The World Health Organization (WHO) versus The International Association of Diabetes and Pregnancy Study Group (IADPSG) diagnostic criteria of gestational diabetes mellitus (GDM) and their associated maternal and neonatal outcomes

Abstract

Background Gestational diabetes mellitus (GDM) is a common medical complication in pregnancy. The aim of this study was to compare the prevalence of GDM using the World Health Organization (WHO) criteria and the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria in our population. We further compared the incidence of adverse maternal and neonatal outcomes in women diagnosed with GDM using these criteria and determined whether the IADPSG criteria is suitable in our population. Methods This randomized controlled trial was conducted at our antenatal clinic involving 520 patients from 1st February 2015 until 30th September 2017. They were randomized into the WHO and the IADPSG groups. All eligible women underwent a standard oral glucose tolerance test with 75 g glucose, their fasting and 2 h post prandial glucose levels were taken. The primary outcome was the prevalence of GDM. The secondary outcomes were the incidence of primary cesarean section, gestational hypertension or preeclampsia, preterm delivery <37 weeks, fetal macrosomia, neonatal hypoglycemia and shoulder dystocia or birth injury. Results The prevalence of GDM in both groups were similar (37.9% vs. 38.6%). GDM women in the WHO group had a significantly higher incidence of gestational hypertension or preeclampsia (p = 0.004) and neonatal hypoglycemia (p = 0.042). In contrast, GDM women in the IADPSG group had a significantly higher incidence of fetal macrosomia (p = 0.027) and cesarean section (p = 0.012). Conclusion The IADPSG diagnostic criteria for GDM may not be suitable for use in our population as it resulted in women being diagnosed later and being undertreated, thus leading to adverse maternal and neonatal outcomes.

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

“…Although we did not use the IADPSG criteria for our cohort, the low prevalence of fasting abnormalities among our women was unlikely to affect the overall study findings. A previously published study from our institution found no significant difference in the prevalence of GDM between the women diagnosed using the 1999 WHO (fasting ≥6.1 mmol/L, 2-h ≥7.8 mmol/L) and IADPSG (fasting ≥5.1 mmol/L, 2-h ≥8.5 mmol/L) criteria [ 18 ], a result that could be attributed to the higher rate of postprandial abnormality in our population.…”

Effect of new diagnostic criteria on detection and pregnancy outcomes of gestational diabetes mellitus: a retrospective study

“…Nonetheless, most studies reported an increase in the number of GDM cases [15][16][17][18][19][20] , although some studies reported similar or decreased in number of GDM cases. 21,22 This reduction reflected that most GDM cases detected in the Chinese population was by the 2HG test. Therefore, a decrease in the number of GDM cases detected was due to the loosening of the 2HG test.…”

The Influence of Preeclampsia, Advanced Maternal Age and Maternal Obesity in Neonatal Outcomes Among Women with Gestational Diabetes

“…As our results showed, the current literature also demonstrated that women with gestational diabetes are at risk of both maternal, fetal and neonatal adverse outcomes, including pre-eclampsia and eclampsia (8-fold raise), increased risk of preterm birth, higher need for labor induction, caesarean section, stillbirths, macrosomia, full term low weight infants, newborns large for gestational age, neonatal morbidity (namely hyperbilirubinemia and jaundice, respiratory distress and asphyxia, hypoglycemia and congenital malformations), increased need to admission in neonatal intensive care unit and neonatal death (5-fold raise). 2,11,16 However, there are also some studies that do not share the same scientific opinion. Some authors stated that the prevalence of newborns large for gestational age, cesarean section and preterm deliveries in gestational diabetes was not elevated.…”

“…35 This same finding is concordant with the results of the present study, which showed that maternal obesity doesn't seem to be an aggravating factor of gestational diabetes, which could be explained by the greater number of prenatal visits and strict vigilance of women with gestational diabetes that should be enough to achieve a more rigorous diet and weight control, as already mentioned in the recent literature. 2,4,11 In the same way, other authors considered advanced maternal age as a potential risk factor of gestational diabetes, as well as an aggravating factor of it, capable to raise the incidence of adverse outcomes for mothers, newborns and infants, as spontaneous late preterm deliveries, fetal growth restriction, small for gestational age infants and birthweight < 2500 g. 3,14,21 However, according to some authors, maternal age does not significantly influence birthweight. 25 Despite the findings in the literature, the present study did not find advanced maternal age as an aggravating factor of gestational diabetes, which could be explained also by a more rigorous vigilance of these pregnant women.…”