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

Abstract

BackgroundWe assessed the impact of adopting the 2013 World Health Organization (WHO) diagnostic criteria on the rates of gestational diabetes (GDM), pregnancy outcomes and identification of women at future risk of type 2 diabetes.MethodsDuring a period when the 1999 WHO GDM criteria were in effect, pregnant women were universally screened using a one-step 75 g 2-h oral glucose tolerance test at 26–28 weeks’ gestation. Women were retrospectively reclassified according to the 2013 criteria, but without the 1-h glycaemia measurement. Pregnancy outcomes and glucose tolerance at 4–5 years post-delivery were compared for women with GDM classified by the 1999 criteria alone, GDM by the 2013 criteria alone, GDM by both criteria and without GDM by both sets of criteria.ResultsOf 1092 women, 204 (18.7%) and 142 (13.0%) were diagnosed with GDM by the 1999 and 2013 WHO criteria, respectively, with 27 (2.5%) reclassified to GDM and 89 (8.2%) reclassified to non-GDM when shifting from the 1999 to 2013 criteria. Compared to women without GDM by both criteria, cases reclassified to GDM by the 2013 criteria had an increased risk of neonatal jaundice requiring phototherapy (relative risk (RR) = 2.78, 95% confidence interval (CI) 1.32, 5.86); despite receiving treatment for GDM, cases reclassified to non-GDM by the 2013 criteria had higher risks of prematurity (RR = 2.17, 95% CI 1.12, 4.24), neonatal hypoglycaemia (RR = 3.42, 95% CI 1.04, 11.29), jaundice requiring phototherapy (RR = 1.71, 95% CI 1.04, 2.82), and a higher rate of abnormal glucose tolerance at 4–5 years post-delivery (RR = 3.39, 95% CI 2.30, 5.00).ConclusionsAdoption of the 2013 WHO criteria, without the 1-h glycaemia measurement, reduced the GDM rate. Lowering the fasting glucose threshold identified women who might benefit from treatment, but raising the 2-h threshold may fail to identify women at increased risk of adverse pregnancy and future metabolic outcomes.Trial registrationNCT01174875. Registered 1 July 2010 (retrospectively registered).Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1707-3) contains supplementary material, which is available to authorized users.

Correlation between Oral Glucose Tolerance Test Abnormalities and Adverse Pregnancy Outcomes in Gestational Diabetes: A Cross-Sectional Study

“…The insulin requirement among our GDM women (8.7%) was low in comparison to other published data (10.8–52.8%) [ 5 , 20 , 21 , 22 , 26 , 27 , 28 ]. Singapore, which has a similar multi-ethnic population to Malaysia, reported a comparable rate to ours (5.6–10.4%) [ 32 ]. Studies have shown that the underlying disturbance in glucose metabolism was different between subjects with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) [ 33 , 34 ].…”

Silencing of long noncoding RNA PVT1 inhibits podocyte damage and apoptosis in diabetic nephropathy by upregulating FOXA1

“…A total of 32 patients with early DN treated at the First Affiliated Hospital of Zhengzhou University from April 2015 to April 2016 were selected, and their serum samples were collected. The patients included 19 males and 13 females with an average age of 53.6 ± 7.5 years, ranging from 35 to 70 years; all patients met the World Health Organization (WHO) diagnostic criteria for diabetes 14 . The DN patients had a negative urine protein test, with 30–300 mg/24 h urine albumin, indicating early renal damage.…”

Factors Associated With Gestational Diabetes Mellitus in Rural Areas of Limpopo Province: A Descriptive Analysis

“…Another contributing reason could be that studies used different diagnostic criteria in determining the prevalence of GDM. International uniformity for ascertainment and diagnosis of GDM has not been reached and has remained an argumentative issue [20]. WHO has recognized and adopted the IADPSG diagnostic criteria, however the implementation of this new criterion in screening for GDM remains debatable due to lack of evidence from prospective randomised studies to show improved maternal and foetal outcome with this adoption [20].…”