Comparing Different Diagnostic Guidelines for Gestational Diabetes Mellitus in Relation to Birthweight in Sri Lankan Women

Abstract

Introduction While the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria is widely adopted in many countries, clinicians have questioned the applicability of these diagnostic thresholds for different races/ethnicities. We first compared the prevalence of gestational diabetes mellitus (GDM) diagnosed with different criteria including IADPSG, World Health Organization (WHO) 1999 and Sri Lankan national guidelines, and subsequently related individual guidelines-specific GDM prevalence to offspring birthweight in Sri Lanka. Methods We retrospectively collected data on singleton pregnancies (n=795) from two tertiary hospitals in Sri Lanka. We applied three diagnostic guidelines to define GDM, namely IADPSG criteria, the Sri Lankan national and WHO 1999 guidelines. We calculated the age- and first booking BMI-adjusted prevalence rates of GDM and assessed the association of guidelines-specific GDM with birthweight. Results The age- and first booking BMI-adjusted GDM prevalence rates were 31.2 %, 28.0% and 13.1% for IADPSG criteria, Sri Lankan national and WHO 1999 guidelines, respectively. The IADPSG criteria identified 90 distinctive GDM cases at a lower cut-off of fasting glucose (from 5.1 to 5.5 mmol/L) while Sri Lankan national guideline identified 15 distinctive GDM cases at a lower cut-off for 2-hour glucose (from 7.8 to 8.4 mmol/L). After adjusting for age, GDM diagnosed by IADPSG criteria was associated with higher birthweight [90.8 g, 95% CI: 10.8, 170.9], while the associations for GDM diagnosed either by Sri Lankan national or WHO 1999 guidelines were not significant. Conclusion Adopting the IADPSG criteria for diagnosing GDM may be important in Sri Lankan pregnant population.