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Time to Move Beyond a Binary Criterion for Gestational Diabetes?

  • Reproductive Endocrinology: Perspective, Opinions and Commentaries
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Abstract

Over the years, several international guidelines have been developed by specialist organizations for the diagnosis of gestational diabetes mellitus (GDM). However, these guidelines vary and lack consensus on what level of glycemia defines GDM and worryingly, there is now evidence of over- or- under-diagnosis of women with GDM by current criteria. Towards this end, the National Priorities Research Program (NPRP) funded a program of research aimed at elucidating the problem with GDM diagnosis. It was determined, on completion of the project, that the solution required diagnosis of graded levels of dysglycemia in pregnancy and not just a diagnosis of presence or absence of GDM. A new diagnostic criterion (called the NPRP criterion) was created based on a single numerical summary of the three readings from the oral glucose tolerance test (GTT) that diagnosed women in pregnancy into four levels: normal, impaired, GDM and high risk GDM. This paper now examines existing GDM criteria vis-à-vis the NPRP criterion. It is noted that no significant change has happened over the years for existing criteria except for a gradual reduction in the threshold values of individual time-points or the number of time points, bringing us towards over-diagnosis of GDM in pregnancy. The new criterion unifies all readings from the GTT into one numerical value and, because it results in four levels of glycemia, represents a new way forwards for GDM diagnosis and can potentially reduce the rates of under diagnosis and over diagnosis of GDM.

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Data Availability

All data used in this paper are available from the corresponding author in de-identified format on reasonable request.

Abbreviations

NDDG:

National Diabetes Data Group, 1979

C&C:

Carpenter and Coustan, 1982

ADIPS1998AU:

Australasian Diabetes in Pregnancy Society – Australia

ADIPS1998NZ (NZ 2014):

Australasian Diabetes in Pregnancy Society – New Zealand

WHO1998:

World Health Organization

ADA2004:

American Diabetes Association

ADA2006:

American Diabetes Association

IADPSG:

International Association of Diabetes and Pregnancy Study Group (OR 1.75)

ADA2011:

American Diabetes Association

ADIPS2011:

Australasian Diabetes in Pregnancy Society

ACOG:

American College of Obstetricians and Gynecologists, 2013

WHO2013:

World Health Organization

NICE:

National Institute for Health and Care Excellence, 2015

CDA:

Canadian Diabetes Association, 2018

NPRP:

National Priorities Research Program, 2022

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Authors and Affiliations

  1. Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar

    Omran A. H. Musa, Asma Syed, Malkan A. Khatib, Ahmad Hamdan, Amrou Hub Allah, Hamad Almahdi & Suhail A. Doi

  2. Marshfield Clinic Research Institute, Marshfield, WI, USA

    Adedayo A. Onitilo

  3. Department of Endocrinology, Marshfield Clinic Health System–Weston Center, Weston, WI, USA

    Michael T. Sheehan

  4. Division of Endocrinology and Qatar Metabolic Institute, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar

    Stephen F. Beer, Mohamed Bashir & Abdul-Badi Abou-Samra

  5. Department of Population Medicine, College of Medicine, Clinical Epidemiology and Clinical Endocrinology, Qatar University, Doha, Qatar

    Suhail A. Doi

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  1. Omran A. H. Musa
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The multidisciplinary team of authors consisting of endocrinologists and epidemiologists all contributed to this article and critically revised and approved the final manuscript for submission. The corresponding author is the guarantor of the data reported herein.

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Correspondence to Suhail A. Doi.

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Musa, O.A.H., Syed, A., Khatib, M.A. et al. Time to Move Beyond a Binary Criterion for Gestational Diabetes?. Reprod. Sci. (2024). https://doi.org/10.1007/s43032-024-01514-x

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