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• W1543959092 abstract "Sir, Since the new consensus criteria for gestational diabetes mellitus (GDM) were proposed by the International Association of Diabetes and Pregnancy Study Groups based on the results of the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, several studies have demonstrated that women with GDM by the new criteria are at high risk of large for gestational age (LGA) and gestational hypertension (GH) (1–4). For instance, O'Sullivan et al. demonstrated the clinical feature of the new consensus criteria in a predominantly European population (3). However, it remains to be determined whether similar perinatal complications are achieved in clinical practice as much as in research settings. In particular, data on perinatal outcomes in women who were classified as having normal glucose tolerance (NGT) by the previous criteria, but as having GDM by the new criteria (i.e. the new criteria only-defined GDM), are limited. In addition, the majority of participants in the HAPO study were of non-Asian ethnicity, making it difficult to interpret the results in a Japanese population. With this background, we have investigated the clinical impact of the new criteria on perinatal outcomes in a Japanese setting. A retrospective review of medical records was performed for 5749 sequential Japanese women who were cared for at our hospital between 1996 and 2010. Each woman underwent a two-step screening for GDM: universal early testing in women with high-risk characteristics and a standard one hour, 50 g oral glucose challenge test between 24 and 27 weeks of gestation for all women not previously found to have glucose intolerance. Women with positive screening underwent a two hour 75 g oral glucose tolerance test. On the basis of the criteria proposed by the Japan Society of Obstetrics and Gynecology (JSOG), GDM was diagnosed if two or more values reached or exceeded the following thresholds: fasting, 5.6 mmol/L; one hour, 10.0 mmol/L; and two hours, 8.3 mmol/L (5). All women with GDM were treated with a strict glycemic protocol. Using the new criteria (1), 349 (6.1%) women were reclassified into hyperglycemia in pregnancy (overt diabetes 3; GDM 346), compared with 132 (2.3%) by the JSOG criteria. Compared with the ‘new criteria-defined NGT’, those with GDM by the new criteria had a higher incidence of LGA births (12.2 vs. 6.2%, p<0.001) and GH (4.1 vs. 1.8%, p<0.01). The ‘new criteria only-defined GDM’ corresponding to untreated mild hyperglycemia (n=217) showed a significantly higher incidence of LGA and GH, compared with the ‘new criteria-defined NGT’ (Table 1). After adjustment for maternal age, pre-pregnancy body mass index, previous GDM, a family history of diabetes and the glucose intolerance status using a multiple linear regression model, the ‘new criteria only-define GDM’ was correlated with LGA and GH (adjusted odds ratio 1.76 and 2.20; 95% confidence interval 1.14–2.71 and 1.13–4.28, respectively). Our results suggest that women with GDM defined by the new consensus criteria only are at high risk of subsequent development of GH as well as LGA. Currently, a number of healthcare associations in the world are contemplating the adoption of the new criteria. Based on our findings, the new criteria appear to be acceptable to a Japanese clinical setting with regard to LGA and GH. As discussed in several articles (3,4), however, further studies are warranted to determine the cost-effective therapeutic strategies for treatment of GDM defined by the new criteria." @default.
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• W1543959092 date "2012-01-10" @default.
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• W1543959092 title "Fetal growth and gestational hypertension in women classified as gestational diabetes mellitus defined by the new consensus criteria only" @default.
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• W1543959092 doi "https://doi.org/10.1111/j.1600-0412.2011.01326.x" @default.
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