Implications of the introduction of new criteria for the diagnosis of gestational diabetes: a health outcome and cost of care analysis

Abstract

ObjectiveTo identify effects on health outcomes from implementing new criteria diagnosing gestational diabetes mellitus(GDM) and to analyse costs-of-care associated with this change.DesignQuasi-experimental study comparing data from the calendar year before (2014) and after (2016) the change.SettingSingle, tertiary-level, university-affiliated, maternity hospital.ParticipantsAll women giving birth in the hospital, excluding those with pre-existing diabetes or multiple pregnancy.Main outcome measuresPrimary outcomes were caesarean section, birth weight >90th percentile for gestation, hypertensive disorder of pregnancy and preterm birth less than 37 weeks. A number of secondary outcomes reported to be associated with GDM were also analysed.Care packages were derived for those without GDM, diet-controlled GDM and GDM requiring insulin. The institutional Business Reporting Unit data for average occasions of service, pharmacy schedule for the costs of consumables and medications, and Medicare Benefits Schedule ultrasound services were used for costing each package. All costs were estimated in figures from the end of 2016 negating the need to adjust for Consumer Price Index increases.ResultsThere was an increase in annual incidence of GDM of 74% without overall improvements in primary health outcomes. This incurred a net cost increase of AUD$560 093. Babies of women with GDM had lower rates of neonatal hypoglycaemia and special care nursery admissions after the change, suggesting a milder spectrum of disease.ConclusionNew criteria for the diagnosis of GDM have increased the incidence of GDM and the overall cost of GDM care. Without obvious changes in short-term outcomes, validation over other systems of diagnosis may require longer term studies in cohorts using universal screening and treatment under these criteria.

Women’s experiences of a diagnosis of gestational diabetes mellitus: a systematic review

“…There is opportunity to improve lifestyle and to assist the prevention of diabetes after pregnancy, however, this needs to be managed alongside the potential harms of a GDM diagnosis such as the negative psychological impact and social isolation. In the context of rising prevalence [14][15][16][17], potential minimal clinical [14][15][16] improvements, and the wide range of psychosocial experiences identified in this study, the findings of this review highlight the need for HCPs to consider the implications that a GDM diagnosis may have on women. It is essential that women diagnosed with GDM receive consistent evidence-based information and ongoing psychological and social support.…”

“…In our review, the experiences of women diagnosed with GDM suggest psychosocial harms appear to outweigh the qualitative benefits. Quantitative studies [14,15] that report prevalence increases in GDM after the IADSPG [71] definition changed, also report minimal improvements to maternal and infant physical outcomes.…”

“…In many countries the prevalence of GDM is rising [14][15][16]. Some of this is due to the increasing age at which women are becoming pregnant, an increase in obesity amongst women, more testing during pregnancy, and better recording during pregnancy.…”

Prognostic prediction models for pregnancy complications in women with gestational diabetes: a protocol for systematic review, critical appraisal and meta-analysis

“…Limitations of this glucocentric approach and lack of risk stratification are evident from epidemiologic outcome data following the adoption of the new IADPSG diagnostic criteria. As expected, the application of these criteria have led to an increase in GDM incidence, with maternity centres reporting increases in the number of diagnoses by 28 to 74% [22–25]. This increasing incidence is most likely due to a change from a two- to one-step testing procedure and more inclusive blood glucose level criteria rather than changes in population characteristics.…”

“…As such, a greater proportion of pregnancies are identified as being at high risk and treated with a package of care that includes additional education, lifestyle modification and pharmacologic therapy. However, intervening in a greater proportion of pregnancies has not led to an overall reduction in pregnancy complications [22, 26, 27] yet has increased the overall costs of GDM care [22] and psychosocial burden for affected women [28]. Therefore, there is a mandate to develop a more sophisticated prognosis and risk-stratified focused approach to GDM considering other relevant clinical factors driving adverse outcomes in addition to glycaemic measures.…”