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Local versus International Criteria in Predicting Gestational Diabetes Mellitus-Related Pregnancy Outcomes

Shalimar A. Serafica-Hernandez, MD; Charisse Espina-Tan, MD, FPOGS; Ma. Asuncion Tremedal, MD, FPOGS; Larisa Julia Diaz-Roa, MD, FPOGS
Department of Obstetrics and Gynecology, Cebu Doctors’ University Hospital

Objective: To evaluate the Philippine Obstetrical and Gynecological Society Clinical Practice Guidelines (POGS-CPG) and the International Association of Diabetes and Pregnancy Study Group (IADPSG) diagnostic criteria for gestational diabetes mellitus (GDM) against pregnancy outcomes.

Methods: This is a randomized controlled trial which enlisted patients attending the Out-patient clinic of our institution. All women included in the study were requested to take a 2-hour 75-gram oral glucose tolerance test (OGTT) between estimated 24th and 28th gestational weeks. In order to diagnose GDM, POGS-CPG consensus required a fasting plasma glucose of ?92 mg/dl (5.1 mmol/L) or a 2-hour post-glucose load of ?140 mg/dl (7.8 mmol/ml) while IADPSG criteria required 92 mg/dL (5.1 mmol/L) for fasting plasma glucose, 180 mg/dL (10 mmol/L) 1-hour post-glucose load, or 153 mg/dL (8.5 mmol/L) 2-hour post-glucose load. Only 1 abnormal value on the OGTT is needed on both criteria to diagnose GDM. Women with diabetes antedating pregnancy were excluded in this study. Based on the 75-g OGTT result, the patients were divided into 4 groups and were followed through delivery. Pregnancy outcomes of the 4 groups were then compared.

Results: Among the 389 patients studied, POGS-CPG group had a GDM prevalence rate of 29% whereas the IADPSG group had 16%. Trends have shown that in patients diagnosed with GDM under IADSGP and POGS criteria, no significant differences in the birth-weight status (p=0.156), mode of delivery (p=1.000), indication of cesarean section (p=1.000), and other complications (p=1.000) were noted. The 75 g OGTT values of patients in both groups were not significant predictors of APGAR scores. However, the 1-hour post-glucose load value was shown to be a significant predictor of birthweight. Yet, the regression models of FBS parameters in predicting APGAR scores and birthweight were still weak.

Conclusion: There was no significant difference noted between the IADPSG group versus the POGS-CPG group in terms of maternal and neonatal outcome.