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01-06-2005 | Article

Potential impact of American Diabetes Association (2000) criteria for diagnosis of gestational diabetes mellitus in Spain

Authors: W. Ricart, J. López, J. Mozas, A. Pericot, M. A. Sancho, N. González, M. Balsells, R. Luna, A. Cortázar, P. Navarro, O. Ramírez, B. Flández, L. F. Pallardo, A. Hernández, J. Ampudia, J. M. Fernández-Real, R. Corcoy, Spanish Group for the Study of the Impact of Carpenter and Coustan GDM thresholds

Published in: Diabetologia | Issue 6/2005

Abstract

Aims/hypothesis

This study was carried out to determine the impact of American Diabetes Association (ADA) 2000 criteria for the diagnosis of gestational diabetes mellitus (GDM) in the Spanish population.

Methods

Pregnant women were assigned to one of four categories: negative screenees, false-positive screenees, ADA-only-GDM (untreated) and GDM according to National Diabetes Data Group (NDDG) criteria (treated). Fetal macrosomia and Caesarean section were defined as primary outcomes, with seven additional secondary outcomes.

Results

Of 9,270 pregnant women screened for GDM, 819 (8.8%) met NDDG criteria. If the threshold for defining GDM had been lowered to ADA criteria, an additional 2.8% of women would have been defined as having the condition (relative increase of 31.8%). Maternal characteristics of women with ADA-only-GDM were between those of false-positive screenees and women with NDDG-GDM. The risk of diabetes-associated complications was slightly elevated in the individuals who would have been classified as abnormal only after the adoption of ADA criteria. In addition, the ADA-only-GDM contribution to morbidity was lower than that of other variables, especially BMI.

Conclusions/interpretation

Use of the ADA criteria to identify GDM would result in a 31.8% increase in prevalence compared with NDDG criteria. However, as the contribution of these additionally diagnosed cases to adverse GDM outcomes is not substantial, a change in diagnostic criteria is not warranted in our setting.

Metzger BE (1991) Summary and recommendations of the third international workshop–conference on gestational diabetes mellitus. Diabetes 40[Suppl 2]:197–201

Langer O, Rodriguez DA, Xenakis EM, McFarland MB, Berkus MD, Arrendondo F (1994) Intensified versus conventional management of gestational diabetes. Am J Obstet Gynecol 170:1036–1046; discussion 1046–1037PubMed

Kjos SL, Buchanan TA (1999) Gestational diabetes mellitus. N Engl J Med 341:1749–1756CrossRefPubMed

Sermer M, Naylor CD, Farine D et al (1998) The Toronto tri-hospital gestational diabetes project. A preliminary review. Diabetes Care 21[Suppl 2]:B33–B42PubMed

Carpenter MW, Coustan DR (1982) Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 144:768–773PubMed

National Diabetes Data Group (1979) Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 28:1039–1057

American Diabetes Association (2000) Gestational diabetes mellitus. Diabetes Care 23:S77–S79

Dooley SL, Metzger BE, Cho NH (1991) Gestational diabetes mellitus. Influence of race on disease prevalence and perinatal outcome in a US population. Diabetes 40[Suppl 2]:25–29PubMed

Magee MS, Walden CE, Benedetti TJ, Knopp RH (1993) Influence of diagnostic criteria on the incidence of gestational diabetes and perinatal morbidity. JAMA 269:609–615CrossRefPubMed

10.

Ferrara A, Hedderson MM, Quesenberry CP, Selby JV (2002) Prevalence of gestational diabetes mellitus detected by the national diabetes data group or the Carpenter and Coustan plasma glucose thresholds. Diabetes Care 25:1625–1630PubMed

11.

González NL, Medina V, Suárez MN, Clemente C, Seral E (2002) Base de datos perinatales nacionales del año 2000. Prog Obstet Gynecol 45:510–516

12.

Comino-Delgado R (1986) Hypertensive states of pregnancy in Spain. Clin Exp Hyper B 5:217–230

13.

Schwartz ML, Ray WN, Lubarsky SL (1999) The diagnosis and classification of gestational diabetes mellitus: is it time to change our tune? Am J Obstet Gynecol 180:1560–1571PubMed

14.

Garcia-Patterson A, Martin E, Ubeda J et al (2003) Nurse-based management in patients with gestational diabetes. Diabetes Care 26:998–1001PubMed

15.

Santamaria Lozano R, Verdú Martín L, Martín Caballero C, García López G (1998) Tablas españolas de pesos neonatales según edad gestacional. Ed Artes Gráficas Beatulo, Badalona

16.

Gorgojo Martinez JJ, Almodovar Ruiz F, Lopez Hernandez E, Donnay Candil S (2002) Incidence of gestational diabetes mellitus according to different diagnostic criteria in the southeast Madrid area. Influence of diagnosis on materno-fetal parameters. Rev Clin Esp 202:136–141PubMed

17.

Diez JJ, Grande C, Pallardo LF, de la Morena ML, Ibars MT (1989) Detection of gestational diabetes with the 50-gram glucose test: prevalence and relationship with to factors. Med Clin (Barc) 93:41–45

18.

Corcoy R, Cerqueira MJ, Codina M, Ordoñez J, de Leiva A, Cabero L (1988) Diagnóstico de la diabetes gestacional: importancia del screening matutino y utilidad relacionada con los factores de riesgo. Avances Diabetologia 1:90–94

19.

Ricart W, Bach C, Fernandez-Real JM, Biarnes J, Sabria J (1999) Impacto del screening selectivo para diabetes gestacional en una población española. Med Clin (Barc) 113:331–333

20.

Jimenez-Moleon JJ, Bueno-Cavanillas A, Luna-Del-Castillo JD, Garcia-Martin M, Lardelli-Claret P, Galvez-Vargas R (2002) Prevalence of gestational diabetes mellitus: variations related to screening strategy used. Eur J Endocrinol 146:831–837CrossRefPubMed

21.

Weijers RNM, Bekedam DJ, Smulders YM (2002) Determinants of mild gestational hyperglycemia and gestational diabetes mellitus in a large Dutch multiethnic cohort. Diabetes Care 25:72–77PubMed

22.

Koukkou E, Taub N, Jackson P, Metcalfe G, Cameron M, Lowy C (1995) Difference in prevalence of gestational diabetes and perinatal outcome in an innercity multiethnic London population. Eur J Obstet Gynecol Reprod Biol 59:153–157CrossRefPubMed

23.

Dornhorst A, Paterson CM, Nicholls JS et al (1992) High prevalence of gestational diabetes in women from ethnic minority groups. Diabet Med 9:820–825PubMed

24.

Sebire NJ, Jolly M, Harris JP et al (2001) Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 25:1175–1182CrossRefPubMed

25.

Aberg A, Rydhstroem H, Frid A (2001) Impaired glucose tolerance associated with adverse pregnancy outcome: a population-based study in southern Sweden. Am J Obstet Gynecol 184:77–83CrossRefPubMed

26.

e-Atlas. IDF (2003) http://www.idf.org/e-atlas/home, accessed in December 2003

27.

Beischer NA, Wein P, Sheddy MT, Steffen B (1996) Identification and treatment of women with hyperglycemia diagnosed during pregnancy can significantly reduce perinatal mortality rates. Aust N Z J Obstet Gynecol 36:239–247

28.

Naylor CD, Sermer M, Chen E, Sykora K (1996) Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? Toronto trihospital gestational diabetes investigators. JAMA 275:1165–1170CrossRefPubMed

29.

Deerochanawong C, Putiyanum C, Wongsuryrat M, Serirat S, Jinayon P (1996) Comparison of national diabetes data group and word health organization criteria for detecting gestational diabetes mellitus. Diabetologia 39:1070–1073PubMed

30.

Pettitt DJ, Bennett PH, Hanson RL, Narayan KM, Knowler WC (1994) Comparison of World Health Organization and National Diabetes Data Group procedures to detect abnormalities of glucose tolerance during pregnancy. Diabetes Care 17:1264–1268PubMed

31.

Rust OA, Bofill JA, Andrew ME et al (1996) Lowering the threshold for the diagnosis of gestational diabetes. Am J Obstet Gynecol 175:961–965PubMed

32.

Okun N, Verma A, Mitchell BF, Flowerdew G (1997) Relative importance of maternal constitutional factors and glucose intolerance of pregnancy in the development of newborn macrosomia. J Matern Fetal Med 6:157–162CrossRef

33.

Xiao R, Sorensen TK, Williams MA, Luthy DA (2003) Influence of pre-eclampsia on fetal growth. J Matern Fetal Neonatal Med 13:157–162PubMed

34.

Sims CJ, Meyn L, Caruana R, Rao RB, Mitchell T, Krohn M (2000) Predicting cesarean delivery with decision tree models. Am J Obstet Gynecol 183:1198–1206CrossRefPubMed

35.

Michlin R, Oettinger M, Odeh M et al (2000) Maternal obesity and pregnancy outcome. Isr Med Assoc J 2:10–13PubMed

36.

Parazzini F, Bortolus R, Chatenoud L et al (1996) Risk factors for pregnancy-induced hypertension in women at high risk for the condition. Italian study of aspirin in pregnancy group. Epidemiology 7:306–308PubMed

37.

Hedderson MM, Ferrara A, Sacks DA (2003) Gestational diabetes mellitus and lesser degrees of pregnancy hyperglycemia: association with increased risk of spontaneous preterm birth. Obstet Gynecol 102:850–856CrossRefPubMed

38.

Spellacy WN, Miller S, Winegar A, Peterson PQ (1985) Macrosomia—maternal characteristics and infant complications. Am J Obstet Gynecol 66:158–161

39.

Catlin EA, Carpenter MW, Brann BS et al (1986) The apgar score revisited: influence of gestational age. J Pediatr 109:865–868PubMed

40.

Pennison EH, Egerman RS (2001) Perinatal outcomes in gestational diabetes: a comparison of criteria for diagnosis. Am J Obstet Gynecol 184:1118–1121CrossRefPubMed

41.

Jensen DM, Damm P, Soensen B et al (2003) Pregnancy outcome and prepregnancy body mass index in 2,459 glucose-tolerant Danish women. Am J Obstet Gynecol 189:239–244CrossRefPubMed

42.

Langer O, Levy J, Brustman L, Anyaegbunam A, Merkatz R, Divon M (1989) Glycemic control in gestational diabetes mellitus—how tight is tight enough: small for gestational age versus large for gestational age? Am J Obstet Gynecol 161:646–653PubMed

Title: Potential impact of American Diabetes Association (2000) criteria for diagnosis of gestational diabetes mellitus in Spain
Authors: W. Ricart
J. López
J. Mozas
A. Pericot
M. A. Sancho
N. González
M. Balsells
R. Luna
A. Cortázar
P. Navarro
O. Ramírez
B. Flández
L. F. Pallardo
A. Hernández
J. Ampudia
J. M. Fernández-Real
R. Corcoy
Spanish Group for the Study of the Impact of Carpenter and Coustan GDM thresholds
Publication date: 01-06-2005
Publisher: Springer-Verlag
Published in: Diabetologia / Issue 6/2005
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-005-1756-9

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