Gestational Diabetes: Implications of Variation in Post-Partum Follow-Up Criteria

Eur J Obstet Gynecol Reprod Biol. 2004 Apr 15;113(2):149-53. doi: 10.1016/j.ejogrb.2003.09.021.

Abstract

Objective: To compare the recommendations of the American Diabetes Association (ADA) with the World Health Organization (WHO) for evaluating women with gestational diabetes (GDM) after delivery.

Study design: During a 5-year period, 549 patients underwent the 2h, 75 g oral glucose tolerance test (OGTT), 4-8 weeks after delivery. They were classified by the criteria of WHO (1985), the ADA [1997, fasting glucose (FPG)] and the revised WHO (1999).

Results: The prevalence of diabetes by WHO-1985 and ADA-1997 were similar (8.2% versus 6.6%) but estimates of impaired glucose homeostasis varied widely (15.5% impaired glucose tolerance (IGT) versus 9.3% impaired fasting glucose, respectively). 118 (21.5%) women and 83 (15.1%) women showed a classification discrepancy between ADA-1997 with the WHO-1985 and -1999, respectively. The receiver-operating characteristic (ROC) curve area of the FPG was 0.94 for DM by the OGTT (WHO-1985 criteria) but only 0.59 for IGT by the 2h post-glucose.

Conclusions: The various guidelines for GDM follow-up after delivery, often based on expert opinion, produce similar estimates for diabetes prevalence but widely discordant results for glucose intolerance. Until more uniform evidence-based criteria become available, the various strategies for GDM follow-up will continue to cause confusion in clinical practice.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Blood Glucose / analysis
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / epidemiology
  • Diabetes, Gestational*
  • Fasting
  • Female
  • Glucose Intolerance / diagnosis
  • Glucose Intolerance / epidemiology
  • Glucose Tolerance Test*
  • Humans
  • Organizations
  • Postpartum Period*
  • Practice Guidelines as Topic
  • Pregnancy
  • ROC Curve
  • United States
  • World Health Organization

Substances

  • Blood Glucose