National Diabetes Data Group vs Carpenter-Coustan criteria to diagnose gestational diabetes

Abstract

Objective To compare perinatal outcomes among women diagnosed with gestational diabetes by National Diabetes Data Group (NDDG) with women only meeting Carpenter-Coustan criteria. Study design Fourteen-year retrospective cohort; women screened positive with 1-hour glucose load ≥140 mg/dL underwent a diagnostic 3-hour oral glucose tolerance test. We report adjusted prevalence ratios (aPR) of multivariate analyses. Results Of the 4659 screen-positive women with diagnostic testing, 1082 (3.3%, 1082/33,179) met NDDG criteria; 1542 (4.6%, 1542/33,179), or 460 more, met Carpenter-Coustan. These untreated 460 women had greater risk of pre-eclampsia than women diagnosed by NDDG criteria (aPR 1.70, 95% CI 1.23-2.35). They had greater risk of cesarean delivery (aPR 1.16, 95% CI 1.04-1.30) and infants >4000g (aPR 1.25, 95% CI 1.01-1.56) than women not meeting either diagnostic criteria. Conclusion The 42.5% additional women diagnosed only by Carpenter-Coustan criteria are at greater risk for some adverse outcomes. Cost-effectiveness of a change remains to be determined.

Diagnosis of gestational diabetes mellitus: comparison between National Diabetes Data Group and Carpenter– Coustan criteria

“…The results also showed that CC criteria would identify 27.6% more GDM cases during their first visit, at an average of 13 weeks earlier than using NDDG criteria. These findings are similar to those of previous studies, which found an increase in GDM prevalence of between 30% and 50% [7,12]. These findings can be explained by the increased sensitivity of CC criteria because of lower thresholds compared with NDDG criteria.…”

“…Whether women with OGTT values above the CC threshold, but below the NDDG threshold, are at increased risk of adverse perinatal outcomes has been inconsistently reported [8,9,11,12,14,15]. The results of this study revealed that, while mean birth weight was comparable between CC only and NDDG groups, it was significantly greater than in those without GDM (P <0.001).…”

“…Like this study, other studies have also found an increase in both maternal and neonatal adverse outcomes in GDM women diagnosed by CC criteria only. The risks included higher rates of cesarean and operative vaginal delivery [8,9,11,12], macrosomia [8,9,11,12,14,15], neonatal hyperbilirubinemia and hypoglycemia [12,15].…”

“…However, the magnitude of this increase across populations with different risks of carbohydrate intolerance is not exactly known. In addition, effects on perinatal outcome are even less clear [7][8][9][10][11][12].…”

Pregnancy outcome in women with gestational diabetes mellitus according to the Carpenter–Coustan criteria in Thailand

“…16,17 In the present study, however, the incidence of LGA was no statistically difference among the three groups. As a result, the incidence of maternal complications between group 1 and 2 was not different.…”