Cited by 398Gestational Diabetes Research and ManagementDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

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The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus

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Coustan, Donald R., Lowe, Lynn P., Metzger, Boyd E., Dyer, Alan R.·2010·American Journal of Obstetrics and Gynecology

DOI 10.1016/j.ajog.2010.04.006PMC PMC2897007

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Abstract

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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“This also has a direct impact on the developing foetal pancreas and remains a risk factor for developing DM in future.(11,12) The present study was aimed to know the feto-maternal outcome of pregestational and gestational diabetes.”
Background
Comparing the first trimester and second trimester fifty grams oral glucose tolerance test values in gestational diabetes mellitus
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“This condition is usually diagnosed at 24–28weeks of gestation during which placental lactogen secretion rises (Woodside and Bradford 2021) and it has been observed that glucose intolerance returns to normal postpartum in the majority of the cases (Coustan et al. 2010).”
Background
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Applications of path analysis and functional data analysis in a longitudinal, clinical cohort study of pregnant women and their neonates.
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Kandauda, C., Manathunga, S. S., Abeyagunawardena, I. A., & Thilakarathne, K. M. H. C. (2022) · medRxiv · doi:10.1101/2022.03.29.22273154 · Cited by 1
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Einstein, F. H. (2012) · Diabetes · doi:10.2337/db12-0087
“With the new diagnostic criteria for gestational diabetes mellitus, this number is expected to rise to ;18% of pregnant women worldwide (5,6).”
Method
PERTINENCE DES CRITERES DE DEPISTAGE DU DIABETE GESTATIONNEL, INDIQUES PAR LE CNGOF, POUR LA POPULATION OBSTETRICALE DU SUD DE LA BASSE TERRE
Bastaraud, H. (2015)
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Onyiriuka, A. N., & Edorhe, S. O. (2016) · Romanian Journal of Diabetes Nutrition and Metabolic Diseases · doi:10.1515/rjdnmd-2016-0041
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Frier, E. M., McKay, G., & Carty, D. (2017) · Practical Diabetes · doi:10.1002/pdi.2113
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Romero, R. J. (2017) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2017.06.037
SOP Laboruntersuchungen in Schwangerschaft und Wochenbett – Teil 2
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“Seit der Veröffentlichung der HAPO-Studie [1] soll bei allen Schwangeren ein oraler Glukosetoleranztest zwischen 24 und 28 Schwangerschaftswochen durchgeführt werden.”
Influential
Metformin use in polycystic ovary syndrome pregnancy impacts on offspring obesity
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Jena, P., Panda, S. K., Nayak, M. K., Rath, S., & Pradhan, D. D. (2019) · International Journal of Community Medicine and Public Health · doi:10.18203/2394-6040.ijcmph20194152
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BackgroundMethod
Gestational diabetes (GDM) does not predict large birthweight or perinatal death in a relatively untreated population in Uganda; a prospective observational cohort study.Preprint
Milln, J., Nakabuye, B., Natamba, B., Sekitoleko, I., Mubiru, M. C., Namara, A. A., Tumwesigire, S., Tino, S., Wilja, M., Kakande, A., et al. (2020) · doi:10.22541/au.158921420.03445354
Screening for Gestational Diabetes
Li, K. E. (2014)
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de Almeida, V. A. H. (2021) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/d.5.2021.tde-22092021-140604
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Current World Literature
(2011) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0b013e3283457c7d
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Medical disorders in pregnancy
Collins, S., Arulkumaran, S., Hayes, K., Jackson, S., & Impey, L. W. M. (2013) · doi:10.1093/med/9780199698400.003.0005
Gestational diabetes
Mackeen, A. D., & Trauffer, P. M. L. (2011) · Series in maternal-fetal medicine · doi:10.3109/9781841848235.005
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Otálora, M., & Ortiz, G. M. (2012) · Revista Repertorio de Medicina y Cirugía · doi:10.31260/repertmedcir.v21.n1.2012.790
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Association of Body Mass Index with Gestational Diabetes Mellitus—an Indian Viewpoint
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More Is Not Always Better
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“GDM diagnosis followed guidelines outlined by the Hellenic Society of Obstetricians and Gynecologists, aligned with criteria established by the HAPO study [16].”
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“Based on the analysis of the HAPO study [36], where about a 5% difference in AUC was associated with an increased positive predictive value (PPV) of infant birth weight and body fat > 90th centile, achieving a 5% difference (mean = 37.5, standard deviation = 99.8, effect size = 0.376) in AUC was…”
Influential
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“In the Lower Criteria Group, GDM was diagnosed if one or more of the following criteria were met, as recommended by the IADPSG: fasting plasma glucose ≥ 5.1 mmol/L[ ≥ 92 mg/dL], one-hour plasma glucose ≥ 10.0 mmol/ L[ ≥ 180 mg/dL] or two-hour plasma glucose ≥ 8.5 mmol/L[ ≥ 153 mg/dL] [18].”
Influential
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“It has been shown that when using the one-step procedure, the prevalence estimates of GD might increase by 1.5 to 3 times higher than those estimated using a two-step procedure [8–11].”
Influential
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Bashir, M. M., Ahmed, L. A., Al‐Rifai, R. H., Elbarazi, I., Loney, T., Afandi, B. O., Alkaabi, J., & Al‐Maskari, F. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1641326
Gestational Diabetes mellitus: The evolution of diagnostic criteria
Holtz, B. M., Paula, V. G., Gomes, M. E. P., Volpato, G. T., & Damasceno, D. C. (2025) · Research Society and Development · doi:10.33448/rsd-v14i11.50245
Additional file 2 of HbA1c at term delivery and adverse pregnancy outcome
Hong, J. G. S., Fadzleeyanna, M. Y. N., Omar, S. Z., & Tan, P. C. (2022) · Figshare · doi:10.6084/m9.figshare.20887418
Additional file 1 of Facilitating safety evaluation in maternal immunization trials: a retrospective cohort study to assess pregnancy outcomes and events of interest in low-risk pregnancies in England
Riley, M., Lambrelli, D., Graham, S., Henry, O., Sutherland, A., Schmidt, A., Sawalhi-Leckenby, N., Donaldson, R., & Stoszek, S. (2022) · Figshare · doi:10.6084/m9.figshare.19960005
Additional file 1 of Development of machine learning models to predict gestational diabetes risk in the first half of pregnancy
Cubillos, G., Monckeberg, M., Plaza, A., Morgan, M., Estévez, P. A., Choolani, M., Kemp, M. W., Illanes, S. E., & Perez, C. A. (2024) · Figshare · doi:10.6084/m9.figshare.26599286
Additional file 4 of Facilitating safety evaluation in maternal immunization trials: a retrospective cohort study to assess pregnancy outcomes and events of interest in low-risk pregnancies in England
Riley, M., Lambrelli, D., Graham, S., Henry, O., Sutherland, A., Schmidt, A., Sawalhi-Leckenby, N., Donaldson, R., & Stoszek, S. (2022) · Figshare · doi:10.6084/m9.figshare.19960014
Additional file 9 of Facilitating safety evaluation in maternal immunization trials: a retrospective cohort study to assess pregnancy outcomes and events of interest in low-risk pregnancies in England
Riley, M., Lambrelli, D., Graham, S., Henry, O., Sutherland, A., Schmidt, A., Sawalhi-Leckenby, N., Donaldson, R., & Stoszek, S. (2022) · Figshare · doi:10.6084/m9.figshare.19960029
Additional file 6 of Facilitating safety evaluation in maternal immunization trials: a retrospective cohort study to assess pregnancy outcomes and events of interest in low-risk pregnancies in England
Riley, M., Lambrelli, D., Graham, S., Henry, O., Sutherland, A., Schmidt, A., Sawalhi-Leckenby, N., Donaldson, R., & Stoszek, S. (2022) · Figshare · doi:10.6084/m9.figshare.19960020
Additional file 1 of Antenatal management and maternal/fetal outcomes associated with hyperglycaemia in pregnancy (HIP) in Uganda; a prospective cohort study
Milln, J., Nakabuye, B., Natamba, B., Sekitoleko, I., Mubiru, M. C., Namara, A. A., Tumwesigire, S., Tino, S., Mirembe, M., Kakande, A., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14623252
Additional file 7 of Facilitating safety evaluation in maternal immunization trials: a retrospective cohort study to assess pregnancy outcomes and events of interest in low-risk pregnancies in England
Riley, M., Lambrelli, D., Graham, S., Henry, O., Sutherland, A., Schmidt, A., Sawalhi-Leckenby, N., Donaldson, R., & Stoszek, S. (2022) · Figshare · doi:10.6084/m9.figshare.19960023
Additional file 1 of National and regional prevalence of gestational diabetes mellitus in India: a systematic review and Meta-analysis
Mantri, N. M., Goel, A. D., Patel, M., Baskaran, P., Dutta, G., Gupta, M. K., Yadav, V., Mittal, M., Shekhar, S., & Bhardwaj, P. (2024) · Figshare · doi:10.6084/m9.figshare.26683228
Additional file 1 of HbA1c at term delivery and adverse pregnancy outcome
Hong, J. G. S., Fadzleeyanna, M. Y. N., Omar, S. Z., & Tan, P. C. (2022) · Figshare · doi:10.6084/m9.figshare.20887415
Additional file 2 of Facilitating safety evaluation in maternal immunization trials: a retrospective cohort study to assess pregnancy outcomes and events of interest in low-risk pregnancies in England
Riley, M., Lambrelli, D., Graham, S., Henry, O., Sutherland, A., Schmidt, A., Sawalhi-Leckenby, N., Donaldson, R., & Stoszek, S. (2022) · Figshare · doi:10.6084/m9.figshare.19960008
Effect of Myo‐Inositol Treatment on Serum Asprosin Levels of Pregnant Women: A Prospective Randomized Controlled Pilot Study
Özay, A. C., Özay, Ö. E., Edebal, O. H., Özay, Y., Oliva, M. M., Dinicola, S., & Unfer, V. (2025) · Journal of Pregnancy · doi:10.1155/jp/8816154
First trimester prediction of gestational diabetes mellitus by machine learning in twin pregnancies
Louzoun, Y., Michelson, T., Bennasar, M., Svirsky, R., Bevilacqua, E., Kugler, N., Kagan, K. O., Brown, R. N., Rodriguez, H. P., Goncé, A., et al. (2026) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-025-08262-6
Association between oral glucose tolerance test (OGTT) glucose levels and fetal macrosomia in non-diabetic women
Bayram, T. Y., Aslancan, R., Güler, O. M., & Yücel, B. (2026) · Journal of Perinatal Medicine · doi:10.1515/jpm-2025-0416
Increased risk of gestational diabetes in women with IBD: pregnancy outcomes for women with IBD from a multidisciplinary clinic at a tertiary centre
Yeo, J. H., Lambo, D., Green, N., Parker, H., McCartney, S. A., Williams, D. J., & Harrow, P. (2026) · Frontline Gastroenterology · doi:10.1136/flgastro-2026-103630
Agouti signalling protein and triglyceride-glucose index in early pregnancy with gestational diabetes: a prospective cohort study
Wei, X., Gong, H., Zhang, Q., Dong, S., Wei, J., & Lu, Y. (2026) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2026.2665634
Redefining Blood Glucose Screening in Pregnancy: From Gestational Diabetes to a Gestational Dysglycemia Spectrum—A Systematic Review and Translational Case Proposal
Kusuma, A. A. N. J., Andonotopo, W., Bachnas, M. A., Prabowo, W., Yuliantara, E. E., Pramono, M. B. A., Dewantiningrum, J., Lukas, E., Sanjaya, N. H., Wiradnyana, A. A. G. P., et al. (2026) · Bangladesh Journal of Endocrinology and Metabolism · doi:10.4103/bjem.bjem_14_26
Independent and synergistic effects of OGTT-based hyperglycemia phenotypes and gestational weight gain on feto-maternal outcomes in GDM
Zhou, Y., Zhu, L., An, H., Wen, H., & Hao, P. (2026) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-026-09264-1
Verbessert ein frühes Screening das Schwangerschaftsoutcome?
Sontag, I., & Adamek, H. E. (2026) · Info Diabetologie · doi:10.1007/s15034-026-5281-x
Gestational diabetes mellitus: Bridging research gaps through a translational framework
Dey, B. K., Basak, M., Maity, S., Roy, S., Kar, A., Chowdhury, S., Roy, S. B., Roy, M., Sahana, P., & Bhattacharjee, R. (2026) · Annals of Medical Science and Research · doi:10.4103/amsr.amsr_30_26
Fetal behavior as a window to later gross motor function: a 10-year follow-up of children prenatally exposed to gestational diabetes mellitus
Vasilj, O., Marinić, D., Trošt, T., & Žeželj, Z. (2026) · Frontiers in Clinical Diabetes and Healthcare · doi:10.3389/fcdhc.2026.1938676
Early prediction of gestational diabetes mellitus using deep learning applied to routinely collected clinical data
Cubillos, G., Mönckeberg, M., Illanes, S. E., & Perez, C. A. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1941799

Authors: Coustan, D. R., Lowe, L. P., Metzger, B. E., & Dyer, A. R.
Affiliations: Brown University (US)
Northwestern University (US)
ORCID: Coustan, Donald R.
Lowe, Lynn P.
Metzger, Boyd E.
Dyer, Alan R.
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)
DOI: 10.1016/j.ajog.2010.04.006
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
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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The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus

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