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

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

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.
1471-2393
Chi, Claudia
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Loy, See
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Chan, Shiao-Yng
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Choong, Cherie
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Cai, Shirong
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Soh, Shu E.
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Tan, Kok Hian
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Yap, Fabian
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Gluckman, Peter D.
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Godfrey, Keith
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Shek, Lynette
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Chan, Jerry K.Y.
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Kramer, Michael S.
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Chong, Yap Seng
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Chi, Claudia
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Loy, See
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Chan, Shiao-Yng
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Choong, Cherie
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Cai, Shirong
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Soh, Shu E.
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Tan, Kok Hian
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Yap, Fabian
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Gluckman, Peter D.
e916630e-5ae2-437c-a1d1-8e24c0e05589
Godfrey, Keith
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Shek, Lynette
517f03d8-e62a-43bd-aabe-d76d870a81ea
Chan, Jerry K.Y.
2d78152d-94ae-4bb7-a040-eaa6fbd4e9b3
Kramer, Michael S.
89f86ceb-c49e-4402-a1e3-d79c406c178d
Chong, Yap Seng
7043124b-e892-4d4b-8bb7-6d35ed94e136

Chi, Claudia, Loy, See, Chan, Shiao-Yng, Choong, Cherie, Cai, Shirong, Soh, Shu E., Tan, Kok Hian, Yap, Fabian, Gluckman, Peter D., Godfrey, Keith, Shek, Lynette, Chan, Jerry K.Y., Kramer, Michael S. and Chong, Yap Seng (2018) Impact of adopting the 2013 World Health Organization criteria for diagnosis of gestational diabetes in a multi-ethnic Asian cohort: a prospective study. BMC Pregnancy and Childbirth, 18. (doi:10.1186/s12884-018-1707-3).

Record type: Article

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.

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Accepted/In Press date: 15 March 2018
e-pub ahead of print date: 21 March 2018

Identifiers

Local EPrints ID: 419224
URI: https://eprints.soton.ac.uk/id/eprint/419224
ISSN: 1471-2393
PURE UUID: bc2c7e88-af59-47ee-a40b-dbb4b189c8c0
ORCID for Keith Godfrey: ORCID iD orcid.org/0000-0002-4643-0618

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Date deposited: 09 Apr 2018 16:30
Last modified: 03 Dec 2019 02:04

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