Screening and diagnosis of gestational diabetes mellitus by IADPSG criteria

Authors

  • Gunjan Chaudhary Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, Delhi, India
  • Chita Raghunandan Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, Delhi, India
  • Kanika Chopra Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20190281

Keywords:

Gestational diabetes mellitus, IADPSG criteria, Maternal outcome, Screening

Abstract

Background: GDM is a complex clinical entity and its screening, diagnosis, and management warrants attention. With this issue in mind, we aimed to study the prevalence of gestational diabetes mellitus in the antenatal group of patients attending tertiary hospital in New Delhi and its association with maternal outcome.

Methods: 300 pregnant patients were enrolled in the first trimester and RBS (random blood sugar) was done. Those who had RBS >200mg/dl were labelled as overt diabetes and excluded from the study. The patients who were screened negative in phase 1 of screening were subjected to the next phase of screening at 24-28 weeks of gestation with 2-hour 75g OGTT using IADPSG criteria. Those who were diagnosed as GDM were followed in the antepartum, intrapartum and postpartum period.

Results: The prevalence of overt diabetes and GDM in the study population is 1.33% and 13.33%. The prevalence of gestational hypertension, pre-eclampsia, chronic hypertension, polyhydramnios was 15%, 5%, 5%, 7.5% respectively. Normal and instrumental vaginal delivery was in 50 %, 5% patients respectively and 45 % had the caesarean section.

Conclusions: The single step OGTT with lower threshold value cut-offs and single abnormal value for the diagnosis of GDM as advocated by IADPSG seem to be effective as it helps to screen and diagnose GDM at the same time as a single step procedure and thus more cost-effective.

References

American Diabetes Association Diabetes Care. 2011;34(1):S62-9.

International Diabetes Federation. Diabetes Atlas 2011, 5th ed. Brussels, Belgium: IDF 2012.

Cunningham FG, Lenovo KJ, Bloom SL, Haut JC, Rouse DJ, Spongy CY. Diabetes. In: Williams Obstetrics. New York: MC Graw-Hill, 2010; pp. 1104-1125.

ACOG Practice Bulletin. Gestational Diabetes 2001;98(3);525-37.

Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53.

Bhattacharya C, Awasathi RT, Kumar S, Lamba PS. Routine screening for gestational diabetes mellitus with glucose challenge test in antenatal patients. J Obstet Gynaecol India. 2001;51:75.

Ganguly, A. A Study of Diabetes Mellitus over 8 years. J Obstet Gynecol India.1995;45:27-31.

Goel N, Bathla S. Diabetes in pregnancy. Obstet Gynaecol Today 1999;46:135.

Kumar A, Takkar D, Sunesh K. Diabetes complicating pregnancy. J Obstet Gynaecol India 1993;43:27.

Maheswari J., Mataliya MV. Diabetes in pregnancy. J Obstet Gynaecol India. 1989;39:351.

Lawrence JM, Conteras R, Chen W, Sacks DA. Trends in the prevalence of pre-existing diabetes and gestational diabetes mellitus among a racially/ ethnically diverse population of pregnant women. 1999-2005. Diabetes Care. 2008;31(5):899-904.

Wahi P, Dogra V, Jandial K, Bhagat R, Gupta R, Gupta S, et al. Prevalence of gestational diabetes mellitus and its outcomes in Jammu region. J Assoc Physicians India. 2011;59(4):227-30.

Rajput R, Yadav Y, Nanda S, Rajput M. Prevalence of gestational diabetes mellitus and associated risk factors at a tertiary care hospital in Haryana. Indian J Med Res.2013;137(4):728-33.

K Sreekanthan A, Belicit A, K Rajendran, Anil, Vijay Kumar. Prevalence of Gestational Diabetes Meliitus in a Medical College in South India: Pilot Study. Indian J Clinic Res. 2014;25(4):342-347.

Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment of mild gestational diabetes. New Eng J Med. 2009;361(14):1339-1348.

HAPO study cooperative research group. Hyperglycemia and adverse pregnancy outcome. New Eng J Med. 2008;358(19):1991-2002.

Cosson E. Screening and insulin sensitivity in gestational diabetes. In Abstract volume of the 40th Annual Meeting of the EASD 2004 Sep (p. A350).

Getahun D, Nath C, Ananth CV, Chavez MR, Smulian JC. Gestational diabetes in the United States: temporal trends 1989 throught 2004. Am J Obstet Gynecol 2008;198(5): 525-e1.

Coustan DR, Lowe LP, Metzger BE. The hyperglycemia and adverse pregnancy outcome (HAPO) study: can we use the results as a basis for change? J Matern Fetal Neonatal Med 2010:23(3): 204-9.

Metzger BE, Gabbe SG, Persson B et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabtes Care. 2010;33(3):676-682.

Karcaaltincaba D, Kandemir O, Yalvac S, Güvendag‐Guven S, Haberal A. Prevalence of gestational diabetes mellitus and gestational impaired glucose tolerance in pregnant women evaluated by National Diabetes Data Group and Carpeneter and Coustan criteria. Int J Gynaecol Obstet 2009;106(3): 246-9.

Bhavadharini B, Mahalakshmi MM, Anjana RM, Maheswari K, Uma R, Deepa M, et al. Prevalence of gestational diabetes mellitus in urban and rural Tamil Nadu using IADPSG and WHO 1999 criteria (WINGS 6). Clinic Diab Endocrinol. (2016);2(1):8.

O’Sullivan EP, Avalos G, O’reilly M, Dennedy MC, Gaffney G, Dunne F. Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria. Diabetol. 2011;54(7):1670-5.

Gopalakrishnan V, Singh R, Pradeep Y et al. Evaluation of the prevalence of gestational diabetes mellitus in North Indians using the International Association of diabetes and pregnancy study groups (IADPSG) criteria. J Postgrad Med. 2015;61(3):155-8.

Hung TH. The effects of implementing the International Association of Diabetes and Pregnancy Study Groups criteria for diagnosing gestational diabetes on maternal and neonatal outcomes. PLoS One. 2015;10(3):e0122261.

Arora G, Thaman RG, Prasad R, Almgren P, Brøns C, Groop L, et al. Prevalence and risk factors of gestational diabetes in Punjab, North India: results from a population screening program. Eur J Endocrinol.2015;173(2):257-67.

Nayak PK, Mitra S, Sahoo JP, Daniel M, Mathew A, Padma A. Fetomaternal outcomes in women with and without gestational diabetes mellitus according to the International association of diabetes and pregnancy study groups (IADPSG) diagnostic criteria. Diabe Metabol Syndrome: Clinical Res and Reviews. 2013;7(4):206-9.

Dahanayaka NJ, Agampodi SB, Ranasinghe OR, Jayaweera PM, Wickramasinghe WA, Adhikari AN et al. Inadequacy of the risk factor-based approach to detect gestational diabetes mellitus. Ceylon Med J. 2012;57(1):5-9.

Moradi S, Shafieepour MR, Motazavi M, Pishgar F. Prevalence of gestational diabetes in Rajasthan: a comparison of different criteria. Med J Islam Repub Iran. 2015;29:209.

Shang M, Lin L. IADPSG criteria for diagnosing gestational diabetes mellitus and predicting adverse pregnancy outcomes. J Perinatol. 2014;34(2):100-4.

Downloads

Published

2019-01-25

Issue

Section

Original Research Articles