Oral Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2019

Increased rate of SGA in GDM patients diagnosed according to IADPSG criteria (#16)

Rona Francisco 1 , Tang Wong 1 2 , Sarah Abdo 1 , Robyn Barnes 1 3 , Jeff Flack 1 2 4
  1. Diabetes Centre, Bankstown-Lidcombe Hospital, Bankstown, NSW
  2. Faculty of Medicine, University of NSW, Sydney, NSW
  3. University of Newcastle, Newcastle, NSW
  4. School of Medicine, Western Sydney University, Sydney, NSW

Background  Controversy exists as to whether Gestational Diabetes (GDM) diagnosed according to IADPSG thresholds benefits maternal and neonatal outcomes across all population groups1.

Aims To evaluate whether LGA and SGA rates differ in GDM women diagnosed according to IADPSG versus ADIPS1998 criteria.

Methods Bankstown-Lidcombe Hospital implemented IADPSG criteria (Fasting ≥5.1mmol/L, 1 hour≥10mmol/L, 2 hour≥8.5mmol/L) on 1-Mar-2016. We reviewed prospectively collected data from a cohort of GDM women diagnosed according to ADIPS1998 criteria (Feb 2014-Feb 2016, Group 1) versus those diagnosed with IADPSG criteria (March 2016 onwards, Group 2). Management involved 1-2 weekly multidisciplinary clinic visits and insulin was prescribed if treatment targets were not met. Variables analysed were maternal age, parity, pre-pregnancy BMI, maternal weight gain up to first clinic visit and between 1st and last clinic visits, ethnicity, OGTT results and HbA1c at diagnosis. Data were expressed as Odds Ratios (OR) with 95% confidence intervals (95%CI).

Results There were 723 patients in Group 1 and 1280 in Group 2. No significant differences in baseline characteristics between groups apart from gestational age at diagnosis (25.2vs23.6years), weight gain up to first visit (9.9-vs-9.2kg), gestational weight gain between 1st and last visits (2.5-vs-2.9kg), ethnicity (European 22.3% vs 28.7%, East/SE Asian 29.7%vs21.6%) and HbA1c (5.22%-vs-5.16%). There was an increased rate of SGA using IADPSG criteria (6.5% vs 10.2%,p<0.01) without significant difference in rates of LGA. Neonatal hypoglycaemia was increased (3.0%vs10.5%,p<0.0001). On univariate analysis, increased rate of SGA was associated with diagnosis using IADPSG criteria (OR 1.64, 95%CI 1.151-2.329, p<0.01), parity (OR 0.87,95%CI 0.762-0.983,p<0.05), gestational weight gain (OR0.93,95%CI 0.89-0.98,p<0.01) and fasting glucose (OR 0.77,95%CI 0.593-0.997,p<0.05). On multivariate analysis, GDM diagnosed according to IADPSG criteria remained significant associated with SGA compared to those diagnosed using ADIPS1998 criteria (adjusted OR 1.73,95%CI 1.21-2.37).

Conclusions Compared to ADIPS1998 criteria, there was a higher rate of SGA in women diagnosed using IADPSG criteria, without any significant improvement in the rate of LGA.

  1. McIntyre HD, Jensen DM, Jensen RC, Kyhl HB, Glintbord D, Andersen M. Gestational Diabetes Mellitus: Does one size fit all? A challenge to uniform worldwide diagnostic thresholds. Diabetes Care. 2018: 41(7) 1339-1342