Lower glycemic criteria for diagnosing gestational diabetes fail to yield health benefits
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Compared with higher glycemic criteria for the diagnosis of gestational diabetes, lower criteria did not reduce risks for women giving birth to a large for gestational age infant or other infant or maternal complications.
The findings were published in The New England Journal of Medicine.
Although the diagnostic criteria for gestational diabetes remain unclear, treatment of the condition is known to improve maternal and infant health, Caroline A. Crowther, MD, a maternal fetal medicine subspecialist and professor of maternal and perinatal health at the Liggins Institute of the University of Auckland in New Zealand, and colleagues wrote in the study background.
The researchers randomly assigned 4,061 women at 24 to 32 weeks’ gestation 1:1 to evaluation for gestational diabetes with the use of lower (n = 2,022) or higher (n = 2,039) glycemic criteria for diagnosis.
The criteria for the lower-glycemic arm were a fasting plasma glucose level of at least 92 mg/dL ( 5.1 mmol/L), a 1-hour level of at least 180 mg/dL ( 10 mmol/L) or a 2-hour level of at least 153 mg/dL ( 8.5 mmol/L). For the higher-glycemic arm, the criteria included an FPG level of at least 99 mg/dL ( 5.5 mmol/L) or a 2-hour level of at least 162 mg/dL ( 9 mmol/L).
An infant large for gestational age — defined as a birth weight above the 90th percentile by the Fenton-WHO standards — served as the primary outcome. Maternal health and infant health were secondary outcomes.
Researchers observed gestational diabetes in 15.3% of the lower-glycemic arm and 6.1% of the higher-glycemic arm. Both groups had a similar rate of infants born large for gestational age (lower-glycemic arm, 8.8% vs. higher-glycemic arm, 8.9%; adjusted RR = 0.98; 95% CI, 0.8-1.19; P = 0.82).
Compared with the higher-glycemic group, the lower-glycemic group had an increased rate of induction of labor, use of health services, use of pharmacologic agents and neonatal hypoglycemia.
Secondary outcome analysis revealed comparable results between groups, and no significant differences in adverse events were reported.
In subgroup analysis of women from both groups who had glucose test results fall between the lower and higher glycemic criteria, those treated for gestational diabetes (n = 195) compared with those who were not (n = 178) displayed maternal and infant health benefits, including fewer large for gestational age infants.
“Overall, use of the lower diagnostic glycemic criteria compared with the higher diagnostic glycemic criteria increased the proportion of women diagnosed with gestational diabetes, did not reduce perinatal morbidity and increased the use of health services,” Crowther told Healio. “However, for the women with milder gestational diabetes, there were health benefits for them and their baby from detection and treatment. These included less preeclampsia, fewer large for gestational age infants and fewer occasions of shoulder dystocia.”
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