Assessing the incidence of gestational diabetes and neonatal outcomes using the IADPSG guidelines in comparison with the Carpenter and Coustan criteria in a Belgian general hospital

Abstract

We have conducted a systematic universal screening for gestational diabetes mellitus (GDM) since 2008, following the criteria outlined by the International Association of Diabetes and Pregnancy Study Group (IADPSG) since 2011. However, we recently replaced the IADPSG standards with those established by the Belgian French Language Gynecologists and Obstetricians Group (GGOLFB). These new criteria indicate GDM when fasting plasma glucose (FPG) is ≥0·92 g/l at the beginning of pregnancy or when an orally provoked hyperglycaemia test (75 g of glucose) between the twenty-fourth and twenty-eighth week results in an FPG of ≥0·92 g/l and/or ≥1·80 g/l after 1 hour and/or ≥1·53 g/l after 2 hours. The goal of this retrospective study was to evaluate the incidence of GDM, neonatal outcomes, and the use of insulin therapy 21 months post-implementation of the IADPSG criteria within our centre. A total of 393 patients were diagnosed with GDM from January 2009 to December 2012. After applying the new criteria, the incidence of GDM rose significantly from 8 to 23% (P<0·0001). However, there were no significant changes in the proportion of GDM patients requiring insulin therapy (34·2% versus 34·7%) or the rate of foetal large for gestational age (11·2% versus 8·8%). In addition, the ≥90% percentile decreased non-significantly from 96·3±0·6% to 94·3±0·70% (P = 0·057), whereas the lower quartiles and the proportion of cesarean deliveries (27·0% versus 25·6%) did not change significantly. Therefore, non-targeted screening significantly increased the incidence of GDM in our centre without significantly decreasing large for gestational age or the number of cesarean deliveries.

Effects of Implementing International Association of Diabetes and Pregnancy Study Groups Gestational Diabetes Screening on Pregnancy Outcomes at a Small Community Teaching Hospital

“…Our retrospective study demonstrated a 2.5-fold increase in the diagnosis of GDM with the implementation of IADPSG criteria, with no statistically significant differences in maternal or neonatal outcomes. This result has been similarly reported in two other studies (12,13). …”

Are women positive for the One Step but negative for the Two Step screening tests for gestational diabetes at higher risk for adverse outcomes?

“…Several prospective non‐RCTs or retrospective studies comparing the incidence of GDM and/or outcomes between the One Step and Two Step methods have also been published . Polled data of these studies show that GDM‐positive women at One Step test, when treated, have better maternal and neonatal outcomes, compared with treated women GDM positive at Two Step test.…”

Analysis of the Prevalence and Risk Factors of Gestational Diabetes Mellitus Using Novel Diagnostic Criteria

“…By comparison, the GDM prevalence rate in Australia was 13.0% when using the IADPSG standard, with 82% sensitivity and 94% specificity (4). The Oriot et al study (5) reported that the GDM prevalence rate ranged from 8-23% according to the IADPSG standard, and these patients required insulin therapy. The prospective studies of Nayak et al indicated that the GDM prevalence rate was 27% by applying IADPSG standard screening, and the number of pregnancy complications increased in the GDM group [25% vs 12%] (6).…”