Change in prevalence of gestational diabetes and obstetric complications when applying IADPSG screening criteria in a Belgian French speaking University Hospital. A retrospective cohort study

Abstract

Background In April 2012 our institution chose to switch from a two- step criteria for Gestational Diabetes Mellitus (GDM) screening, to the International Association of Diabetes in Pregnancy Study Group (IADSPG) criteria. This shift led to an increased prevalence of GDM in our pregnant population. We designed a study in order to estimate the magnitude of the increase in GDM prevalence before and after the switch in screening strategy. As a secondary objective we wanted to evaluate if there was a significant difference between the two periods in the percentage of maternal and neonatal complications such as gestational hypertensive disorders (GHD), primary cesarean section (pCS), preterm birth, large for gestational age (LGA) newborns, macrosomia, shoulder dystocia, 5′ Apgar score less than to 7 at birth, neonatal intensive care unit (NICU) transfer and neonatal hypoglycemia. Methods We selected retrospectively 3496 patients who delivered between January 2009 and December 2011 who were screened with the two-step criteria (group A), and compared them to 2555 patients who delivered between January 2013 and December 2014 and who were screened with IADPSG criteria (Group B). We checked patients’ electronic files to establish GDM status, baseline characteristics (age, body mass index, nationality, parity) and the presence of maternal and neonatal complications. Results GDM prevalence increased significantly from group A (3.4%; 95%CI 2.8–4.06%) to group B (16.28%; 95%CI 14.8 -17.7%). In group B there were significantly more non-Belgian and primiparous patients. There was no statistically significant difference in maternal and neonatal complications between the two groups, even after adjustment for nationality and parity. There was a non-significant reduction of the proportion of macrosomic and of LGA babies. Conclusions In our population the introduction of IADPSG screening criteria has increased the prevalence of GDM without having a statistically significant impact on pregnancy outcomes.

Effect of the IADPSG screening strategy for gestational diabetes on perinatal outcomes in Switzerland

“…In the current study, we observed that the prevalence of GDM increased by more than a factor of 4 from 2005 to 2017, and by 3 comparing the two study periods. This rise of prevalence is in line with previous studies after the new criteria were adopted [11,31,32]. In Spain, GDM prevalence increased 3.3 times (10.6 to 35.5%), in the USA 2.8 times (5.5% to 15,6%) and 4.5 times in Japan (2.9% to 13%) using the IADPSG criteria [13,33,34].…”

“…However, it should be noted that GDM prevalence (35.5%) and risk factors occurrence in this Spanish population were particularly high compared to those reported in our and other studies study population [32,34,41,43]. Conclusively, countries with high GDM prevalence and risk factor burden might benefit most from adopting of the IADPSG screening criteria to substantially improve perinatal outcomes to an extent of being able to ignore the drawbacks of increased medical cost.…”

“…Several other observational studies have explored the changes in perinatal outcomes associated with hyperglycemia during two successive periods of time [31,32,[41][42][43].…”

Projections of the prevalence of hyperglycaemia in pregnancy in 2019 and beyond: Results from the International Diabetes Federation Diabetes Atlas, 9th edition

“…This method was devised to determine whether linear regression would provide a suitable projection. However, we expected there could be large distortions in the data due to the change in our scoring method and the known increase in prevalence when using the IADPSG diagnostic criteria compared with older criteria [29][30][31][32]. Method 3 involved linear regression of only the previous IDF Diabetes Atlas HIP edition estimates that showed a consistent trend, followed by extrapolation from the age-adjusted 2019 HIP estimate.…”

An Update on Screening Strategies for Gestational Diabetes Mellitus: A Narrative Review

“…There are no RCTs that have compared treatment of GDM based on the IADPSG criteria with no treatment. Some observational studies reported no difference or even an increase in adverse perinatal outcomes, 46,47,[50][51][52][53][54][55] whereas others showed a significant improvement in perinatal outcomes associated with the use of the IADPSG criteria [56][57][58] (Table 3).…”