Perinatal outcomes for untreated women with gestational diabetes by IADPSG criteria: a population‐based study

Abstract

Objective To estimate the risk for adverse perinatal outcomes for women who met the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria but not the two‐step criteria for gestational diabetes mellitus (GDM). Design Population‐level cross‐sectional study. Setting Ontario, Canada. Population A total of 90 140 women who underwent a 75‐g oral glucose tolerance test. Methods Women were divided into those who met the diagnostic thresholds for GDM by two‐step criteria and were therefore treated, those who met only the IADPSG criteria for GDM and so were not treated, and those who did not have GDM by either criteria. Main outcome measures Hypertensive disorders of pregnancy, preterm delivery, primary caesarean section, large‐for‐gestational‐age, shoulder dystocia and neonatal intensive care unit admission. Results Women who met the IADPSG criteria had an increased risk for all adverse perinatal outcomes compared with women who did not have GDM. Women with GDM by two‐step criteria also had an increased risk of most outcomes. However, their risk for large‐for‐gestational‐age neonates and for shoulder dystocia was actually lower than that of women who met IADPSG criteria. Conclusion Women who met IADPSG criteria but who were not diagnosed with GDM based on the current two‐step diagnostic strategy, and were therefore not treated, had an increased risk for adverse perinatal outcomes compared with women who do not have GDM. The current strategy for diagnosing GDM may be leaving women who are at risk for adverse events without the dietary and pharmacological treatments that could improve their pregnancy outcomes. Tweetable abstract Women who meet IADPSG criteria for GDM have an increased risk for adverse perinatal outcomes compared with women without GDM.

Trends in National Canadian Guideline Recommendations for the Screening and Diagnosis of Gestational Diabetes Mellitus over the Years: A Scoping Review

“…Fuelling the controversy, several studies have compared these adverse pregnancy outcomes across the two approaches with divergent findings [ 44 , 46 , 47 , 48 , 49 , 50 ]. In a retrospective cohort study conducted by Pouliot et al [ 44 ], the investigators compared pregnant women who were screened for GDM using the two-step approach (pre-IADPSG group) to women who were screened using the one-step approach (post-IADPSG group).…”

“…Maternal data were obtained from the McGill Obstetric and Neonatal Database. Furthermore, in a recent population-based cross-sectional study conducted by Shah and Sharifi [ 47 ], the authors assessed 90,140 pregnant women in Ontario who underwent a 75 g OGTT between 2007 and 2015. Women were classified as those who met the 2013 DC criteria for the two-step approach and were treated, those who were untreated but would have only met the IADPSG criteria for the one-step approach (but not the two-step thresholds), and those who did not meet the criteria for GDM.…”

Gestational diabetes mellitus diagnosed at 24 to 28 weeks of gestation in older and obese Women: Is it too late?

“…In 2010, the IADPSG proposed universal screening with one-step 75-g OGTT for the diagnosis of hyperglycemia in pregnancy [12] based on the results of the HAPO study which decided the diagnostic glucose threshold upon the risk for neonatal obesity [13] instead of the risk for maternal progression to DM postpartum [31]. From countries adopting selective screening based on their known risk factors, such as maternal age, various levels of pre-pregnancy BMI, macrosomia ≥4.5kg, previous GDM, and family history of type 2 DM, many researchers have reported that the prevalence of GDM was at least tripled by adopting the IADPSG guidelines and that 15% - 50% of GDM patients who were missed by selective screening exhibited a higher risk for adverse perinatal outcome compared with the NGT subjects [32–36]. Several reports have revealed that this universal screening with stringent diagnostic criteria increased the prevalence of GDM without a significant reduction in maternal and neonatal complications [37–39].…”

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

“…Untreated diabetes in pregnancy was associated with an increased rate of shoulder dystocia (risk ratio, 1.25 compared to controls). Treated diabetes in pregnancy had a shoulder dystocia rate similar to controls even when higher glucose levels were depicted [ 181 ]. None of the offspring of 149 women who had pre-pregnancy care suffered from shoulder dystocia compared to 6/265 among those with no pregnancy care ( p = 0.07) [ 182 ].…”