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Critical evaluation of the diagnosis of Gestational Diabetes Mellitus (GDM). Simon Weitzman, MD, MPH. Critical evaluation of the diagnosis of Gestational Diabetes Mellitus (GDM). Diagnostic methods and criteria Screening strategies Maternal and offspring outcomes.

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critical evaluation of the diagnosis of gestational diabetes mellitus gdm1

Critical evaluation of the diagnosis of Gestational Diabetes Mellitus (GDM)

Diagnostic methods and criteria

Screening strategies

Maternal and offspring outcomes

critical evaluation of the diagnosis of gestational diabetes mellitus gdm2

Critical evaluation of the diagnosis of Gestational Diabetes Mellitus (GDM)

Diagnostic methods and criteria

Screening strategies

Maternal and offspring outcomes

diagnostic methods for gdm
Diagnostic Methods for GDM
  • 1-hr. Oral Glucose Challenge Test (GCT)
  • Oral Glucose Tolerance Test (OGTT)

World Health Organization (WHO)

National Diabetes Data Group (NDDG)

Coustan Modification

diagnostic criteria for gdm
Diagnostic criteria for GDM

Method Criteria (mg/dl)

FPG 1 hr. 2 hr. 3 hr.

WHO (75 gr) 140 - 200 -

NDDG (100 gr) 105 190 165 145

Coustan (100 gr) 95 180 155 140

FPG: Fasting plasma glucose

critical evaluation of the diagnosis of gestational diabetes mellitus gdm3

Critical evaluation of the diagnosis of Gestational Diabetes Mellitus (GDM)

Diagnostic methods and criteria

Screening strategies

Maternal and offspring outcomes

screening strategies for gdm
Screening strategies for GDM
  • The approach

One-step approach

Two-step approach

the 50 gr gct cutoff 186 mg dl
Sensitivity: 38.2%

Specificity: 93.3%

Positive Predictive Value: 78.6 %

Negative Predictive Value : 70.0 %

The 50 gr. GCT (Cutoff >186 mg/dl)
the 50 gr gct cutoff 186mg dl
Sensitivity: 38.2%

Specificity: 93.3%

Positive Predictive Value:19.5%

Negative Predictive Value: 97.2%

The 50 gr. GCT (Cutoff >186mg/dl)
screening strategies for gdm1
Screening strategies for GDM
  • The population
  • Universal screening
  • High risk groups screening
universal versus high risk strategy
Universal versus high risk strategy

Universal screening

  • 57.4% agreed to screening
  • 27.7 % GCT positive have abnormal OGTT
  • Non-participants have more risk factors
  • High Risk Group Screening
    • Would miss > 40% of GDM
universal screening in the negev
Universal screening in the Negev
  • 70 % of Jewish and 57% of Bedouins agreed to screening
  • GCT only in 49% of women
  • OGTT only in 10%
  • Overall non- participation: 40%
critical evaluation of the diagnosis of gestational diabetes mellitus gdm4

Critical evaluation of the diagnosis of Gestational Diabetes Mellitus (GDM)

Diagnostic methods and criteria

Screening strategies

Maternal and offspring outcomes

influence of gdm on the later development of diabetes in the child
Influence of GDM on the later development of diabetes in the child
  • Hyperglycemia affects fetal beta-cell function in animals
  • Intrauterine nutritional deprivation and maternal hyperglycemia increase the risk of diabetes in later life
maternal and offspring outcomes
Maternal and offspring outcomes

Characteristic Normal OGTT GDM

LGA (%) 34 38

Gestational age (w) 39 39.2

Hospital days 3.7 3.9

perinatal characteristics of women with gdm according to risk factors
Perinatal characteristics of women with GDM, according to risk factors

Characteristic Risk Factors OR(95%CI) Yes No

Cesarean section (%) 38 35 1.6 (0.7-3.7)

Macrosomia (%) 33 17 2.4 (0.9-6.7)

Shoulder Dystocia (%) 7 13 0.5 (0.1-2.1)

Insulin therapy (%) 30 28 1.1 (0.4-2.7)

plasma glucose levels in non obese and obese women with previous gdm after 5 10 years of follow up
Plasma glucose levels in non obese, and obese women with previous GDM, after 5-10 years of follow-up
plasma insulin levels in non obese and obese women with previous gdm after 5 10 years of follow up
Plasma insulin levels in non obese and obese women with previous GDM, after 5-10 years of follow-up
slide19
Logistic regression analysis of factors relatedto the development of diabetes in women with previous GDM
conclusions
Conclusions
  • J. Nerup said that Type 1 diabetes is the nightmare of geneticists. Paraphrasing his statement, we can say that GDM is the nightmare of epidemiologists. There is controversy about its definition, the best diagnostic method, diagnostic criteria, and the population to be screened.
conclusions 2
Conclusions (2)
  • Despite this confusion, the management of the condition has greatly improved, and the perinatal outcomes of offspring's of GDM mothers are comparable to those of non-diabetic women, except for macrosomia.
conclusions 3
Conclusions(3)
  • There is an increasing body of evidence supporting the risk of developing diabetes mellitus (and particularly type 2 diabetes) among women with previous GDM
  • Among obese GDM women, even years after delivery, features of insulin resistance can be found