This article is more than 5 years old. Information may no longer be current.
New UK criteria for diagnosing gestational diabetes overlooks women at risk
Click Here to Manage Email Alerts
Many women at risk for the complications of gestational diabetes would not be identified under new guidelines introduced by United Kingdom’s National Institute for Health and Care Excellence, according to research in Diabetologia.
The National Institute for Health and Care Excellence (NICE) proposed criteria in February that called for identifying pregnant women with a high fasting plasma glucose threshold (75 g oral glucose tolerance test, ≥ 5.6 mmol/L) and a single, 2-hour timed glucose test (2 hour, ≥ 7.8 mmol/L) compared with criteria adopted by the International Association of the Diabetes and Pregnancy Study Groups ( IADPSG) and WHO in 2013, which use a lower FPG threshold (75 g oral glucose tolerance test, ≥ 5.1 mmol/L) and two timed glucose tests (1-hour, ≥ 10 mmol/L and 2 hour, ≥ 8.5 mmol/L) .
In a retrospective study comparing women who would test positive under the IADPSG criteria but negative under the NICE diagnostic criteria, researchers found that up to 4,000 women per year may be at risk for gestational diabetes, yet overlooked under the NICE guidelines.
“Women with hyperglycemia, whether or not they are diagnosed with gestational diabetes, have increased rates of high birth weight babies and diseases such as preeclampsia and polyhydramnios,” Claire L. Meek, MD, of the University of Cambridge, told Endocrine Today. “This risk increases gradually as blood sugar levels increase, so even women just below the diagnostic thresholds are at risk of adverse outcomes.”
Claire L. Meek
Meek and colleagues at Cambridge University Hospitals and the University of Western Sydney in Australia analyzed data from 25,543 women who delivered babies at the Rosie Maternity Hospital in Cambridge between 2004 and 2008, relying on anonymous hospital records. They found that using WHO 2013 diagnostic criteria compared with NICE 2015 criteria would have diagnosed 126 more women with gestational diabetes over 5 years, but that these women were at particularly high risk for adverse pregnancy outcomes.
“Although these 126 women represented only 0.49% of pregnancies, they accounted for 3.82% of cases of high birth weight babies, 2.68% of cases of preeclampsia and 5.3% of cases of polyhydramnios,” Meek said. “The women at highest risk of having a high birth weight baby were those with high fasting blood sugar levels who had babies on average 350 g (more than 12 oz) heavier than women with normal blood sugar levels.”
Overall, the researchers estimate that this issue is likely to affect 3,000 to 4,000 women each year in the United Kingdom — women who many benefit from dietary changes or treatments to reduce their risk and the risk to their babies.
“The new NICE guidelines contain many different recommendations for the management of diabetes in pregnancy and almost all of these recommendations are beneficial and based upon up-to-date evidence,” David Simmons, MD, of Cambridge University Hospitals, said in a press release. “This is not the case with the diagnostic criteria for gestational diabetes. These should aim to improve health for all pregnant women and their babies by identifying those at greatest risk of complications, and who may benefit the most from dietary changes or other forms of treatment.”
Future research should identify the best and most cost-effective strategies to identify and diagnose women with gestational diabetes, Meek said.
“Although all women with gestational diabetes are at increased risk of adverse outcomes, the risk seems to be higher for some than for others,” she said. “We need research to identify which women are at highest risk, to allow us to target our interventions most effectively. This would allow us to direct our resources to those most at risk.” – by Regina Schaffer
Disclosure: Meek reports receiving funding from the Wellcome Trust Translational Medicine and Therapeutics Program, which is funded in part by GlaxoSmithKline. Simmons reports receiving honoraria from Sanofi and Novo Nordisk and is a member of the GlaxoSmithKline Advisory Panel. Please see the full study for a list of all other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts