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Cited by 14Gestational Diabetes Research and ManagementMaternal and Perinatal Health InterventionsDiabetes Management and Research

The impact of revised diagnostic criteria on hospital trends in gestational diabetes mellitus rates in a high income country

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McMahon, Léan E., O’Malley, Eimer G., Reynolds, Ciara M. E., Turner, Michael J.·2020·BMC Health Services Research
DOI 10.1186/s12913-020-05655-yPMC PMC7449010
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Abstract

Objective: In 2010, national guidelines were published in Ireland recommending more sensitive criteria for the diagnosis of Gestational Diabetes Mellitus (GDM). The criteria were based on the 2008 Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study and were endorsed subsequently by the World Health Organization (WHO). Screening nationally is selective based on risk factors. We examined the impact of the new criteria on hospital trends nationally for GDM over the 10 years 2008–17. Research design and methods: Data from three national databases, the Hospital Inpatient Enquiry System (HIPE), National Perinatal Reporting System (NPRS) and the Irish Maternity Indicator System (IMIS), were analyzed using descriptive statistics, analysis of variance, and Poisson loglinear modelling. Results: The overall incidence of GDM nationally increased almost five-fold from 3.1% in 2008 to 14.8% in 2017 (p ≤ 0.001). The incidence varied widely across maternity units. In 2008, the incidence varied from 0.4 to 5.9% and in 2017 it varied from 1.9 to 29.4%. There were increased obstetric interventions among women with GDM over the decade, specifically women with GDM having increased cesarean sections (CS) and induction of labor (IOL) (p ≤ 0.001). These trends were significant in large and mid-sized maternity hospitals (p ≤ 0.001). The increase in GDM diagnosis could not be explained by an increase in maternal age nationally over the decade. The data did not include information on other risk factors such as obesity. The increased incidence in GDM diagnosis was accompanied by a decrease in high birthweight ≥ 4.5 kg nationally. Conclusions: We found adoption of the new criteria for diagnosis of GDM resulted in a major increase in the incidence of GDM rates. Inter-hospital variations increased over the decade, which may be explained by variations in the implementation of the new national guidelines in different maternity units. It is likely to escalate further as compliance with national guidelines improves at all maternity hospitals, with implications for provision and configuration of maternity services. We observed trends that may indicate improvements for women and their offspring, but more research is required to understand patterns of guideline implementation across hospitals and to demonstrate how increased GDM diagnosis will improve clinical outcomes.

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  • In an Irish hospital between 2008 and 2017, McMahon et al. presented a five-fold increase in GDM incidence from 3.1% in 2008 to 14.8% in 2017, closely connected with changing guidelines.

    “They presented a five-fold increase in the GDM incidence from 3.1% in 2008 to 14.8% in 2017, which is closely connected with changing guidelines for GDM diagnosis [163].”

    From Evolution of Gestational Diabetes Mellitus across Continents in 21st Century (2022) · cites this paper as [163]

    The Results report an almost five-fold rise in GDM diagnosis from 3.1% in 2008 to 14.8% in 2017, with variation becoming more pronounced after the new diagnostic criteria were introduced in 2011. The Discussion associates the national increase with the more sensitive test and guideline implementation. However, these figures cover maternity hospitals across Ireland, not one Irish hospital. (LLM, conf=0.90)

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Research works printed but not linked: 23

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Authors
McMahon, L. E., O’Malley, E. G., Reynolds, C. M. E., & Turner, M. J.
Affiliations
Coombe Women & Infants University Hospital (IE)
Corresponding author
McMahon, Léan E.
ORCID
Venue
BMC Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2020-08-26
Volume
20
Issue
1
Pages
795-795
ISSN
1472-6963 (ISSN-L)
DOI
10.1186/s12913-020-05655-y
PMC
PMC7449010
OpenAlex
W3081438732
Cited by
14
References
2
Citations by year
2026: 2 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 3
FWCI
1.38
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Health Services Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
gestational diabetes mellitus, diagnostic criteria, guideline implementation, incidence, cesarean section, labor induction, obstetric surgery, interhospital variation, obstetric care, high birth weight, Ireland
MeSH terms
Female, Health Services Research, Hospitals, Humans, Ireland, Mass Screening, Pregnancy, Incidence, Diabetes, Gestational, Practice Guidelines as Topic

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