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

Abstract

OBJECTIVETo 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.RESEARCH DESIGN AND METHODSThis 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.RESULTSAmong 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.CONCLUSIONSWomen 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.

Reciprocal Relationship Between Insulin Resistance and Disturbed Adma/No Axis in Gestational Diabetes Mellitus.

“…In line with the reported figure for GDM, Sacks et al (29) found the overall frequency of GDM was 17.8% and ranged between 9.3 and 25.5% among centers that participated in HAPO Study using the IADPSG criteria and Waters et al (30) out of meta-analysis found 14.3% of studied pregnant women had GDM defined according to IADPSG criteria. Also, Lacaria et al (31) and Du et al (32) reported prevalence rates of GDM of 10.9% and 8.5%, respectively.…”

The unmet need for universal testing for hyperglycaemia in pregnancy and the FIGO guideline

“…Without preventive care almost half of women with gestational diabetes go on to develop type‐2 diabetes, and a significant proportion develop premature cardiovascular disease within 10 years of childbirth . Children born to women with HIP are also at very high risk of obesity, early onset type‐2 diabetes, and cardiovascular disease, whereby HIP perpetuates these conditions into the next generation.…”

Comparison of Two Screening Strategies for Gestational Diabetes (GDM 2 ) Trial: Design and rationale

“…In 2013, an NIH consensus conference on diagnosing GDM was held to “address controversial questions of public health importance when there may be discordance between clinical practice and the available evidence.”[8] While there have been observational studies and a pilot feasibility trial comparing the two groups, [12–14] there has yet to be a confirmatory, randomized controlled trial directly comparing the one-step (IADPSG) and two-step (CC) approaches. Thus, the consensus committee recommended continuing with the two-step approach until there is sufficient evidence from randomized trials on comparative detection, treatment, and outcomes.…”