Combining the IADPSG criteria with the WHO diagnostic criteria for gestational diabetes mellitus optimizes predictability of adverse pregnancy outcome
Background: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes, yet there are no universally accepted diagnostic criteria for GDM. The International Association of Diabetes in Pregnancy Study Group (IADPSG) and World Health Organization’s (WHO) diagnostic criteria are commonly used criteria, although clinical outcome data of diagnostic performance of these diagnostic criteria are limited. This study examines the IADPSG and WHO criteria for predicting adverse pregnancy outcomes.
Materials and Methods: This longitudinal study involved 130 pregnant women who underwent Oral Glucose Tolerance Testing (OGTT) during 24–32 weeks of gestation. Fasting, 1‑hour and 2‑hour glucose were measured. Participants were classified as GDM and non‑GDM women based on the IADPSG and WHO diagnostic criteria. Five pregnancy outcomes were observed, namely, pre‑eclampsia, shoulder dystocia or birth injury, birth weight ≥4.0 kg, clinical neonatal hypoglycaemia and birth asphyxia.
Results: Twenty‑eight participants (21.5%) had GDM by the IADPSG criteria (GDMIADPSG) and 21 (16.2%) women had GDM by the WHO criteria (GDMWHO). Only 15 women (11.5%) met the criteria for GDM by both criteria. The association of GDM with macrosomia was stronger in GDMWHO women [Odds ratio (OR) =13.1, 95% confidence interval (CI) = 3.4–50.6] compared to the GDMIADPSG women (OR = 5.3, 95% CI 1.5–18.9). Macrosomia or at least one adverse outcome were more likely in GDM patients who met the diagnostic criteria by both the IADPSG and WHO criteria (P = 0.001).
Conclusion: A diagnosis of GDM that meets both the WHO and IADPSG criteria provides stronger prediction for adverse pregnancy outcome than a diagnosis that meets only WHO or IADPSG criteria.
Keywords: Gestational diabetes mellitus; macrosomia; oral glucose tolerance test; pregnancy outcome