Identification of severe gestational diabetes mellitus after new criteria used in China

Abstract

Objective: To evaluate the way to identify severe gestational diabetes mellitus (GDM) according to the Ministry of Health (MOH) criteria associated with high risk of adverse pregnancy outcomes. Study Design: Medical records of 9803 pregnant women attending Peking University First Hospital were analyzed retrospectively. Participants diagnosed as GDM were divided into different groups according to the different number of oral glucose tolerance test (OGTT) results and the prepregnancy body mass index (BMI). Participants without GDM were included in group N. The incidence of adverse pregnancy outcomes was analyzed according to incremental differences in prepregnancy BMI and the number of abnormal OGTT result. Result: (1) There were 21.8% (2133/9803) women diagnosed as GDM. (2) The frequency of large for gestational age in group 2 (GDM with 2 or more abnormal OGTT value; 21.6%) was significantly higher than group 1 (GDM with only 1 abnormal OGTT value; 16.8%) and group N (13.2%), and there was also significant difference between group 1 and group N. (3) Risk of adverse pregnancy outcomes in GDM would be increased in women with prepregnancy body mass index ≥24 kg m-2 in GDM. (4) Women with BMI <24 kg m-2 in group 1 have low risk of adverse pregnancy outcomes and seldom need insulin (1.3%) in pregnancy. (5) There were 1142 cases (53.5%) of severe GDM in this study and 991 cases (46.5%) of mild GDM. Conclusion: GDM women with ≥2 abnormal OGTT values or only 1 abnormal OGTT value but with prepregnancy BMI ≥24 kg m-2 should be recognized as severe GDM. We should pay more attention to and treat selectively with the severe GDM, especially in rural areas.