Gestational diabetes: dilemma caused by multiple international diagnostic criteria

Agarwal, Mukesh; Dhatt, Gurdeep S.; Punnose, John; Koster, Gertrude

doi:10.1111/j.1464-5491.2005.01706.x

Cited by 87 publications

(64 citation statements)

References 27 publications

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“…Previous research, carried out to quantify the differences in GDM diagnosis with its potential implications among six well-known criteria, has shown similar results. 18 Most studies have compared two criteria 19 and inclusion of more increases the variability and the differences in GDM. Endorsing the new IADPSG criteria from major DM/obstetric organizations as has ADA and most probably WHO, ACOG, CDA, NICE, EASD, etc.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of current diagnostic criteria for gestational diabetes mellitus

Boyadzhieva¹,

Atanasova²,

Zacharieva³

et al. 2012

Obstet Med

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Background To compare current guidelines for diagnosis of gestational diabetes mellitus (GDM) and to identify the ones that are the most relevant for application among pregnant Bulgarian population. Methods A total of 800 pregnant women at high risk for GDM underwent 75 g oral glucose tolerance test between 24 and 28 weeks of gestation as antenatal screening. The results were interpreted and classified according to the guidelines of the International Association of Diabetes and Pregnancy Study Groups (IADPSG), American Diabetes Association (ADA), Australasian Diabetes in Pregnancy Society, Canadian Diabetes Association, European Association for the Study of Diabetes, New Zealand Society for the study of Diabetes and World Health Organization. Results The application of different diagnostic criteria resulted in prevalences of GDM between 10.8% and 31.6%. Using any two sets of criteria, women who were classified differently varied between 0.1% and 21.1% ( P < 0.001).The IADPSG criteria were the most inclusive criteria and resulted in the highest prevalence of GDM. There was a significant difference in the major metabolic parameters between GDM and control groups, regardless of which of the diagnostic criteria applied. GDM diagnosed according to all criteria resulted in increased proportion of delivery by caesarean section (CS). However, only ADA and IADPSG criteria identified both increased macrosomia (odds ratio, 2.36; 2.29) and CS rate. Conclusion The need for GDM screening is indisputable. In our view, the new IADPSG guidelines offer a unique opportunity for a unified national and global approach to GDM.

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Section: Discussionmentioning

confidence: 99%

Comparative analysis of current diagnostic criteria for gestational diabetes mellitus

Boyadzhieva¹,

Atanasova²,

Zacharieva³

et al. 2012

Obstet Med

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“…Other criteria included those described by the Australasian Diabetes in Pregnancy Society (ADIPS) (23), which recommended confirmation of GDM by administration of a 75-g glucose load and then at least one value equaling or exceeding the following cut points: fasting glucose, 100 mg/dl; and 2-h glucose, 144 mg/dl. These criteria were found to be the most sensitive compared with other testing criteria that also used a 75-g glucose load (24). The Japan Society of Obstetrics and Gynecology recommended a 75-g glucose load and then at least two values equaling or exceeding the following cutoffs: fasting glucose, 100 mg/dl; 1-h glucose, 180 mg/ dl; and 2-h glucose, 150 mg/dl (25).…”

Section: Search For Published Datamentioning

confidence: 99%

Recurrence of Gestational Diabetes Mellitus

2007

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OBJECTIVE -The purpose of this study was to examine rates and factors associated with recurrence of gestational diabetes mellitus (GDM) among women with a history of GDM.RESEARCH DESIGN AND METHODS -We conducted a systematic literature review of articles published between January 1965 and November 2006, in which recurrence rates of GDM among women with a history of GDM were reported. Factors abstracted included recurrence rates, time elapsed between pregnancies, race/ethnicity, diagnostic criteria, and, when available, maternal age, parity, weight or BMI at the initial and subsequent pregnancy, weight gain at the initial or subsequent pregnancy and between pregnancies, insulin use, gestational age at diagnosis, glucose tolerance test levels, baby birth weight and presence of macrosomia, and breast-feeding. RESULTS-Of 45 articles identified, 13 studies were eligible for inclusion. After the index pregnancy, recurrence rates varied between 30 and 84%. Lower rates were found in nonHispanic white (NHW) populations (30 -37%), and higher rates were found in minority populations (52-69%). Exceptions to observed racial/ethnic variations in recurrence were found in cohorts that were composed of a significant proportion of both NHW and minority women or that included women who had subsequent pregnancies within 1 year. No other risk factors were consistently associated with recurrence of GDM across studies. The rates of future preexisting diabetes in pregnancy, socioeconomic status, postpartum diabetes screening rates after the index pregnancy, and the average length of time between pregnancies were generally not reported.CONCLUSIONS -Recurrence of GDM was common and may vary most significantly by NHW versus minority race/ethnicity. Diabetes Care 30:1314 -1319, 2007G estational diabetes mellitus (GDM), or impaired glucose tolerance first diagnosed during pregnancy, affects between 4 and 12% of pregnancies but resolves after pregnancy in ϳ90% of women (1). However, women with a history of GDM have an increased risk for future glucose intolerance, as manifested by maternal diabetes (2) or by recurrent GDM in subsequent pregnancies. As with the index GDM diagnosis, recurrent GDM may reflect preexisting type 2 diabetes that was undiagnosed until pregnancy or a glucose-intolerant state that was amplified by the physiological demands and hormonal changes of pregnancy (3). Rates of recurrence of GDM range widely across reports, and risk factors for recurrence also vary considerably, reflecting variation in screening practices and diagnostic criteria for GDM and underlying risk for glucose intolerance, particularly by race/ ethnicity (4 -16). Rates may also vary with the proportion of women undergoing postpartum diabetes screening after the index pregnancy and subsequent diagnosis of diabetes, as this may distinguish between a subsequent pregnancy labeled as preexisting diabetes instead of GDM. However, the relative importance of these sources of variation is unknown. Therefore, we conducted a systematic review of reports on rates...

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“…In the one-step screening program, all pregnancies are screened with the 75 g oral glucose tolerance test (OGTT) at between 24 and 28 weeks of gestation while in the two-step screening, this is performed using the 50 g oral glucose challenge test (OGCT) and according to the result of the 1-hour blood glucose value, the 100 g OGTT is per-formed (8)(9). Different diagnostic criteria can be used to diagnose GDM in these two screening programs (10).…”

Section: Introductionmentioning

confidence: 99%

An Evaluation of the Effect of a One or Two-Step Gestational Diabetes Mellitus Screening Program on Obstetric and Neonatal Outcomes in Pregnancies

Akgöl

Obut

Bağlı

et al. 2019

Gynecol Obstet Reprod Med

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OBJECTIVES:The aim of this study was to compare the obstetric and neonatal outcomes of pregnant women who were screened with one or two-step screening programs for diagnosis of gestational diabetes mellitus. STUDY DESIGN:A retrospective evaluation was made of pregnant women who were screened with one step [75 g oral glucose tolerance test] or two-step screening programs [50 g oral glucose challenge test and 100 g oral glucose tolerance test] depending on the preference of the physician between September 2016 and August 2017. RESULTS:The one-step screening program was applied to 34.1% (n:1358) of the pregnancies and the remaining 65.9% (n=2623) were screened using the two-step program. The following results were obtained for the pregnant women applied with the one and two-step screening programs, respectively; mean age: 29.37±7.6 years and 28.1 ± 6.2 years, gestational diabetes mellitus: 8.8% and 4.8%, preterm birth:5.2% and 6.9%, term birth: 89.8% and 85.5%, post-term birth: 5% and 7.6%, vaginal delivery: 74.8% and 67.5%, caesarean section delivery: 25.2% and 32.5%, birth weight: 3389±432 gr and 3234.1 ± 415.9 gr, and mean 5-minute APGAR score: 9.1 ± 0.4 and 9.2 ± 0.7. Comparisons showed statistically significant differences between the groups. CONCLUSION:The study results showed a significantly higher rate of gestational diabetes mellitus diagnosis for the pregnant women screened with the one-step screening program than the two-step screening program. Although the mean maternal age was significantly higher in the pregnant women screened with the one-step screening program, these pregnancies were observed to have better outcomes (low rates of preterm birth, post-term birth, caesarean delivery and high rates of term birth, vaginal delivery). These results can be attributed to the early referral to a treatment program and follow-up, even though more cases of gestational diabetes mellitus were diagnosed with the one-step screening program.

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Gestational diabetes: dilemma caused by multiple international diagnostic criteria

Cited by 87 publications

References 27 publications

Comparative analysis of current diagnostic criteria for gestational diabetes mellitus

Comparative analysis of current diagnostic criteria for gestational diabetes mellitus

Recurrence of Gestational Diabetes Mellitus

An Evaluation of the Effect of a One or Two-Step Gestational Diabetes Mellitus Screening Program on Obstetric and Neonatal Outcomes in Pregnancies

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