Evidence in support of the International Association of Diabetes in Pregnancy study groups' criteria for diagnosing gestational diabetes mellitus worldwide in 2019.
Level 5 - mechanism / opinion, no new human data
Expert commentary and narrative review synthesizing existing cohort data (HAPO-FUS) and trial literature without primary human data or systematic review methodology.
PubMed 30682358 · doi:10.1016/j.ajog.2019.01.206
What was done
This narrative review and commentary evaluated the evidence supporting the one-step International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria for gestational diabetes mellitus (GDM) compared to the two-step Carpenter-Coustan criteria favored by the American College of Obstetricians and Gynecologists (ACOG). The authors synthesized findings from the Hyperglycemia and Adverse Pregnancy Outcome Follow Up Study (HAPO-FUS) and related post-pregnancy intervention trials.
What was found
Carpenter-Coustan criteria identify GDM in 5–6% of US pregnancies, whereas IADPSG criteria increase prevalence to 15–20%. IADPSG-defined GDM is associated with nearly double the risk of large-for-gestational-age infants, fetal adiposity, neonatal hyperinsulinemia, and preeclampsia, plus a 50% increase in preterm delivery and shoulder dystocia. In HAPO-FUS at 11.4 years follow-up, untreated hyperglycemia identified post hoc by IADPSG criteria carried a 41.5% risk of maternal prediabetes (OR 3.72, 95% CI 3.09–4.47), a 10.7% risk of type 2 diabetes (OR 7.63, 95% CI 5.33–10.95), and higher offspring overweight/obesity (39.3% prevalence; OR 1.5, 95% CI 1.56–2.44). Postpartum lifestyle or metformin interventions reduced overt diabetes risk by >50%.
Why it matters
The paper argues for standardizing on IADPSG criteria globally to capture a larger cohort of mothers and infants at high risk for cardiometabolic disease, enabling earlier prevention.
Limits
This is a narrative opinion piece rather than a systematic review or primary clinical study. The abstract notes that treating GDM in pregnancy has not yet been demonstrated to prevent offspring obesity or prediabetes, and the resource implications of tripling GDM prevalence are not assessed.
Cited by
- supports Studies across tens of thousands of mothers show higher maternal glucose levels during pregnancy are associated with greater neonatal fat mass.