Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • Log out
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • Log out
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
Online Letters: Comments and Responses

International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy

Comment to the International Association of Diabetes and Pregnancy Study Groups Consensus Panel

  1. Letícia S. Weinert, MD
  1. From the Postgradute Program in Endocrinology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
  1. Corresponding author: Letícia S. Weinert, leticiasweinert{at}yahoo.com.br.
Diabetes Care 2010 Jul; 33(7): e97-e97. https://doi.org/10.2337/dc10-0544
PreviousNext
  • Article
  • Info & Metrics
  • PDF
Loading

Lack of international uniformity for the diagnosis of gestational diabetes mellitus (GDM) has been a clinical problem. The International Association of Diabetes and Pregnancy Study Groups (IADPSG) suggested new criteria for diagnosis and classification of diabetes in pregnancy (1) based on the association of maternal glycemia with perinatal outcomes reported in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study (2).

Clinical outcomes are the best way to define diagnostic thresholds, and this approach to GDM diagnosis has already been reported in the Brazilian population. The study by Schmidt et al. (3) merits mentioning since it is one of the few large studies of unselected pregnant women universally evaluated with the 75-g oral glucose tolerance test (OGTT). The authors compared the 2-h 75-g OGTT criteria for GDM diagnosis by the World Health Organization (WHO) and the American Diabetes Association (ADA) (fasting glucose ≥7.0 mmol/l or 2-h ≥7.8 mmol/l; and at least two of fasting glucose ≥5.3 mmol/l, 1-h ≥10 mmol/l, or 2-h ≥8.6 mmol/l, respectively) and showed their ability to predict macrosomia, preeclampsia, and perinatal death. Subjects were 4,977 women from the cohort of the Brazilian Gestational Diabetes Study.

No significant differences between the two diagnostic criteria were observed regarding the frequencies of clinical outcomes. GDM diagnosis resulted in greater risk for macrosomia (RR 1.29 and 1.45, based on ADA and WHO criteria, respectively), preeclampsia (RR 2.28 and 1.94), and perinatal death (RR 3.10 and RR 1.59) (3). In comparison with the IADPSG proposal of an RR 1.75 for pregnancy outcomes (1), ADA criteria resulted in greater risk for preeclampsia and perinatal death (3). The higher ADA threshold detected only pregnancies with major risk for adverse outcomes. GDM incidence was 2.4% based on ADA criteria, 7.2% based on WHO criteria, and 17.8% based on IADPSG proposed criteria.

In 2008, the same study group reported the evaluation of a shorter version of the 2-h 75-g OGTT, a 1-h 75-g test (4). Again, the diagnosis threshold was evaluated by assessing its capacity to predict adverse maternal and fetal outcomes. The 1-h and 2-h tests' receiver operating characteristic curves virtually overlapped for predicting fetal macrosomia and composite outcome (macrosomia, preeclampsia, or perinatal death). The 1-h cutoff point that maximized sensitivity (83%) and specificity (83%) was 141 mg/dl (7.8 mmol/l), but at the cost of a high GDM prevalence of 22%. The value of 180 mg/dl (10 mmol/l), as suggested by IADPSG, reached very high specificity in detecting GDM (99%), but would identify only 3.2% of the women as GDM. An intermediate value (160 mg/dl; 8.9 mmol/l) had high specificity (94%) and reasonable sensitivity (62%) for the detection of GDM, diagnosing 8.6% women as having GDM. It is important to remember that in the IADPSG analysis, fasting glucose plus 1-h plasma glucose levels identified a large majority of GDM woman.

In conclusion, in comparison with Brazilian studies, IADPSG criteria would result in a higher frequency of GDM with lower-risk pregnancies being diagnosed as GDM. The advantages of shortening the duration of the test include convenience for the patient, lower cost, and a good diagnostic accuracy in all populations evaluated.

Acknowledgments

No potential conflicts of interest relevant to this article are reported.

  • © 2010 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

References

  1. ↵
    International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676–682
    OpenUrlFREE Full Text
  2. ↵
    1. HAPO Study Cooperative Research Group,
    2. Metzger BE,
    3. Lowe LP,
    4. Dyer AR,
    5. Trimble ER,
    6. Chaovarindr U,
    7. Coustan DR,
    8. Hadden DR,
    9. McCance DR,
    10. Hod M,
    11. McIntyre HD,
    12. Oats JJ,
    13. Persson B,
    14. Rogers MS,
    15. Sacks DA
    : Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991–2002
    OpenUrlCrossRefPubMed
  3. ↵
    1. Schmidt MI,
    2. Duncan BB,
    3. Reichelt AJ,
    4. Branchtein L,
    5. Matos MC,
    6. Costa e Forti A,
    7. Spichler ER,
    8. Pousada JM,
    9. Teixeira MM,
    10. Yamashita T
    Brazilian Gestational Diabetes Study Group. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care 2001; 24: 1151–1155
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Campos MA,
    2. Reichelt AA,
    3. Façanha C,
    4. Forti AC,
    5. Schmidt MI
    : Evaluation of a 1-h 75-g oral glucose tolerance test in the diagnosis of gestational diabetes. Braz J Med Biol Res 2008; 41: 684–688
    OpenUrlPubMed
View Abstract
PreviousNext
Back to top
Diabetes Care: 33 (7)

In this Issue

July 2010, 33(7)
  • Table of Contents
  • About the Cover
  • Index by Author
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Diabetes Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy
(Your Name) has forwarded a page to you from Diabetes Care
(Your Name) thought you would like to see this page from the Diabetes Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy
Letícia S. Weinert
Diabetes Care Jul 2010, 33 (7) e97; DOI: 10.2337/dc10-0544

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy
Letícia S. Weinert
Diabetes Care Jul 2010, 33 (7) e97; DOI: 10.2337/dc10-0544
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Acknowledgments
    • References
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Comment on Khunti et al. Clinical Inertia in People With Type 2 Diabetes: A Retrospective Cohort Study of More Than 80,000 People. Diabetes Care 2013;36:3411–3417
  • Response to Comment on Khunti et al. Clinical Inertia in People With Type 2 Diabetes: A Retrospective Cohort Study of More Than 80,000 People. Diabetes Care 2013;36:3411–3417
  • Comment on Lázaro-Martínez et al. Antibiotics Versus Conservative Surgery for Treating Diabetic Foot Osteomyelitis: A Randomized Comparative Trial. Diabetes Care 2014;37:789–795
Show more Online Letters: Comments and Responses

Similar Articles

Navigate

  • Current Issue
  • Standards of Care Guidelines
  • Online Ahead of Print
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Clinical Diabetes
  • Diabetes Spectrum
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.