Gestational diabetes in Saudi women identified by the International Association of Diabetes and Pregnancy Study Group versus the former American Diabetes Association criteria: a prospective cohort study

BACKGROUND AND OBJECTIVES: Use of the criteria of the International Association of Diabetes and Pregnancy Study Group (IADPSG) identifies additional cases of gestational diabetes mellitus (GDM) that have a lesser degree of hyperglycemia. The objective of this study was to compare the clinical characteristics and the pregnancy outcomes of GDM cases identified by IADPSG versus those identified by the former American Diabetes Association (ADA) criteria. DESIGN AND SETTING: Prospective cohort study of Saudi women conducted at the Maternity and Children Hospital, Madinah, Saudi Arabia from October 2011 to August 2012. PATIENTS AND METHODS: Consecutive pregnant women treated in the antenatal service performed oral glucose tolerance tests between 24 to 28 weeks of gestation. GDM was diagnosed according to IADPSG and the former ADA criteria. The women were divided into three groups by GDM diagnosed by both criteria, additional GDM identified by the IADPSG criteria, and cases with normal glucose tolerance (NGT). Clinical characteristics and pregnancy outcomes were compared. RESULTS: Of 277 women who underwent OGTT, 47 (16.9%) were diagnosed by the former ADA criteria and 115 (41.5%) by the IADPSG criteria. The IADPSG criteria identified all women with GDM by the former ADA criteria and an additional 68 cases. The additional GDM cases had the same clinical characteristics as cases diagnosed by both criteria except for lower blood pressure and less frequent glycosuria. On the other hand, they were older, heavier and had a higher frequency of past GDM and history of recurrent abortions than the NGT group. In addition, they had significantly more cesarean deliveries, neonatal hypoglycemia, and a lower Apgar score than the NGT group. LIMITATIONS: Relatively small numbers of subjects, which could limit the power of statistical findings. CONCLUSIONS: The IADPSG criteria increased GDM frequency. The additional GDM cases identified by IADPSG have the same clinical characteristics and adverse pregnancy outcomes as cases with GDM identified by the older criteria.