Impact of the new Australian, New Zealand and Swedish GDM criteria on GDM prevalence among high risk women in the TOBOGM study — ASN Events
  1. Schedule
  2. Lunch & Poster Session
  3. Impact of the new Australian, New Zealand and Swedish GDM criteria on GDM prevalence among high risk women in the TOBOGM study

Impact of the new Australian, New Zealand and Swedish GDM criteria on GDM prevalence among high risk women in the TOBOGM study (#121)

David Simmons 1 , Bill Hague 2 , Helena Teede 3 , N Wah Cheung 4 , Emily Hibbert 5 , Christopher Nolan 6 , Michael Peek 7 , Vincent Wong 8 , Jeff Flack 9 , Mark Mclean 10 , Arianne Sweeting 11 , Alexandra Kautzky-Willer 12 , Jürgen Harreiter 12 , Emily Hibbert 13 , Mohan Viswanathan 14 , Helena Backman 15
  1. Western Sydney University, Campbelltown, NSW, Australia
  2. Robinson Research Institute, and Women's and children's Hospital, The University of Adelaide, Adelaide, South Australia, Australia
  3. Monash University, Melbourne, Vic, Australia
  4. Westmead Hospital, Sydney, NSW, Australia
  5. Nepean Hospital, Penrith, NSW, Australia
  6. Canberra Hospital and Australian National University, Canberra, ACT, Australia
  7. Australian National University, Canberra, ACT, Australia
  8. Liverpool Hospital, Liverpool, NSW, Australia
  9. Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
  10. Blacktown Hospital, Blacktown, NSW, Australia
  11. Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
  12. Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
  13. Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA, Australia
  14. Dr. Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
  15. Department of Obstetrics and Gynaecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden

Background

Many countries changed their GDM diagnostic criteria after the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial showed major benefits of treating early gestational diabetes mellitus (eGDM) using higher diagnostic criteria than the WHO-2013 criteria. The aim of this secondary TOBOGM analysis was to compare the reduction in numbers with eGDM and new GDM at 24-28 weeks' gestation (weeks’) (GDM@24) using the different new criteria.

 

Methods

Pregnant women with GDM risk factors completed an oral glucose tolerance test (OGTT) before 20 weeks’. Non-European ethnicity was considered a risk factor. Those without eGDM repeated the OGTT at 24-28 weeks’. GDM was diagnosed using the WHO-2013 criteria. This analysis assessed the prevalence of GDM at any time using WHO-2013, Swedish (5.3, 10.0, 8.5 mmol/l: uncorrected for citrate), ADIPS-2025 (5.3, 10.6, 9.0 mmol/l) and NZ (5.3, 10.6, [omitted] mmol/l) fasting, 1h and 2h time-point criteria respectively. Women with eGDM were excluded from the GDM@24 numbers. Prevalence was compared using chi squared. Simple proportions with 95% Confidence intervals (95%CI) were calculated to compare the reductions in numbers diagnosed.

Results

Among 3672 women, 857(23.3%), 658(17.9%), 522(14.2%) and 450(12.3%) women were classified as having eGDM using WHO-2013, Swedish, ADIPS-2025 and NZ criteria respectively (p<0.001). Among the remaining 2541 women at 24-28 weeks’, 449(17.7%), 369(14.5%), 253(10.0%) and 205(8.1%) were classified as having GDM@24 respectively (p<0.001).  Total GDM was therefore 35.6%, 28.0%, 21.1% and 17.8% respectively. Proportions remaining with eGDM (vs WHO-2013=1) were similar between high-risk Europeans (0.72, 0.60, 0.54) and non-Europeans (0.80, 0.61,0.51) across the Swedish, ADIPS-2025 and NZ criteria. Proportions remaining with GDM@24 were similar between Europeans (0.77, 0.40) and non-Europeans (0.85, 0.49) across Swedish and NZ criteria, but lower in Europeans (0.47(95%CI:0.39-0.55)) than non-Europeans (0.62(95%CI:0.56-0.68)) using ADIPS-2025 criteria. Proportions remaining with eGDM or GDM@24 were significantly higher among Maaori/Pasifika (0.66(95%CI:0.54-0.77)) than Europeans (0.49(95%CI:0.45-0.54)) or East/South Asians (0.47(95%CI:0.43-0.51)) using NZ criteria.

 

Conclusions

The majority of women with risk factors have eGDM rather than GDM@24 independent of criteria. Changes in criteria decrease European and East/South Asian more than Maaori/Pasifika proportions being diagnosed particularly with the NZ criteria with its omission of the 2h glucose.