Comparison of Different Diagnostic Criteria for Gestational Diabetes Mellitus Based on the 75-G Oral Glucose Tolerance Test: A Cohort Study

Abstract

Objective: To compare the different diagnostic criteria for gestational diabetes mellitus (GDM) proposed by the American Diabetes Association (ADA), World Health Organization (WHO), and Australian Diabetes in Pregnancy Society (ADIPS) in a 75-g, 2-hour oral glucose tolerance test (OGTT) and to investigate their effects on neonatal birth weight. Methods: Healthy pregnant women were enrolled in a cohort study to undergo a 75-g OGTT during 24 to 28 weeks of pregnancy and then followed up to delivery. ADA criteria and recommendations were used for the management of patients. Results: Among 670 pregnant women, GDM was diagnosed in 41 (6.1%), 81 (12.1%), and 126 (18.8%) on the basis of ADA, WHO, and ADIPS criteria, respectively. The kappa value was 0.38 (P<.0001) for the agreement between ADA and WHO criteria, 0.41 (P<.0001) for agreement between ADA and ADIPS criteria, and 0.64 (P<.0001) for agreement between WHO and ADIPS criteria. WHO-only "positive" women had significantly lower fasting plasma glucose (87.9 versus 102.2 mg/dL; P<.0001) and 1-hour plasma glucose levels (146.4 versus 200.5 mg/dL; P<.0001) but higher 2-hour plasma glucose levels (150.1 versus 109.1 mg/dL; P<.0001) than women diagnosed with GDM by only ADA criteria. The correlation coefficient between 1-hour glucose level and neonatal birth weight was 0.09 (P<.02). The adjusted odds ratio of macrosomia associated with GDM according to ADA criteria was 1.34 (95% confidence interval, 0.15 to 12). Conclusion: The frequency of occurrence of GDM was 6.1% in a 75-g OGTT based on ADA criteria, and there was fair agreement between ADA and WHO criteria, moderate agreement between ADA and ADIPS criteria, and strong agreement between WHO and ADIPS criteria. A modest correlation was found between the 1-hour serum glucose value and neonatal birth weight.

Detailed Review on Gestational Diabetes Mellitus with Emphasis on Pathophysiology, Epidemiology, Related Risk Factors, and its Subsequent Conversion to Type 2 Diabetes Mellitus

“…▶ Table 1 [39] shows comparison of different diagnostic criteria for GDM (NDDG: National diabetes data group, ADA: American diabetic association, WHO: World Health Organisation, ADIPS: Australian Diabetes in Pregnancy).…”