Screening pregnant women in a high-risk population with WHO-2013 or NICE diagnostic criteria does not affect the prevalence of gestational diabetes

Abstract

There are currently several diagnostic criteria for gestational diabetes (GDM). Both the WHO -2013 and NICE diagnose GDM based on a single step 75 g OGT; however; each uses different glucose thresholds. Previous studies have shown that the prevalence of GDM using the NICE criteria (GDM-N) is lower than that using the WHO-2013 criteria (GDM-W). Qatar has national diabetes in pregnancy program in which all pregnant women undergo OGTT screening using the WHO-2013 criteria. This study aims to define the prevalence of GDM using both criteria in a high-risk population. This retrospective study included 2000 women who underwent a 75 g (OGTT) between Jan 2016 and Apr 2016 and excluded patients with known pre-conception diabetes, multiple pregnancy, and those who did not complete the OGTT. We then classified the women into GDM-W positive, GDM-N positive but GDM-W negative, and normal glucose tolerance (NGT) population. A total of 1481 women (74%) had NGT using the NICE or the WHO-2013 criteria. The number of patients who met both criteria was 279 subjects (14%) with a good agreement (Kappa coefficient 0.67, p < 0.001). The NICE and the WHO-2013 criteria were discordant in 240 subjects (12% of the cohort); 6.7% met the WHO -2013 criteria only and only 5.3% met the NICE criteria. The frequency of pre-eclampsia, pre-term delivery, Caesarean-section, LGA and neonatal ICU admissions were significantly increased in the GDM-W group. However, the GDM-N positive but GDM-W negative had no increased risk of maternal or fetal complications apart from pregnancy-induced hypertension. The WHO-2013 and the NICE criteria classified a similar proportion of pregnant women, 21.5% and 20.1%, respectively, as having GDM; however, they were concordant in only 14% of the cases. Women who are GDM-N positive but GDM-W negative are not at increased risk of maternal and fetal pregnancy complications, except for pregnancy-induced hypertension. As the NICE criteria are more specific to the UK population, we would recommend the use of the WHO-2013 criteria to diagnose GDM in the MENA region and possibly other regions that do not have the same set-up as the UK.

Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis

“…Of the 44 993 studies identified, 156 studies,2324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105106107108109110111112113114115116117118119…”

“…Of the 44 993 studies identified, 156 studies, 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 …”

Continuous glucose monitoring system profile of women diagnosed as gestational diabetes mellitus by International Association of Diabetes and Pregnancy Study Groups criteria and labeled as normoglycemic by alternate criteria in early pregnancy

“…also reported an increased risk of adverse perinatal outcomes in women with elevated fasting plasma glucose (5.1–5.5 mmol/L), who were identified as normoglycemic by the UK NICE criteria. Similarly, Bashir et al 24 . and Todi et al 25 .…”

Unifying diagnostic criteria for gestational diabetes mellitus

“…This data-set has previously been reported (7) and was a convenience sample that included all women who underwent a 75 g OGTT between January 2016 and April 2016 with and without GDM at a tertiary hospital of the Hamad Medical Corporation (Women's Wellness and Research Center) in Qatar (Supplementary Table S2). This is the main maternity hospital in Qatar with 16,000-18,000 births annually.…”

“…The two widely used criteria for the diagnosis of GDM rely on individual time-point thresholds on a 2-hour (5) or a 3-hour (6) glucose tolerance test (GTT), and requires elevated values at one or two time points respectively for the diagnosis. As such, the number of elevated time-point values required and different glycaemic thresholds will alter the selection of women and prevalence of GDM (7) but such changes in selection and prevalence have not, thus far, been associated with maternal or perinatal benefit overall (8;9). For a country like Denmark, changing to criteria that define GDM based on application of the International Association for the Diabetes in Pregnancy Study Group (IADPSG) 2010 (5) definition of GDM would result in a marked increase in GDM prevalence to 40% based on the fasting criterion alone, without convincing evidence of adverse pregnancy outcomes (10).…”