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Diagnosis of gestational diabetes mellitus: falling through the net.

Meek CL, Lewis HB, Patient C, Murphy HR, Simmons D - Diabetologia (2015)

Bottom Line: Women who 'fell through the net', testing NICE-negative but IADPSG-positive (n = 387), had a higher risk of having a large-for-gestational-age (LGA) infant (birthweight >90th percentile for gestational age; adjusted OR [95% CI] 3.12 [2.44, 3.98]), Caesarean delivery (1.44 [1.15, 1.81]) and polyhydramnios (6.90 [3.94, 12.08]) compared with women with negative screening results and no OGTT (n = 21,695).LGA risk was highest among women with fasting plasma glucose 5.1-5.5 mmol/l (n = 167): the mean birthweight was 350 g above that of the reference population and 37.7% of infants were LGA.The IADPSG criteria identify women at substantial risk of complications who would not be identified by the NICE 2015 criteria.

View Article: PubMed Central - PubMed

Affiliation: The Wellcome Trust-MRC Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Addenbrooke's Hospital, Box 289, Hills Road, Cambridge, CB2 0QQ, UK, clm70@cam.ac.uk.

ABSTRACT

Aims/hypothesis: Gestational diabetes mellitus (GDM) is associated with increased risks to mother and child, but globally agreed diagnostic criteria remain elusive. Identification of women with GDM is important, as treatment reduces adverse outcomes such as perinatal death, shoulder dystocia and neonatal hypoglycaemia. Recently, the UK's National Institute for Health and Care Excellence (NICE) recommended new diagnostic thresholds for GDM which are different from the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria endorsed by the WHO. The study aim was to assess neonatal and obstetric outcomes among women who would test positive for the IADPSG criteria but negative for the NICE 2015 criteria.

Methods: Data from 25,543 consecutive singleton live births (2004-2008) were obtained retrospectively from hospital records. Women were screened with a random plasma glucose (RPG; 12-16 weeks) and a 50 g glucose challenge test (GCT; 26-28 weeks). If RPG >7.0 mmol/l, GCT >7.7 mmol/l or symptoms were present, a 75 g OGTT was offered (n = 3,848).

Results: In this study, GDM prevalence was 4.13% (NICE 2015) and 4.62% (IADPSG). Women who 'fell through the net', testing NICE-negative but IADPSG-positive (n = 387), had a higher risk of having a large-for-gestational-age (LGA) infant (birthweight >90th percentile for gestational age; adjusted OR [95% CI] 3.12 [2.44, 3.98]), Caesarean delivery (1.44 [1.15, 1.81]) and polyhydramnios (6.90 [3.94, 12.08]) compared with women with negative screening results and no OGTT (n = 21,695). LGA risk was highest among women with fasting plasma glucose 5.1-5.5 mmol/l (n = 167): the mean birthweight was 350 g above that of the reference population and 37.7% of infants were LGA.

Conclusions/interpretation: The IADPSG criteria identify women at substantial risk of complications who would not be identified by the NICE 2015 criteria.

No MeSH data available.


Related in: MedlinePlus

Classification of pregnant women according to GDM diagnosis. Data are mean (95% CI). BW, birthweight; LGA classified as BW >90th percentile for gestational age. aThis group may contain some patients with undiagnosed GDM due to fasting hyperglycaemia that is not identified by the GCT
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Fig1: Classification of pregnant women according to GDM diagnosis. Data are mean (95% CI). BW, birthweight; LGA classified as BW >90th percentile for gestational age. aThis group may contain some patients with undiagnosed GDM due to fasting hyperglycaemia that is not identified by the GCT

Mentions: Data were collected for demographic information, glucose screening results and pregnancy outcomes. Women were classified into groups according to their OGTT results: OGTT not done; NICE-negative IADPSG-negative; NICE-positive IADPSG-positive; NICE-negative IADPSG-positive; and NICE-positive IADPSG-negative (Table 1, Fig. 1). Groups were further divided according to the OGTT criterion that was abnormal. Women could test positive for some but not all GDM diagnostic criteria by having an FPG 5.1–5.5 mmol/l (IADPSG-only 0 h group), an OGTT 1 h glucose ≥10.0 mmol/l (IADPSG-only 1 h group) or an OGTT 2 h glucose 7.8–8.4 mmol/l (NICE-only 2 h group, which was also the NICE-positive IADPSG-negative group) (Table 1, Fig. 1).Fig. 1


Diagnosis of gestational diabetes mellitus: falling through the net.

Meek CL, Lewis HB, Patient C, Murphy HR, Simmons D - Diabetologia (2015)

Classification of pregnant women according to GDM diagnosis. Data are mean (95% CI). BW, birthweight; LGA classified as BW >90th percentile for gestational age. aThis group may contain some patients with undiagnosed GDM due to fasting hyperglycaemia that is not identified by the GCT
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4526580&req=5

Fig1: Classification of pregnant women according to GDM diagnosis. Data are mean (95% CI). BW, birthweight; LGA classified as BW >90th percentile for gestational age. aThis group may contain some patients with undiagnosed GDM due to fasting hyperglycaemia that is not identified by the GCT
Mentions: Data were collected for demographic information, glucose screening results and pregnancy outcomes. Women were classified into groups according to their OGTT results: OGTT not done; NICE-negative IADPSG-negative; NICE-positive IADPSG-positive; NICE-negative IADPSG-positive; and NICE-positive IADPSG-negative (Table 1, Fig. 1). Groups were further divided according to the OGTT criterion that was abnormal. Women could test positive for some but not all GDM diagnostic criteria by having an FPG 5.1–5.5 mmol/l (IADPSG-only 0 h group), an OGTT 1 h glucose ≥10.0 mmol/l (IADPSG-only 1 h group) or an OGTT 2 h glucose 7.8–8.4 mmol/l (NICE-only 2 h group, which was also the NICE-positive IADPSG-negative group) (Table 1, Fig. 1).Fig. 1

Bottom Line: Women who 'fell through the net', testing NICE-negative but IADPSG-positive (n = 387), had a higher risk of having a large-for-gestational-age (LGA) infant (birthweight >90th percentile for gestational age; adjusted OR [95% CI] 3.12 [2.44, 3.98]), Caesarean delivery (1.44 [1.15, 1.81]) and polyhydramnios (6.90 [3.94, 12.08]) compared with women with negative screening results and no OGTT (n = 21,695).LGA risk was highest among women with fasting plasma glucose 5.1-5.5 mmol/l (n = 167): the mean birthweight was 350 g above that of the reference population and 37.7% of infants were LGA.The IADPSG criteria identify women at substantial risk of complications who would not be identified by the NICE 2015 criteria.

View Article: PubMed Central - PubMed

Affiliation: The Wellcome Trust-MRC Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Addenbrooke's Hospital, Box 289, Hills Road, Cambridge, CB2 0QQ, UK, clm70@cam.ac.uk.

ABSTRACT

Aims/hypothesis: Gestational diabetes mellitus (GDM) is associated with increased risks to mother and child, but globally agreed diagnostic criteria remain elusive. Identification of women with GDM is important, as treatment reduces adverse outcomes such as perinatal death, shoulder dystocia and neonatal hypoglycaemia. Recently, the UK's National Institute for Health and Care Excellence (NICE) recommended new diagnostic thresholds for GDM which are different from the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria endorsed by the WHO. The study aim was to assess neonatal and obstetric outcomes among women who would test positive for the IADPSG criteria but negative for the NICE 2015 criteria.

Methods: Data from 25,543 consecutive singleton live births (2004-2008) were obtained retrospectively from hospital records. Women were screened with a random plasma glucose (RPG; 12-16 weeks) and a 50 g glucose challenge test (GCT; 26-28 weeks). If RPG >7.0 mmol/l, GCT >7.7 mmol/l or symptoms were present, a 75 g OGTT was offered (n = 3,848).

Results: In this study, GDM prevalence was 4.13% (NICE 2015) and 4.62% (IADPSG). Women who 'fell through the net', testing NICE-negative but IADPSG-positive (n = 387), had a higher risk of having a large-for-gestational-age (LGA) infant (birthweight >90th percentile for gestational age; adjusted OR [95% CI] 3.12 [2.44, 3.98]), Caesarean delivery (1.44 [1.15, 1.81]) and polyhydramnios (6.90 [3.94, 12.08]) compared with women with negative screening results and no OGTT (n = 21,695). LGA risk was highest among women with fasting plasma glucose 5.1-5.5 mmol/l (n = 167): the mean birthweight was 350 g above that of the reference population and 37.7% of infants were LGA.

Conclusions/interpretation: The IADPSG criteria identify women at substantial risk of complications who would not be identified by the NICE 2015 criteria.

No MeSH data available.


Related in: MedlinePlus