Evolution of maternal and neonatal outcomes before and after the adoption of the IADPSG/WHO guidelines in Belgium: A descriptive study of 444,228 pregnancies.
Oriot, Philippe; Leroy, Charlotte; Van Leeuw, Virginieet al.
[en] OBJECTIVES: To appraise adverse pregnancy outcomes after the adoption of IADPSG/WHO guidelines in Belgium. METHODS: A retrospective study of the Center for Perinatal Epidemiology registry was conducted. Demographic changes and adverse pregnancy outcomes were compared between a pre- and post-guideline period in women with and without hyperglycemia in pregnancy (HIP). Adjusted odds ratios with a 95% confidence interval (CI) were used to compare maternal and neonatal outcomes controlling for potential confounders (maternal age, body mass index (BMI), hypertension, parity, and multiple births). RESULTS: The prevalence of HIP increased (6.0%-9.2%). In the overall population regardless of glycemic status, gestational weight gain (12.3 ± 5.7 vs 11.9 ± 5.8; p < 0.001), hypertension (0.92; 95% CI, 0.89-0.94; p < 0.001), and neonatal intensive care unit/special care nursery (0.89; 95% CI, 0.87-0.91; p < 0.001) decreased despite increasing maternal age and pre-pregnancy BMI. Emergency cesarean section rates (1.07; 95% CI, 1.05-1.09; p < 0.001) increased, but not in the HIP population (1.02; 95% CI, 0.95-1.10; ns). The overall incidence of preterm birth (1.09; 95% CI, 1.06-1.12; p < 0.001), stillbirth (1.10; 95% CI, 1.01-1.21; p < 0.05), and perinatal mortality (1.10; 95% CI, 1.01-1.19; p < 0.05) increased, except in the HIP population (1.03; 95% CI, 0.95-1.11; ns), (1.04; 95% CI, 0.74-1.47; ns) and (1.09; 95% CI, 0.80-1.49; ns), respectively. The overall incidence of small- for-gestational-age remained unchanged (0.99; 95%CI, 0.97-1.01; ns) regardless of glycemic status. In the HIP population, large-for-gestational age (0.90; 95% CI, 0.84-0.95; p < 0.001) and macrosomia (0.84; 95% CI, 0.78-0.92; p < 0.001) decreased. CONCLUSION: After the implementation of IADPSG/WHO guidelines, the prevalence of HIP increased by 53.7% and the incidence of major HIP-related pregnancy complications appears to be lower. However, we cannot conclude that the reduction of LGA-macrosomia is due to a better management of diabetes or due to greater recruitment of women with mild HIP associated with a lower risk of obstetrical complications.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Oriot, Philippe; Department of Diabetology, Mouscron Hospital Centre, Avenue de Fécamp 49, 7700,
Leroy, Charlotte; Centre d'Épidémiologie Périnatale (CEpiP), Clos Chapelle-aux-Champs 30, bte
Van Leeuw, Virginie; Centre d'Épidémiologie Périnatale (CEpiP), Clos Chapelle-aux-Champs 30, bte
Philips, Jean Christophe; Diabetes, Nutrition and Metabolic Disorders, Liege University, CHU Sart-Tilman,
Vanderijst, Jean François; Department of General Internal Medicine, Clinique Saint-Pierre, Av. Reine Fabiola
Vuckovic, Aline; Neonatal Intensive Care Unit, Hôpital Universitaire des Enfants Reine Fabiola,
Costa, Elena; Department of Obstetrics and Gynecology, Erasme Hospital, Route de Lennik 808,
Debauche, Christian; Department of Neonatology, Cliniques Universitaires Saint Luc, UCLouvain, Av.
Chantraine, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR) ; Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de
Language :
English
Title :
Evolution of maternal and neonatal outcomes before and after the adoption of the IADPSG/WHO guidelines in Belgium: A descriptive study of 444,228 pregnancies.
Wendland, E.M., Torloni, M.R., Falavigna, M., Trujillo, J., Dode, M.A., Campos, M.A., et al. Gestational diabetes and pregnancy outcomes - a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in pregnancy study groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth, 12(1), 2012, 23.
Duran, A., Saenz, S., Torrejon, M.J., Bordiú, E., Del Valle, L., Galindo, M., et al. Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study. Diabetes Care 37:9 (2014), 2442–2450.
Weile, L.K., Kahn, J.G., Marseille, E., Jensen, D.M., Damm, P., Lohse, N., Global cost-effectiveness of GDM screening and management: current knowledge and future needs. Best. Pract. Res. Clin. Obstet. Gynaecol. 29:2 (2015 Feb), 206–224 Epub 2014 Aug 21. PMID: 25225056.
Vanderijst, J.F., Debieve, F., Doucet, F., Emonts, P., Haumont, S., Hubinont, C., et al. Groupement des Gynécologues Obstétriciens; Langue Française de Belgique. Stratégie de dépistage et critères diagnostiques du diabète gestationnel. Propositions du GGOLFB [Screening strategy and diagnostic criteria for gestational diabetes. Proposals of the GGOLFB]. Rev. Med. Liege 67:4 (2012 Apr), 179–185 (French). PMID: 22670444.
Metzger, B.E., Gabbe, S.G., Persson, B., Buchanan, T.A., Catalano, P.A., Damm, P., et al. International association of diabetes and pregnancy study group consensus panel: recommendations on the diagnostic and classification of hyperglycemia in pregnancy. Diabetes Care 33:3 (2010), 676–682.
Benhalima, K., Van Crombrugge, P., Moyson, C., Verhaeghe, J., Vandeginste, S., Verlaenen, H., et al. A modified two-step screening strategy for gestational diabetes mellitus based on the 2013 WHO criteria by combining the glucose challenge test and clinical risk factors. J. Clin. Med., 7(10), 2018, 351.
Benhalima, K., Minschart, C., Van Crombrugge, P., Calewaert, P., Verhaeghe, J., Vandamme, S., et al. The 2019 Flemish consensus on screening for overt diabetes in early pregnancy and screening for gestational diabetes mellitus. Acta Clin. Belg. 75:5 (2020), 340–347.
Cosson, E., Vicaut, E., Sandre-Banon, D., Gary, F., Pharisien, I., Portal, J.-J., et al. Performance of a selective screening strategy for diagnosis of hyperglycaemia in pregnancy as defined by IADPSG/WHO criteria. Diabetes Metab. 46:4 (2020), 311–318.
Wei, Y., Xu, Q., Yang, H., Yang, Y., Wang, L., Chen, H., et al. Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: a population-based cohort study in China. PLoS Med., 16(10), 2019, e1002926.
Razzaghi, H., Marcinkevage, J., Peterson, C., Prevalence of undiagnosed diabetes among nonpregnant women of reproductive age in the United States. 1999-2010. Prim. Care Diabetes 9:1 (2015), 71–73.
Alexopoulos, A.S., Blair, R., Peters, A., Management of preexisting diabetes in pregnancy: a Review. JAMA 321:18 (2019), 1811–1819.
Chivese, T., Hoegfeldt, C.A., Werfalli, M., Yuen, L., Sun, H., Karuranga, S., Li, N., Gupta, A., Immanuel, J., Divakar, H., Powe, C.E., Levitt, N.S., Yang, X., Simmons, D., IDF Diabetes Atlas: the prevalence of pre-existing diabetes in pregnancy - a systematic review and meta-analysis of studies published during 2010-2020. Diabetes Res. Clin. Pract., 2021 Sep 14, 109049 Epub ahead of print. PMID: 34883190.
Khalil, A., Syngelaki, A., Maiz, N., Zinevich, Y., Nicolaides, K.H., Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound Obstet. Gynecol. 42:6 (2013 Dec), 634–643 PMID: 23630102.
Farrar, D., Simmonds, M., Bryant, M., Lawlor, A.D., Dunne, F., Tuffnell, D., et al. Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: a systematic review and meta-analysis and analysis of two pregnancy cohorts. PLoS One, 12(4), 2017, e0175288.
Villar, J., Cheikh Ismail, L., Victora, C.G., Ohuma, E.O., Bertino, E., Altman, D.G., et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet 384:9946 (2014), 857–868.
Metzger, B.E., Lowe, L.P., Dyer, A.R., Trimble, E.R., Chaovarindr, U., Coustan, D.R., et al. Hyperglycemia and adverse pregnancy outcomes. N. Engl. J. Med. 358:19 (2008), 1991–2002.
Clarke, E., Cade, J.T., Brennecke, S., Early Pregnancy Screening for Women at High-Risk of GDM Results in reduced neonatal morbidity and similar maternal outcomes to routine screening. J. Pregnancy, 2020, 2020 Jan 29, 9083264.
Wu, E.-T., Nien, F.-J., Kuo, C.-H., Chen, S.-C., Chen, K.-Y., Chuang, L.M., et al. Diagnosis of more gestational diabetes lead to better pregnancy outcomes: comparing the international association of the diabetes and pregnancy study group criteria, and the carpenter and coustan criteria. J. Diabetes Investig. 7:1 (2016), 121–126.
Lucovnik, M., Steblovnik, L., Verdenik, I., Premru-Srsen, T., Tomazic, M., Tul, N., Changes in perinatal outcomes after implementation of IADPSG criteria for screening and diagnosis of gestational diabetes mellitus: a national survey. Int. J. Gynaecol. Obstet. 149:1 (2020 Apr), 88–92 Epub 2020 Jan 27. PMID: 31925788.
Feldman, R.K., Tieu, R.S., Yasumura, L., Gestational diabetes screening: the international association of the diabetes and pregnancy study groups compared with carpenter-coustan screening. Obstet. Gynecol. 127:1 (2016), 10–17.
Benhalima, K., Hanssens, M., Devlieger, R., Verhaeghe, J., Mathieu, C., Analysis of pregnancy outcomes using the new IADPSG recommendation compared with the carpenter and coustan criteria in an area with a low prevalence of gestational diabetes. Internet J. Endocrinol., 2013, 2013, 248121.
Costa, E., Kirckpartick, C., Gerday, C., De Kempeneer, A., Derisbourg, S., Vercoutere, A., et al. Change in prevalence of gestational diabetes and obstetric complications when applying IADPSG screening criteria in a Belgian French speaking University Hospital. A retrospective cohort study. BMC Pregnancy Childbirth, 19(1), 2019, 249.
Oriot, P., Radikov, J., Gilleman, U., Loumaye, R., Ryckoort, V., Debue, E., et al. Gestational diabetes mellitus screening according to carpenter-coustan and IADPSG criteria: a 7-year follow-up of prevalence, treatment, and neonatal complications at a Belgian general hospital. Diabetes Metab. 44:3 (2018), 309–312.
Hillier, T.A., Pedula, K.L., Ogasawara, K.K., Vesco, K.K., Oshiro, C.E.S., Lubarsky, S.L., Van Marter, J., A pragmatic, randomized clinical trial of gestational diabetes screening. N. Engl. J. Med. 384:10 (2021 Mar 11), 895–904 PMID: 33704936.
O'Sullivan, E.P., Avalos, G., O'Reilly, M., Dennedy, M.C., Graffney, G., Dunne, F., On behalf of the Atlantic DIP collaborators. Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using the new criteria. Diabetologia 54:7 (2011), 1670–1675.
Ellenberg, A., Sarvilinna, N., Gissler, M., Ulander, V.M., New guidelines for screening, diagnosing, and treating gestational diabetes - evaluation of maternal and neonatal outcomes in Finland from 2006 to 2012. Acta Obstet. Gynecol. Scand. 96:3 (2017), 372–381.
Feldman, R.K., Tieu, R.S., Yasumura, L., Gestational diabetes screening: the international association of the diabetes and pregnancy study groups compared with carpenter-coustan screening. Obstet. Gynecol. 127:1 (2016), 10–17.
Leroy, Ch, Van Leeuw, V., Englert, Y., Données périnatales en Wallonie – Année 2013. 2015, Centre d’Épidémiologie Périnatale https://www.cepip.be.
Leroy, Ch, Van Leeuw, V., Englert, Y., Zhang, W.H., Santé périnatale en Wallonie – Année 2015. 2017, Centre d’Épidémiologie Périnatale https://www.cepip.be.
Caissutti, C., Khalifeh, A., Saccone, G., Berghella, V., Are women positive for the One Step but negative for the Two Step screening tests for gestational diabetes at higher risk for adverse outcomes?. Acta Obstet. Gynecol. Scand. 97:2 (2018 Feb), 122–134 Epub 2017 Dec 12. PMID: 29091257.
Long, H., Cundy, T., Establishing consensus in the diagnosis of gestational diabetes following HAPO: where do we stand?. Curr. Diabetes Rep. 13 (2013), 43–50.
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. 161:3 (1989 Sep), 646–653 PMID: 2782347.
Catalano, P.M., Mele, L., Landon, M.B., Ramin, S.M., Reddy, U.M., Casey, B., et al. Shriver national institute of child health and human development maternal-fetal medicine units network. Inadequate weight gain in overweight and obese pregnant women: what is the effect on fetal growth?. Am. J. Obstet. Gynecol. 211:2 (2014 Aug), 137.e1–137.e7 Epub 2014 Feb 11. PMID: 24530820; PMCID: PMC4117705.
