Analysis Of NDDG And IADPSG Criteria For Gestational Diabetes Mellitus And Perinatal Outcome

Background Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM is is a frequent medical condition during pregnancy, is associated with an increased risk of complications for both the mother and the baby during pregnancy and birth, including large for gestational age (LGA), pregnancy hypertension(PTH), premature birth, polyhydramnios, Neonatal hypoglycemia(NH), hyperbilirubinemia of newborn and so on. The risk of hypertensive disorders in women with GDM is raised2-3times compared with normal, and the risk of hypertensive disorders in pregnancy is correlated with the degree of abnormal glucose metabolism. The risk of polyhydramnios in women with GDM is raised10times compared with non-diabetic women, since the maternal glucose crosses the placenta and cause hypoglycemia of fetus, which cause hypertonic diuretic and lead to fetal hydrouria. GDM has long been known to raise the risk of a large for gestational age (LGA) foetus or macrosomia, LGA or macrosomia increases risks of shoulder dystocia, injury of birth canal and caesarian deliveries. Since the maternal glucose crosses the placenta and stimulates foetal insulin secretion, and insulin can inhibit the glucocorticoid to promote granular pneumonocyte to synthesis and release surface active substance, thus delay the fetal lung maturity, and raised the incidence of respiratory distress syndrome (RDS) and transient tachypnea. Hyperinsulinemia of the newborn of GDM women cause Neonatal hypoglycemia and polycythemia, which lead to hyperbilirubinemia. Besides, some studies demonstrate the pre-pregnancy weight and body mass index (BMI) and weight gain during pregnancy is associated with adverse outcomes of the mother and the baby, it is recognized that maternal nutrients especially high lipid level is linked with infant birth weight and may lead to the future cardiovascular disease or metabolic syndrome (MS).Different criteria for screening and diagnosis of GDM including the National Diabetes Data Group (NDDG) criteria, American Diabetes Association (ADA) criteria, World Health Organization (WHO) criteria, and other are currently in clinical use, which lead to different morbidity and outcome of GDM. In the year, our hospital start to use the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, which is based on the results of Hyperglycemia and Adverse Pregnancy Outcome (HAPO) held by National Institutes of Health (NIH) Office. However, whether the IADPSG criteria is suit for Chinese women is unkown because of the lack of Chinese women in the HAPO study, and the morbidity of GDM will be high as a result of the lower cut-off vale of blood glucose level according to the new IADPSG criteria. It will be of momentous clinical meaning to discuss different criteria and pregnancy outcomes of GDM women in South China.Objective To investigate the relationship of adverse pregnancy outcomes of GDM diagnosed by NDDG criteria and IADPSG criteria and find optimum diagnose criteria of GDM for Chinese women.Methods A retrospective population-based study of6681pregnant women who delivered between June1st2011to December31st2011in Women’s Hospital, School of Medicine, Zhejiang University and accepted the75g oral glucose tolerance test(OGTT) at the24-28week. The prevalence of gestational hyperglycemia according to different criteria was calculated, and the incidence of adverse outcomes of mother and baby and patient’s medical records was analyzed.Results(1) According to the NDDG criteria and IADPSG criteria, the prevalence of GDM of singleton pregnancy was5.28%(353/6681) and9.09%(607/6681) respectively, the prevalence of GDM differed significantly between NDDG and IADPSG criteria (P<0.01).(2) Rate of Cesarean section (CS) in GDM diagnosed according to NDDG criteria and IADPSG criteria was61.76%(218/353) and62.11%(377/607) respectively, differed significantly between NDDG and IADPSG criteria (P<0.01). Except social factors and previous scar, Pregnancy complications (preeclampsia, placental presentation, oligoamnios and intrahepatic cholestasis of pregnancy(ICP))(18.81%), Failed trial of labor (Relative cephalopelvic disproportion, Arrested labor and abnormal uterine action or parturient canal)(18.81%), abnormal fetal position (12.39%), macrosomia (11.01%) and fetal distress (6.88%) were the top five Cesarean section indications of the GDM according to NDDG criteria, while the new group of GDM according to IADPSG criteria, the top five were Failed trial of labor (20.75%), fetal distress (14.47%), Pregnancy complications (13.21%), macrosomia (10.69%) and abnormal fetal position (10.06%).(3) The prevalence of preeclampsia and ICP of GDM according to NDDG criteria (4.25%and7.65%) is significantly increased compared with the new group of GDM according to IADPSG criteria (1.18%and4.72%)(P<0.05and P<0.01, respectively), while the prevalence premature rupture of membrane (PROM) of GDM according to new group of IADPSG (21.65%) was significantly increased compared with NDDG group (16.15%)(P<0.01). The prevalence of other maternal complications in GDM of NDDG criteria, new group of IADPSG criteria and total IADPSG criteria were:pregnancy hypertension (9.63%,7.87%,8.9%), polyhydramnios (3.4%,3.54%,3.46%), oligoamnios (4.82%,8.27%,6.26%), respectively, no statistic difference was found.(4) The prevalence of premature according to new group of IADPSG criteria (12.20%) was significantly increased to NDDG group (11.61%)(P<0.05), but no statistic difference with total IADPSG group(11.86%). The prevalence of other newborn outcomes of in GDM of NDDG criteria, new group of IADPSG criteria and total IADPSG criteria were:transient tachypnea (3.4%,7.09%,4.94%), macrosomia (7.49%,8.66%,8.07%), LGA (8.93%,9.16%,9.03%), SGA (1.7%,1.18%,1.48%), RDS (1.42%,0.39%,0.99%), neonatal asphyxia (4.82%,5.91%,5.27%), Neonatal hypoglycemia (2.27%,0.79%,1.65%), Neonatal hyperbilirubinemia (7.08%,11.42%,8.90%), stress hyperglycemia (1.98%,0,1.15%), congenital malformation (1.41%,3.54%,2.31%), respectively, no statistic difference was found.(5) The high risk of GDM of NDDG criteria, new group of IADPSG criteria and total IADPSG criteria were:Family history of diabetes (6.8%,7.09%,6.92%), history of spontaneous abortion (13.03%,11.02%,12.19%), history of LGA(4.25%,4.33%,4.28%), History of adverse pregnancy(4.25%,4.33%,4.28%), oligomenorrhea (22.7%,20.5%,21.7%) and rate of assisted reproductive technology (ART)(3.97%,5.12%,4.45%), respectively, no statistic difference was found.(6) The weigh gain and BMI of GDM women according to NDDG criteria, new group of IADPSG criteria and total IADPSG criteria were:pre-pregnancy weight (54.09±9.46kg,54.64±9.08kg,54.32±9.30kg), antepartum weight (68.38±10.18kg,69.39±9.47kg,68.80±9.89kg), weigh gain during pregnancy (14.32±4.37kg,14.70±4.15kg,14.48±4.28kg) and pre-pregnancy BMI (21.17±3.46kg/m2, 21.09±3.24kg/m2,21.14±3.37kg/m2), antepartum BMI (26.77±3.63kg/m2,26.78±3.35kg/m2,26.77±3.51kg/m2), respectively, no statistic difference was found.(7) The lipid and other level of GDM women according to NDDG criteria, new group of IADPSG criteria and total IADPSG criteria were:triglyceride(TG)(3.60±1.58mmol/L,3.42±1.51mmol/L,3.52±1.55mmol/L), total cholesterol(TC)(6.10±1.28mmol/L,6.22±1.33mmol/L,6.15±1.30mmol/L), high density lipoprotein-cholesterol (HDL-C)(1.70±0.45mmol/L,1.76±0.41mmol/L,1.72±0.44mmol/L), low density lipoprotein-cholesterol (LDL-C)(2.73±0.99mmol/L,4.27±21.01mmol/L,3.39±13.75mmol/L). And the serum substance level of iron metabolism in three groups were:serum iron level (16.36±9.30mmol/L,16.44±10.57mmol/L,16.39±9.85mmol/L), transferring (TF)(3.95±0.70g/L,3.94±0.74g/L,3.95±0.72g/L), hemoglobin (HB)(122.84±11.69g/L,122.11±13.40g/L,122.53±12.43g/L), and C-reactive protein(CRP)(6.75±14.86mg/L,5.25±6.33mg/L,6.11±12.01mg/L), respectively, no statistic difference was found.Conclusion(1) The prevalence of GDM is increased according to IADPSG criteria than the NDDG criteria.(2) The prevalence of preeclampsia, premature labor, transient tachypnea increased in GDM according to IADPSG criteria, so take more care of the GDM women diagnosed by IADPSG criteria would decrease the morbidity of these adverse perinatal outcomes, and control of the weigh gain and pre-pregnancy BMI and lipid level would be of importance to prevention of future cardiovascular disease or Metabolic syndrome.(3) The IADPSG criteria is more receptive and convenient for clinical use, for only one-step2hour75g OGTT is requested.