National Diabetes Data Group vs Carpenter-Coustan criteria to diagnose gestational diabetes

Abstract

Objective: The objective of the study was to compare perinatal outcomes among women diagnosed with gestational diabetes by the National Diabetes Data Group (NDDG) criteria with women meeting only Carpenter-Coustan criteria.

Study design: This was a 14 year retrospective cohort. Women who screened positive with 1 hour glucose load 140 mg/dL or greater underwent a diagnostic 3 hour oral glucose tolerance test. We report adjusted prevalence ratios (aPRs) of perinatal outcome risk.

Results: Of the 4659 screen-positive women with diagnostic testing, 1082 (3.3%, of 33,179) met NDDG criteria; 1542 (4.6%, of 33,179), or 460 more, met Carpenter-Coustan criteria. These 460 untreated women had greater risk of preeclampsia than women diagnosed by NDDG criteria (aPR, 1.70; 95% confidence interval [CI], 1.23-2.35). They had a greater risk of cesarean delivery (aPR, 1.16; 95% CI, 1.04-1.30) and infants greater than 4000 g (aPR, 1.25; 95% CI, 1.01-1.56) than women not meeting either diagnostic criteria.

Conclusion: The 42.5% additional women diagnosed only by Carpenter-Coustan criteria are at greater risk for some adverse outcomes. Cost-effectiveness of a change remains to be determined.

Figure 1

Flow diagram of inclusion and exclusion criteria for three study groups (CC only, NDDG, and negative OGTT) of women eligible for gestational diabetes (GDM) screening

Figure 2

Inset of weeks 38 to 40 to show relationship between gestational age at delivery and birthweight for the three study groups with symbols placed at the median gestational age at delivery.