Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Impact of adopting the 2013 World Health Organization criteria for diagnosis of gestational diabetes in a multi-ethnic Asian cohort: a prospective study

Authors: Claudia Chi, See Ling Loy, Shiao-Yng Chan, Cherie Choong, Shirong Cai, Shu E. Soh, Kok Hian Tan, Fabian Yap, Peter D. Gluckman, Keith M. Godfrey, Lynette Pei-Chi Shek, Jerry Kok Yen Chan, Michael S. Kramer, Yap-Seng Chong

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

Login to get access

Abstract

Background

We assessed the impact of adopting the 2013 World Health Organization (WHO) diagnostic criteria on the rates of gestational diabetes (GDM), pregnancy outcomes and identification of women at future risk of type 2 diabetes.

Methods

During a period when the 1999 WHO GDM criteria were in effect, pregnant women were universally screened using a one-step 75 g 2-h oral glucose tolerance test at 26–28 weeks’ gestation. Women were retrospectively reclassified according to the 2013 criteria, but without the 1-h glycaemia measurement. Pregnancy outcomes and glucose tolerance at 4–5 years post-delivery were compared for women with GDM classified by the 1999 criteria alone, GDM by the 2013 criteria alone, GDM by both criteria and without GDM by both sets of criteria.

Results

Of 1092 women, 204 (18.7%) and 142 (13.0%) were diagnosed with GDM by the 1999 and 2013 WHO criteria, respectively, with 27 (2.5%) reclassified to GDM and 89 (8.2%) reclassified to non-GDM when shifting from the 1999 to 2013 criteria. Compared to women without GDM by both criteria, cases reclassified to GDM by the 2013 criteria had an increased risk of neonatal jaundice requiring phototherapy (relative risk (RR) = 2.78, 95% confidence interval (CI) 1.32, 5.86); despite receiving treatment for GDM, cases reclassified to non-GDM by the 2013 criteria had higher risks of prematurity (RR = 2.17, 95% CI 1.12, 4.24), neonatal hypoglycaemia (RR = 3.42, 95% CI 1.04, 11.29), jaundice requiring phototherapy (RR = 1.71, 95% CI 1.04, 2.82), and a higher rate of abnormal glucose tolerance at 4–5 years post-delivery (RR = 3.39, 95% CI 2.30, 5.00).

Conclusions

Adoption of the 2013 WHO criteria, without the 1-h glycaemia measurement, reduced the GDM rate. Lowering the fasting glucose threshold identified women who might benefit from treatment, but raising the 2-h threshold may fail to identify women at increased risk of adverse pregnancy and future metabolic outcomes.

Trial registration

NCT01174875. Registered 1 July 2010 (retrospectively registered).
Appendix
Available only for authorised users
Literature
1.
American Diabetes Association. Diagnosis and classification of diabetes. Diabetes Care. 2014;37(Suppl 1):S81–90.CrossRef
2.
Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.CrossRefPubMed
3.
Retnakaran R, Qi Y, Sermer M, Connelly PW, Hanley AJ, Zinman B. Glucose intolerance in pregnancy and future risk of pre-diabetes or diabetes. Diabetes Care. 2008;31:2026–31.CrossRefPubMedPubMedCentral
4.
Weinert LS. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy: comment to the International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Diabetes Care. 2010;33:e97.CrossRefPubMed
5.
International Association of Diabetes Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–82.CrossRef
6.
World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization guideline. Diabetes Res Clin Pract. 2014;103:341–63.CrossRef
7.
Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–53.CrossRefPubMed
8.
O’sullivan JB, Mahan CM. Criteria for oral glucose tolerance test in pregnancy. Diabetes. 1964;13:278–85.PubMed
9.
Cundy T, Ackermann E, Ryan EA. Gestational diabetes: new criteria may triple the prevalence but effect on outcomes is unclear. BMJ. 2014;348:g1567.CrossRefPubMed
10.
Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the hyperglycemia and adverse pregnancy outcome (HAPO) study. Diabetes Care. 2012;35:526–8.CrossRefPubMedPubMedCentral
11.
12.
13.
Phan TP, Alkema L, Tai ES, Tan KH, Yang Q, Lim WY, et al. Forecasting the burden of type 2 diabetes in Singapore using a demographic epidemiological model of Singapore. BMJ Open Diabetes Res Care. 2014;2:e000012.CrossRefPubMedPubMedCentral
14.
Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373:1773–9.CrossRefPubMed
15.
Soh SE, Tint MT, Gluckman PD, Godfrey KM, Rifkin-Graboi A, Chan YH, et al. Cohort profile: growing up in Singapore towards healthy outcomes (GUSTO) birth cohort study. Int J Epidemiol. 2014;43:1401–9.CrossRefPubMed
16.
Hutcheon JA, Platt RW, Abrams B, Himes KP, Simhan HN, Bodnar LM. A weight-gain-for-gestational-age z score chart for the assessment of maternal weight gain in pregnancy. Am J Clin Nutr. 2013;97:1062–7.CrossRefPubMedPubMedCentral
17.
World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. Switzerland: report of a WHO/IDF consultation; 2006.
18.
Mikolajczyk RT, Zhang J, Betran AP, Souza JP, Mori R, Gulmezoglu AM. A global reference for fetal-weight and birthweight percentiles. Lancet. 2011;377:1855–61.CrossRefPubMed
19.
Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–6.CrossRefPubMed
20.
Yew TW, Khoo CM, Thai AC, Kale AS, Yong EL, Tai ES. The prevalence of gestational diabetes mellitus among Asian females is lower using the new 2013 World Health Organization diagnostic criteria. Endocr Pract. 2014;20:1064–9.CrossRefPubMed
21.
Pan L, Leng J, Liu G, Zhang C, Liu H, Li M, et al. Pregnancy outcomes of Chinese women with gestational diabetes mellitus defined by the IADPSG's but not by the 1999 WHO’s criteria. Clin Endocrinol. 2015;83:684–93.CrossRef
22.
Moses RG, Morris GJ, Petocz P, San Gil F, Garg D. The impact of potential new diagnostic criteria on the prevalence of gestational diabetes mellitus in Australia. Med J Aust. 2011;194:338–40.PubMed
23.
O’Sullivan EP, Avalos G, O’Reilly M, et al. Atlantic diabetes in pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using the new diagnostic criteria. Diabetologia. 2011;54:1670–5.CrossRefPubMed
24.
Gilder ME, Zin TW, Wai NS, Ner M, Say PS, Htoo M, et al. Gestational diabetes mellitus prevalence in Maela refugee camp on the Thai-Myanmar border: a clinical report. Glob Health Action. 2014;7:23887.CrossRefPubMed
25.
Sagili H, Kamalanathan S, Sahoo J, Lakshminarayanan S, Rani R, Jayalakshmi D, et al. Comparison of different criteria for diagnosis of gestational diabetes mellitus. Indian J Endocrinol Metab. 2015;19:824–8.CrossRefPubMedPubMedCentral
26.
Tran TS, Hirst JE, Do MA, Morris JM, Jeffery HE. Early prediction of gestational diabetes mellitus in Vietnam: clinical impact of currently recommended diagnostic criteria. Diabetes Care. 2013;36:618–24.CrossRefPubMedPubMedCentral
27.
Chu SY, Abe K, Hall LR, Kim SY, Njoroge T, Qin C. Gestational diabetes mellitus: all Asians are not alike. Prev Med. 2009;49:265–8.CrossRefPubMed
28.
Morkrid K, Jenum AK, Sletner L, Vardal MH, Waage CW, Nakstad B, et al. Failure to increase insulin secretory capacity during pregnancy-induced insulin resistance is associated with ethnicity and gestational diabetes. Eur J Endocrinol. 2012;167:579–88.CrossRefPubMed
29.
Nallaperumal S, Bhavadharini B, Mahalakshmi MM, Maheswari K, Jalaja R, Moses A, et al. Comparison of the World Health Organization and the International Association of Diabetes and Pregnancy Study Groups criteria in diagnosing gestational diabetes mellitus in south Indians. Indian J Endocrinol Metab. 2013;17:906–9.CrossRefPubMedPubMedCentral
30.
Seshiah V, Balaji V, Shah SN, Joshi S, Das AK, Sahay BK, et al. Diagnosis of gestational diabetes mellitus in the community. J Assoc Physicians India. 2012;60:15–7.PubMed
31.
Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352:2477–86.CrossRefPubMed
32.
Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361:1339–48.CrossRefPubMedPubMedCentral
33.
Metadata
Title
Impact of adopting the 2013 World Health Organization criteria for diagnosis of gestational diabetes in a multi-ethnic Asian cohort: a prospective study
Authors
Claudia Chi
See Ling Loy
Shiao-Yng Chan
Cherie Choong
Shirong Cai
Shu E. Soh
Kok Hian Tan
Fabian Yap
Peter D. Gluckman
Keith M. Godfrey
Lynette Pei-Chi Shek
Jerry Kok Yen Chan
Michael S. Kramer
Yap-Seng Chong
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1707-3

Other articles of this Issue 1/2018

BMC Pregnancy and Childbirth 1/2018 Go to the issue

Research article

The effect of Kenya’s free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities

Research article

Long-term significant seasonal differences in the numbers of new-borns with an orofacial cleft in the Czech Republic – a retrospective study

Research article

Perceived causes of adverse pregnancy outcomes and remedies adopted by Kalenjin women in rural Kenya

Research article

Reintroducing vacuum extraction in primary health care facilities: a case study from Tanzania

Research article

Comparison of hepatitis B viral loads and viral antigen levels in child-bearing age women with and without pregnancy

Research article

Intrapartum fetal deaths and unexpected neonatal deaths in the Republic of Ireland: 2011 – 2014; a descriptive study