Poster Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2019

How has changing the diagnostic criteria for GDM impacted perinatal outcomes in Queensland? (#45)

Nina Meloncelli 1 2 , Adrian Barnett 3 , Michael D'emden 4 5 , Susan de Jersey 2 6
  1. Nutrition and Dietetics, Allied Heatlh, Sunshine Coast University Hospital, Birtinya, QLD, Australia
  2. School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia
  3. School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
  4. Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
  5. Clinical Medicine, University of Queensland, Brisbane, QLD, Australia
  6. Nutrition and Dietetics and Centre for Allied Health Research, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia

In 2015, Queensland Health changed its screening and diagnostic criteria for GDM, in line with the ADIPS Consensus Guidelines. This resulted in 37% more women being diagnosed with GDM. To date, there have been mixed results on the impact of changing the diagnostic criteria for GDM. This study aimed to examine the impact of changing diagnostic criteria on perinatal outcomes for women diagnosed with GDM in Queensland.

Methods

We used routinely collected Queensland perinatal data of over 124,000 women to examine the difference in perinatal outcomes in the year before (2014) and after (2016) state-wide policy was changed for diagnosing GDM.  Logistic regression was used to estimate the odds ratio (OR) and 95% confidence intervals (CIs) for the risk of developing key perinatal outcomes in women with GDM.

Results

In 2016, 11.9% (n = 7317) of pregnant women were diagnosed with GDM compared with 8.7% (n = 5462) in 2014. There was no difference detected for the following outcomes:  pregnancy-induced hypertension (OR 1.20, 95% CI 0.88 – 1.18), caesarean delivery (OR 0.94, 95% CI 0.86 - 1.02); small-for-gestational age infants (OR 0.90 95% CI 0.79 – 1.03) and large-for-gestational age infants (OR 0.91, 95% CI 0.81 - 1.00). There was a reduction in preterm birth (OR 0.87, 95% CI 0.78 - 0.97), and respiratory distress (OR 0.83, 95% CI 0.73 - 0.95), but an increase in neonatal hypoglycaemia (OR 1.21, 95% CI 1.10 - 1.34).

Discussion

Our results add to the growing body of evidence that changing diagnostic criteria has had little impact on many outcomes for women GDM. Our study represents the largest sample of Australia women examined to date.  Considering the increased costs associated with treating GDM and the personal and emotional burden a GDM diagnosis has on women, the changed diagnostic criteria needs to be questioned.