitus on long-term maternal and infant health. This study clearly demonstrates that hyperglycemia in pregnancy, untreated and identified post hoc by the International Association of Diabetes in Pregnancy Study Groups criteria, carries a 41.5% risk of maternal prediabetes (odds ratio, 3.72; 95% confidence interval, 3.09-4.47) and 10.7% risk of type 2 diabetes (odds ratio, 7.63; 95% confidence interval, 5.33-10.95) after 11.4 years of follow up. Gestational diabetes mellitus was also associated with higher rates of childhood overweight and obesity (prevalence 39.3% with maternal gestational diabetes mellitus; odds ratio, 1.5; 95% confidence interval, 1.56-2.44). This article places these findings in the context of other recent studies that have demonstrated that interventions that include lifestyle measures and/or metformin offer a >50% reduction in the risk of women with gestational diabetes mellitus experiencing the development of overt diabetes mellitus after their index gestational diabetes mellitus pregnancy. Although prevention of obesity and prediabetes in offspring by pregnancy treatment of gestational diabetes mellitus has not been demonstrated to date, we argue that the immediate pregnancy benefits and opportunities for long-term improvements in maternal health justify a reevaluation of the current ambivalent approach taken by the American College of Obstetricians and Gynecologists to gestational diabetes mellitus diagnosis, which currently allow for a choice of alternative criteria. The Carpenter-Coustan or National Diabetes Data Group criteria, listed as preferred criteria by American College of Obstetricians and Gynecologists, markedly limit the frequency of gestational diabetes mellitus in comparison with the International Association of Diabetes in Pregnancy Study Groups criteria and limit the opportunity for immediate and long-term follow up and treatment. We consider that new information from the Hyperglycemia and Pregnancy Outcome Follow Up Study and other recent publications on long-term maternal and offspring risk provides compelling arguments for a more comprehensive approach to the promotion of maternal and infant health through all the life cycle.

403: Screening for GDM– can we use the results of the GCT of the previous pregnancy?

To assess whether previous pregnancy glucose challenge test (GCT) result among non-diabetic women may serve in an index pregnancy. as a screening tool for Gestational Diabetes Mellitus (GDM) Retrospective study based on computerized records in a single large university medical center. All women who had a singleton pregnancy and two subsequent deliveries in our medical center between 2005 and 2017 were included. Women with Diabetes Mellitus or GDM in the previous pregnancy and women without documented GCT results in their previous pregnancy, were excluded. GDM diagnosis is based on either National Diabetes Data Group criteria or the Carpenter and Coustan criteria. Unpaired student T-test and one way ANOVA were used to asses associations between GCT levels and maternal characteristics. Multivariable logistic model was conducted to assess the independent role of GCT level at previous pregnancy on GDM at index pregnancy. ROC curves were constructed. All tests are two-sided. P value below 0.05 was considered statistically significant. Analyses were carried out using SPSS software package version 22 (IBM, Armonk, NY). A total of 31,861 women met inclusion criteria. Of those, 670 (2.1%) had GDM in the index pregnancy. Parturients with GDM in the index pregnancy had higher mean levels of GCT in the previous pregnancy in comparison to parturients without GDM (127.5±28 VS. 98.7±24 mg/dl, respectively, p<0.001). There was a positive association between GCT results in previous pregnancy and rates of GDM in index pregnancy (Figure). Multivariate analysis controlling for known risk factors for GDM revealed that GCT levels in previous pregnancy were independently associated with rates of GDM in index pregnancy (1.04, 95% CI 1.03-1.04, p<0.001). Using a GCT value of 107 mg/dl (65th percentile), the area under the ROC curve was 0.79, suggesting a fair to good accuracy of GCT results in previous pregnancy in predicting GDM in index pregnancy. In addition, the NPV of this value is very high, only 7 of 1000 women with this results or lower will have GDM in the index pregnancy (Table). GCT result in previous pregnancy may serve as a screening tool for GDM in an index pregnancy. Parturients with low levels of GCT may not need repeat screening for GDM in the index pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The association between HIV, antiretroviral therapy, and gestational diabetes mellitus.

The widespread, chronic use of antiretroviral therapy raises questions concerning the metabolic consequences of HIV infection and treatment. Antiretroviral therapy, and specifically protease inhibitors, has been associated with hyperglycemia. As pregnant women are vulnerable to development of hyperglycemia, the objective of this study was to explore existing literature on the relationship between HIV infection, HIV treatment, and gestational diabetes mellitus (GDM). A systematic search was conducted in six databases for articles providing data on HIV-positivity, protease inhibitor exposure, and GDM or glucose intolerance development in pregnancy. The quality of articles was evaluated using an adapted Cochrane Collaboration bias assessment tool. Risk ratios were generated from pooled data using meta-analysis by the Mantel-Haenszel method. Of 891 references screened, six studies on the role of HIV-positivity, 10 on protease inhibitor use, and two on both were included. Meta-analysis showed no significant relationship between HIV infection and the development of GDM [risk ratio 0.80, 95% confidence interval (CI): 0.47-1.37, I = 0%]. Meta-analysis of protease inhibitor exposure showed increased GDM in studies using first-generation protease inhibitors (risk ratio 2.29, 95% CI: 1.46-3.58) and studies using the strictest diagnosis criteria, the National Diabetes Data Group criteria for 3-h oral glucose tolerance test (risk ratio 3.81, 95% CI: 2.18-6.67). Meta-analysis showed no significant association between HIV-positivity and GDM. Significance of protease inhibitor use was limited to studies using the strictest diagnostic criteria for GDM. Results are limited by high risk of bias. Well designed prospective studies are needed to further clarify this relationship and its consequences for clinical practice.

Carpenter-Coustan Compared With National Diabetes Data Group Criteria for Diagnosing Gestational Diabetes.

Use of Carpenter-Coustan compared with National Diabetes Data Group criteria increases the number of women diagnosed with gestational diabetes mellitus (GDM) by 30-50%, but whether treatment of this milder GDM reduces adverse outcomes is unknown. We explored the effects of the diagnostic criteria used on the benefits of GDM treatment. This was a secondary analysis of a randomized trial for treatment of mild GDM diagnosed using Carpenter-Coustan criteria. We evaluated the effect of treatment within two mutually exclusive diagnostic groups: 1) women who met the stricter National Diabetes Data Group as well as Carpenter-Coustan criteria (National Diabetes Data Group), and 2) those diagnosed by Carpenter-Coustan but not meeting National Diabetes Data Group criteria (Carpenter-Coustan only). Maternal outcomes examined were pregnancy-induced hypertension, shoulder dystocia, maternal weight gain, and cesarean delivery. Neonatal outcomes were large for gestational age, macrosomia (greater than 4,000 g), fat mass, small for gestational age, and a composite outcome of perinatal death, birth injury, hypoglycemia, hyperbilirubinemia, and hyperinsulinemia. Analysis of variance or the Breslow-Day test, as appropriate, was used to test for the interaction between diagnostic criteria and GDM treatment on the outcomes of interest. Of 958 patients, 560 (58.5%) met National Diabetes Data Group criteria and 398 (41.5%) met Carpenter-Coustan only. Compared with untreated women, the direction of treatment effect did not differ by diagnostic criteria used and was consistent with the original trial. The P value for interaction between diagnostic criteria and treatment status was not significant for any outcome. The overall beneficial treatment effect on pregnancy-induced hypertension, shoulder dystocia, cesarean delivery, and macrosomia was seen in patients diagnosed by the higher National Diabetes Data Group and by the lower thresholds of the Carpenter-Coustan criteria.

Diagnostic ability of elevated 1-h glucose challenge test.

ObjectiveTo determine if a threshold of a 1-hour glucose challenge test (GCT) eliminates the need for a 3-hour glucose tolerance test (GTT).Study DesignA retrospective cohort of patients undergoing GTT after GCT was ≥140 mg/dL. GDM was diagnosed using National Diabetes Data Group (NDDG) and Carpenter Coustan(CC) criteria. Sensitivity, specificity, and predictive values were calculated for 1-hour GCT values of 160 to 220 mg/dL.ResultOf 6218 patients, 988(15.9%) had an elevated GCT and 753(12.1%) underwent a GTT. 165(2.7%) were diagnosed with GDM using NDDG criteria, and 250(4.0%) by CC criteria. The positive predictive value of a 1-hour GCT≥200 mg/dL for GDM was 68.6% by NDDG and 80.0% for GDM by CC criteria.ConclusionAlthough the predictive value of an elevated 1-hour ≥200 mg/dL for GDM was high, 1 in 3 to 1 in 5 women would be overdiagnosed with GDM if the 3-hour GTT were omitted.

Postpartum outcome and its risk factors of increased gestational diabetes mellitus according to the new diagnostic criteria

Objective To investigate the outcomes of increased gestational diabetes mellitus (GDM) and the influencing factors after the implementation of the new GDM diagnostic criteria. Methods A total of 1 439 GDM women who delivered in the Peking University First Hospital between May 1, 2011 and December 31, 2012 were studied and divided into two groups. Group I included the women who met the new GDM diagnostic criteria (fasting plasma glucose and 1 or 2 h plasma glucose levels for 75-g oral glucose tolerance test performed between 24 and 28 weeks of gestation were no less than 5.1, 10.0 and 8.5 mmol/L), but did not meet the National Diabetes Data Group (NDDG) criteria; and Group Ⅱ included the women who met the NDDG criteria only. Women in Group Ⅰ were further divided into two subgroups according to whether attending the one-day GDM outpatient visit. Follow-up rate and detecting rate of abnormal glucose metabolism at 6-12 weeks after delivery were analyzed. Chi-square test, t test and multivariate Logistic analysis were used for statistical analysis. Results There were 849 GDM women in GroupⅠ (59.0%, 849/1 439) and 590 (41.0%, 590/1 439) in Group Ⅱ. The follow-up rate in group Ⅰ was lower than in group Ⅱ [25.9%(220/849) vs 32.0%(189/590), χ2=6.112, P=0.013]. There were five cases of impaired fasting glucose and 34 impaired glucose tolerance in Group I; and four cases of impaired fasting glucose, 56 impaired glucose tolerance, eight impaired fasting glucose tolerance with impaired glucose tolerance and five diabetes mellitus in GroupⅡ; there were significant differences [17.7%(39/220) vs 38.6%(73/189), χ2=33.810, P=0.000]. (2) In GroupⅠ, the increased glucose level at 2 h in oral glucose tolerance test during pregnancy (OR=1.547, 95%CI: 1.038-2.306, P=0.032) and family history of diabetes mellitus (OR=1.879, 95%CI: 1.066-3.313, P=0.020) were risk factors for postpartum abnormal glucose metabolism, while breast-feeding was a protective factor (OR=0.290, 95%CI: 0.092-0.914, P=0.035). (3) In groupⅠ, the follow-up rate in those who attended the one-day GDM outpatient visit was higher than those who did not [30.7%(185/603) vs 14.2%(35/246), χ2=23.780, P=0.000], but the detecting rate of postpartum abnormal glucose metabolism were similar in women attending the one-day GDM outpatient visit and those not attending [17.8%(33/185) vs 17.1%(6/35), χ2=0.020, P=0.887]. Conclusions Increased GDM women still have glucose metabolism abnormality after delivery, especially those who have higher glucose level at 2 h after glucose intake in 75-g oral glucose tolerance test during pregnancy and who have a family history of diabetes mellitus. The one-day GDM outpatient visit may improve the follow-up rate for these women. Key words: Diabetes, gestational; Postpartum period; Follow-up studies

Glyburide in Women With Mild Gestational Diabetes: A Randomized Controlled Trial.

To evaluate whether the addition of glyburide to diet therapy modifies pregnancy outcomes in women with mild gestational diabetes. Women with at least two abnormal values on a 3-hour, 100-g oral glucose tolerance test according to National Diabetes Data Group criteria and fasting values less than 105 mg/dL between 24 and 30 weeks of gestation were randomized to blinded glyburide or placebo study drug. All women were placed on a 35-kcal/kg diet and recorded four times daily capillary glucose measurements. The study drug was titrated based on weekly maternal capillary glucose values with targets of less than 95 mg/dL (5.3 mmol/L) and 120 mg/dL (6.7 mmol/L) for fasting and 2-hour postprandial glucose measurements, respectively. The primary study outcome was a 200-g birth weight decrement in neonates of women treated with glyburide. The sample size estimate for this outcome was 334 total randomized women with a one-to-one allocation. A total of 395 women were enrolled at a single center between September 2008 and October 2012. Women treated with glyburide had a significantly greater decline in fasting glucose values over the course of therapy. However, there was no difference in the primary study outcome. Specifically, the mean birth weight was 33 g lower in the group treated with glyburide (P=.52). Although not powered to examine all outcomes associated with gestational diabetes, treatment with glyburide did not affect need for operative delivery, shoulder dystocia, clavicular fracture, Erb's palsy, or neonatal hypoglycemia. Four women in each group required insulin. The addition of glyburide to diet therapy significantly improved maternal glycemic control over time when compared with placebo. However, adding glyburide to diet did not decrease birth weight or improve maternal or neonatal outcomes in women with mild gestational diabetes. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00744965. I.

Is omitting the 3rd hour measurement in the 100 g oral glucose tolerance test feasible?

To evaluate the diagnostic value of the 3rd hour plasma glucose level in the 100 g oral glucose tolerance test (OGTT). Records of all pregnant patients with abnormal 50 g glucose challenge test (GCT) between January 2005 and December 2013 were reviewed (n=1963). The 100 g OGTT results were analyzed separately for both Carpenter & Couston (CC) and National Diabetes Data Group (NDDG) criteria. The number of patients diagnosed with gestational diabetes mellitus (GDM) was 297 (15.1%) according to CC criteria and 166 (8.4%) according to NDDG criteria. The 1st hour plasma glucose level showed the highest correlation with GDM diagnosis (ρ=0.595 for CC and ρ=0.567 for NDDG). However, the 3rd hour plasma glucose level showed the weakest correlation with GDM diagnosis (ρ=0.216 for CC and ρ=0.213 for NDDG). The 3rd hour value of 100 g OGTT was one of the two elevated measurements in 10.8% of patients when CC criteria are used and in 13.8% of patients when NDDG criteria are used. Omitting 3rd hour plasma glucose measurement in 100 g OGTT results in unacceptable rates of underdiagnosed patients.

Pregnancy outcome in women with gestational diabetes mellitus according to the Carpenter-Coustan criteria in Thailand.

To compare the pregnancy outcome of patients diagnosed with gestational diabetes mellitus (GDM) using the Carpenter-Coustan (CC) criteria with that of non-GDM pregnant women at Siriraj Hospital, Bangkok. A retrospective study was carried out by reviewing medical records of pregnant women who underwent 100-g oral glucose tolerance test (OGTT) for diagnosing GDM between January 2009 and December 2012 at Siriraj Hospital. Pregnant women were divided into three groups according to the 100-g OGTT result: group 1, pregnant women with normal OGTT on both CC and National Diabetes Data Group (NDDG) criteria; group 2, pregnant women with normal OGTT on NDDG criteria but GDM on CC criteria; and group 3, pregnant women with GDM on CC criteria after December 2012 and enrolled in glycemic control program. Maternal and perinatal outcomes were compared between the groups. During the study period, the incidence of GDM increased 32.76% using the CC criteria. These women (group 2) had a higher risk of neonatal hypoglycemia (6.7% vs 0.6%; OR, 12.3; P < 0.0001), neonatal hyperbilirubinemia (13.7% vs 7.8%; OR, 1.9; P = 0.013) compared with group 1. Pregnant women in group 3 had a lower incidence of immediate post-partum hemorrhage from vaginal delivery than group 2 (0 vs 2.9%; P = 0.04) as well as lower rates of neonatal hypoglycemia and neonatal hyperbilirubinemia. Use of CC criteria increases the prevalence of GDM, but managing these women according to the program for GDM can improve the adverse neonatal outcome.