The impact of revised diagnostic criteria on hospital trends in gestational diabetes mellitus rates in a high income country

Abstract

Objective In 2010, national guidelines were published in Ireland recommending more sensitive criteria for the diagnosis of Gestational Diabetes Mellitus (GDM). The criteria were based on the 2008 Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study and were endorsed subsequently by the World Health Organization (WHO). Screening nationally is selective based on risk factors. We examined the impact of the new criteria on hospital trends nationally for GDM over the 10 years 2008–17. Research design and methods Data from three national databases, the Hospital Inpatient Enquiry System (HIPE), National Perinatal Reporting System (NPRS) and the Irish Maternity Indicator System (IMIS), were analyzed using descriptive statistics, analysis of variance, and Poisson loglinear modelling. Results The overall incidence of GDM nationally increased almost five-fold from 3.1% in 2008 to 14.8% in 2017 ( p ≤ 0.001). The incidence varied widely across maternity units. In 2008, the incidence varied from 0.4 to 5.9% and in 2017 it varied from 1.9 to 29.4%. There were increased obstetric interventions among women with GDM over the decade, specifically women with GDM having increased cesarean sections (CS) and induction of labor (IOL) ( p ≤ 0.001). These trends were significant in large and mid-sized maternity hospitals ( p ≤ 0.001). The increase in GDM diagnosis could not be explained by an increase in maternal age nationally over the decade. The data did not include information on other risk factors such as obesity. The increased incidence in GDM diagnosis was accompanied by a decrease in high birthweight ≥ 4.5 kg nationally. Conclusions We found adoption of the new criteria for diagnosis of GDM resulted in a major increase in the incidence of GDM rates. Inter-hospital variations increased over the decade, which may be explained by variations in the implementation of the new national guidelines in different maternity units. It is likely to escalate further as compliance with national guidelines improves at all maternity hospitals, with implications for provision and configuration of maternity services. We observed trends that may indicate improvements for women and their offspring, but more research is required to understand patterns of guideline implementation across hospitals and to demonstrate how increased GDM diagnosis will improve clinical outcomes.

IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group’s Criteria

“…It is noticed that women identified to have GDM by the IADPSG's diagnostic criteria had an increased risk for adverse perinatal outcomes as compared to women identified by others' diagnostic criteria, e.g., the WHO's criteria [19]. A switch from others' diagnostic criteria to the IADPSG's was expected to result in an increase in the prevalence of GDM, which has been confirmed in a number of studies [8,[20][21][22][23] national databases and found that overall national prevalence of GDM increased from 3.1% in 2008 to 14.8% in 2017, a fivefold increase mainly due to use of the IADPSG's diagnostic criteria [24]. An early meta-analysis reported a sharp difference in the prevalence of GDM by different diagnostic criteria, with 1.5-15.5% by the ADA's criteria, 20.8% by the Australian Diabetes in Pregnancy Society's criteria, 13.6% by the Diabetes in Pregnancy Study Group India's criteria, 1.6% by the European Association for the Study of Diabetes' criteria, 0.56% by the National Diabetes Data Group's criteria and 0.4-24.3% by the WHO 1999's criteria, in contrast to 8.9-20.4% by the IADPSG's criteria [25].…”

Evolution of Gestational Diabetes Mellitus across Continents in 21st Century

“…McMahon et al analyzed data from an Irish hospital between 2008 and 2017. They presented a five-fold increase in the GDM incidence from 3.1% in 2008 to 14.8% in 2017, which is closely connected with changing guidelines for GDM diagnosis [ 163 ].…”

A Systematic Review of the Prevalence of Gestational Diabetes in Norway

“…During the last 20 years, the prevalence of GDM has increased worldwide and it is expected to continue to rise along with an increase in advanced maternal age, pre-conception obesity and impaired glucose tolerance among women [ 16 , 17 ]. Moreover, the use of the universal screening strategy and the more stringent diagnostic criteria for GDM lead to a higher prevalence of GDM among pregnant women and potentially increase the costs of health care [ 18 ].…”