Pregnancy Outcomes in Women with Gestational Diabetes under the Old ADIPS and New IADPSG Diagnostic Criterias — ASN Events
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  3. Pregnancy Outcomes in Women with Gestational Diabetes under the Old ADIPS and New IADPSG Diagnostic Criterias

Pregnancy Outcomes in Women with Gestational Diabetes under the Old ADIPS and New IADPSG Diagnostic Criterias (#12)

Shan Jiang 1 2 , N Wah Cheung 1 2 , David R Chipps 1 2
  1. Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia
  2. Department of Medicine, University of Sydney, Sydney, NSW, Australia

Background: The diagnostic criteria for gestational diabetes (GDM) has been controversial following the IADPSG recommendations to lower the diagnostic fasting blood sugar level threshold. Issues surrounding the new criteria include resource utilisation and a lack of interventional data to evaluate benefits and harms.

Aim: The aim of this study was to assess the risk profile of the untreated women who did not satisfy the old ADIPS fasting glucose diagnostic criteria but would be diagnosed as gestational diabetes under the new IADPSG fasting glucose criteria.

Method: A retrospective observational cohort study was conducted on a sample of 4271 pregnant women without pre-gestational diabetes, who had failed an initial 50g glucose challenge test and proceeded to a 2 sample formal 75g oral glucose tolerance test at Westmead Hospital, and subsequently had a singleton delivery>20weeks gestation. Participants were grouped into a NO GDM control group (n=3322), an IADPSG ONLY group (5.1mmol/L≤fasting BGL<5.5mmol/L, 2hr BGL<8.0mmol/L, n=99), an old ADIPS ONLY group (fasting BGL<5.1mmol/L, 8.0mmol/L≤2 hr BGL<8.5mmol/L, n=230) and a group meeting BOTH criteria (fasting BGL≥5.5mmol/L or 2hr BGL≥8.5mmol/L, or fasting BGL≥5.1mmol/L and 2hr BGL≥8.0mmol/L, n=620). All women who satisfied the old criteria were treated during pregnancy. Pregnancy outcome measures included birthweight centile, gestation of delivery, primary caesarean section, shoulder dystocia and neonatal stillbirth.

Results: The untreated IADPSG ONLY group had a higher rate of large for gestation(LGA) (19.2%, vs No GDM 11.6%, p=0.023), higher median birth weight centile (59th, vs No GDM 49th, p=0.02), and a higher rate of primary caesarean section (32.9%, vs No GDM 19.9%, p=0.008). In the treated BOTH group, primary caesarean section rate was higher (24.1%, control 19.9%, p=0.035), but other outcome parameters were similar to No GDM. In the treated Old ADIPS ONLY group, there was less LGA (4.8%, p=0.002), more small for gestation (17.4%, vs No GDM 9.5%, p<0.001), and lower median birth weight centile (35th, p<0.001).

 Conclusion: These results demonstrated the increased pregnancy complications in the untreated women who are now diagnosed as GDM under the new criteria. However, there is a risk of lower birthweight associated with treatment amongst those meeting the old criteria only.