Eh. Pennison et Rs. Egerman, Perinatal outcomes in gestational diabetes: A comparison of criteria for diagnosis, AM J OBST G, 184(6), 2001, pp. 1118-1121
OBJECTIVE: The purpose of this study was to compare the perinatal outcomes
of women after diagnosis of gestational diabetes by the current American Co
llege of Obstetricians and Gynecologists-National Diabetes Data Group recom
mendations with outcomes after diagnosis by the American Diabetes Associati
on criteria.
STUDY DESIGN: We identified records of 242 women who had had the standard 3
-hour oral glucose tolerance test between 1995 and 1999 at the Regional Med
ical center in Memphis. Patients were categorized into 1 of 3 groups as fol
lows. euglycemic control subjects (n = 69), subjects with gestational diabe
tes diagnosed by the National Diabetes Data Group criteria (n = 130), and s
ubjects with gestational diabetes diagnosed by the American Diabetes Associ
ation criteria (n = 43). Maternal and infant charts were reviewed. Primary
outcomes included frequency of cesarean delivery, preeclampsia, and macroso
mia. In univariate analysis the chi (2) test was used to compare group diff
erences, and in multivariate analysis we used stepwise logistic regression
and controlled for confounding factors.
RESULTS: No differences existed among the 3 groups regarding maternal race,
body mass index, history of preeclampsia, or family history of diabetes. T
he frequency of overall cesarean delivery, of cesarean delivery for macroso
mia or arrest disorder, of preeclampsia, and of macrosomia did not differ s
ignificantly among the 3 groups. Neonatal hypoglycemia was more frequent in
the groups with a diagnosis by the American Diabetes Association criteria
(23.3%) and by the National Diabetes Data Group criteria (16.2%) than in th
e control subjects (7.2%), reaching near significance (P = .057). in the mu
ltivariate analysis, cesarean delivery for macrosomia or an arrest disorder
correlated negatively with parity and positively with body mass index. Pre
-eclampsia was associated with African American race and body mass index; m
acrosomia correlated with a history of macrosomia and familial diabetes. Ne
onatal hypoglycemia was more common in the American Diabetes Association gr
oup (odds ratio, 2.45; 95% confidence interval, 1.004-5.97) and in the insu
lin-requiring National Diabetes Data Group category (odds ratio, 3.71; 95%
confidence interval, 1.20-11.44).
CONCLUSION: The benefits of defining an additional high-risk population of
women with gestational diabetes by the American Diabetes Association criter
ia are unclear Further large-scale prospective clinical trials are required
.