The alarming incidence of gestational diabetes mellitus using currently used and new international diagnostic criteria

Czech version

Authors: K. Anderlová ^1,2; H. Krejčí ^1,2; P. Klusáčková ¹; M. Moravcová ²; H. Benáková ³; V. Krejčí ²; A. Pažízek ²; M. Haluzík ¹
Authors‘ workplace: III. interní klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. Š. Svačina, DrSc., MBA ¹; Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. A. Martan, DrSc. ²; Ústav lékařské biochemie a laboratorní diagnostiky 1. LF UK a VFN, Praha, přednosta prof. MUDr. T. Zima, DrSc., MBA ³
Published in: Ceska Gynekol 2014; 79(3): 213-218

Overview

Objective:
The aim of our study was to analyze the results of oral glucose tolerant test (oGTT) of pregnant woman with currently used Czech criteria for diagnosis of GDM, to find out the prevalence of GDM if the measurement of glycemia in 1 hour of oGTT is included and to compare the prevalence of GDM using the new IADPSG (International Association of Diabetes and Pregnancy Study Groups) criteria versus the currently used Czech criteria.

Design:
Retrospective analysis.

Settings:
Department of Obstetrics and Gynecology of the First Faculty of Medicine and General Teaching Hospital, Prague.

Methods:
Data from the standard 75g 2-hour oral glucose tolerance test (oGTT) of 2567 pregnant females were analyzed using the currently recommended Czech cut-off values for plasma glucose at baseline and at2 hours of oGTT (5.6 and 7.7 mmol/l) and at baseline, 1 and2 hours oGTT (5.6, 8.9 and 7.7 mmol/l). The frequency of GDM using the Czech criteria was compared with the frequency of GDM using the novel IADPSG criteria (5.1, 10.0 and 8.5 mmol/l). Statistical analysis was done using the software GNU PSPP Statistical Analysis Software version 0.8.0-g0ad9f6.

Results:
When using the current Czech criteria (at baseline and 2 hours of oGTT) GDM was diagnosed in 362 (14.11%) females. Inclusion of glycemia at 1 hour of oGTT increased the frequency of GDM to 571 (22.26%) females (p<0.00). With the novel IADPSG criteria GDM was diagnosed in 818 (31.89%) females (p=0.038). 503 females i.e. 19.61% and 394 females i.e. 15.36% (when glycemia at 1 h of oGTT included) respectively met the IADPSG but not the Czech criteria and thus were not treated for GDM. In contrast, 47 (1.83%) resp. 147 (5.73%) of tested women who met the Czech but not the IADPSG criteria received unnecessary diabetes treatment.

Conclusion:
The frequency of GDM is higher with the novel IADPSG criteria when compared with the currently used Czech recommendation. Switching to IADPSG criteria might help unravel hitherto unidentified cases of GDM and thus improve outcomes for females with GDM and their offsprings.

Keywords:
gestational diabetes, oral glucose tolerant test, oGTT, Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study

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