The incidence of gestational diabetes mellitus before and after the introduction of HAPO diagnostic criteria

Czech version

Authors: H. Krejčí ^1,2,3; P. Šimják ¹; K. Anderlová ^1,2; H. Benáková ⁴; A. Pařízek ¹; V. Krejčí ¹; J. Škrha ²
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. A. Martan, DrSc. ¹; III. interní klinika 1. LF UK a VFN, Praha, přednosta prof. prof. MUDr. M. Kršek, CSc., MBA ²; Ústav patologické fyziologie 1. LF UK, Praha, přednosta doc. MUDr. M. Vokurka, CSc. ³; Ústav lékařské biochemie a laboratorní diagnostiky 1. LF UK a VFN, Praha, přednosta prof. MUDr. T. Zima, DrSc., MBA ⁴
Published in: Ceska Gynekol 2019; 84(6): 404-411
Category: Original Article

Overview

Introduction: During the years 2014–2015 new diagnostic criteria for gestational diabetes mellitus (GDM) were gradually adopted by the Czech professional societies, which emerged from the results of the large prospective multicenter HAPO study (The Hyperglycemia and Adverse Pregnancy Outcome). The adoption of the new criteria was accompanied by concerns about the increase in the number of women with GDM. The paper deals with epidemiological results of GDM incidence in the first three years since the introduction of new criteria.

Methods and results: In the years 2013–2014 GDM screening was performed at 1,594 pregnant woman at the General Teaching Hospital in Prague. According to that time valid diagnostic criteria (fasting glucose ≥ 5.6 mmol/g and/or ≥ 8.9 mmol/l in 60 min and/or ≥ 7.7 mmol/l in 120 min 75 g OGTT) GDM was found in 324, i.e. 20 % of women. In the years 2016–2018 were 2,629 pregnant women examined. GDM based on the new criteria (fasting blood glucose ≥ 5.1 mmol/l and/or ≥ 10 mmol/l in 60 min and/or ≥ 8.5 mmol/l in 120 min OGTT) was diagnosed in significantly less women – in 375, i.e. 14.3% (p < 0.0001). Overt diabetes, i.e. fasting glucose ≥ 7.0 mmol/l and/or ≥ 11.1 mmol/l in 120 min OGTT, was newly detected in 6 pregnant women, i.e. 0.2 %. Gestational diabetes was found in 62% cases based on repeated fasting fasting blood glucose and in 38% on the basis of higher blood glucose at 60 min and/or 120 min OGTT. GDM was significantly more prevalent in the age category over 30 years. Among women aged under 25 years GDM was present at 9.9%, aged 25–29.9 years at 9.6%, aged 30–34.9 years at 14.2% and aged ≥ 35 years at 18.6 %. Hypoglycaemia < 3.5 mmol/l experienced 2.9% of women during OGTT.

When the screening in 2016–2018 was evaluated according to the previous diagnostic criteria, diabetes would be diagnosed in 16.2% of pregnant women. The result of the test would be falsely negative in 6% of all pregnant women, i.e. these women have repeatedly higher fasting glucose (5.1–5.5 mmol/l) according to the current criteria which was evaluated as physiological according to the previous criteria. However, in the HAPO, these values were already associated with a significant increase of complications. A total of 50% of women with GDM diagnosed according to the previous criteria would have a false positive result of OGTT (8.9–9.9 mmol/l in 60 min and/or 7.7–8.4 mmol/l in 120 min OGTT). These values are not considered to be significantly at risk under the new criteria.

Conclusion: Our data do not confirm the increase in GDM incidence following the introduction of new diagnostic criteria which, according to current knowledge, better reflect the real risks of complications for the child and the mother. Applying the previous criteria has led to a number of false negative and positive results, so we consider the adoption of better-funded new criteria a step in the right direction. The incidence of diabetes was significant in all age categories and significantly increased in women over 30 years of age.

Keywords:

diagnostic criteria – gestational diabetes mellitus – screening – HAPO study – IADPSG

Sources

1. Andělová, K. Doporučený postup provádění screeningu poruch glukózové tolerance v graviditě. Čes Gynek, 2013, 78, suppl.

2. Andělová, K., Anderlová, K., Bláha, J., et al. Gestační diabetes mellitus. Doporučený postup screeningu, gynekologické, perinatologické, diabetologické a neonatologické péče. DMEV, 2018, 21(3), s. 113–120.

3. Anderlová, K., Krejčí, H., Klusáčková, P., et al. Alarmující výskyt gestačního diabetes mellitus při použití stávajících i nových mezinárodních diagnostických kritérií. Čes Gynek, 2014, 79, s. 213–218.

4. Franeková, J., Jabor, A. Gestační diabetes mellitus: analýza 2043 výsledků oGTT – je čas na změnu? Klin Biochem Metab, 2010, 18, s. 30–37.

5. Gaillard, R., Durmus, B., Hofman, A., et al. Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy. Obesity (Silver Spring), 2013, 21(5), p. 1046–1055.

6. Hod, M., Kapur, A., Mcintyre, HD., FIGO Working Group on Hyperglycemia in Pregnancy and the FIGO Pregnancy and Prevention of early NCD Committee. Evidence in support of the international association of diabetes in pregnancy study groups‘ criteria for diagnosing gestational diabetes worldwide in 2019. Am J Obstet Gynecol, 2019, pii: S0002–9378(19)30235-2. doi: 10.1016/j.ajog.2019.01.206.

7. International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care, 2010, 33, p. 676–682.

8. Krejčí, H., Andělová, K., Anderlová, K. Gestační diabetes mellitus. Mezioborová spolupráce. Čes Gynek, 2018, 83(5), s. 397–406.

9. Krejčí, H., Anderlová K., Andělová, K. Proč bychom měli přijmout nová mezinárodní kritéria pro diagnózu gestačního diabetes mellitus? Actual Gyn, 2014, 6, s. 95–99.

10. Krystyník, O., Goldmannova, D., Karásek, D. Využití diagnostických kritérií k predikci průběhu gestačního diabetu a jeho komplikací. Vnitřní lék, 2017, 63, Suppl. 1, s. 17.

11. Parekh, S., Bodicoat, DH., Brady, E., et al. Clinical characteristics of people experiencing biochemical hypoglycaemia during an oral glucose tolerance test: cross-sectional analyses from a UK multi-ethnic population. Diabetes Res Clin Pract, 2014, 104(3), p. 427–434.

12. Peddinti, G., Bergman, M., Tuomi, T., Groop L. One hour post-OGTT glucose improves the early prediction of type 2 diabetes by clinical and metabolic markers. J Clin Endocrinol Metab, 2018, 104(4), p. 1131–1140.

13. The HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med., 2008, 358, p. 1991–2002.

14. The HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: Associations With Neonatal Anthropometrics. Diabetes, 2009, 58(2), p. 453–459.

15. Visser, GHA., de Valk, HW. Is the evidence strong enough to change the diagnostic criteria for gestational diabetes now? Am J Ob Gyn, 2013, 208(4), p. 260–264.

16. WHO 2013. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. http://apps.who.int/iris/bitstream/10665/85975/1/WHO_NMH_MND_13.2_eng.pdf

17. Yuen, L., Bontempo, S., Wong, VW., Russell, H. Hypoglycaemia on an oral glucose tolerance test in pregnancy – Is it clinically significant? Diabetes Res Clin Pract, 2019, 147, p 111–117.