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The Impact of Risk Factors and More Stringent Diagnostic Criteria of Gestational Diabetes on Outcomes in Central European Women

Departments of Endocrinology and Metabolism (A.K.-W., T.P.), Obstetrics and Gynecology (D.B.-T.), Neonatology (R.B.), and Statistics (B.S.), Medical University of Vienna, Vienna, Austria; First Department of Medicine (R.W.) and Department of Obstetrics and Gynecology (H.S.), Paracelsus Private Medical University Salzburg, Salzburg, Austria; Department of Internal Medicine I (N.S., G.S.), Rudolfstiftung Vienna, Vienna, Austria; First Department of Medicine (M.R.), Hanusch-Krankenhaus, Vienna, Austria; and Department of Internal Medicine (C.M., M.L.), University of Innsbruck, Innsbruck, Austria, for The Austrian Gestational Diabetes Study Group

Address all correspondence and requests for reprints to: Alexandra Kautzky-Willer, M.D., Associate Professor of Medicine, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna; Austria. E-mail: alexandra.kautzky-willer{at}meduniwien.ac.at.

Objectives: In the face of the ongoing discussion on the criteria for the diagnosis of gestational diabetes (GDM), we aimed to examine whether the criteria of the Fourth International Workshop Conference of GDM (WC) select women and children at risk better than the World Health Organization (WHO) criteria.

Design and Setting: This was a prospective longitudinal open study in five tertiary care centers in Austria.

Patients and Outcome Measures: The impact of risk factors, different thresholds (WC vs. WHO), and numbers of abnormal glucose values (WC) during the 2-h, 75-g oral glucose tolerance test on fetal/neonatal complications and maternal postpartum glucose tolerance was studied in 1466 pregnant women. Women were treated if at least one value according to the WC (GDM-WC1) was met or exceeded.

Results: Forty-six percent of all women had GDM-WC1, whereas 29% had GDM-WHO, and 21% of all women had two or three abnormal values according to WC criteria (GDM-WC2). Eighty-five percent of the GDM-WHO were also identified by GDM-WC1. Previous GDM [odds ratio (OR) 2.9], glucosuria (OR 2.4), preconceptual overweight/obesity (OR 2.3), age 30 yr or older (OR 1.9), and large-for-gestational age (LGA) fetus (OR 1.8) were the best independent predictors of the occurrence of GDM. Previous GDM (OR 4.4) and overweight/obesity (OR 4.0) also independently predicted diabetes postpartum. GDM-WC1 had a higher rate of obstetrical complications (LGA neonates, neonatal hypoglycemia, cesarean sections; P < 0.001) and impaired postpartum glucose tolerance (P < 0.0001) than GDM-WHO.

Conclusion: These results suggest the use of more stringent WC criteria for the diagnosis of GDM with the initiation of therapy in case of one fasting or stimulated abnormal glucose value because these criteria detected more LGA neonates with hypoglycemia and mothers with impaired postpartum glucose metabolism than the WHO criteria.

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