Comparison of different criteria for diagnosis of gestational diabetes mellitus

Abstract

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

Impact of adopting the 2013 World Health Organization criteria for diagnosis of gestational diabetes in a multi-ethnic Asian cohort: a prospective study

“…We also observed a similar pattern among women of Indian ethnicity. This is consistent with the findings of several studies on Indian women showing the majority of GDM were detected not by the FPG but by the 2-h PG threshold of ≥7.8 mmol/L based on the 1999 WHO Criteria [25, 29, 30]. Hence the 2-h PG is important in Chinese and Indian women and raising the 2-h PG fails to detect many cases that may benefit from identification and treatment to reduce adverse outcomes.…”

“…However, reported changes in GDM rates have varied across studies of Asian populations. The 2013 WHO criteria diagnosed more GDM cases in the studies by Pan et al [21] from China (7.7% vs. 6.8%, n  = 17,808) and Gilder et al [24] from Thailand (10.1% vs. 6.6%, n  = 228), a similar proportion of GDM cases in the study by Sagili et al [25] from India (12.6% vs. 12.4%, n  = 1231), and fewer GDM cases in studies by Tran et al [26] from Vietnam (20.4% vs. 24.3%, n  = 2772) and Yew et al [20] from Singapore (21.1% vs. 28.8%, n  = 855). These disparities and data from our study and others’ [27] support the notion of variation in glycaemic responses to a glucose load in pregnancy among different Asian ethnicities.…”

Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis

“…Seven studies using the IADPSG criteria reported the percent of GDM cases diagnosed by the fasting plasma glucose criterion alone (fasting glucose > 92 g/dL), which ranged from 24.8 to 94%, with a median of 70% (see Appendix S8) [13, 25, 26, 31, 38, 49, 54]. …”

“…[13, 18, 31, 38, 44, 49, 50, 54, 71, 77] All ten studies reported a higher prevalence using the IADPSG criteria than the WHO99 criteria, with the difference between the two criteria ranging from 0.16 to 25.90% [13, 49]. …”

“…The most commonly observed risk factors were higher BMI (twenty-six studies [13, 20, 22, 23, 29, 30, 34, 37–39, 41–43, 45, 49, 51, 52, 55, 60, 61, 65–67, 75, 76]), older age (twenty-five studies [12, 18, 26, 30, 33, 34, 38, 39, 41–43, 46, 48–50, 52, 55, 56, 60, 66, 67, 72, 73, 75, 76]), and family history of diabetes mellitus (twenty-four studies [9, 18–21, 25, 29, 30, 33, 34, 37–39, 41, 42, 45, 46, 52, 55, 61, 66, 67, 72, 76]). Other observed risk factors include history of spontaneous abortions or stillbirths (nine studies [21, 33, 34, 39, 42, 53, 65, 66, 76]), history of macrosomia (7 studies [39, 42, 43, 45, 66, 72, 75]), multiparity (7 studies [11, 13, 39, 45, 52, 72, 76]), and higher socioeconomic status (5 studies [13] Hill, 2005 #21} […”