New criteria for the diagnosis of gestational diabetes mellitus and their consequences
Authors:
Richard Školka 1; Karol Dókuš 1; Silvia Dókušová 2
Authors‘ workplace:
II. gynekologicko-pôrodnícka klinika SZU a FNsP F. D. Roosevelta, Banská Bystrica
1; Národný endokrinologický a diabetologický ústav, n. o., Ľubochňa
2
Published in:
Forum Diab 2022; 11(3): 157-163
Category:
Original Article
Overview
Study aims: Assessment of the effect of new recommended procedure application for a diagnosis and screening of gestational diabetes mellitus, which originated based on the results of the study HAPO (Hyperglycaemia and Adverse Pregnancy Outcomes) published in 2008 and initiated by IADPSG (International Association of the Diabetes and Pregnancy Study Groups), and which were accepted by WHO in 2013. Design and methods: Prospective cohort study in 1414 women with singe-foetal gravidity underwent the complete GDM screening in the first trimester and between 24–28th week in 3 years (2016–1018). We used two types of screening criteria for result analysis (according to the Bulletin of MH SR 2011 and IADPSG). In the particular groups, we compared the incidence of specific maternal and perinatal complications. Results: In the monitored population of patients, the incidence of gestational diabetes with the use of new criteria was significantly higher in comparison with the group where we used present criteria (n – 144, 10.18 %; or n – 68, 4.8 %, p < 0.0001). After inclusion of a facultative examination in the 60th minute of oGTT we diagnosed GDM in other 5.55 % (n – 78) women. Using the present criteria, we diagnosed the highest number of positive pregnant women with the determination of glycaemia in the 120th minute of oGTT (n-66.97 %), on the contrary with the application of IADPSG criteria examining FPG in the first trimester (n=68, 47.2 %) and between the 24–28th week (n = 58, 40.3 %). In comparison of the complication incidence, we detected statistically significant difference between the groups in the number of blood transfusions (n-10, 6.9 %; or n-10, 14.7 %, p – 0.0411) and mother and foetus injury (n – 10, 6.94 %; or n – 8, 11.7 %, p = 0.0155). The Caesarean section was the most frequent complication in both groups (n – 52, 36.11 %; or n=30, 44.11 %, p = 0.0084). Conclusion: After the implementation of new international criteria for GDM screening one can expect an increased number and different spectrum of GDM diagnosed pregnant women, with the majority being detected based on fasting glycaemia. The question is if the increased number of diagnosed and treated women following the new criteria would result in an adequate decrease of pregnancy complications.
Keywords:
diagnostic criteria – screening – gestational diabetes mellitus – oral glucose tolerance test (oGTT)
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Diabetology Endocrinology Internal medicineArticle was published in
Forum Diabetologicum
2022 Issue 3
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