Diagnosis of gestational diabetes.
Level 5 - mechanism / opinion, no new human data
Narrative review and commentary without systematic search methodology or new human data
PubMed 25083890 · doi:10.3109/00365513.2014.936677
What was done
This narrative review outlines historical approaches to diagnosing gestational diabetes mellitus (GDM) and describes the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. These recommendations were established from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, a prospective cohort of >23,000 pregnancies across nine countries evaluated using a blinded 75 g, 2-hour oral glucose tolerance test (OGTT) at 24–28 weeks of gestation.
What was found
In the discussed HAPO cohort, primary adverse outcomes (large for gestational age, primary cesarean section, neonatal hypoglycemia, high cord C-peptide) and secondary outcomes (preeclampsia, preterm birth, shoulder dystocia, birth injury) were continuously and directly related to all three OGTT glucose measurements. The IADPSG thresholds requiring ≥1 elevated value on a 75 g OGTT are: fasting plasma glucose ≥5.1 mmol/L (92 mg/dL), 1-hour ≥10 mmol/L (180 mg/dL), and 2-hour ≥8.5 mmol/L (153 mg/dL). Implementing these criteria is projected to increase GDM prevalence to 16–18%.
Why it matters
The criteria establish standardized diagnostic thresholds tied to perinatal outcome risks rather than long-term maternal diabetes risk, aiming to harmonize global practice with a single 75 g OGTT strategy.
Limits
As a narrative review, it presents no new human data and does not follow a systematic review methodology. Specific effect sizes, confidence intervals, and p-values for the continuous glucose associations are not reported in the abstract. Quantitative cost-effectiveness trade-offs regarding the higher prevalence are omitted.
Cited by
- supports The standard fasting blood glucose cutoff between healthy and prediabetes is 100 mg/dL in non-pregnant adults, whereas in pregnancy a fasting level above 92 mg/dL indicates gestational diabetes.