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Internationally, there is no consensus about the optimum diagnostic criteria for gestational diabetes mellitus (GDM). This prospective study compared the characteristics and pregnancy outcomes of those diagnosed with GDM using the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria with those diagnosed according to the less sensitive Canadian and NICE (UK) criteria.
Study Design
Women were selectively screened based on maternal risk factors with a 75g Oral Glucose Tolerance Test at 26-28 weeks gestation. Clinical and sociodemographic details were recorded at the first prenatal visit and Body Mass Index was calculated. Laboratory standards were strictly implemented to avoid false negative results due to preanalytical glycolysis. Women who fulfilled the IADPSG criteria for the diagnosis of GDM were referred to the multidisciplinary service for management, including pharmacological management.
Results
Of the 202 women, 53.5% had GDM diagnosed based on the IADPSG criteria compared with 35.1% and 17.8% with the IADPSG, Canadian and NICE criteria respectively (p< 0.001). The characteristics of the study population and their outcomes analysed by OGTT result are shown in Table 1. Women treated based on the IADPSG criteria did not have a higher rate of primary caesarean section or Large-for-Gestational-Age (LGA) compared with normal women. Women with more than one risk factor and obese women were more likely to have GDM diagnosed irrespective of the criteria used. Women who met the Canadian or NICE criteria had a higher CS rate compared with normal women due to an increase in elective CS (majority due to previous CS).
Conclusion
With application of strict laboratory standards, the pregnancy outcomes of women treated with for GDM diagnosed according to IADPSG criteria did not differ to those women without GDM. The reduction in the LGA rate failed to reach statistical significance (p=0.056). The rate of primary CS did not differ significantly amongst any of the three diagnostic criteria groups compared to normal women.
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