Poster Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2019

Impact of changes in diagnostic criteria for gestational diabetes on maternal characteristics and pregnancy outcomes (#79)

Aishah Virk 1 , Lili Yuen 1 , David Simmons 1 2 3
  1. Western Sydney University, Sydney, NSW
  2. Diabetes, Obesity and Metabolism Translation Research Unit , Sydney, NSW, Australia
  3. Campbelltown Hospital, Sydney, NSW

Aims: Gestational Diabetes Mellitus (GDM) is a common pregnancy complication, with significant implications for maternal and neonatal healthcare. In 2013, the Australasian Diabetes in Pregnancy Society (ADIPS) modified the diagnostic criteria for GDM based on data demonstrating a continuum of risk across maternal glycaemic levels. This study compared pregnancy outcomes 12 months before and after the change at a single tertiary level hospital.

Methods: Data were retrospectively collected for women attending the GDM clinic at Campbelltown Hospital from January 2015 to December 2016. From January 2016, GDM was diagnosed using the new ADIPS diagnostic criteria. For analysis, patients were divided into two cohorts: those diagnosed with GDM according to the old diagnostic criteria (“old”), or after implementation of the new criteria (“new”). All women were treated following local management guidelines.  Women with pre-pregnancy diabetes were excluded.

Results: Baseline characteristics of age, body mass index and prior history of GDM were similar between “old” (n=630) and “new” (n=955) groups. The proportion of smokers in the “old” cohort (33% vs. 18%, p=0.0001) was higher. The rate of insulin (2.1% vs. 2.4%, p=0.65) and metformin (1.7& vs 1.1%, p=0.36) use was similar between the “old” and “new” cohorts, respectively. The “old” cohort displayed higher mean HbA1c during pregnancy (5.5±0.5% vs. 5.4±0.4%, p=0.014) and higher mean APGAR score at 1 minute (8.6±1.3 vs 8.5±1.6, p=0.028). There was no significant difference between the “old” and “new” cohorts, respectively, with regards to the incidence of macrosomia (8% vs 10%, p=0.12), shoulder dystocia (0.3% vs 0.3%, p=0.46), neonatal hypoglycaemia (1% vs 2%, p=0.11), pre-eclampsia (0.3% vs 0.8%, p=0.18), caesarean section (29% vs 30%, p=0.44) or neonatal deaths (0.6% vs 0.5%, p=0.54) 

Conclusions: Implementation of the revised ADIPS diagnostic criteria for treated GDM in a tertiary hospital clinic did not significantly impact on the incidence of major obstetric and neonatal complications.