Changes in perinatal outcomes after implementation of IADPSG criteria for screening and diagnosis of gestational diabetes mellitus: A national survey

Abstract

Objective To compare perinatal outcomes before and after implementation of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for testing of gestational diabetes mellitus (GDM). Methods A national, perinatal, registry‐based cohort study of prospectively collected data was conducted. Patients with diabetes type 1 or 2 were excluded. Outcomes of 135 786 pregnancies before (January 1, 2004 to May 31, 2010) and 140 524 after (June 1, 2011 to December 31, 2017) the introduction of IADPSG criteria were compared using Student t test and χ2 test (P<0.05 was significant). Multivariable logistic regression was used to compare outcomes controlling for potential confounders. Results Prevalence of GDM increased from 2.6% to 9.7% (adjusted odds ratio 3.92; 95% confidence interval 3.78–4.08). Incidence of large‐for‐gestational age (LGA), macrosomia (birth weight >4500 g), Erb's palsy, and hypertensive disorders in pregnancy decreased despite increasing maternal age and pre‐pregnancy obesity. Rates of cesarean delivery increased in both GDM and non‐GDM groups, with a less pronounced increase in GDM mothers. Incidence of small‐for‐gestational age (SGA) increased in GDM but not in non‐GDM group. Conclusion Implementation of IADPSG criteria in a country with a relatively low prevalence of GDM did not result in higher rates of cesarean delivery and was associated with reductions in LGA and hypertensive disorders in pregnancy.

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

“…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.…”

“…In Japan, despite a substantial rise in GDM diagnosis frequency from 2.9% to 13%, a significantly decreased odds were only observed for NICU admission and neonatal hypoglycemia [34]. With a similar change in GDM prevalence (2.6% vs. 9.7%), the introduction of the IADPSG criteria resulted in reduction in incidences of LGA, macrosomia and hypertensive disorders in Slovenian pregnant women [43].…”

“…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].…”

Evolution of maternal and neonatal outcomes before and after the adoption of the IADPSG/WHO guidelines in Belgium: A descriptive study of 444,228 pregnancies

“…Indeed, international studies show conflicting results on the effects of screening and treatment of HIP by comparing the one-step approach with the two-step approach. Some studies have reported better pregnancy outcomes [ 3 , 17 , 18 , 19 ], while others have not [ 20 , 21 , 22 , 23 , 24 ].…”

Searching for Utopia, the Challenge of Standardized Medical Nutrition Therapy Prescription in Gestational Diabetes Mellitus Management: A Critical Review

“…Furthermore, updated screening and diagnostic practices have played a large role in the additional diagnoses. 1,5,6 Although GDM diagnostic criteria are not consistent worldwide, there has been an increase in universal screening and many countries have updated their criteria in line with the 2010 International Association of Diabetes in Pregnancy Study Group (IADPSG) recommendations. 7…”