A large trial of screening for gestational diabetes mellitus in the United States highlights the need to revisit the Australian diagnostic criteria

Doust, Jenny A; Glasziou, Paul P; dʼEmden, Michael C

doi:10.5694/mja2.51388

Topics

Recent trial results validate previous concerns about the IADPSG criteria for gestational diabetes

The definition of gestational diabetes mellitus (GDM) varies considerably depending on the region where a woman lives, and considerable controversy remains on the best approach to diagnosis. A 2021 trial showed no benefit for women or infants screened with the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) one‐step criteria over the Carpenter–Coustan two‐step diagnostic criteria.1 The results of the trial validate the concerns expressed by several groups, including the Royal Australian College of General Practitioners (RACGP) and a National Institutes of Health consensus panel, over the introduction of the IADPSG criteria and should prompt an early review of the diagnostic criteria used in Australia.

1 Centre for Longitudinal and Life Course Research, University of Queensland, Brisbane, QLD
2 Institute for Evidence‐Based Healthcare, Bond University, Gold Coast, QLD
3 Royal Brisbane and Women’s Hospital, Brisbane, QLD
4 University of Queensland, Brisbane, QLD

Correspondence: j.doust@uq.edu.au

Competing interests:

No relevant disclosures.

1. Hillier TA, Pedula KL, Ogasawara KK, et al. A pragmatic, randomized clinical trial of gestational diabetes screening. N Engl J Med 2021; 384: 895–904.
2. Guideline Development Group. Management of diabetes from preconception to the postnatal period: summary of NICE guidance. BMJ 2008; 336: 714–717.
3. Ministry of Health. Screening, diagnosis and management of gestational diabetes in New Zealand: a clinical practice guideline. Wellington: Ministry of Health, 2014. https://www.health.govt.nz/publication/screening‐diagnosis‐and‐management‐gestational‐diabetes‐new‐zealand‐clinical‐practice‐guideline (viewed Dec 2021).
4. Duran A, Sáenz S, Torrejón MJ, et al. Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study. Diabetes Care 2014; 37: 2442–2450.
5. Sormani MP. The Will Rogers phenomenon: the effect of different diagnostic criteria. J Neurol Sci 2009; 287 (Suppl): S46–S49.
6. Meloncelli NJL, Barnett AG, dʼEmden M, De Jersey SJ. Effects of changing diagnostic criteria for gestational diabetes mellitus in Queensland, Australia. Obstet Gynecol 2020; 135: 1215–1221.
7. McIntyre HD, Gibbons KS, Ma RCW, et al. Testing for gestational diabetes during the COVID‐19 pandemic. An evaluation of proposed protocols for the United Kingdom, Canada and Australia. Diabetes Res Clin Pract 2020; 167: 108353.
8. Bonongwe P, Lindow SW, Coetzee EJ. Reproducibility of a 75 g oral glucose tolerance test in pregnant women. J Perinat Med 2015; 43: 333–338.
9. Crowther CA, McCowan LME, Rowan JA, et al. GEMS Study Group. Lower versus higher diagnostic criteria for the detection of gestational diabetes for reducing maternal and perinatal morbidity: study protocol for the GEMS randomised trial. BMC Pregnancy Childbirth 2020; 20: 547.
10. Simmons D, Hague WM, Teede HJ, et al. Hyperglycaemia in early pregnancy: the treatment of booking gestational diabetes mellitus (TOBOGM) study. A randomised controlled trial. Med J Aust 2018; 209: 405–406. https://www.mja.com.au/journal/2018/209/9/hyperglycaemia‐early‐pregnancy‐treatment‐booking‐gestational‐diabetes‐mellitus
11. Crowther CA, Hiller JE, Moss JR, et al; Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352: 2477–2486.
12. Landon MB, Spong CY, Thom E, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal‐Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361: 1339–1348.
13. Royal Australian College of General Practitioners. Management of type 2 diabetes: a handbook for general practice. Melbourne, Vic: RACGP, 2020. https://www.racgp.org.au/getattachment/41fee8dc‐7f97‐4f87‐9d90‐b7af337af778/Management‐of‐type‐2‐diabetes‐A‐handbook‐for‐general‐practice.aspx (viewed Dec 2021).
14. Vandorsten JP, Dodson WC, Espeland MA, et al. NIH consensus development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statements 2013; 29: 1–31.
15. Feldman RK, Tieu RS, Yasumura L. Gestational diabetes screening: the International Association of the Diabetes and Pregnancy Study Groups compared with Carpenter–Coustan screening. Obstet Gynecol 2016; 127: 10–17. Erratum in: Obstet Gynecol 2016; 127: 806.
16. Kong JM, Lim K, Thompson DM. Evaluation of the International Association of the Diabetes In Pregnancy Study Group new criteria: gestational diabetes project. Can J Diabetes 2015; 39: 128–132.

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