The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

Abstract

This systematic review and meta-analysis aimed to examine the impact of different gestational-diabetes (GDM) diagnostic-criteria on the risk of adverse-maternal-outcomes. The search process encompassed PubMed (Medline), Scopus, and Web of Science databases to retrieve original, population-based studies with the universal GDM screening approach, published in English language and with a focus on adverse-maternal-outcomes up to January 2020. According to GDM diagnostic criteria, the studies were classified into seven groups. A total of 49 population-based studies consisting of 1409018 pregnant women with GDM and 7,667,546 non-GDM counterparts were selected for data analysis and knowledge synthesis. Accordingly, the risk of adverse-maternal-outcomes including primary-cesarean, induction of labor, maternal-hemorrhage, and pregnancy-related-hypertension, overall, regardless of GDM diagnostic-criteria and in all diagnostic-criteria subgroups were significantly higher than non-GDM counterparts. However, in meta-regression, the increased risk was not influenced by the GDM diagnostic-classification and the magnitude of the risks among patients, using the IADPSG criteria-classification as the most strict-criteria, was similar to other criteria. In conclusion, a reduction in the diagnostic-threshold increased the prevalence of GDM, but the risk of adverse-maternal-outcome was not different among those women who were diagnosed through more or less intensive strategies. Our review findings can empower health-care-providers to select the most cost-effective approach for the screening of GDM among pregnant women.

Insulin Aspart Combined with Exercise Therapy in Spleen Deficiency Type Gestational Diabetes Mellitus: The Effect on Disease Control and Pregnancy Outcomes

“…To the best of our knowledge, exercise therapy is exercise program tailored based on the patient's conditions to help them control their blood sugar [ 17 , 18 ]. Previous research has demonstrated that insulin combined with individualized exercise gains promising results in the treatment of gestational diabetes [ 19 ].…”

The Analytical Reliability of the Oral Glucose Tolerance Test for the Diagnosis of Gestational Diabetes: An Observational, Retrospective Study in a Caucasian Population

“…We did not have information regarding the potential impact of the different glucose tolerance classifications on neonatal outcomes, which is a major limitation of our study. However, a recent systematic review and meta-analysis showed that the increased risk of maternal outcomes (i.e., primary cesarean, induction of labor, maternal hemorrhage, and pregnancy-related hypertension) of women with GDM compared with women without GDM was not influenced by the GDM diagnostic classification [21]. A second limitation is the lack of information on pregnant women from follow-ups after the pregnancy.…”

The Role of Kisspeptin in the Pathogenesis of Pregnancy Complications: A Narrative Review

“…It is defined as a glucose tolerance disorder that develops or is first recognized during pregnancy [ 57 ]. The recommended diagnostic criteria are based on the presence of at least one of the threshold values during the 75 g-oral glucose tolerance test (75g-OGTT): fasting glucose level of 5.1–6.9 mmol/L (92–125 mg/dL) at the first hour ≥ 10.0 mmol/L (≥180 mg/dL) and at the second hour 8.5–11.0 mmol/L (153–199 mg/dL) [ 58 ]. Epidemiological studies have revealed that a previous history of impaired glucose tolerance, personal history of medical conditions associated with diabetes (e.g., metabolic syndrome, polycystic ovary syndrome, glucocorticoids use), overweight or obesity, advanced maternal age, dyslipidemia, and history of poor pregnancy outcome or macrosomia in a previous pregnancy seem to be the pivotal risk factors for GDM development [ 59 , 60 ].…”