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Incidence and Outcomes of Gestational Diabetes Mellitus Using the New International Association of Diabetes in Pregnancy Study Group Criteria in Hôpital Maisonneuve-Rosemont

Published:October 17, 2019DOI:https://doi.org/10.1016/j.jcjd.2019.10.003

      Abstract

      Objectives

      At 1 Canadian university hospital, pregnant women were routinely screened for gestational diabetes mellitus (GDM) with a 75-g oral glucose tolerance test (OGTT). Diagnostic plasma glucose thresholds were as follows: fasting: ≥5.3 mmol/L, 1 h: ≥10.6 mmol/L and 2 h: ≥9.0 mmol/L. In 2015, diagnostic thresholds were reduced to those recommended by the International Association of Diabetes in Pregnancy Study Group (IADPSG) as follows: fasting: ≥5.1 mmol/L, 1 h: ≥10.0 mmol/L and 2 h: ≥8.5 mmol/L. However, subsequent Diabetes Canada guidelines state that further evidence is required before recommending those thresholds. Our objectives were to compare pregnancy outcomes of all pregnant women who underwent a 75-g OGTT before and after the adoption of the IADPSG criteria.

      Methods

      Pregnancy outcomes of all women (N=2,830) that had a pregnancy OGTT at the Hôpital Maisonneuve-Rosemont between July 1, 2014 and March 1, 2015 (pre-IADPSG group) were compared with women who were screened between March 1, 2015 and January 1, 2016 (post-IADPSG group). Medical files were reviewed to compare outcomes.

      Results

      Women in the post-IADPSG group had a higher early body mass index (26.3 vs 25.5 kg/m2, p=0.01) and more chronic hypertension (3.7% vs 1.2%, p<0.0001), respectively. OGTT results were similar, but rates of GDM were 10.8% (141 of 1,295) in the pre-IADPSG group and 17.6% (271 of 1,535) in the post-IADPSG group. In the post-IADPSG group, pre-eclampsia rates were lower (1.0% vs 2.2%, p=0.021), as was labour induction (25.6% vs 32.8%, p<0.0001) and neonatal intensive care unit admission (4.8% vs 8.5%, p<0.001), respectively.

      Conclusions

      Adopting IADPSG criteria for GDM improved pregnancy outcomes in our obstetric population.

      Résumé

      Objectifs

      Dans un centre hospitalier universitaire, les femmes enceintes sont dépistées pour le diabète gestationnel (DG) avec une hyperglycémie orale provoquée (HGOP) de 75 g. Les valeurs pour un diagnostic étaient: á jeûn ≥5.3 mmol/L, 1-hr: ≥10.6 mmol/L, 2-hr: ≥9.0 mmol/L. En mars 2015, les valeurs diagnostiques ont été réduites á celles recommandées par le International Association of Diabetes in Pregnancy Study Group (IADPSG): á jeûn ≥5.1 mmol/l, 1-hr ≥10.0 mmol/l, 2-hr ≥8.5 mmol/l. Les lignes directrices canadiennes mentionnent que davantage d'évidences sont nécessaires avant de recommander ces critères. L'objectif de cette étude était de comparer les taux de complications obstétricales avant et après l'adoption des critères IADPSG.

      Méthodes

      Étude de cohorte rétrospective incluant 2830 femmes. Les complications obstétricales des femmes ayant eu une HGOP avant l'adoption des critères IADPSG ont été comparées à celles des femmes ayant été dépistées par IADPSG.

      Résultats

      Les femmes ayant été dépistées par IADPSG, ont un IMC pré-gestationnel plus important (26.3 kg/m2 vs 25.5 kg/m2, p=0.01) et davantage d'hypertension chronique (3.7% vs 1.2%, p < 0.0001). L'incidence de DG était de 10.8% (141 femmes de 1295) dans le groupe avant l'adoption de l'IADPSG, alors qu'elle est de 17.6% (271 patientes de 1535) après leur adoption. Dans le groupe utilisant les critères IADPSG, le taux de prééclampsie est moindre (1.0% vs 2.2%, p=0.021), tout comme le taux d'induction (25.6% vs 32.8%, p< 0.0001) ainsi que les admissions en néonatalogie (4.8% vs 8.5%, p< 0.001).

      Conclusions

      Grâce à l'adoption des critères IADPSG, les taux de complications liées à la grossesse sont significativement réduits.

      Keywords

      Mots clés

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