Clinical impact of women with gestational diabetes mellitus by the new consensus criteria: two year experience in a single institution in Japan

Abstract

In 2010, International Association of Diabetes and Pregnancy Study Group (IADPSG) proposed new criteria for diagnosing and classifying gestational diabetes mellitus (GDM), based on data of the observational hyperglycemia and adverse pregnancy outcomes (HAPO) study [1]. Since the new diagnostic criteria would increase the frequency of GDM diagnosis without a detailed cost-effectiveness analysis, the number of health care associations implementing the new criteria is still limited [2]. Thus, there is a paucity of information on the IADPSG-defined GDM from a real experi- Abstract. There is a paucity of information on perinatal data regarding gestational diabetes mellitus (GDM) by the new criteria from a real experience because the number of health care associations implementing the new criteria is still limited. The aim of this study is to investigate perinatal features of the new criteria-defined GDM. We reviewed a total of 995 women with singleton pregnancy that underwent GDM screening followed by a diagnostic oral glucose tolerance test (OGTT). All women found to have GDM underwent self-monitoring of blood glucose measurements as well as dietary management. Insulin treatment was initiated when dietary treatment did not achieve the glycemic goal. Of the 995 women, 141 had GDM (14.2%): 104 with one, 27 with two, and 10 with three abnormal OGTT values. Women with two or three abnormal OGTT values (2/3-AV) needed insulin treatment more frequently than those with one abnormal OGTT value (1-AV) (70.3% vs 23.1%, P < 0.0001). After adjustment for age, pregravid overweight, gestational weeks at diagnosis, a first-degree family history of diabetes was correlated with the implementation of insulin treatment in women with 1-AV (adjusted odds ratio 3.9; 95% Confidence Interval 1.7-9.2; P = 0.001). When compared perinatal outcomes between women with normal glucose tolerance and GDM, fetal growth and the occurrence of pregnancy-induced hypertension were comparable between the two groups. Our data suggest that the IADPSG-defined GDM with 1-AV show less severe glucose intolerance, but might be at risk of insulin requirement when a first-degree family history of diabetes exists. Key words:The new consensus criteria, Gestational diabetes mellitus, Large-for gestational age, Gestational hypertension ence. Especially, clinical significance of GDM by one abnormal value under the IADPSG criteria remains unknown [3]. In Japan, the IADPSG recommendation was adopted in July 2010 [4], and is commonly used in the obstetric practice, although the screening strategy varies in hospitals. With this background, we have investigated perinatal outcomes of the IADPSG-defined GDM in our hospital. First, maternal clinical and metabolic features were compared between women with a single and two or three abnormal oral glucose tolerance test (1-and 2/3-AV) values. Second, factors associated with insulin treatment in women with 1-AV were investigated. Third, perinatal outcomes were compared between women with normal glucose tolerance and IADPSG-defined ...

Early diabetes screening in women with previous gestational diabetes: a new insight

“…Firstly, patients were included since 2008 and were classified according to two different criteria for GDM diagnosis (Carpenter and Coustan and the IADPSG). Ikenoue et al suggested that the IADPSG-defined GDM of one abnormal OGTT value indicates a less severe glucose intolerance, but may still signal a risk of requiring insulin when a first-degree family history of diabetes exists [54]. Our participants had a high prevalence of a relative with diabetes (68.4 %).…”

Adverse Pregnancy Outcomes Using The International Association of the Diabetes and Pregnancy Study Groups Criteria

“…24,25 Whether in the latter studies the absence of differences in these two groups was the result of effectiveness of treatment or a lack of difference in prevalence of adverse outcomes independent of treatment cannot be inferred as a result of the lack of an untreated IADPSG GDM control group.…”

Indicators of the need for insulin treatment and the effect of treatment for gestational diabetes on pregnancy outcomes in Japan

“…The universal initial screening for GDM assessed whether the pregnant women had the following clinical risk factors: (1) pre-gravid overweight (body mass index (BMI) ≥ 30); (2) past history of GDM; (3) past history of macrosomia (birth weight ≥ 4,000 g); (4) family history of type 2 diabetes in first-degree relatives; and (5) random plasma glucose ≥ 95 mg/dL [8]. Women with one or more risk factors underwent a diagnostic 75-g oral glucose tolerance test (OGTT) to measure plasma glucose (mg/dL) in the fasting state and at 1-h and 2-h after the glucose load.…”

“…The daily calorie count was calculated from the ideal body weight. GDM patients received 30 kcal/kg + 150 kcal in the early gestational stage and 30 kcal/kg + 350 kcal in the late gestational stage, according to the recommendations of Japan Diabetes Society and previous report [8]. Patients with GDM consumed calories three times a day in the hospital.…”