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)


Sources

1. [American Diabetes Association]. Diagnosis and classification of diabetes mellitus. Diabetes Care 2017; 40(Suppl 1): S11-S24. Dostupné z DOI: <http://dx.doi.org/10.2337/dc17-S005>.

2. Anderlová K, Krejčí H, Haluzík M et al. Co obnáší přijetí nových mezinárodních doporučení pro screening a diagnózu gestačního diabetes mellitus? Forum Diab 2014; 3(2): 67–73.

3. Anderlová K, Krejčí H, Klusáčková P et al. Alarmující výskyt gestačního diabetes mellitus při použití stávajících i nových mezinárodních diagnostických kritérií. Čes Gynekol 2014; 79(3): 213–218.

4. Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with type 2 diabetes. Diabet Med 2004; 21(2):103–113. Dostupné z DOI: <http://dx.doi.org/10.1046/j.1464–5491.2003.00985.x>-

5. Bhavadharini B, Mahalakshmi MM, Anjana RM et al. Prevalence of Gestational Diabetes Mellitus in urban and rural Tamil Nadu using IADPSG and WHO 1999 criteria (WINGS 6). Clin Diabetes Endocrinol 2016; 2: 8. Dostupné z DOI: <http://dx.doi.org/10.1186/s40842–016–0028–6>.

6. Brown MF, Wyckoff J. Application of One-Step IADPSG versus Two-Step Diagnostic Criteria for Gestational Diabetes in the Real World: Impact on Health Services, Clinical Care, and Outcomes. Curr Diab Rep 2017; 17(10): 85. Dostupné z DOI: <http://dx.doi.org/10.1007/s11892–017–0922-z>.

7. Cosson E, Carbillon L, Valensi P. High fasting plasma glucose during early pregnancy: a review about early gestational Diabetes Mellitus. J Diabetes Res 2017; 2017: 8921712. Dostupné z DOI: <http://dx.doi.org/10.1155/2017/8921712>.

8. Česká společnost klinické biochemie ČLS JEP. Diabetes mellitus – laboratorní diagnostika a sledování stavu pacientů. ČSKB: Praha 2015. Dostupné z WWW: <http://www.cskb.cz/res/file/doporuceni/DM/DM_dop_201601.pdf>.

9. Doporučený postup ČGPS ČLS JEP. Gestační diabetes mellitus – doporučený postup. Čes Gynekol 2015; 80(5): 386–388.

10. Krejčí H, Anderlová K. Proč stále váháme s přijetím nových mezinárodních kritérií pro diagnózu gestačního diabetes mellitus? Současný screening je nejednotný a neodpovídá medicíně založené na důkazech. Čes Gynekol 2014; 79(3): 206–212.

11. Krejčí H, Anderlová K, Andělová K. Proč bychom měli přijmout nová mezinárodní kritéria pro diagnózu gestačního diabetes mellitus? Actual Gyn 2014; 6: 95–99. Dostypné z WWW: <https://www.actualgyn.com/pdf/en_2014_151.pdf>.

12. Mission JF, Ohno MS, Cheng YV et al. Gestational diabetes screening with new IADPSG guidelines: a cost-effectiveness analysis. Am J Obstet Gynecol 2012; 207(4): 1–9. Dostupné z DOI: <http://dx.doi.org(10.1016/j.ajog.2012.06.048>.

13. Reinauer H, Home PD, Kanabasagapathy AS et al. Laboratory diagnosis and monitoring of diabetes mellitus. World Health Organization 2002; 9–15. Dostupné z WWW: <https://www.paho.org/hq/dmdocuments/2012/WHO-Laboratory-Diagnosis-Diabetes-2002.pdf>.

14. Rybka J. Diabetes mellitus – komplikace a přidružená onemocnení. Grada Publishing: Praha 2007. ISBN 978–80–247–1671–8.

15. Sibartie P, Quinlivan J. Implementation of the International Association of Diabetes and Pregnancy Study Groups Criteria: Not Always a Cause for Concern. J Pregnancy 2015; 2015: 754085. Dostupné z DOI: <http://dx.doi.org/10.1155/2015/754085>.

16. Slovenská diabetologická spoločnosť. Diagnosticko-terapeutické štandardy v diabetológii. 2012.

17. Vestník MZSR 2011, ročník 59, čiastka 49–60 zo dňa 16. 12. 2011. Odborné usmernenie Ministerstva zdravotníctva Slovenskej republiky na poskytovanie zdravotnej starostlivosti pacientom s diabetes mellitus č. 43, zo dňa: 16. 12. 2011, Číslo: 01255-OZS-2011.

18. Metzger BE, Lowe LP, Dyer AR et al. [HAPO Study Cooperative Research Group]. Hyperglycemie and adverse pregnancy outcomes. N Engl J Med 2008; 358(19): 1991–2002. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0707943>.

19. Werner EF, Pettker CM, Zuckerwise L et al. Screening for gestational diabetes mellitus: Are the criteria proposed by the International Association of the Diabetes and Pregnancy Study Groups cost-effective? Diab Care 2012; 35(3): 529–535. Dostupné z DOI: <http://dx.doi.org/10.2337/dc11–1643>.

20. [World Health Organization]. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. 2013. Dostupné z WWW: <https://www.idf.org/webdata/docs/WHO_IDF_definition_diagnosis_of_diabetes.pdf>.

21. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Report of a WHO Consultation. World Health Organization: Geneva1999.

22. Yogev Y, Visser GH. Obesity, gestational diabetes and pregnancy outcome. Semin Fetal Neonat Med 2009; 14(2): 77–84. Dostupné z DOI: <http://dx.doi.org/10.1016/j.siny.2008.09.002>.

23. Zareba-Szczudlik J, Pykalo-Gawinska D, Gawinski C et al. New criteria for gestational diabetes mellitus – do they impact the outcome? Neuro Endocrinol Lett 2017; 38(6): 441–448.

Labels
Diabetology Endocrinology Internal medicine
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account