A Comparison of Pregnancy Outcomes Using Two Diagnostic Criteria for Gestational Diabetes Mellitus-Carpenter Coustan Criteria and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) Criteria

Objective

To compare the maternal and perinatal outcomes in women with GDM diagnosed by Carpenter & Coustan (CC) criteria and by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria.

Methodology

A cross-sectional comparative study was conducted using data of women who were screened and diagnosed with GDM between April 2006-March 2007 using the CC criteria and April 2013-March 2014 using IADPSG criteria. Maternal and perinatal outcomes were noted. Means and proportions were calculated for continuous and categorical variables respectively. Data were analyzed using t-test for normally distributed data and Mann-Whitney U test for those that were not normally distributed. Pearson Chi-square test was used to find an association between the various outcomes between the two groups.

Results

Among 500 pregnant women screened, 36 were diagnosed GDM in the CC group. In the IADPSG group, 733 women were screened and 167 were diagnosed GDM. Prevalence of GDM was 7.2% in CC group and 22.78% in IADPSG group (p=0.000). There was a statistically significant difference in the number of women who developed hypertension and polyhydramnios among the two groups. Women who had an operative vaginal delivery (16.67% vs. 6.6%, p=0.085) and mean birth weight (3.10 ± 0.55 kg vs. 2.97 ± 0.48 kg, p=0.165) were higher in CC group than the IADPSG group. Among the perinatal outcomes, a statistically significant improvement was found in the number of neonates developing respiratory distress syndrome (p=0.000) and hyperbilirubinemia (p=0.000), when the IADPSG criteria were used.

Conclusions

There is a statistically significant difference between the maternal and neonatal outcomes when the newer IADPSG criteria were used for diagnosis of GDM.

Use of the National Diabetes Data Group and the Carpenter-Coustan criteria for assessing gestational diabetes mellitus and risk of adverse pregnancy outcome

Background

The influence of different diagnostic thresholds for gestational diabetes mellitus (GDM) on pregnancy outcomes is not fully understood. Degrees of glucose intolerance according to the Carpenter-Coustan (CC) criteria were less severe than the National Diabetes Data Group (NDDG) criteria for GDM. Recent studies have shown inconsistent results regarding the risk of adverse pregnancy outcomes between the NDDG and CC criteria. Therefore, the objective of this study was to investigate whether pregnant women who met only the CC criteria but not the NDDG criteria and those who met the NDDG criteria had increased risks of adverse pregnancy outcomes compared to a negative screening group.

Methods

A total of 11,486 Taiwanese pregnancies were enrolled in a retrospective cohort study. The study subjects were classified as follows: (1) negative screening group: women with negative 50-g glucose challenge test (GCT) results, (2) false-positive screening group: women with positive GCT results and negative 100-g OGTT results according to both CC and NDDG criteria, (3) CC-only-GDM group: women with positive GCT results plus GDM diagnosis meeting the CC but not the NDDG criteria, and (4) NDDG-GDM group: women diagnosed with GDM using the NDDG criteria. Multiple mixed effects logistic regression analysis was used to examine the relationships between the groups and pregnancy outcomes.

Results

There were 9002 (78.4 %), 1776 (15.5 %), 251 (2.2 %), and 457 (4.0 %) study pregnancies in the 4 groups. Compared with the negative screening group, the maternal outcomes were not different within groups except for gestational hypertension/preeclampsia. For neonatal outcomes, the CC-only-GDM group had significantly greater risks of macrosomia, low birth weight, and admission to a neonatal intensive care unit [adjusted odds ratio (aOR), (95 % confidence interval, CI): 2.73 (1.18–6.31), 1.64 (1.01–2.64), and 1.61 (1.05–2.46), respectively]. The NDDG-GDM group also showed significantly greater risks, and the false-positive screening group showed no differences from the negative screening group.

Conclusion

Women who met only the CC criteria and women who met NDDG criteria had significant increased risks of adverse neonatal outcomes. This evidence adds important information to the current debate about the diagnostic criteria for GDM regarding pregnancy outcomes.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-1030-9) contains supplementary material, which is available to authorized users.

Pregnancy outcome in women with gestational diabetes mellitus according to the Carpenter-Coustan criteria in Thailand

AIM

To compare the pregnancy outcome of patients diagnosed with gestational diabetes mellitus (GDM) using the Carpenter-Coustan (CC) criteria with that of non-GDM pregnant women at Siriraj Hospital, Bangkok.

METHODS

A retrospective study was carried out by reviewing medical records of pregnant women who underwent 100-g oral glucose tolerance test (OGTT) for diagnosing GDM between January 2009 and December 2012 at Siriraj Hospital. Pregnant women were divided into three groups according to the 100-g OGTT result: group 1, pregnant women with normal OGTT on both CC and National Diabetes Data Group (NDDG) criteria; group 2, pregnant women with normal OGTT on NDDG criteria but GDM on CC criteria; and group 3, pregnant women with GDM on CC criteria after December 2012 and enrolled in glycemic control program. Maternal and perinatal outcomes were compared between the groups.

RESULTS

During the study period, the incidence of GDM increased 32.76% using the CC criteria. These women (group 2) had a higher risk of neonatal hypoglycemia (6.7% vs 0.6%; OR, 12.3; P < 0.0001), neonatal hyperbilirubinemia (13.7% vs 7.8%; OR, 1.9; P = 0.013) compared with group 1. Pregnant women in group 3 had a lower incidence of immediate post-partum hemorrhage from vaginal delivery than group 2 (0 vs 2.9%; P = 0.04) as well as lower rates of neonatal hypoglycemia and neonatal hyperbilirubinemia.

CONCLUSION

Use of CC criteria increases the prevalence of GDM, but managing these women according to the program for GDM can improve the adverse neonatal outcome.