Pregnancy outcomes according to the definition of gestational diabetes

Sanna Koivunen; Matti Viljakainen; Tuija Männistö; Mika Gissler; Anneli Pouta; Risto Kaaja; Johan Eriksson; Hannele Laivuori; Eero Kajantie; Marja Vääräsmäki

doi:10.1371/journal.pone.0229496

Pregnancy outcomes according to the definition of gestational diabetes

PLoS One. 2020 Mar 5;15(3):e0229496. doi: 10.1371/journal.pone.0229496. eCollection 2020.

Authors

Sanna Koivunen^{1

2}, Matti Viljakainen^{1

2}, Tuija Männistö³, Mika Gissler⁴, Anneli Pouta⁵, Risto Kaaja⁶, Johan Eriksson⁷, Hannele Laivuori^{8

9

10}, Eero Kajantie^{1

2

11

12}, Marja Vääräsmäki^{1

2}

Affiliations

¹ PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and the University of Oulu, Finland.
² Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki and Oulu, Finland.
³ Northern Finland Laboratory Centre NordLab, Department of Clinical Chemistry and MRC Oulu, Oulu University Hospital and the University of Oulu, Oulu, Finland.
⁴ Information Department, National Institute for Health and Welfare, Helsinki, Finland and the Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
⁵ Department of Government Services, National Institute of Health and Welfare, Helsinki, Finland.
⁶ University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland.
⁷ Department of General Practice, University of Helsinki and Helsinki University Hospital Folkhälsan Research Centre, Helsinki, Finland.
⁸ Department of Obstetrics and Gynaecology, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Helsinki.
⁹ Medical and Clinical Genetics. University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹⁰ Institute for Molecular Medicine Finland, Helsinki Institute of Life Sciences, University of Helsinki, Helsinki, Finland.
¹¹ Department of Clinical and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway.
¹² Children's Hospital, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland.

Abstract

Objective: To assess the frequency and perinatal outcomes of gestational diabetes mellitus (GDM) defined by the criteria according to the International Association of Diabetes in Pregnancy Study Group (IADPSG) and the National Institute for Health and Care Excellence (NICE) diagnostic criteria for GDM.

Design: A retrospective cohort study.

Setting: Six secondary and tertiary delivery hospitals in Finland in 2009.

Population: Pregnant women (N = 4,033) and their offspring.

Methods: We used data on comprehensive screening of pregnant women with a 2-h 75-g oral glucose tolerance test (OGTT), performed between gestational weeks 24 and 40. OGTT glucose concentrations were used to identify women who fulfilled IADPSG and NICE criteria. While cut-offs according to Finnish national criteria partly overlapped with both criteria, a subgroup of IADPSG- or NICE-positive GDM women remained undiagnosed by Finnish criteria and hence non-treated. They were analysed as subgroups and compared to controls who were negative with all cut-offs.

Main outcome measures: GDM prevalence, birth weight SD score (BWSDS), large for gestational age (LGA) and caesarean section (CS) rates.

Results: Among the 4,033 women screened for GDM, 1,249 (31.0%) and 529 (13.1%) had GDM according to the IADPSG and NICE criteria, respectively. The LGA rate was similar in both groups. Regardless of the diagnostic criteria, women with GDM had a higher risk of induced delivery and CSs than controls. In IADPSG-positive non-treated women, offspring's BWSDS and CS rate were higher than in controls.

Conclusions: GDM prevalence was 2.4-fold higher according to the IADPSG compared with the NICE criteria but the LGA rate did not differ. BWSDS and CS rate were increased already with mild untreated hyperglycaemia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Blood Glucose / analysis
Cesarean Section / statistics & numerical data*
Diabetes, Gestational / physiopathology*
Female
Fetal Macrosomia / diagnosis*
Fetal Macrosomia / epidemiology
Glucose Tolerance Test
Humans
Mass Screening / methods*
Pregnancy
Pregnancy Outcome
Prevalence
Retrospective Studies

Substances

Blood Glucose

Grants and funding

This work was supported by the Academy of Finland (Grants 127437, 129306, 130326, 134791, 263924 and 315690 to Eero Kajantie); the European Commission (Horizon 2020 award 733280) RECAP Research on Children and Adults born preterm to EK); the Finnish Foundation for Pediatric Research (to EK); the Juho Vainio Foundation (to EK and Marja Vääräsmäki); the Novo Nordisk Foundation (to EK and MV); The Signe and Ane Gyllenberg Foundation (to EK); the Sigrid Juselius Foundation (to EK); and the Yrjö Jahnsson Foundation (to EK and MV), Medical Research Center Oulu (Sanna Koivunen); National Graduate School of Clinical Investigation (SK); Pohjois-Suomen terveydenhuollon Tukisäätiö (SK) and The Finnish Medical Foundation (SK). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.