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Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus

Background: In response to concerns that the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria labeled too many women with gestational diabetes mellitus (GDM) without evidence of clinical or economic benefit, NICE recommended a change in diagnostic criteria in 2015. Ai...

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Autores principales: Bhatia, Meena, Mackillop, Lucy H., Bartlett, Katy, Loerup, Lise, Kenworthy, Yvonne, Levy, Jonathan C., Farmer, Andrew J., Velardo, Carmelo, Tarassenko, Lionel, Hirst, Jane E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209967/
https://www.ncbi.nlm.nih.gov/pubmed/30360376
http://dx.doi.org/10.3390/jcm7100376
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author Bhatia, Meena
Mackillop, Lucy H.
Bartlett, Katy
Loerup, Lise
Kenworthy, Yvonne
Levy, Jonathan C.
Farmer, Andrew J.
Velardo, Carmelo
Tarassenko, Lionel
Hirst, Jane E.
author_facet Bhatia, Meena
Mackillop, Lucy H.
Bartlett, Katy
Loerup, Lise
Kenworthy, Yvonne
Levy, Jonathan C.
Farmer, Andrew J.
Velardo, Carmelo
Tarassenko, Lionel
Hirst, Jane E.
author_sort Bhatia, Meena
collection PubMed
description Background: In response to concerns that the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria labeled too many women with gestational diabetes mellitus (GDM) without evidence of clinical or economic benefit, NICE recommended a change in diagnostic criteria in 2015. Aim: To compare diabetes associated maternal and neonatal complications in pregnancies complicated by GDM diagnosed using IADPSG criteria only, to those with GDM diagnosed using both IADPSG and NICE 2015 criteria. GDM screening was risk factor based. Methods: This was a secondary analysis of a trial of women with GDM diagnosed by the IADPSG criteria (fasting blood glucose (BG) ≥ 5.1 mmol/L, 1 h ≥ 10.0 mmol/L and 2 h ≥ 8.5 mmol/L). Outcomes were compared for two groups: NICE + IADPSG defined as those with GDM diagnosed by both the NICE 2015 and IADPSG criteria (fasting BG ≥ 5.6 mmol/L, 2 h ≥ 8.5 mmol/L); and IADPSG-ONLY (fasting BG 5.1 mmol/L to 5.5 mmol/L, and/or 1-hour ≥10.0 mmol/L, and 2 h ≥ 8.5 mmol/L). We were not able to obtain data for women with a 2-h value between BG 7.8–8.4 mmol/L (i.e., NICE-ONLY; NICE 2015 positive and IADPSG negative). All women were treated for GDM using targets of fasting BG < 5.3 mmol/L and 1-h post prandial BG < 7.8 mmol/L respectively. Results: Of 159 women, 65 (40.9%) were NICE + IADPSG and 94 (59.1%) IADPSG-ONLY. Hypoglycaemic medication use was similar in both groups: 52.3% NICE + IADPSG, 46.8% IADPSG-ONLY, OR 1.0 (0.5–1.9). The IADPSG-ONLY group delivered later than the NICE + IADPSG group; 39.0 weeks (sd 1.4) compared to 38.2 weeks (sd 2.5), p value 0.02. Fewer caesarean sections occurred in IADPSG-ONLY group 30.9% vs. 52.3%, OR 0.4 (0.2–0.9). Birthweight, large for gestational age, and other neonatal complications were not significantly different between groups. Conclusions: Gestational diabetes-associated perinatal complications were similar in both groups. The IADPSG criteria detect women with evidence of ongoing hyperglycaemia who may benefit from treatment during pregnancy.
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spelling pubmed-62099672018-11-02 Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus Bhatia, Meena Mackillop, Lucy H. Bartlett, Katy Loerup, Lise Kenworthy, Yvonne Levy, Jonathan C. Farmer, Andrew J. Velardo, Carmelo Tarassenko, Lionel Hirst, Jane E. J Clin Med Article Background: In response to concerns that the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria labeled too many women with gestational diabetes mellitus (GDM) without evidence of clinical or economic benefit, NICE recommended a change in diagnostic criteria in 2015. Aim: To compare diabetes associated maternal and neonatal complications in pregnancies complicated by GDM diagnosed using IADPSG criteria only, to those with GDM diagnosed using both IADPSG and NICE 2015 criteria. GDM screening was risk factor based. Methods: This was a secondary analysis of a trial of women with GDM diagnosed by the IADPSG criteria (fasting blood glucose (BG) ≥ 5.1 mmol/L, 1 h ≥ 10.0 mmol/L and 2 h ≥ 8.5 mmol/L). Outcomes were compared for two groups: NICE + IADPSG defined as those with GDM diagnosed by both the NICE 2015 and IADPSG criteria (fasting BG ≥ 5.6 mmol/L, 2 h ≥ 8.5 mmol/L); and IADPSG-ONLY (fasting BG 5.1 mmol/L to 5.5 mmol/L, and/or 1-hour ≥10.0 mmol/L, and 2 h ≥ 8.5 mmol/L). We were not able to obtain data for women with a 2-h value between BG 7.8–8.4 mmol/L (i.e., NICE-ONLY; NICE 2015 positive and IADPSG negative). All women were treated for GDM using targets of fasting BG < 5.3 mmol/L and 1-h post prandial BG < 7.8 mmol/L respectively. Results: Of 159 women, 65 (40.9%) were NICE + IADPSG and 94 (59.1%) IADPSG-ONLY. Hypoglycaemic medication use was similar in both groups: 52.3% NICE + IADPSG, 46.8% IADPSG-ONLY, OR 1.0 (0.5–1.9). The IADPSG-ONLY group delivered later than the NICE + IADPSG group; 39.0 weeks (sd 1.4) compared to 38.2 weeks (sd 2.5), p value 0.02. Fewer caesarean sections occurred in IADPSG-ONLY group 30.9% vs. 52.3%, OR 0.4 (0.2–0.9). Birthweight, large for gestational age, and other neonatal complications were not significantly different between groups. Conclusions: Gestational diabetes-associated perinatal complications were similar in both groups. The IADPSG criteria detect women with evidence of ongoing hyperglycaemia who may benefit from treatment during pregnancy. MDPI 2018-10-22 /pmc/articles/PMC6209967/ /pubmed/30360376 http://dx.doi.org/10.3390/jcm7100376 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bhatia, Meena
Mackillop, Lucy H.
Bartlett, Katy
Loerup, Lise
Kenworthy, Yvonne
Levy, Jonathan C.
Farmer, Andrew J.
Velardo, Carmelo
Tarassenko, Lionel
Hirst, Jane E.
Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus
title Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus
title_full Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus
title_fullStr Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus
title_full_unstemmed Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus
title_short Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus
title_sort clinical implications of the nice 2015 criteria for gestational diabetes mellitus
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209967/
https://www.ncbi.nlm.nih.gov/pubmed/30360376
http://dx.doi.org/10.3390/jcm7100376
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