Screening and Diagnosis of Gestational Diabetes Mellitus
Critical appraisal of the new International Association of Diabetes in Pregnancy Study Group recommendations on a national level
- Ofra Kalter-Leibovici, MD1,2⇓,
- Laurence S. Freedman, PHD3,
- Liraz Olmer, MA3,
- Nicky Liebermann, MD4,
- Anthony Heymann, MD5,
- Orna Tal, MD6,
- Liat Lerner-Geva, PHD2,7,
- Nir Melamed, MD2,8 and
- Moshe Hod, MD2,8
- 1Unit of Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Israel
- 2Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- 3Unit of Biostatistics, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Israel
- 4Community Medicine Division, Clalit Health Services, Tel-Aviv, Israel
- 5Department of Community Medicine, Maccabi Health Services, Tel-Aviv, Israel
- 6Medical Technology Policy Division, Israel Ministry of Health, Jerusalem, Israel
- 7Women and Children’s Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Israel
- 8Helen Schneider Hospital for Women, Rabin Medical Center, Petah-Tiqva, Israel
- Corresponding author: Ofra Kalter-Leibovici, .
OBJECTIVE To study the implications of implementing the International Association of Diabetes in Pregnancy Study Group (IADPSG) recommendations for screening and diagnosis of gestational diabetes mellitus (GDM) in Israel and explore alternative methods for identifying women at risk for adverse pregnancy outcomes.
RESEARCH DESIGN AND METHODS We analyzed data of the Israeli Hyperglycemia and Adverse Pregnancy Outcomes study participants (N = 3,345). Adverse outcome rates were calculated and compared for women who were positive according to 1) IADPSG criteria; 2) IADPSG criteria with risk-stratification; or 3) screening with BMI or fasting plasma glucose (FPG).
RESULTS Adopting IADPSG recommendations would increase GDM diagnosis by ∼50%. One-third of IADPSG-positive women were at low risk for adverse outcomes and could be managed less intensively. FPG ≥89 mg/dL or BMI ≥33.5 kg/m2 at 28–32 weeks of gestation detected proportions of adverse outcomes similar to IADPSG criteria.
CONCLUSIONS Implementing IADPSG recommendations will substantially increase GDM diagnosis. Risk-stratification in IADPSG-positive women may reduce over-treatment. Screening with FPG or BMI may be a practical alternative.
- Received January 8, 2012.
- Accepted April 16, 2012.
- © 2012 by the American Diabetes Association.
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