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

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dc.contributor.authorWendland, Eliana M.
dc.contributor.authorTorloni, Maria Regina [UNIFESP]
dc.contributor.authorFalavigna, Maicon
dc.contributor.authorTrujillo, Janet
dc.contributor.authorDode, Maria Alice
dc.contributor.authorCampos, Maria Amelia
dc.contributor.authorDuncan, Bruce B.
dc.contributor.authorSchmidt, Maria Ines
dc.contributor.institutionFed Univ Hlth Sci
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionUniv Fed Rio Grande do Sul
dc.contributor.institutionUniv Fed Pelotas
dc.contributor.institutionConceicao Hosp
dc.date.accessioned2016-01-24T14:26:59Z
dc.date.available2016-01-24T14:26:59Z
dc.date.issued2012-03-31
dc.description.abstractBackground: Two criteria based on a 2 h 75 g OGTT are being used for the diagnosis of gestational diabetes (GDM), those recommended over the years by the World Health Organization ( WHO), and those recently recommended by the International Association for Diabetes in Pregnancy Study Group (IADPSG), the latter generated in the HAPO study and based on pregnancy outcomes. Our aim is to systematically review the evidence for the associations between GDM ( according to these criteria) and adverse outcomes.Methods: We searched relevant studies in MEDLINE, EMBASE, LILACS, the Cochrane Library, CINHAL, WHO-Afro library, IMSEAR, EMCAT, IMEMR and WPRIM. We included cohort studies permitting the evaluation of GDM diagnosed by WHO and or IADPSG criteria against adverse maternal and perinatal outcomes in untreated women. Only studies with universal application of a 75 g OGTT were included. Relative risks (RRs) and their 95% confidence intervals (CI) were obtained for each study. We combined study results using a random-effects model. Inconsistency across studies was defined by an inconsistency index (I-2) > 50%.Results: Data were extracted from eight studies, totaling 44,829 women. Greater risk of adverse outcomes was observed for both diagnostic criteria. When using the WHO criteria, consistent associations were seen for macrosomia (RR = 1.81; 95%CI 1.47-2.22; p < 0.001); large for gestational age ( RR = 1.53; 95%CI 1.39-1.69; p < 0.001); perinatal mortality (RR = 1.55; 95% CI 0.88-2.73; p = 0.13); preeclampsia (RR = 1.69; 95%CI 1.31-2.18; p < 0.001); and cesarean delivery (RR = 1.37; 95%CI 1.24-1.51; p < 0.001). Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I-2 >= 73%). Magnitudes of RRs and their 95%CIs were 1.73 (1.282.35; p = 0.001) for large for gestational age; 1.71 (1.38-2.13; p < 0.001) for preeclampsia; and 1.23 (1.01-1.51; p = 0.04) for cesarean delivery. Excluding either the HAPO or the EBDG studies minimally altered these associations, but the RRs seen for the IADPSG criteria were reduced after excluding HAPO.Conclusions: the WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes. Associations were of similar magnitude for both criteria. However, high inconsistency was seen for those with the IADPSG criteria. Full evaluation of the latter in settings other than HAPO requires additional studies.en
dc.description.affiliationFed Univ Hlth Sci, Porto Alegre, RS, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, São Paulo, Brazil
dc.description.affiliationUniv Fed Rio Grande do Sul, Porto Alegre, RS, Brazil
dc.description.affiliationUniv Fed Pelotas, Pelotas, Brazil
dc.description.affiliationConceicao Hosp, Porto Alegre, RS, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, EPM, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipWorld Health Organization
dc.description.sponsorshipIDWorld Health Organization: 2010/119177-0
dc.description.sponsorshipIDWorld Health Organization: APW 200308151
dc.format.extent13
dc.identifierhttp://dx.doi.org/10.1186/1471-2393-12-23
dc.identifier.citationBmc Pregnancy and Childbirth. London: Biomed Central Ltd, v. 12, 13 p., 2012.
dc.identifier.doi10.1186/1471-2393-12-23
dc.identifier.fileWOS000304308300001.pdf
dc.identifier.issn1471-2393
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/34722
dc.identifier.wosWOS:000304308300001
dc.language.isoeng
dc.publisherBiomed Central Ltd
dc.relation.ispartofBmc Pregnancy and Childbirth
dc.rightsinfo:eu-repo/semantics/openAccess
dc.titleGestational 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 criteriaen
dc.typeinfo:eu-repo/semantics/article
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