Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: The St. Carlos gestationaldiabetes study

摘要

OBJECTIVE: The use of the new International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) for the diagnosis of gestational diabetesmellitus (GDM) results in an increased prevalence of GDM. Whether their introduction improves pregnancy outcomes has yet to be established. We sought to evaluate the costeffectiveness of one-step IADPSGC for screening and diagnosis of GDM compared with traditional two-step Carpenter-Coustan (CC) criteria. RESEARCH DESIGN AND METHODS GDM risk factors and pregnancy and newborn outcomes were prospectively assessed in 1,750 pregnant women from April 2011 to March 2012 using CC and in 1,526 pregnant women from April 2012 to March 2013 using IADPSGC between 24 and 28 weeks of gestation. Both groups received the same treatment and follow-up regimes. RESULTS: The use of IADPSGC resulted in an important increase in GDM rate (35.5% vs. 10.6%) and an improvement in pregnancy outcomes, with a decrease in the rate of gestational hypertension (4.1 to 3.5%: 214.6%, P ≤ 0.021), prematurity (6.4 to 5.7%: 210.9%, P ≤ 0.039), cesarean section (25.4 to 19.7%: 223.9%, P ≤ 0.002), small for gestational age (7.7 to 7.1%: 26.5%, P ≤ 0.042), large for gestational age (4.6 to 3.7%:220%, P ≤ 0.004), Apgar 1-min score ≤7 (3.8 to 3.5%:29%, P ≤ 0.015), and admission to neonatal intensive care unit (8.2 to 6.2%: 224.4%, P ≤ 0.001). Estimated cost savings was of V14,358.06 per 100 women evaluated using IADPSGC versus the group diagnosed using CC. CONCLUSIONS: The application of the new IADPSGC was associated with a 3.5-fold increase in GDM prevalence in our study population, as well as significant improvements in pregnancy outcomes, and was cost-effective. Our results support their adoption.