Aims

Disagreement about the appropriate criteria for the diagnosis of gestational diabetes mellitus (GDM) persists. This study examines an alternative approach which combines information from all time-points on the glucose tolerance test (GTT) into a single index and expands the GDM spectrum into four categories using data from three geographically and ethnically distinct populations.

Methods

A retrospective observational study design was used. Data from Wisconsin, USA (723 women) was used in derivation of the criterion and data from Doha, Qatar (1284 women) and Cape Town, South Africa (220 women) for confirmation. Pregnant women without pre-existing diabetes with a GTT done between 23 and 30 weeks gestation were included. A novel index was derived from the GTT termed the weighted average glucose (wAG). This was categorized into four pre-defined groups (henceforth National Priorities Research Program (NPRP) criterion); i) normal gestational glycemia (NGG), ii) impaired gestational glycemia (IGG), iii) GDM and iv) high risk GDM (hGDM).

Results

In the Doha cohort, compared to the NGG group, the odds of large for gestational age babies increased 1.33 fold (P = 0.432), 2.86 fold (P < 0.001) and 3.35 fold (P < 0.001) in the IGG, GDM and hGDM groups respectively. The odds of pregnancy induced hypertension increased 2.10 fold (P = 0.024) in GDM & hGDM groups compared to the IGG and NGG groups. In the Cape Town cohort, a third of women in the GDM group and two-thirds in the hGDM group progressed to T2DM at 5 years.

Conclusions

The NPRP categorization identifies four distinct risk clusters of glycemia in pregnancy which may aid better decision making in routine management, avoid potential over-diagnosis of women at lower risk of complications and assist with diabetes prevention in women at high-risk after an index pregnancy with GDM.

中文翻译：

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统一妊娠糖尿病的诊断：引入NPRP标准

目标

关于妊娠期糖尿病 (GDM) 诊断的适当标准的分歧仍然存在。本研究探讨了一种替代方法，该方法将来自葡萄糖耐量测试 (GTT) 的所有时间点的信息组合成一个单一指标，并使用来自三个地理和种族不同的人群的数据将 GDM 谱扩展到四类。

方法

采用回顾性观察研究设计。来自美国威斯康星州的数据（723 名女性）用于推导标准，来自卡塔尔多哈（1284 名女性）和南非开普敦（220 名女性）的数据用于确认。包括在妊娠 23 至 30 周之间进行 GTT 且没有预先存在糖尿病的孕妇。一种新的指数源自 GTT，称为加权平均葡萄糖 (wAG)。这被分为四个预定义的组（以下称为国家重点研究计划 (NPRP) 标准）；i) 正常妊娠血糖 (NGG)，ii) 妊娠血糖受损 (IGG)，iii) GDM 和 iv) 高危 GDM (hGDM)。

结果

在多哈队列中，与 NGG 组相比，在 IGG、GDM 和 hGDM 中，大于胎龄儿的几率增加了 1.33 倍（P = 0.432）、2.86 倍（P < 0.001）和 3.35 倍（P < 0.001）分别分组。与 IGG 和 NGG 组相比，GDM 和 hGDM 组妊娠高血压的几率增加了 2.10 倍（P = 0.024）。在开普敦队列中，GDM 组中三分之一的女性和 hGDM 组中三分之二的女性在 5 年时进展为 T2DM。

结论

NPRP 分类确定了妊娠期血糖的四个不同风险群，这可能有助于在常规管理中做出更好的决策，避免对并发症风险较低的女性进行潜在的过度诊断，并有助于在指数妊娠后预防高危女性的糖尿病。 GDM。