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The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus
Open accessAbstract
The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was performed in response to the need for internationally agreed upon diagnostic criteria for gestational diabetes, based upon their predictive value for adverse pregnancy outcome. Increases in each of the 3 values on the 75-g, 2-hour oral glucose tolerance test are associated with graded increases in the likelihood of pregnancy outcomes such as large for gestational age, cesarean section, fetal insulin levels, and neonatal fat content. Based upon an iterative process of decision making, a task force of the International Association of Diabetes and Pregnancy Study Groups recommends that the diagnosis of gestational diabetes be made when any of the following 3 75-g, 2-hour oral glucose tolerance test thresholds are met or exceeded: fasting 92 mg/dL, 1-hour 180 mg/dL, or 2 hours 153 mg/dL. Various authoritative bodies around the world are expected to deliberate the adoption of these criteria.
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Placental Histomorphometry in Gestational Diabetes Mellitus
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“The short-term effects of GDM are well documented [4] and our understanding about the long term consequences for mother and child is growing as results from longitudinal studies become available [5, 6].”
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DESFECHOS MATERNO-FETAIS DE GESTANTES COM E SEM DIABETES MELLITUS GESTACIONAL
Silva, R. R. E., de Souza, M. L. R., de Oliveira, L. C., Silva, T. R. E., Bertoli, J. P. D. P., & Silva, J. C. (2019) · Arquivos Catarinenses de Medicina · doi:10.63845/370yzg60 · Cited by 21
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“For the diagnosis of GDM, all women underwent a 75 g oral glucose tolerance test (OGTT) at 24–28 weeks of gestation, following the criteria suggested by the Hellenic Society of Obstetricians and Gynecologists (HSOG) [36], which are based on the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study [37].”
MethodTranidou, A., Tsakiridis, I. G., Apostolopoulou, A., Xenidis, T., Pazaras, N., Mamopoulos, A. M., Athanasiadis, A. P., Chourdakis, M., & Dagklis, T. (2023) · Nutrients · doi:10.3390/nu16010120 · Cited by 23
“With regards to GDM screening, the Hellenic Society of Obstetricians and Gynecolo-gists recommends universal screening at 24–28 weeks of gestation, using GDM diagnostic criteria that are based on the results of the “Hyperglycemia and Adverse Pregnancy Out-come” (HAPO) study [22].”
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“…recommended new GDM diagnostic criteria mainly based on the results from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study (Metzger et al. 1991; HAPO Study Cooperative Research Group 2002; Coustan et al. 2010; International Association of Diabetes and Pregnancy Study Groups 2010).”
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A mouse model of gestation-specific transient hyperglycemia for translational studies
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Diet and exercise interventions for preventing gestational diabetes mellitus
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“Since 2010, the International Association of Diabetic Pregnancy Study Groups’ (IADPSG) recommended criteria (i.e., the oral glucose tolerance test) [16] have increasingly been used as diagnostic criteria for GDM globally; however, there is still ongoing debate about their usage.”
BackgroundSaeedi, M., Hanson, U., Simmons, D. S., & Fadl, H. (2018) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-018-1875-1 · Cited by 18
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Gestational diabetes mellitus is rare in primigravida Pakistani women
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“The HAPO study extended the Pedersen hypothesis about how maternal hyperglycemia affects the foetus [13] to the normalglycaemic range, thereby giving rise to a comprehensive debate about the GDM diagnosis [11,43–47].”
MethodLifestyle interventions for the treatment of women with gestational diabetes
Brown, J., Alwan, N. A., West, J., Brown, S. C., McKinlay, C. J. D., Farrar, D., & Crowther, C. A. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011970 · Cited by 16
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“GDM is associated with various adverse maternal and fetal outcomes, including preeclampsia, preterm birth, macrosomia, and neonatal hypoglycemia [2].”
BackgroundDoes Maternal Body Mass Index Influence Treatment Effect in Women with Mild Gestational Diabetes?
Mele, L., Landon, M. B., Spong, C. Y., Ramin, S. M., Wapner, R. J., Varner, M. W., Rouse, D. J., Thorp, J. M., Catalano, P., Harper, M., et al. (2014) · American Journal of Perinatology · doi:10.1055/s-0034-1374815 · Cited by 17
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“Gestational diabetes mellitus (GDM), defined as a carbohydrate intolerance of varying severity with onset or first recognition during pregnancy, is one of the most common pregnancy complications, affecting between 3% and 17% of all pregnancies, depending on the population studied and the diagnostic criteria used [1].”
BackgroundOral anti-diabetic pharmacological therapies for the treatment of women with gestational diabetes
Brown, J., Martis, R., Hughes, B., Rowan, J., & Crowther, C. A. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011967 · Cited by 15
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“recognition during pregnancy that complicates 1–22% of all pregnancies, depending on the ethnic background of the study population and the diagnostic criteria used (Coustan et al., 2010; Jenum et al., 2012).”
BackgroundHbA1c at term delivery and adverse pregnancy outcome
Hong, J. G. S., Fadzleeyanna, M. Y. N., Omar, S. Z., & Tan, P. C. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-05000-7 · Cited by 16
Gestational Glucose Intolerance and Birth Weight–Related Complications
Maya, J., Selen, D. J., Thaweethai, T., Hsu, S. C., Godbole, D., Schulte, C. C. M., James, K. E., Sen, S., Kaimal, A. J., Hivert, M., et al. (2023) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000005278 · Cited by 13
Zhang, Y. P., Mei, H., Xiao, H., Zhang, Y., Gao, W., Qi, H., & Zhang, J. (2022) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2022.111101 · Cited by 13
Bashir, M. M., Ahmed, L. A., Elbarazi, I., Loney, T., Al‐Rifai, R. H., Alkaabi, J., & Al‐Maskari, F. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1069477 · Cited by 15
Preeclampsia mediates the association between shorter height and increased risk of preterm delivery
Morisaki, N., Ogawa, K., Urayama, K. Y., Sago, H., Sato, S., & Saito, S. (2017) · International Journal of Epidemiology · doi:10.1093/ije/dyx107 · Cited by 13
Niroomand, M., Afsar, J., Hosseinpanah, F., Afrakhteh, M., Farzaneh, F., & Serahati, S. (2019) · Intern J Endocrinol Metab · doi:10.5812/ijem.88343 · Cited by 14
Rosta, K., Ott, J., Kelemen, F., Temsch, W., Lahner, T., Reischer, T., Helmer, H., & Somogyi, A. (2018) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-018-4895-1 · Cited by 13
Abdelwahab, M., Frey, H. A., Lynch, C. D.-J., Klebanoff, M. A., Thung, S., Costantine, M. M., Landon, M. B., & Venkatesh, K. K. (2023) · American Journal of Perinatology · doi:10.1055/s-0043-1764206 · Cited by 12
Ahmed, M. A., Bailey, H. D., Pereira, G. F., White, S. W., Wong, K., & Shepherd, C. (2022) · BMC Public Health · doi:10.1186/s12889-022-12663-6 · Cited by 11
Shi, Y., Qian, J., Zhang, Q., Hu, Y., Sun, D., & Jiang, L. (2020) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2020.04.058 · Cited by 12
Low-carbohydrate diet and maternal glucose metabolism in Chinese pregnant women
Chen, Q., Chen, Y., Wu, W., Tang, N., Wang, D., Chen, Y., Jin, J., & Cai, L. (2020) · British Journal Of Nutrition · doi:10.1017/s0007114520004092 · Cited by 14
“Considerable evidence showed a continuous positive relationship between fasting plasma glucose (FPG) and postprandial glucose with caesarean section, clinical neonatal hypoglycaemia and preeclampsia(6).”
BackgroundGerome, J. M., Bucher, L. K. M., & Dogbey, G. Y. (2017) · Clinical Diabetes · doi:10.2337/cd16-0031 · Cited by 12
Han, S., Crowther, C. A., & Middleton, P. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009037 · Cited by 12
Impact de la chirurgie bariatrique sur le pronostic obstétrical
Fumery, L., Pigeyre, M., Fournier, C., Arnalsteen, L., Rivaux, G., Subtil, D., & Deruelle, P. (2012) · Gynécologie Obstétrique & Fertilité · doi:10.1016/j.gyobfe.2012.09.004 · Cited by 11
The Effect of the 50 g Glucose Challenge Test on The Thiol/Disulfide Homeostasis in Pregnancy
Mertoğlu, C., Günay, M., Siranli, G., Külhan, M., Gök, G., & Erel, Ö. (2018) · Fetal and Pediatric Pathology · doi:10.1080/15513815.2018.1453002 · Cited by 11
“Since GDM may result in serious complications in both pregnant women and their infants, it is crucial to make an early diagnosis by performing screening tests (3).”
BackgroundCharacteristics of bone turnover markers in women with gestational diabetes mellitus
Zhang, J., Zhang, Y., Wang, J., & Fan, Y. (2019) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2019.12.013 · Cited by 11
Gestational diabetes and pregnancy outcome – do we have right diagnostic criteria?
Tomić, V., Petrović, O., Orlić, Ž. C., & Mandić, V. (2013) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.3109/14767058.2013.776530 · Cited by 11
‘Dealing with ambiguity’– the role of obstetricians in gestational diabetes mellitus
Persson, M., Hörnsten, Å., Winkvist, A., & Mogren, I. (2011) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/j.1600-0412.2011.01240.x · Cited by 11
“However, as the results from the HAPO study are being presented, evidence for consensus criteria for the diagnosis and screening of GDM increases (1,3,23,24).”
Metallinou, D., Lykeridou, A., Karampas, G., Liosis, G., Skevaki, C. L., Rizou, M., Papassotiriou, I., & Rizos, D. (2019) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2019.1628191 · Cited by 11
Unifying the diagnosis of gestational diabetes mellitus: Introducing the NPRP criteria
Doi, S. A. R., Bashir, M., Sheehan, M. T., Onitilo, A. A., Chivese, T., Ibrahim, I., Beer, S. F., Furuya‐Kanamori, L., Abou‐Samra, A., & McIntyre, D. H. (2021) · Primary care diabetes · doi:10.1016/j.pcd.2021.08.006 · Cited by 12
Cord serum dipeptidyl‐peptidase 4 activity in gestational diabetes
Al‐Aissa, Z., Rosta, K., Hadarits, O., Harreiter, J., Zóka, A., Bancher‐Todesca, D., Patócs, A., Kiss, K., Sármán, B., Pusztai, P., et al. (2015) · European Journal of Clinical Investigation · doi:10.1111/eci.12397 · Cited by 11
Metadata
- Authors
- Coustan, D. R., Lowe, L. P., Metzger, B. E., & Dyer, A. R.
- Affiliations
- Brown University (US)
- Northwestern University (US)
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2010-06
- Volume
- 202
- Issue
- 6
- Pages
- 654.e1-654.e6
- ISSN
- 0002-9378 (ISSN-L)
- PMC
- PMC2897007
- OpenAlex
- W2063955121
- Cited by
- 398
- References
- 16
- Citations by year
- 2026: 14 · 2025: 32 · 2024: 20 · 2023: 28 · 2022: 41 · 2021: 25 · 2020: 30 · 2019: 27 · 2018: 20 · 2017: 30 · 2016: 25 · 2015: 23 · 2014: 25 · 2013: 17 · 2012: 12
- FWCI
- 24.86
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01-HD34242, R01-HD34243)
- National Center for Research Resources (M01-RR00048, M01-RR00080)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- American Diabetes Association
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- gestational diabetes mellitus, diagnostic criteria, HAPO study, oral glucose tolerance test, hyperglycemia, adverse pregnancy outcomes, large for gestational age, cesarean section, fetal insulin
- MeSH terms
- Blood Glucose, Female, Glucose Tolerance Test, Humans, Insulin, Predictive Value of Tests, Pregnancy, Pregnancy Outcome, Odds Ratio, Diabetes, Gestational
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