Endocrine Abstracts

Objective: The aim of this study was to evaluate maternal and perinatal outcomes before and after implementation of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for testing of gestational diabetes mellitus (GDM).

Methods: This is a retrospective cohort study of women with GDM followed at a single university hospital. We compared maternal and neonatal outcomes of singleton pregnancies in women with GMD before (from January to December 2014) and after (from January to December 2016) the introduction of IADPSG criteria for the diagnosis of GDM. The same therapeutic interventions were offered to women with GDM diagnosed by both criteria.

Results: Use of IADPSG compared to Carpenter and Coustan (C& C) criteria increased the rate of women diagnosed with GDM (6.4% vs 11.9%, P=0.001). The IADPSG group had a lower rate of small for gestational age (14.8 vs 4.8%, P=0.001), but there were no differences in cesarean delivery rate (22.9 vs 22.9 %, P=0.988), instrumental delivery rate (11.4 vs 9.5%, P=0.542), large for gestational age rate (17.0 vs 20.6 %; P=0.404), and neonatal intensive care unit admission rate (15.6 vs 11.4%, P=0.244). Insulin use was similar in both groups (45.8 vs 43.0%, P=0.115), but a basal-bolus regimen was used more frequently in the C& C group (13.6 vs 7.0%, P=0.031). There were no significant differences in any other pregnancy outcomes. To better characterize the differences in the rate of SGA, we analyzed maternal and neonatal outcomes stratifying the IADPSG group according to whether women were diagnosed by FPG in the first trimester (FPG-IADPSG group) or by 75 g OGGT in the second trimester (OGGT-IADPSG group). There were no significant differences in the rates of maternal and neonatal outcomes among the three groups except for SGA, which remained more frequent in the C& C group than in the FPG-IADPSG and OGTT-IADPSG groups (14.0% vs 4.8% vs 4.4%, respectively; P=0.006). Only the C& C screening (OR 3.76, 95% CI 1.65-8.57), and smoking habit (OR 3.31, 95% CI 1.44-7.59) were associated with SGA in the multivariate logistic regression model to evaluate predictors of this outcome.

Conclusion: Except for a decrease in the rate of small for gestational age, adopting the IADPSG criteria was associated with more GDM diagnoses without better maternal and neonatal outcomes.