Download PDF
Semin Reprod Med 2016; 34(02): 102-109
DOI: 10.1055/s-0036-1572440
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diagnostic Criteria and Treatment for Gestational Diabetes Mellitus

Daphne N. Voormolen
1   Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
,
Sally K. Abell
2   Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
,
Rachel James
3   Department of Obstetrics and Gynaecology, Women's and Children's Hospital, Adelaide, Australia
,
William M. Hague
5   The Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
,
Ben Willem Mol
4   Department of Obstetrics and Gynaecology, South Australian Health and Medical Research Institute, Adelaide, Australia
5   The Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
11 February 2016 (online)

    Permissions and Reprints

Abstract

The prevalence of gestational diabetes mellitus (GDM) is high, and the risks of maternal and perinatal complications with clear hyperglycemia are well recognized. The worldwide obesity epidemic and the consequent excess of hyperglycemia have resulted in a rising prevalence of GDM. Changing definitions and more intensive screening may also be contributing to an increased prevalence. Despite the recognized risks, much controversy surrounds the screening, diagnosis, and treatment of GDM. The more stringent diagnostic criteria, advocated in new guidelines, are based on observational studies and are not guided by interventional studies. Here, we review the evidence behind updated diagnostic criteria, stricter treatment targets, and current controversies and conclude that international consensus regarding diagnosis and treatment will only be achieved with further evidence from interventional studies.

Keywords

gestational diabetes - GDM diagnostic criteria - treatment - guidelines
 

  • References

  • 1 Metzger BE, Coustan DR ; The Organizing Committee. Summary and recommendations of the fourth international workshop-conference on gestational diabetes mellitus. Diabetes Care 1998; 21 (Suppl. 02) B161-B167
    PubMedGoogle Scholar
  • 2 Metzger BE, Lowe LP, Dyer AR , et al; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358 (19) 1991-2002
    CrossrefPubMedGoogle Scholar
  • 3 Solomon CG, Willett WC, Carey VJ , et al. A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA 1997; 278 (13) 1078-1083
    CrossrefPubMedGoogle Scholar
  • 4 King H. Epidemiology of glucose intolerance and gestational diabetes in women of childbearing age. Diabetes Care 1998; 21 (Suppl. 02) B9-B13
    CrossrefPubMedGoogle Scholar
  • 5 Scifres C, Feghali M, Althouse AD, Caritis S, Catov J. Adverse outcomes and potential targets for intervention in gestational diabetes and obesity. Obstet Gynecol 2015; 126 (2) 316-325
    CrossrefPubMedGoogle Scholar
  • 6 Brunner S, Stecher L, Ziebarth S , et al. Excessive gestational weight gain prior to glucose screening and the risk of gestational diabetes: a meta-analysis. Diabetologia 2015; 58 (10) 2229-2237
    CrossrefPubMedGoogle Scholar
  • 7 Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002; 25 (10) 1862-1868
    CrossrefPubMedGoogle Scholar
  • 8 O'Sullivan JB, Mahan CM. Prospective study of 352 young patients with chemical diabetes. N Engl J Med 1968; 278 (19) 1038-1041
    CrossrefPubMedGoogle Scholar
  • 9 Carr DB, Utzschneider KM, Hull RL , et al. Gestational diabetes mellitus increases the risk of cardiovascular disease in women with a family history of type 2 diabetes. Diabetes Care 2006; 29 (9) 2078-2083
    CrossrefPubMedGoogle Scholar
  • 10 Launer LJ, Hofman A, Grobbee DE. Relation between birth weight and blood pressure: longitudinal study of infants and children. BMJ 1993; 307 (6917) 1451-1454
    CrossrefPubMedGoogle Scholar
  • 11 Harder T, Rodekamp E, Schellong K, Dudenhausen JW, Plagemann A. Birth weight and subsequent risk of type 2 diabetes: a meta-analysis. Am J Epidemiol 2007; 165 (8) 849-857
    CrossrefPubMedGoogle Scholar
  • 12 Pettitt DJ, Baird HR, Aleck KA, Bennett PH, Knowler WC. Excessive obesity in offspring of Pima Indian women with diabetes during pregnancy. N Engl J Med 1983; 308 (5) 242-245
    CrossrefPubMedGoogle Scholar
  • 13 Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS ; Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352 (24) 2477-2486
    CrossrefPubMedGoogle Scholar
  • 14 Landon MB, Spong CY, Thom E , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361 (14) 1339-1348
    CrossrefPubMedGoogle Scholar
  • 15 Moses RG. The recurrence rate of gestational diabetes in subsequent pregnancies. Diabetes Care 1996; 19 (12) 1348-1350
    CrossrefPubMedGoogle Scholar
  • 16 Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373 (9677) 1773-1779
    CrossrefPubMedGoogle Scholar
  • 17 Ratner RE, Christophi CA, Metzger BE , et al; Diabetes Prevention Program Research Group. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab 2008; 93 (12) 4774-4779
    CrossrefPubMedGoogle Scholar
  • 18 O'Sullivan JB. Gestational diabetes. Unsuspected, asymptomatic diabetes in pregnancy. N Engl J Med 1961; 264 (21) 1082-1085
    CrossrefPubMedGoogle Scholar
  • 19 O'Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes 1964; 13: 278-285
    PubMedGoogle Scholar
  • 20 Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a world health organization guideline. Diabetes Res Clin Pract 2014; 103 (3) 341-363
    CrossrefPubMedGoogle Scholar
  • 21 World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus. WHO/NCD/NCS/99.2 ed. Geneva: World Health Organization; 1999
    Google Scholar
  • 22 Metzger BE, Gabbe SG, Persson B , et al; 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 2010; 33 (3) 676-682
    Google Scholar
  • 23 Nankervis A, Conn J. Gestational diabetes mellitus—negotiating the confusion. Aust Fam Physician 2013; 42 (8) 528-531
    PubMedGoogle Scholar
  • 24 Landon MB, Gabbe SG. Gestational diabetes mellitus. Obstet Gynecol 2011; 118 (6) 1379-1393
    CrossrefPubMedGoogle Scholar
  • 25 American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care 2013; 36 (Suppl. 01) S11-S66
    CrossrefPubMedGoogle Scholar
  • 26 Committee on Practice Bulletins--Obstetrics. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol 2013; 122 (2, Pt 1) 406-416
    CrossrefPubMedGoogle Scholar
  • 27 Black MH, Sacks DA, Xiang AH, Lawrence JM. The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth. Diabetes Care 2013; 36 (1) 56-62
    CrossrefPubMedGoogle Scholar
  • 28 Ryan EA. Diagnosing gestational diabetes. Diabetologia 2011; 54 (3) 480-486
    CrossrefPubMedGoogle Scholar
  • 29 Metzger BE, Buchanan TA, Coustan DR , et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care 2007; 30 (Suppl. 02) S251-S260
    CrossrefPubMedGoogle Scholar
  • 30 Thangaratinam S, Rogozinska E, Jolly K , et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ 2012; 344: e2088
    CrossrefPubMedGoogle Scholar
  • 31 Thompson D, Berger H, Feig D , et al; Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Diabetes and pregnancy. Can J Diabetes 2013; 37 (Suppl. 01) S168-S183
    CrossrefPubMedGoogle Scholar
  • 32 National Institute for Health and Care Excellence. Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period. 2015. Available at: nice.org.uk/guidance/ng3 . Accessed September 16, 2015
    PubMedGoogle Scholar
  • 33 Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzales O. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med 2000; 343 (16) 1134-1138
    CrossrefPubMedGoogle Scholar
  • 34 Rowan JA, Hague WM, Gao W, Battin MR, Moore MP ; MiG Trial Investigators. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med 2008; 358 (19) 2003-2015
    CrossrefPubMedGoogle Scholar
  • 35 Rø TB, Ludvigsen HV, Carlsen SM, Vanky E. Growth, body composition and metabolic profile of 8-year-old children exposed to metformin in utero. Scand J Clin Lab Invest 2012; 72 (7) 570-575
    CrossrefPubMedGoogle Scholar
  • 36 Tertti K, Eskola E, Rönnemaa T, Haataja L. Neurodevelopment of two-year-old children exposed to metformin and insulin in gestational diabetes mellitus. J Dev Behav Pediatr 2015; 36 (9) 752-757
    CrossrefPubMedGoogle Scholar
  • 37 Lambert K, Holt RI. The use of insulin analogues in pregnancy. Diabetes Obes Metab 2013; 15 (10) 888-900
    CrossrefPubMedGoogle Scholar
  • 38 Balsells M, García-Patterson A, Solà I, Roqué M, Gich I, Corcoy R. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ 2015; 350: h102
    CrossrefPubMedGoogle Scholar
  • 39 Rowan JA, Rush EC, Obolonkin V, Battin M, Wouldes T, Hague WM. Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition at 2 years of age. Diabetes Care 2011; 34 (10) 2279-2284
    CrossrefPubMedGoogle Scholar
  • 40 Bahado-Singh RO, Mele L, Landon MB , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-fetal Medicine Units Network. Fetal male gender and the benefits of treatment of mild gestational diabetes mellitus. Am J Obstet Gynecol 2012; 206 (5) 422.e1-422.e5
    CrossrefPubMedGoogle Scholar
  • 41 Lapolla A, Dalfrà MG, Ragazzi E, De Cata AP, Fedele D. New International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations for diagnosing gestational diabetes compared with former criteria: a retrospective study on pregnancy outcome. Diabet Med 2011; 28 (9) 1074-1077
    CrossrefPubMedGoogle Scholar
  • 42 Ethridge Jr JK, Catalano PM, Waters TP. Perinatal outcomes associated with the diagnosis of gestational diabetes made by the international association of the diabetes and pregnancy study groups criteria. Obstet Gynecol 2014; 124 (3) 571-578
    CrossrefPubMedGoogle Scholar
  • 43 O'Sullivan EP, Avalos G, O'Reilly M, Dennedy MC, Gaffney G, Dunne F ; Atlantic DIP collaborators. Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria. Diabetologia 2011; 54 (7) 1670-1675
    CrossrefPubMedGoogle Scholar
  • 44 Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med 2013; 159 (2) 123-129
    CrossrefPubMedGoogle Scholar
  • 45 Vandorsten JP, Dodson WC, Espeland MA , et al. NIH consensus development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statements 2013; 29 (1) 1-31
    PubMedGoogle Scholar
  • 46 Sacks DA, Hadden DR, Maresh M , et al; HAPO Study Cooperative Research Group. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care 2012; 35 (3) 526-528
    CrossrefPubMedGoogle Scholar
  • 47 Wilson J, Jungner G. Principles and Practice of Screening. WHO: Geneva; 1968
    Google Scholar
  • 48 Cuckle H. Principles of screening. Obstetrician Gynaecologist 2004; 6 (1) 21-25
    PubMedGoogle Scholar
  • 49 Grimes DA, Schulz KF. Uses and abuses of screening tests. Lancet 2002; 359 (9309) 881-884
    CrossrefPubMedGoogle Scholar
  • 50 Alberti KGMM, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; 15 (7) 539-553
    CrossrefPubMedGoogle Scholar
  • 51 Godfrey KM, Barker DJ. Fetal nutrition and adult disease. Am J Clin Nutr 2000; 71 (5, Suppl): 1344S-1352S
    PubMedGoogle Scholar
  • 52 Langer O, Levy J, Brustman L, Anyaegbunam A, Merkatz R, Divon M. Glycemic control in gestational diabetes mellitus—how tight is tight enough: small for gestational age versus large for gestational age?. Am J Obstet Gynecol 1989; 161 (3) 646-653
    CrossrefPubMedGoogle Scholar
  • 53 van Leeuwen M, Opmeer BC, Zweers EJ , et al. Estimating the risk of gestational diabetes mellitus: a clinical prediction model based on patient characteristics and medical history. BJOG 2010; 117 (1) 69-75
    CrossrefPubMedGoogle Scholar
  • 54 Hernandez TL. Glycemic targets in pregnancies affected by diabetes: historical perspective and future directions. Curr Diab Rep 2015; 15 (1) 1-12
    CrossrefPubMedGoogle Scholar
  • 55 Hernandez TL, Friedman JE, Van Pelt RE, Barbour LA. Patterns of glycemia in normal pregnancy: should the current therapeutic targets be challenged?. Diabetes Care 2011; 34 (7) 1660-1668
    CrossrefPubMedGoogle Scholar
  • 56 Schaefer-Graf UM, Graf K, Kulbacka I , et al. Maternal lipids as strong determinants of fetal environment and growth in pregnancies with gestational diabetes mellitus. Diabetes Care 2008; 31 (9) 1858-1863
    CrossrefPubMedGoogle Scholar
  • 57 Prutsky GJ, Domecq JP, Wang Z , et al. Glucose targets in pregnant women with diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab 2013; 98 (11) 4319-4324
    CrossrefPubMedGoogle Scholar
  • 58 Rowan JA, Gao W, Hague WM, McIntyre HD. Glycemia and its relationship to outcomes in the metformin in gestational diabetes trial. Diabetes Care 2010; 33 (1) 9-16
    CrossrefPubMedGoogle Scholar
  • 59 Langer O. Glycemic targets for the optimal treatment of GDM. Clin Obstet Gynecol 2013; 56 (4) 788-802
    CrossrefPubMedGoogle Scholar
  • 60 Buchanan TA, Kjos SL, Montoro MN , et al. Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes. Diabetes Care 1994; 17 (4) 275-283
    CrossrefPubMedGoogle Scholar
  • 61 Kjos SL, Schaefer-Graf U, Sardesi S , et al. A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Diabetes Care 2001; 24 (11) 1904-1910
    CrossrefPubMedGoogle Scholar
  • 62 Bonomo M, Cetin I, Pisoni MP , et al. Flexible treatment of gestational diabetes modulated on ultrasound evaluation of intrauterine growth: a controlled randomized clinical trial. Diabetes Metab 2004; 30 (3) 237-244
    CrossrefPubMedGoogle Scholar
  • 63 Schaefer-Graf UM, Kjos SL, Fauzan OH , et al. A randomized trial evaluating a predominantly fetal growth-based strategy to guide management of gestational diabetes in Caucasian women. Diabetes Care 2004; 27 (2) 297-302
    CrossrefPubMedGoogle Scholar
  • 64 Nankervis A, McIntyre H, Moses R , et al; Australasian Diabetes in Pregnancy Society. ADIPS consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia and New Zealand. 2014. Available at: https://www.ranzcog.edu.au/doc/adips-gdm-guidelines.html . Accessed February 3, 2016
    PubMedGoogle Scholar
  • 65 American Diabetes Association. Gestational diabetes mellitus. Diabetes Care 2003; 26 (Suppl. 01) S103-S105
    CrossrefPubMedGoogle Scholar