Skip to main content

Comparison of criteria of International Association of Diabetes and Pregnancy Study Groups (IADPSG) with National Institute for Health and Care Excellence (NICE) for diagnosis of gestational diabetes mellitus

Archives of Gynecology and Obstetrics volume 302, pages 47–52 (2020)Cite this article

Abstract

Background

Different screening procedures and diagnostic criteria are being followed in the same as well as in different countries with no single standard criteria established for diagnosis of GDM. So far, there are no studies in the Indian population comparing IADPSG with NICE criteria.

Objective

To compare International Association of Pregnancy and Study Groups (IADPSG) criteria with the National Institute for Health and Care Excellence (NICE) for diagnosis of gestational diabetes mellitus and its influence on maternal and perinatal outcomes.

Method

This prospective observational study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care institute in South India from March 2017 to October 2018. Six-hundred and eighty women with or without risk factors for GDM were recruited in the study and screened for GDM based on IADPSG and NICE criteria. Women with preexisting diabetes mellitus or with fasting plasma glucose ≥ 126 mg/dl were excluded.

Results

The overall prevalence of GDM in our study was 27.2% by either IADPSG/NICE criteria. In this study, 25.1% women and 11.6% women were diagnosed as GDM using IADPSG and NICE criteria, respectively. The level of agreement between the two diagnostic criteria was found to be poor in our study and was statistically significant (kappa = 0.429, p < 0.001). Women testing IADPSG-positive NICE-negative had a higher risk of GHTN, abortions, PROM, preterm delivery, caesarean section and congenital anomalies, meconium-stained liquor, and low Apgar scores at 1 min when compared to non GDM group. In addition, except for preterm delivery, women diagnosed as GDM by both IADPSG and NICE criteria had adverse outcomes such as preeclampsia, urinary tract infection, and polyhydramnios. Women diagnosed as GDM in IADPSG-negative NICE-positive had no significant adverse maternal or perinatal outcomes.

Conclusions

IADPSG criteria appear to be more robust than NICE criteria for diagnosis of GDM. Women with substantial risk of maternal and perinatal outcomes are better identified by IADPSG criteria who would have been missed if NICE criteria was used.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. American Diabetes Association (2018) Standards of Medical care in diabetes. Diabetes Care 41:S13–S27

    Article  Google Scholar 

  2. Jiwani A, Marseille E, Lohse N, Damm P, Hod M, Kahn JG (2012) Gestational diabetes mellitus: results from a survey of country prevalence and practices. J Matern Fetal Neonatal Med 25:600–610

    Article  Google Scholar 

  3. Dooley S, Metzger B, Cho NH (1991) Gestational diabetes mellitus: influence of race on disease prevalence and perinatal outcome in a US population. Diabetes 40:25–29

    Article  Google Scholar 

  4. Chu SY, Abe K, Hall CR, Kim SY, Njoroge T, Qin C (2009) Gestational diabetes mellitus: All Asians are not alike. Prev Med 4(9):265–268

    Article  Google Scholar 

  5. Li KT, Naik S, Alexander M, Mathad JS (2018) Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis. Acta Diabetol 55:613–625

    Article  Google Scholar 

  6. Buchanan TA, Xiang AH, Page KA (2012) Gestational diabetes mellitus: Risks and management during and after pregnancy. Nat Rev Endocrinol 8:639–649

    CAS  Article  Google Scholar 

  7. Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D, Golder S et al (2016) Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis. BMJ 354:i4694

    Article  Google Scholar 

  8. Bellamy L, Casas J-P, Hingorani AD, Williams D (2009) Type 2 DM after gestational diabetes: a systematic review and meta- analysis. Lancet 373:1773–1779

    CAS  Article  Google Scholar 

  9. Abourawi FI, ChB M (2006) Diabetes mellitus and pregnancy. Libyan J Med 1:14

    Article  Google Scholar 

  10. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, HAPO Study Cooperative Research Group (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358:1991–2002

    Article  Google Scholar 

  11. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P et al (2010) International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care 33:676–682

    Article  Google Scholar 

  12. Agarwal M, Coetzee E, Falavigna M, Meltzer SJ, Boulvain M, Colagiuri S et al (2014) Diagnostic criteria and classification of hyperglycemia first detected in pregnancy: a World health Organization Guideline. Diabetes Res Clin Pract 103:341–363

    Article  Google Scholar 

  13. Nankeris V, Mcintyre HD, Moses R, Ross GP, Callaway L, Porter C, et al.. ADIPS Consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia.2013. Available from: URL: https://www.adips.org/downloads/ADIPSConsensusGuidelinesGDM-03.05.13VersionAcceptedFInal.pdf. Accessed 3 May 2013

  14. American Diabetes Association (2014) Standards of Medical care in diabetes. Diabetes Care 37:S14–S80

    Article  Google Scholar 

  15. Blumer I, Hadar E, Hadden DR, Jovanovic L, Mestman JH, Murad MH et al (2013) Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 98:4227–4249

    CAS  Article  Google Scholar 

  16. Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC et al (2015) The International Federation of Gynecology and Obstetrics Initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management and care. Int J Gynaecol Obstet 131:S173–211

    Article  Google Scholar 

  17. Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE et al (2012) Frequency of gestational diabetes mellitus at collaborating centres based on IADPSG consensus panel-recommended criteria: the hyperglycemia and adverse pregnancy outcome (HAPO) Study. Diabetes Care 35:526–528

    Article  Google Scholar 

  18. Vandorsten JP, Dodson WE, Espeland MA, Grobman WA, Guise JM, Mercer BM et al (2013) Diagnosing gestational diabetes mellitus. Natl Inst Health Consensus State Sci Statements 29:1–31

    Google Scholar 

  19. National Institute for Health and Care Excellence. Putting NICE guidance into practice. https://www.nice.org.uk/guidance/ng3/resources/costing-statement-3782989. Accessed 2015 Feb

  20. Landon M, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B et al (2009) A Multicenter Randomized Trial of Treatment for Mild Gestational Diabetes. N Engl J Med 361:1339–1348

    CAS  Article  Google Scholar 

  21. Meek CL, Lewis HB, Patient C, Murphy HR, Simmons D (2015) Diagnosis of gestational diabetes mellitus: falling through the net. Diabetologia 58:2003–2012

    CAS  Article  Google Scholar 

  22. Djelmis J, Pavic M, Kotori V, Renar I, Ivanisevic M, Oreskovic S (2016) Prevalence of gestational diabetes mellitus according to IADPSG and NICE criteria. Int J Gynecol obstet 135:250–254

    Article  Google Scholar 

  23. Bhatia M, Mackillop LH, Bartlett K, Loerup L, Kenworthy Y, Levy J et al (2018) Clinical implications of the NICE 2015 criteria for gestational diabetes mellitus. J Clin Med 7:376

    CAS  Article  Google Scholar 

  24. Adam S, Rheeder P (2017) Screening for gestational diabetes mellitus in a South African population: revalence, comparison of diagnostic criteria and the role of risk factors. S Afr Med J 107:523–527

    CAS  Article  Google Scholar 

  25. Avalos GE, Owens LA, Dunne F, ATLANTICDIP Collaborators (2013) Applying current screening tools for gestational diabetes mellitus to a European Population: is it time for change? Diabetes Care 36:3040–3044

    Article  Google Scholar 

  26. Nayak PK, Mitra S, Sahoo JP, Daniel M, Mathew A, Padma A (2013) Feto-maternal outcomes in women with and without gestational diabetes mellitus according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria. Diabetes Metab Syndr 7:206–209

    Article  Google Scholar 

  27. Arora GP, Thaman RG, Prasad RB, Almgren P, Brons C, Groop LC et al (2015) Prevalence and risk factors of gestational diabetes in Punjab, North India: results from a population screening program. Eur J Endocrinol 173:257–267

    CAS  Article  Google Scholar 

  28. Gopalakrishnan V, Singh R, Pradeep Y, Kapoor D, Rani AK, Pradhan S et al (2015) Evaluation of the prevalence of gestational diabetes mellitus in North Indians using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. J Postgrad Med 61:155–158

    CAS  Article  Google Scholar 

Download references

Funding

None.

Author information

Affiliations

  1. Departments of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

    Sushila Todi & Haritha Sagili

  2. Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

    Sadish Kumar Kamalanathan

Authors
  1. Sushila Todi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haritha Sagili
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sadish Kumar Kamalanathan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sushila Todi.

Ethics declarations

Conflict of interest

There are no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Todi, S., Sagili, H. & Kamalanathan, S.K. Comparison of criteria of International Association of Diabetes and Pregnancy Study Groups (IADPSG) with National Institute for Health and Care Excellence (NICE) for diagnosis of gestational diabetes mellitus. Arch Gynecol Obstet 302, 47–52 (2020). https://doi.org/10.1007/s00404-020-05564-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-020-05564-9

Keywords

  • Gestational diabetes mellitus
  • International Association of Diabetes and Pregnancy Study Groups
  • National Institute for Health and Care Excellence