Comparison of Pregnancy Outcomes Using Different Gestational Diabetes Diagnostic Criteria and Treatment Thresholds in Multiethnic Communities between Two Tertiary Centres in Australian and New Zealand: Do They Make a Difference?

Lili Yuen, Vincent W. Wong, Louise Wolmarans and David Simmons
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Lili Yuen: School of Medicine and the Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
Vincent W. Wong: South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW 2170, Australia
Louise Wolmarans: Waikato District Health Board, Hamilton 3204, New Zealand
David Simmons: School of Medicine and the Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia

IJERPH, 2021, vol. 18, issue 9, 1-14

Abstract: Introduction: Australia, but not New Zealand (NZ), has adopted the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria to diagnose gestational diabetes (GDM). We compared pregnancy outcomes using these different diagnostic approaches. Method: Prospective data of women with GDM were collected from one NZ (NZ) and one Australian (Aus) hospital between 2007–2018. Aus screening criteria with 2-step risk-based 50 g Glucose Challenge Testing (GCT) followed by 75 g-oral glucose tolerance testing (OGTT): fasting ? 5.5, 2-h ? 8.0 mmol/L (ADIPS98) changed to a universal OGTT and fasting ?5.1, 1-h ? 10, 2-h ? 8.5 mmol/L (IADPSG). NZ used GCT followed by OGTT with fasting ? 5.5, 2-h ? 9.0 mmol/L (NZSSD); in 2015 adopted a booking HbA1c (NZMOH). Primary outcome was a composite of macrosomia, perinatal death, preterm delivery, neonatal hypoglycaemia, and phototherapy. An Aus subset positive using NZSSD was also defined. RESULTS: The composite outcome odds ratio compared to IADPSG (1788 pregnancies) was higher for NZMOH (934 pregnancies) 2.227 (95%CI: 1.84–2.68), NZSSD (1344 pregnancies) 2.19 (1.83–2.61), and ADIPS98 (3452 pregnancies) 1.91 (1.66–2.20). Composite outcomes were similar between the Aus subset and NZ. Conclusions: The IADPSG diagnostic criteria were associated with the lowest rate of composite outcomes. Earlier NZ screening with HbA1c was not associated with a change in adverse pregnancy outcomes.

Keywords: gestational diabetes; multiethnic; IADPSG; perinatal outcomes; high BMI; New Zealand; Australia; diagnostic criteria; treatment threshold (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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