Skip to main content

Advertisement

  • Review
  • Open Access

The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta-analysis

  • 1,
  • 1,
  • 2 and
  • 1Email author
Diabetology & Metabolic Syndrome201911:11

https://doi.org/10.1186/s13098-019-0406-1

  • Received: 27 October 2018
  • Accepted: 22 January 2019
  • Published:

Abstract

Background

The absence of universal gold standards for screening of gestational diabetes (GDM) has led to heterogeneity in the identification of GDM, thereby impacting the accurate estimation of the prevalence of GDM. We aimed to evaluate the effect of different diagnostic criteria for GDM on its prevalence among general populations of pregnant women worldwide, and also to investigate the prevalence of GDM based on various geographic regions.

Methods

A comprehensive literature search was performed in PubMed, Scopus and Google-scholar databases for retrieving articles in English investigating the prevalence of GDM. All populations were classified to seven groups based-on their diagnostic criteria for GDM. Heterogeneous and non-heterogeneous results were analyzed using the fixed effect and random-effects inverse variance model for calculating the pooled effect. Publication bias was assessed by Begg’s test. The Meta-prop method was used for the pooled estimation of the prevalence of GDM. Meta-regression was conducted to explore the association between prevalence of GDM and its diagnostic criteria. Modified Newcastle–Ottawa Quality Assessment Scale for nonrandomized studies was used for quality assessment of the studies included; the ROBINS and the Cochrane Collaboration’s risk of bias assessment tools were used to evaluate the risk of bias.

Results

We used data from 51 population-based studies, i.e. a study population of 5,349,476 pregnant women. Worldwide, the pooled overall-prevalence of GDM, regardless of type of screening threshold categories was 4.4%, (95% CI 4.3–4.4%). The pooled overall prevalence of GDM in the diagnostic threshold used in IADPSG criteria was 10.6% (95% CI 10.5–10.6%), which was the highest pooled prevalence of GDM among studies included. Meta-regression showed that the prevalence of GDM among studies that used the IADPSG criteria was significantly higher (6–11 fold) than other subgroups. The highest and lowest prevalence of GDM, regardless of screening criteria were reported in East-Asia and Australia (Pooled-P = 11.4%, 95% CI 11.1–11.7%) and (Pooled-P = 3.6%, 95% CI 3.6–3.7%), respectively.

Conclusion

Over the past quarter century, the diagnosis of gestational diabetes has been changed several times; along with worldwide increasing trend of obesity and diabetes, reducing the threshold of GDM is associated with a significant increase in the incidence of GDM. The harm and benefit of reducing the threshold of diagnostic criteria on pregnancy outcomes, women’s psychological aspects, and health costs should be evaluated precisely.

Keywords

  • Diagnostic criteria
  • Gestational diabetes
  • Meta-analysis
  • Prevalence

Background

Gestational diabetes mellitus (GDM), is one of the most common endocrinopathies during pregnancy which is defined as hyperglycemia at any time in pregnancy based on defined thresholds that are less than those considered for overt diabetes [1]. Placental production of diabetogenic hormones such as human placental lactogen in late pregnancy, leading to progressive insulin resistance; when adaptation β-cell hyperfunctionality during pregnancy fails to compensate maternal insulin resistance, it may lead to gestational diabetes [2, 3]. It is well documented that GDM is associated with adverse maternal and neonatal outcomes [4, 5] as well as lifelong risk of obesity and diabetes in both mother and child later in life [6, 7].

It is estimated that GDM affects around 7–10% of all pregnancies worldwide [811]; however the prevalence is difficult to estimate as rates differ between studies due to prevalence of different risk factors in the population, such as maternal age and BMI, prevalence of diabetes and ethnicity among women [12]. Moreover, screening strategies, testing methods and even diagnostic optimum glycemic thresholds for GDM remain the subject of considerable debate [13].

In this respect, the first definition of GDM was based on maternal risk for developing postpartum diabetes; subsequently, it was defined based on adverse maternal and neonatal outcomes [14]. The study of the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study [15] demonstrated a linear continuous correlation between increasing levels of maternal blood glucose levels on a 75-g oral glucose tolerance test (GTT) and adverse perinatal outcomes without specific threshold. In this respect, potential GDM diagnostic criteria were defined based on the odds ratio (OR) of 1.75, relative to the mean, for specific selected outcomes [15, 16].

In 2010, the International Association of Diabetes in Pregnancy Study Group (IADPSG) [17] endorsed 75-g oral glucose tolerance test, whereas in the United States and some countries GDM usually is screened and diagnosed based on the two-step screening strategy with a 3-h, 100-g OGTT after an abnormal 1-h, 50-g glucose challenge test (GCT). Furthermore, the World Health Organization (WHO) endorses the IADPSG diagnostic criteria for GDM, although the evidence for this recommendation was not very strong and was based on consensus. Nevertheless, this threshold, which was one of the lowest cut points for GDM diagnosis, has the high sensitivity and specificity [18].

However, the absence of evidenced-based and accepted ‘gold standards’ for the diagnosis of gestational diabetes as a screening strategy can lead to a heterogeneity in the identification of GDM in pregnant women [13] which may influence estimation of the prevalence of GDM and related health outcomes, as well as their health costs and quality of life.

The aim of this systematic review and meta-analysis hence was to evaluate the impact of different diagnostic criteria of blood glucose on the prevalence of GDM among general populations of pregnant women worldwide in different geographic regions.

Methods

The ethics committee of the Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, approved this study.

This systematic review and meta-analysis was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [19] to assess the following objectives:
  • To study the pooled prevalence of GDM among general population of pregnant women;

  • To study the pooled prevalence of pregnant women based on the various diagnostic criteria of blood glucose;

  • To study the pooled prevalence of pregnant women based on various GDM screening criteria groups of pregnant women in different geographic regions;

  • To study the association between prevalence of GDM and its diagnostic criteria regardless of the geographic region.

Search strategy

A comprehensive literature search was conducted in PubMed [including Medline], Web of Science, Google scholar and Scopus databases for retrieving original articles published in English language on the prevalence and incidence of gestational diabetes for all articles up to January 2018. Further, a manual search in the references list of studies included and other relevant reviews was used to maximize the identification of eligible studies. The following MeSH terms keywords, alone or in combination, were used for the search: “gestational diabetes” OR “gestational diabetes mellitus” OR “pregnancy induced diabetes” OR “gestational hyperglycemia,” OR “gestational glucose intolerance” AND “incidence” OR “prevalence” OR “epidemiology”.

Selection criteria, study selection and data extraction

Studies were eligible if (I) they had population based design, (II) universally assessed the prevalence of GDM (III) and provided accurate screening strategies and thresholds of blood sugar in those screening test. We excluded non-original studies including reviews, commentaries, editorials, letters, meeting abstracts, case reports or any papers that did not provide accurate and clear data.

The screening of titles, abstracts and full-text articles was conducted independently by authors (SBG and MA), for determining final eligibility criteria. Disagreements were resolved through discussions with senior investigator (FRT). The general characteristics of the studies including “the first author name, journal, publication year, country of study, years of sampling, study design, sample size, population characteristics including age and BMI, PCOS definition, GDM screening strategy, GDM criteria and laboratory values of blood sugar tests, study quality assessment and prevalence of GDM were extracted from the studies included and assessed. To prevent extraction and data entry errors, a control check between the final data used in the meta-analysis and the original publications was performed by all authors.

Study subgroups

To facilitate clinical interpretation of the results for statistically significant findings, all studies included were further classified to 7 groups based on the GDM screening strategy and the nearest threshold of blood sugar in the screening test as follows:
  • Group 1 or IADPSG definition, screened based on OGTT with 75 g 2-h. Threshold: one value > 92, 180 and 153 mg/dL for fasting, 1, 2 and 3 h;

  • Group 2, screened based on OGTT with 75 g 2-h. Threshold: one value > 100 and 144 mg/dL for fasting and 2 h;

  • Group 3, screened based on OGTT with 75 g 2-h. Threshold: one value > 110 and 140 mg/dL for fasting, 1 and 2 h;

  • Group 4, screened based on OGTT with 75 g 2-h. Threshold: value > 180 mg/dL for 2 h.

  • Group 5, screened based on GCT with 50 g 1-h GCT, Threshold: values > 140 mg/dL following OGTT with 100 g 3-h. Threshold: two value > 95, 180, 155 and 140 mg/dL for fasting, 1, 2 and 3 h or GCT with 50 g 1-h GCT, Threshold: values > 140 mg/dL following OGTT with 75 g 3-h. Threshold: two values > 95, 180, 155 and 140 mmol/L for fasting, 1, 2 and 3 h;

  • Group 6, screened based on Glucose challenge test (GCT) with 50 g 1-h, Threshold: 140 mg/dL following oral glucose tolerance test (OGTT) with 100 g 3-h. Threshold: two values > 105 or 190, 155, 165 and 145 mg/dL for fasting, 1, 2 and 3 h;

  • Group 7, screened based on OGTT with 100 g 3-h. Threshold: one value > 120, 175, 155 and 140 mg/dL for fasting, 1, 2 and 3 h.

Quality assessment and risk of bias

Quality of the studies was critically appraised for their methodology and results presentation. Two reviewers (SBG and MA) who were blinded to study author, journal name and institution evaluated the quality of the studies independently. The quality of observational studies was also assessed using the modification of the Newcastle–Ottawa Quality Assessment Scale for nonrandomized studies (NRS) [20] which evaluates the quality of published nonrandomized studies in terms of selection, comparability and outcomes. Studies with scores above 6 were considered as high quality, 3-5 as moderate and those with scores below than 3 as low quality.

We also evaluated risk of bias for studies included, using the ROBINS for NRS [21] and Cochrane Collaboration’s tool for assessing risk of bias for other methodological studies [22]. Five domains related to risk of bias were assessed in each cross-sectional study including: bias in assessment of exposure, bias in development of outcome of interest in case and controls, bias in selection of cases, bias in selection of controls, and bias in control of prognostic variable. In addition, 7 domains related to risk of bias were assessed bias in selection of exposed and non-exposed cohort, bias in assessment of exposure, bias in presence of outcome of interest at start of study, bias in control of prognostic variables, bias in the assessment of the presence or absence of prognostic factors, bias in the assessment of outcome, bias in adequacy regarding follow up of cohorts. Authors’ judgments were categorized as ‘‘low risk,’’ ‘‘high risk,’’ and ‘‘unclear risk’’ of bias (probably low or high risk of bias) [22].

Statistical analysis

The software package STATA (version 12; STATA Inc., College Station, TX, USA) was applied to conduct statistical analysis. Heterogeneity between studies was assessed using I2 index and P > 0.05 was interpreted as heterogeneity. Heterogeneous and non-heterogeneous results were analyzed using the fixed effects and random-effects inverse variance models for calculating the pooled effect. Publication bias was assessed by Begg’s test. The Meta-prop method was used for pooled estimation of GDM prevalence. Meta-regression was conducted to explore the association between prevalence of GDM and its diagnostic criteria. In this respect, we used the HAPO definition criteria for screening with group 4 as the reference group for comparison.

In addition, meta-analysis of pooled prevalence of GDM was performed in the subgroups of some different geographical regions of countries, based on different GDM diagnostic classifications. P >  0.05 was set as significance level.

Results

Search results, study selection, study characteristics, and quality assessment

Additional file 1: Figure S1 illustrates the flow diagram of the search strategy and study selection. The search strategy yielded 3396 potentially relevant articles. According to the selection inclusion criteria, 338 articles were identified for further full-text assessment. Finally, we included 51 population-based studies which included data of 5,349,476 pregnant women for the meta-analysis. Table 1 presents the summary of studies assessing the prevalence of GDM.
Table 1

Summary of studies assessing GDM prevalence

Author, year

Country

Type of GDM screening test

GDM criteria

Year of sampling

Sample size

Prevalence of GDM

Quality scaling

Aljohani et al. 2008a

Canada

GCT with 50 g 1-h GCT, threshold: values above 7.8 mmol/L following OGTT with 100 g 3-h. Threshold: two value above 5.8, 10.6, 9.2 and 8.1 mmol/L for fasting, 1, 2 and 3 h

National criteria

1985–2004

324,605

2.9

Moderate

Al Mahroos et al. 2005a

Bahrain

GCT with 50 g 1-h GCT, threshold: values above 140 mg/dL following OGTT with 75 g 3-h. Threshold: two value above 95, 180, 155 and 140 mg/dL for fasting, 1, 2 and 3 h

Fourth international conference on GDM

2001–2002

10,495

13.3

High

Anna et al. 2008b

Australia

GCT with 50 g 1-h GCT, threshold: values above 7.8 mmol/L following OGTT with 75 g glucose. Threshold: value above 5.5, 8 mmol/L for fasting and 2 h

National criteria

1995–2005

950,737

3.7

High

Arora et al. 2015b

India

1. OGTT with 75 g glucose. Threshold: value above 5.1 and 8.5 mmol/L for fasting and 2 h

2. OGTT with 75 g glucose. Threshold: value above 7 and 7.8 mmol/L for fasting and 2 h

1. WHO 2013

2. WHO 1999

2009–2012

1. 5100

2. 5100

1. 34.9

2. 9

Moderate

Baptiste-Roberts et al. 2012a

USA

OGTT with 100 g 3-h. Threshold: value above 120 or 175, 155 and 140 mg/dL for fasting and 1 h, and did not return to normal in the 2- and 3-h

National criteria

1959–1966

28,358

1.7

High

Leng et al. 2015a

China

1. GCT with 50 g 1-h GCT, Threshold: values above 7.8 mmol/L following OGTT with 75 g 2-h. Threshold: one value above 5.1, 10.0 and 8.5 mg/dL for fasting, 1 and 2 h

2. GCT with 50 g 1-h GCT, Threshold: values above 7.8 mmol/L following OGTT with 75 g 2-h. Threshold: Fasting < 7.0 mmol/L and 2-h > 7.8 but < 11.1 mmol/L OR fasting > 6.1 but < 7.0 mmol/L and 2-h PG < 7.8 mmol/L

1. IADPSG

2. WHO1999

2010–2012

1. 17,808

2. 17,808

1. 7.7

2. 6.8

High

Chodick et al. 2010a

Israel

GCT with 50 g 1-h GCT, threshold: not mentioned, following OGTT with 100 g 3-h. Threshold: two value above 95, 180, 155 and 140 mg/dL for fasting, 1, 2 and 3 h

Carpenter and Coustan

1995–1999

185,416

6.07

High

Moses et al. 2011a

Australia

1. OGTT with 75 g glucose. Threshold: one value above or equal to 5.5 and 8.0 mmol/L for fasting and 2 h

2. OGTT with (not mentioned) g glucose. Threshold: one value above or equal to 5.1, 10.0 and 8.2 mmol/L for fasting, 1 and 2 h

1. ADIPS

2. IADPSG

NM*

1. 1275

2. 1275

1. 9.6

2. 13

Moderate

Erjavec et al. 2016b

Croatia

1. OGTT with 75 g glucose. Threshold: one value above or equal to 6.1 and 7.8 mmol/L for fasting and 2 h

2. OGTT with 75 g glucose. Threshold: one value above or equal to 5.1, 10.0 and 8.5 mmol/L for fasting, 1 and 2 h

1. WHO 1999

2. National criteria

1. 2010

2. 2014

1. 42,656

2. 39,092

1. 2.2

2. 4.7

High

Ferrara et al. 2004a

USA

1. GCT with 50 g 1-h, threshold: not mentioned, following OGTT with 100 g 3-h. Threshold: Two value above 95 or 180, 155 and 140 mg/dL for fasting, 1 and 2 h

2. 2 hpp > 200 mg/dL, 3. FBS > 126 mg/dL, 4. OGTT with 75 g 2-h, threshold: value above 140 mg/dL for 2 h, 5. GDM histort at time of hospital discharge

ADA, ACOG and WHO

1999–2000

267,051

6.33

Moderate

Ferrara et al. 2002b

USA

1. GCT with 50 g 1-h, threshold: 140 mg/dL following OGTT with 100 g 3-h. Threshold: two value above 105 or 190, 155, 165 and 145 mg/dL for fasting, 1, 2 and 3 h

2. GCT with 50 g 1-h, threshold: 140 mg/dL following OGTT with 100 g 3-h. Threshold: Two value above 95 or 180, 155, 140 and 145 mg/dL for fasting, 1, 2 and 3 h

1. NDDG

2. Carpenter and Coustan

1996

1. 26,481

2. 26,481

1. 3.2

2. 4.8

High

Gao et al. 2010b

China

(1) GCT with 50 g 1-h, Threshold: ≥ 7.8 mmol/L but < 11.1 mmol/L, (2) FPG ≥ 5.8 mmol/L, (3) Random FPG ≥ 5.8 mmol/L twice, following OGTT with 75 g 3-h. Threshold: two value above 5.3, 10.0, 8.6 and 7.8 mmol/L for fasting, 1, 2 and 3 h

ADA

2006

4179

17.9

Moderate

Hedderson et al. 2010a

USA

GCT with 50 g 1-h, threshold: not mentioned following OGTT with 100 g 3-h, threshold: two value above 95 or 180, 155, 140 and 145 mg/dL for fasting, 1, 2 and 3 h

ADA

1995–2004

216,089

5.8

High

Ignell et al. 2014b

Sweden

OGTT with 75 g glucose. Threshold: value above or equal 10.0 mmol/L for 2 h

European Association of the Study of Diabetes

2003–2012

156,144

2.2

Moderate

Jenum et al. 2012a

Norway

1. OGTT with 75 g glucose. Threshold: one value above or equal to 7 and 7.8 mmol/L for fasting and 2 h

2. OGTT with 75 g glucose. Threshold: one value above or equal to 5.1 and 8.5 mmol/L for fasting and 2 h

1. WHO

2. IADPSG

2008–2010

1. 759

2. 759

1. 13

2. 31.5

High

Ishak et al. 2003a

Australia

OGTT with 75 g glucose. Threshold: one value above or equal to 5.5 and 8 mmol/L for fasting and 2 h OR OGTT with 75 g glucose. Threshold: one value above or equal to 7.8 and 11 mmol/L for fasting and 2 h

National criteria

1988–1999

230,011

2.46

Moderate

Janghorbani et al. 2006a

UK

Random plasma glucose, threshold: 6.5 mmol/L following OGTT with 75 g glucose. Threshold: one value above or equal to 6 and 7.5 mmol/L for fasting and 2 h

WHO

1996–1997

4942

1.8

Moderate

Jesmin et al. 2014b

Bangladesh

1. GCT with 50 g 1-h, threshold: 7.8 mmol/L following OGTT with 75 g 2-h, threshold: ne value above or equal to 7 and 7.8 mmol/L for fasting and 2 h

2. GCT with 50 g 1-h, threshold: 7.8 mmol/L following OGTT with 75 g 2-h, threshold: ne value above or equal to 5.3 and 8.6 mmol/L for fasting and 2 h

1. WHO

2. ADA

2012–2013

1. 3447

2. 3447

1. 9.7

2. 12.9

Moderate

Kalamegham et al. 2010a

USA

GCT with 50 g 1-h, threshold: 130 mg/dL following OGTT with 100 g 3-h, threshold: ne value above or equal to 7 and 7.8 mmol/L for fasting and 2 h

ADA

2000–2007

18,307

8.6

Moderate

Lawrence et al. 2008a

USA

GCT with 50 g 1-h, threshold: not mentioned following (1) OGTT with 100 g 3-h, threshold: two value above or equal to 5.3, 10, 8.6 and 7.8 mmol/L for fasting, 1, 2 and 3 h OR (2) OGTT with 75 g glucose, threshold: two value above or equal to 5.3, 10 and 8.6 for fasting, 1 and 2 h OR (3) FBS ≥ 7 mmol/L OR (4) random plasma glucose ≥ 11.1 mmol/L

ADA

1999–2005

199,298

7.6

High

Leng et al. 2016a

China

GCT with 50 g 1-h, threshold: ≥ 7.8 mmol/L following OGTT with 75 g 2-h, threshold: value above 5.1, 10.0 and 8.5 mmol/L for fasting, 1 and 2 h

IADPSG

2010–2012

11,450

7.3

High

Magee et al. 1993a

USA

1. GCT with 50 g 1-h, threshold: ≥ 7.7 mmol/L following OGTT with 100 g 3-h, threshold: two value above 5.9, 10.6, 9.2 and 8.1 mmol/L for fasting, 1, 2 and 3 h

2. GCT with 50 g 1-h, threshold: ≥ 7.7 mmol/L following OGTT with 100 g 3-h, threshold: two value above 5.3, 10.1, 8.7 and 7.8 mmol/L for fasting, 1, 2 and 3 h

1. NDDG

2. Modified NDDG

1985–1986

1. 2019

2. 2019

1. 1.6

2. 5.8

High

McCarth et al. 2010a

Argentina

OGTT with 75 g glucose. Threshold: value above or equal to 7.8 mmol/L for 2 h

National criteria

NM*

1702

5.8

Moderate

Melchior et al. 2017b

Germany

GCT with 50 g 1-h, threshold: ≥ 135 and ≤ 200 mg/dL following OGTT with 75 g 2-h, threshold: value above 92, 180 and 153 mg/dL for fasting, 1 and 2 h

ICD-10

2014–2015

458,291

13.2

Moderate

Mizuno et al. 2016b

Japan

Random blood glucose, threshold: > 100 mg/dL following OGTT with 75 g 2-h, threshold: value above or equal to 92, 180 and 153 mg/dL for fasting, 1 and 2 h

National criteria

2011

8874

2.3

High

Murphy et al. 1993a

USA

GCT with 50 g 1-h, threshold: ≥ 7.8 mmol/L following OGTT with 75 g 2-h, threshold: value above 92, 180 and 153 mg/dL for fasting, 1 and 2 h

O’Sullivan criteria

1987–1988

605

5.8

Moderate

Lindqvist et al. 2014b

Sweden

OGTT with 75 g glucose. Threshold: value above or equal to 10 mmol/L for 2 h

European Association for the Study of Diabetes

2011–2012

20,822

2.2

High

Ostlund et al. 2003a

Sweden

OGTT with 75 g 2-h, threshold: value above or equal to 6.7 and 9 mmol/L for fasting and 2 h

WHO

1994–1996

4918

1.7

Moderate

O’Sullivan et al. 2011a

Ireland

1. OGTT with 75 g 2-h, threshold: value above 5.1, 10 and 8.5 mmol/L for fasting, 1 and 2 h

2. OGTT with 75 g 2-h, threshold: value above or equal to 7 and 11 mmol/L for fasting and 2 h

1. IADPSG

2. WHO

2006–2009

1. 5500

2. 5500

1. 12.4

2. 9.4

Moderate

Bhavadharini et al. 2016b

India

1. OGTT with 75 g 2-h, threshold: value above or equal to 5.1, 10 and 8.5 mmol/L for fasting, 1 and 2 h

2. OGTT with 75 g 2-h, threshold: value above or equal to 7.7 mmol/L for 2 h

1. IADPSG

2. WHO

2013–2014

1. 1774

2. 1774

1. 15.7

2. 10.5

High

Pu et al. 2015a

USA

OGTT with 100 g 3-h, threshold: Two value above 95, 180, 155 and 140 mg/dL for fasting, 1, 2 and 3 h

ICD-9

2007–2012

24,195

10.4

High

Sacks et al. 2012a

HAPO study

OGTT with 75 g 2-h, threshold: value above or equal to 5.1, 10.0 and 8.5 mmol/L for fasting, 1 and 2 h

IADPSG

2000–2006

23,957

17.8

High

Schmidt et al. 2001a

Brazil

1. OGTT with 75 g 2-h, threshold: value above or equal to 5.3, 10.0 and 8.6 mmol/L for fasting, 1 and 2 h

2. OGTT with 75 g 2-h, threshold: value above or equal to 7.0 and 7.8 mmol/L for fasting and 2 h

1. ADA

2. WHO

1991–1995

4977

1. 2.4

2. 7.2

High

Schmidt et al. 2000a

Brazil

OGTT with 75 g 2-h, threshold: value above or equal to 7.0 and 7.8 mmol/L for fasting and 2 h

WHO

1991–1995

5004

7.6

Moderate

Sella et al. 2013a

Israel

GCT with 50 g 1-h, threshold: not mentioned following OGTT with 100 g 3-h, threshold: two value above 5.3, 10.0, 8.6 and 7.8 mmol/L for fasting, 1, 2 and 3 h

Carpenter and Coustan criteria

2000–2010

367,247

3.6

High

Seshiah et al. 2007a

India

OGTT with 75 g 2-h, threshold: value above or equal to 140 mg/dL for 2 h

WHO

2007

4151

3.9

Moderate

Seshiah et al. 2008a

India

OGTT with 75 g 2-h, threshold: value above or equal to 140 mg/dL for 2 h

WHO

2005–2007

12,056

13.9

Moderate

Seyoum et al. 1999a

Ethiopia

OGTT with 75 g 2-h, threshold: value above or equal to 140 mg/dL for 2 h

WHO

1999

890

3.7

Moderate

Shand et al. 2008b

Australia

GCT with 50 g 1-h, threshold: value above or equal to 7.8 mmol/L following OGTT with 75 g 2-h, threshold: value above 5.5 and 8.0 mmol/L for fasting and 2 h

ADIPS

1998–2002

370,703

4.5

High

Sommer et al. 2014a

Norway

OGTT with 75 g 2-h, threshold: value above or equal to 5.1 and 8.5 mmol/L for fasting and 2 h

IADPSG

2008–2010

728

31.5

High

Sudasingh et al. 2016b

Sri Lanka

OGTT with 75 g 2-h, threshold: value above or equal to 126 and 140 mg/dL for fasting and 2 h

WHO

2014–2015

1600

12.1

Moderate

Tamayo et al. 2016b

Germany

GCT with 50 g 1-h, threshold: ≥ 135 mg/dL following OGTT with 75 g 2-h, threshold: value above 92, 180 and 153 mg/dL for fasting, 1 and 2 h

ICD-10

2013–2014

158,839

6.81

Moderate

Tan et al. 2017a

Australia

1. OGTT with 75 g 2-h, threshold: value above or equal to 5.5 and 8.0 mmol/L for fasting and 2 h

2. OGTT with 75 g 2-h, threshold: value above or equal to 5.1, 10 and 8.5 mmol/L for fasting, 1 and 2 h

IADPSG

2014–2015

2895

9

High

Trujillo et al. 2015a

Brazil

OGTT with 75 g 2-h, threshold: value above or equal to 92, 180 and 153 mg/dL for fasting, 1 and 2 h

IADPSG

1991–1995

4926

18

Moderate

Wahabi et al. 20172

Saudi Arabia

OGTT with 75 g 2-h, threshold: value above or equal to 92–125, 180 and 153–199 mg/dL for fasting, 1 and 2 h

WHO

2013–2015

9723

24.2

Moderate

Wang et al. 2012b

USA

GCT with 50 g 1-h, threshold: value above or equal to 140 mg/dL following OGTT with 100 g 3-h, threshold: two value above 95, 180, 155 and 140 mg/dL for fasting, 1, 2 and 3 h

ADA

1997–2009

62,685

4.3

High

Xiong et al. 2001a

Canada

GCT with 50 g 1-h, threshold: value above or equal to 7.8 mmol/L following OGTT with 100 g 3-h, threshold: two value above 5.8, 10.5, 9.2 and 8 mmol/L for fasting, 1, 2 and 3 h

National criteria

1991–1997

111,563

2.5

Moderate

Yang et al. 2009a

China

GCT with 50 g 1-h, threshold: value above or equal to 7.9–11.0 mmol/L following OGTT with 75 g 2-h, threshold: two value above 5.3, 10.0 and 8.6 mmol/L for fasting, 1 and 2 h

ADA

2006

16,286

4.3

High

Yeung et al. 2017a

Canada

GCT with 50 g 1-h, threshold: value above or equal to 7.8 mmol/L following OGTT with 75 g 2-h, threshold: two value above 5.3, 10.6 and 8.9 mmol/L for fasting, 1 and 2 h OR following OGTT with 100 g 3-h, threshold: two value above 5.3, 10.0 8.6 and 7.8 mmol/L for fasting, 1, 2 and 3 h

ICD-10

2004–2010

498,013

6

High

Zhang et al. 2011b

China

GCT with 50 g 1-h, threshold: value above or equal to 7.8 mmol/L following OGTT with 75 g 2-h, threshold: two value above 6.1-7 and 7.8 mmol/L for fasting, 1 and 2 h

WHO

1999–2008

105,473

4.5

High

Zhu et al. 2017a

China

OGTT with 75 g 2-h, threshold: one value above 5.1, 10.6 and 8.5 mmol/L for fasting, 1 and 2 h

National criteria

2013

15,194

19.7

Moderate

* NM not mentioned

aCohort study

bCross sectional study

Details of the quality assessment of studies included are presented in Additional file 1: Tables S1, S2. Twenty-six studies were classified as high [16, 2347], and 25 as moderate [8, 4871]; no study had low quality. A total of 33.3% studies were cross-sectional and 66.6% were prospective or retrospective cohorts published between 1993 and 2017. Thirty-five studies were cohort [8, 16, 23, 2527, 3034, 3840, 42, 43, 45, 46, 48, 50, 51, 54, 55, 57, 6066, 69, 71, 72] and 16 cross-sectional [24, 28, 29, 3537, 41, 44, 47, 49, 52, 53, 56, 67, 68, 70]. Fourteen (27.4%) studies, classified as group 1 [16, 33, 35, 37, 39, 42, 49, 59, 60, 62, 6871] used IADPSG; 6 (11.7%) as group 2 [24, 41, 43, 47, 50, 54], 11 (21.5%) as group 3 [28, 31, 5558, 6367], 2 (3.9%) as group 4 [36, 53], 11 (21.5%) as group 5 [23, 27, 30, 32, 38, 40, 4446, 51, 52], 4 (7.8%) as group 6 [8, 29, 34, 48] and 3 (5.8%) as group 7 [25, 26, 61].

In addition, 13 studies were conducted in the USA and Canada [8, 25, 29, 30, 32, 34, 38, 44, 46, 48, 51, 57, 60], five in Australia [24, 41, 43, 50, 54], seven in China and Japan [26, 33, 35, 45, 47, 52, 71], 9 in north Europe [31, 36, 42, 53, 55, 59, 61, 62, 68], six in India, Bangladesh and Sri Lanka [37, 49, 56, 64, 65, 67] and 10 were from other countries [23, 27, 28, 39, 40, 58, 63, 66, 69, 70], including Bahrain, Israel, Croatia, Argentina, Brazil, Ethiopia and Saudi Arabia. One study by the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group was originally performed in nine countries [16].

Considering the amount of literature included, except for USA, Canada and Australia, the most commonly used threshold in Asia and Europe was IADPSG. Australians were screened based on their national criteria (group 2). The most prevalent criteria used in USA and Canada was the method used for group 5.

Meta-analysis and meta-regression of outcomes

Worldwide, the pooled overall prevalence of GDM among pregnant women, regardless of type of screening criteria categories was 4.4%, (Pooled overall P = 4.4%, 95% CI 4.3–4.4%). The overall pooled prevalence (95% CI) of GDM among different groups, depending on the diagnosis criteria used, is presented in Table 2. I2 index showed that except for subgroup 7, no significant heterogeneity were detected in the meta-analysis.
Table 2

Results of heterogeneity and publication bias estimation and subgroup meta-analysis for prevalence of gestational diabetes based on various GDM screening strategy group among pregnant women

 

Sample size of participants

I2%

P value for Begg’s test

Pooled overall prevalence (95% CI)

GDM screening categorya

 1

722,312

98

0.139

0.106 (0.105–0.106)

 2

1,662,369

99

1.000

0.065 (0.057–0.072)

 3

138,812

98

0.298

0.089 (0.071–0.107)

 4

176,966

0

0.317

0.022 (0.022–0.023)

 5

2,086,957

99

0.443

0.051 (0.051–0.051)

 6

493,168

98

0.851

0.029 (0.028–0.029)

 7

68,892

99

0.051

0.044 (0.013–0.074)

 Overall

5,349,476

99

0.070

0.44 (0.043–0.044)

aGroups are defined as follows

Group 1 or HAPO definition who was screened based on OGTT with 75 g 2-h. Threshold: one value above 92, 180 and 153 mg/dL for fasting, 1, 2 and 3 h

Group 2 who was screened based on OGTT with 75 g 2-h. Threshold: one value above 100 and 144 mg/dL for fasting and 2 h

Group 3 who was screened based on OGTT with 75 g 2-h. Threshold: one value above 110 and 140 mg/dL for fasting, 1 and 2 h

Group 4 who was screened based on OGTT with 75 g 2-h. Threshold: value above 180 mg/dL for 2 h

Group 5 who was screened based on GCT with 50 g 1-h GCT, threshold: values above 140 mg/dL following OGTT with 100 g 3-h. Threshold: two value above 95, 180, 155 and 140 mg/dL for fasting, 1, 2 and 3 h or GCT with 50 g 1-h GCT, threshold: values above 140 mg/dL following OGTT with 75 g 3-h. Threshold: two value above 95, 180, 155 and 140 mmol/L for fasting, 1, 2 and 3 h

Group 6 who was screened based on glucose challenge test (GCT) with 50 g 1-h, Threshold: 140 mg/dL following oral glucose tolerance test (OGTT) with 100 g 3-h. Threshold: Two value above 105 or 190, 155, 165 and 145 mg/dL for fasting, 1, 2 and 3 h

Group 7 who was screened based on OGTT with 100 g 3-h. Threshold: one value above 120, 175, 155 and 140 mg/dL for fasting, 1, 2 and 3 h

The pooled prevalence of GDM in subgroup 1 was 10.6% (Pooled P = 10.6%, 95% CI 10.5–10.6%) which was the highest pooled prevalence of GDM among studies included. Moreover, the lowest prevalence of GDM was 2.2% in subgroup of 4 (Pooled overall P = 2.2%, 95% CI 2.2–2.3%) that used the cut of value of > 180 mg/dL for 2 h in OGTT-75 g glucose (Fig. 1). In this respect, the results of meta-regression showed that, exception for group 3, the prevalence of GDM among study that used the IADPSG criteria was significantly higher (6–11 fold) than other subgroups (Table 3) and (Additional file 1: Figure S2).
Fig. 1
Fig. 1

Forest plot of pooled Prevalence in subgroup of GDM diagnostic thresholds

Table 3

Meta regression of the prevalence of GDM and GDM diagnostic threshold subgroups

GDM diagnostic criteria subgroups

Regression coefficient (95% CI)

2 vs. 1

− 0.06 (− 0.12, − 0.00)*

3 vs. 1

− 0.04 (− 0.09, 0.01)

4 vs. 1

− 0.11 (− 0.22, − 0.00)*

5 vs. 1

− 0.07 (− 0.12, − 0.021)*

6 vs. 1

− 0.11 (− 0.18, − 0.039)*

7 vs. 1

− 0.09 (− 0.17, − 0.01)*

Reference group: 1 (HAPO defined criteria)

* Statistically significant

Table 4 showed the pooled analysis of prevalence of GDM in various GDM screening criteria groups among pregnant women in different geographic regions. The highest and lowest prevalence of GDM, regardless of screening criteria, reported in East Asia and Australia was (Pooled P = 11.4%, 95% CI 11.1–11.7%) and (Pooled P = 3.6%, 95% CI 3.6–3.7%), respectively (Additional file 1: Figures S3–S7).
Table 4

Results of heterogeneity and publication bias estimation and subgroup meta-analysis for prevalence of gestational diabetes based on various GDM screening threshold group among pregnant women in different geographic regions

Regions

GDM diagnostic threshold subgroup

Number of studies included

Begg’s test

P-value

I2%

Pooled measure of GDM (95% CI)

A

1

1

0.058 (0.039–0.076)

2

3

1

0.076 (0.072–0.080)

4

5

9

0.602

99

0.054 (0.054–0.054)

6

6

0.851

98

0.029 (0.028–0.029)

7

1

0.017 (0.016–0.019)

Overall

18

0.692

99

0.045 (0.044–0.045)

B

1

6

0.850

99

0.152 (0.147–0.157)

2

3

5

0.625

99

0.094 (0.090–0.097)

4

5

6

7

Overall

11

0.258

99

0.114 (0.111–0.117)

C

1

2

7

0.625

99

0.036 (0.036–0.037)

3

4

5

6

7

Overall

7

0.625

99

0.036 (0.036–0.037)

D

1

4

0.090

99

0.078 (0.076–0.081)

2

1

0.045 (0.044–0.046)

3

 

4

 

5

2

0.317

99

0.053 (0.050–0.056)

6

7

2

0.317

91

0.072 (0.070–0.075)

Overall

9

0.051

99

0.055 (0.054–0.056)

E

1

7

0.293

99

0.108 (0.107–0.108)

2

3

2

0.317

98

0.194 (0.175–0.213)

4

2

0.317

0

0.022 (0.022–0.023)

5

6

7

1

0.012 (0.009–0.015)

Overall

12

0.520

100

0.060 (0.059–0.060)

A: USA and Canada; B: South Asia including India, Bangladesh and Sri Lanka; C: Australia; D: East Asia including China and Japan; E: north Europe including Finland, Ireland, Sweden, Norway and Germany

We performed a subgroup analysis based on the various threshold groups for screening in different geographic regions (Table 4). In this respect, the prevalence of GDM, based on the IADPSG criteria was (Pooled P = 15.2%, 95% CI 14.7–15.7%), (Pooled P = 7.8%, 95% CI 7.6–8.1%) and (Pooled overall P = 10.8, 95% CI 10.7–10.8%) respectively. USA, Canada and Australia did not use the IADPSG criteria most of the time. The pooled prevalence of GDM in USA and Canada, that mostly used criterion No. 5, were 5.4%; (Pooled P = 5.4%, 95% CI 5.4–5.4%) and in Australia screened based on criterion No. 2, was 3.6%, (Pooled P = 3.6%, 95% CI 3.6–3.7%). We did not have sufficient studies to perform meta-analyses in other regions.

Publication bias and risk of bias

There was no substantial publication bias for meta-analyses based on the Begg’s test (Tables 2 and 4). Overall most of studies were judged as having low risk of bias for the evaluated domains; details are presented in Additional file 1: Figures S8, S9; as shown most cross-sectional and case–control studies had a low risk of bias in the assessment of exposure, development of outcome of interest in case and controls and selection of cases, approximately one-third of them had a high risk of bias in control of prognostic variables and selection of controls.

In addition, cohort studies had a low risk of bias for selection of exposed and non-exposed cohorts, assessment of exposure, presence of outcome of interest at start of study, outcome assessment, and adequacy of follow up of cohorts; however one-third of them had a high risk of bias in controlling prognostic variables and assessment of the presence or absence of prognostic factors and 3% of them had a high risk of bias in presence of outcome of interest at initiation of study.

Discussion

The current meta-analysis of population based studies provided data on the impact of various thresholds of diagnostic GDM criteria on prevalence of GDM. Results of the meta-analysis showed that using lower glucose level thresholds as recommended by the IADPSG, identified significantly higher numbers (6–11 fold) of women with GDM, compared to other diagnostic criteria; in this respect, except for USA, Canada and Australia, this criteria was the most commonly used screening method worldwide. The highest prevalence of GDM was found in south Asia, where approximately 2 in ten women were diagnosed with GDM.

Despite the wide range of recommendations and guidelines for detection of women with GDM adopted by expert international societies [17, 7380], there is strong controversy over the identification of GDM. Both the screening methods and diagnostic criteria vary among obstetricians and endocrine societies and more commonly even between regions within a single country. Screening approaches was include universal or targeted high risk screening, screening methods including fasting plasma glucose, random glucose and oral glucose challenge, diagnostic criteria including one steps or two, amount of the 75 g or 100 g glucose load, the duration of the test for 2 or 3 h, as well as the glucose threshold values, and whether 1 or 2 high glucose values are all used.

On the basis of the of Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study [16], the International Association of Diabetes and Pregnancy Study Groups (IADPSG) suggested that a 75-g OGTT be performed and that GDM be diagnosed if any one of the following is observed: fasting plasma glucose > 92 mg/dL, 1 h: 180 mg/dL and 2 h: 153 mg/dL [17] selected based on the odds ratio of 1.75-fold, the mean for outcomes of the HAPO study. Although the IADPSG recommendations are the first evidence-based, large-scale guideline for GDM and are now widely used around the world, lack of sufficient data on the increased effectiveness in improving feto-maternal outcomes has led to the use of different criteria, which are often based on expert opinion and have all not been to acceptable universally.

However, the more stringent criteria of IADPSG, lead to higher prevalence of GDM among pregnant women and potentially increase the costs of care for many pregnant women worldwide [81]. Considering the fact that majority of births annually occur in low- and low–middle income countries with limited resources, the cost-effectivity of this definition must be precisely defined on short-term pregnancy and neonatal outcomes, as well as long-term cardio-metabolic benefits for mother and offspring and the cost effectiveness of treatment [82].

In addition, the diagnosis of GDM and its treatment is stressful situation can be accompanied by serious psychological challenges for women and their families due to the complex interaction between psychological factors based on patients experience [83, 84]. While not recognizing the GDM is associated with adverse pregnancy outcomes; over-diagnosis may leads to psychological stress, unnecessary treatments and impaired quality of life. Maternal concerns about one’s own and unborn health status may strong negative effects on the maternal health status, diminishing overall quality of life (QoL). Marchetti et al. in a systematic review, showed that QoL among women with GDM, is significantly worse in both the short and long term health status [72]. Moreover, a “diabetic” label carries familial and social stigma especially in gender biased cultures, possibly leading to conflict among families [83].

One of our main findings was the estimation of the prevalence of GDM worldwide. There are two documented meta-analyses that evaluated the prevalence of GDM; Eades et al. describes a meta-analysis of primary research data reporting the prevalence of gestational diabetes mellitus in the general pregnant population in Europe; they reported that the overall prevalence of GDM was 5.4% (95% CI 3.8–7.8%) [85]. In another recent meta-analysis, Nguyen et al. reported that the pooled prevalence of GDM in Eastern and Southeastern Asia was 10.1% (95% CI 6.5–15.7%), whereas those were across nations [9]. Results of both these studies are comparable with our meta-analysis. However, the first review was limited to developed countries in Europe which may have had a different prevalence of GDM from developing countries even in Europe. The second review were not references the population based studies and both of studies did not evaluate the effect of diagnostic criteria on GDM prevalence.

The present review has the strength of a large sample size with population-based design studies involving approximately five and a half million women, using different methods for screening and diagnosis of GDM and consistency of method, quality, and focus. However, there are some limitations that need to be considered when interpreting the results of this meta-analysis. This study focused on evaluating the prevalence of GDM based on different criteria and did not assess the impact of diagnostic criteria on maternal and neonatal outcomes, which is a limitation. In addition, most of the included studies did not report the maternal age and BMI; we could not adjust for these confounders in our analysis. Moreover, we included studies that used the universal screening strategy; so countries with a low prevalence, that mostly used the targeted high-risk screening strategy was not included in our meta-analysis, which may lead to overestimation of the prevalence of GDM in low prevalent areas e.g. north Europe. In addition, most of the included studies did not exclude the twin or multiple pregnancy in their report and some even reported the proportion of deliveries affected by GDM. However, since multiple pregnancies constitute approximately 3% of births [86, 87], it seems that could not confound the results. However, due to the lack of data available for some regions, we could not perform subgroup analysis in some areas. In addition, it should be noted that in the last quarter century, the definition of GDM has been changed several time. Moreover, the increasing trend of obesity and diabetes may increase the prevalence of gestational diabetes; and can lead to heterogeneity of data.

Conclusion

Over the past quarter century, the diagnosis of gestational diabetes has been changed several times; there is still no general consensus about it. International communities have adopted different diagnostic methods and thresholds. Along with a worldwide increasing trend of obesity and diabetes, reducing the threshold for diagnosis of GDM are associated with a significant increase in the incidence of GDM. The harm and benefit of reducing the threshold of diagnostic criteria on pregnancy outcomes, women’s psychological aspects, and health costs should be evaluated precisely.

Abbreviations

GDM: 

gestational diabetes mellitus

HAPO: 

hyperglycaemia and adverse pregnancy outcomes

OGTT: 

oral glucose tolerance test

OR: 

odds ratio

IADPSG: 

International Association of Diabetes in Pregnancy Study Group

WHO: 

World Health Organization

GCT: 

glucose challenge test

Declarations

Authors’ contributions

SBG was involved in study design, search in databases, quality assessment, study selection, data extraction, data analysis, manuscript drafting, and critical discussion. FRT conceptualized the study and was involved in study design, quality assessment, data analysis, revising manuscript, and critical discussion. MA contribute in quality assessment, data extraction, critical discussion, and manuscript drafting. RBY contributed in statistical analysis, interpreting data and manuscript drafting. All authors read and approved the final manuscript.

Acknowledgements

The authors would like to acknowledge Ms. Niloofar Shive for critical editing of English grammar and syntax of the manuscript.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

Consent for publication

Not applicable.

Ethics approval and consent to participate

This study was approved by the ethics committee of the Research Institute for Endocrine Sciences and a written informed consent was obtained from all subjects before initiation of the study.

Funding

None.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Parvane Street, Yaman Street, Velenjak, Tehran, P.O.Box: 19395-4763, Iran
(2)
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poor sina street, Tehran, P.O.Box: 1417653761, Iran

References

  1. http://apps.who.int/iris/bitstream/handle/10665/85975/WHO_NMH_MND_13.2_eng.pdf; jsessionid = FD8DC8872A84924274CB92855D70888A?sequence = 1. Accessed 12 Oct 2018.
  2. Barbour LA, McCurdy CE, Hernandez TL, Kirwan JP, Catalano PM, Friedman JE. Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes. Diabetes Care. 2007;30:S112–9.PubMedView ArticleGoogle Scholar
  3. Genevay M, Pontes H, Meda P. Beta cell adaptation in pregnancy: a major difference between humans and rodents? Diabetologia. 2010;53:2089–92.PubMedView ArticleGoogle Scholar
  4. Wendland EM, Torloni MR, Falavigna M, Trujillo J, Dode MA, Campos MA, et al. Gestational diabetes and pregnancy outcomes—a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth. 2012;12:23.PubMedPubMed CentralView ArticleGoogle Scholar
  5. Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D, Golder S, et al. Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis. BMJ. 2016;354:i4694.PubMedPubMed CentralView ArticleGoogle Scholar
  6. Kim SY, Sharma AJ, Callaghan WM. Callaghan, gestational diabetes and childhood obesity: what is the link? Curr Opin Obstet Gynecol. 2012;24:376–81.PubMedPubMed CentralView ArticleGoogle Scholar
  7. Garcia-Vargas L, Addison SS, Nistala R, Kurukulasuriya D, Sowers JR. Gestational diabetes and the offspring: implications in the development of the cardiorenal metabolic syndrome in offspring. Cardiorenal Med. 2012;2:134–42.PubMedPubMed CentralView ArticleGoogle Scholar
  8. Xiong X, Saunders LD, Wang FL, Demianczuk NN. Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. Int J Gynaecol Obstet. 2001;75:221–8.PubMedView ArticleGoogle Scholar
  9. Nguyen CL, Pham NM, Binns CW, Duong DV, Lee AH. Prevalence of gestational diabetes mellitus in eastern and southeastern Asia: a systematic review and meta-analysis. J Diabetes Res. 2018;2018:6536974.PubMedPubMed CentralView ArticleGoogle Scholar
  10. Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care. 2007;30:S141–6.PubMedView ArticleGoogle Scholar
  11. Adam S, Rheeder P. Screening for gestational diabetes mellitus in a South African population: prevalence, comparison of diagnostic criteria and the role of risk factors. S Afr Med J. 2017;107:523–7.PubMedView ArticleGoogle Scholar
  12. Lin PC, Hung CH, Chan TF, Lin KC, Hsu YY, Tzeng YL. The risk factors for gestational diabetes mellitus: a retrospective study. Midwifery. 2016;42:16–20.PubMedView ArticleGoogle Scholar
  13. Cheung NW, Moses RG. Gestational diabetes mellitus: is it time to reconsider the diagnostic criteria? Diabetes Care. 2018;41:1337–8.PubMedView ArticleGoogle Scholar
  14. Jacklin PB, Maresh MJ, Patterson CC, Stanley KP, Dornhorst A, Burman-Roy S, et al. A cost-effectiveness comparison of the NICE 2015 and WHO 2013 diagnostic criteria for women with gestational diabetes with and without risk factors. BMJ Open. 2017;7:e016621.PubMedPubMed CentralView ArticleGoogle Scholar
  15. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.View ArticleGoogle Scholar
  16. Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care. 2012;35:526–8.PubMedPubMed CentralView ArticleGoogle Scholar
  17. International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–82.PubMed CentralView ArticlePubMedGoogle Scholar
  18. Bhavadharini B, Uma R, Saravanan P, Mohan V. Screening and diagnosis of gestational diabetes mellitus—relevance to low and middle income countries. Clin Diabetes Endocrinol. 2016;2:13.PubMedPubMed CentralView ArticleGoogle Scholar
  19. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(264–9):W64.Google Scholar
  20. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute; 2009. Available in March 2016.Google Scholar
  21. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.PubMedPubMed CentralView ArticleGoogle Scholar
  22. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions, vol. 4. New York: Wiley; 2011.Google Scholar
  23. Al Mahroos S, Nagalla DS, Yousif W, Sanad H. A population-based screening for gestational diabetes mellitus in non-diabetic women in Bahrain. Ann Saudi Med. 2005;25:129–33.PubMedPubMed CentralView ArticleGoogle Scholar
  24. Anna V, van der Ploeg HP, Cheung NW, Huxley RR, Bauman AE. Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005. Diabetes Care. 2008;31:2288–93.PubMedPubMed CentralView ArticleGoogle Scholar
  25. Baptiste-Roberts K, Nicholson WK, Wang NY, Brancati FL. Gestational diabetes and subsequent growth patterns of offspring: the National Collaborative Perinatal Project. Matern Child Health J. 2012;16:125–32.PubMedPubMed CentralView ArticleGoogle Scholar
  26. Leng J, Shao P, Zhang C, Tian H, Zhang F, Zhang S, et al. Prevalence of gestational diabetes mellitus and its risk factors in Chinese pregnant women: a prospective population-based study in Tianjin, China. PLoS ONE. 2015;10:e0121029.PubMedPubMed CentralView ArticleGoogle Scholar
  27. Chodick G, Elchalal U, Sella T, Heymann AD, Porath A, Kokia E, Shalev V. The risk of overt diabetes mellitus among women with gestational diabetes: a population-based study. Diabet Med. 2010;27:779–85.PubMedView ArticleGoogle Scholar
  28. Erjavec K, Poljičanin T, Matijević R. Impact of the implementation of new WHO diagnostic criteria for gestational diabetes mellitus on prevalence and perinatal outcomes: a population-based study. J Pregnancy. 2016;2016:2670912.PubMedPubMed CentralView ArticleGoogle Scholar
  29. Ferrara A, Hedderson MM, Quesenberry CP, Selby JV. Prevalence of gestational diabetes mellitus detected by the national diabetes data group or the carpenter and coustan plasma glucose thresholds. Diabetes Care. 2002;25:1625–30.PubMedView ArticleGoogle Scholar
  30. Hedderson MM, Darbinian JA, Ferrara A. Disparities in the risk of gestational diabetes by race-ethnicity and country of birth. Paediatr Perinat Epidemiol. 2010;24:441–8.PubMedPubMed CentralView ArticleGoogle Scholar
  31. Jenum AK, Mørkrid K, Sletner L, Vangen S, Torper JL, Nakstad B, et al. Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study. Eur J Endocrinol. 2012;166:317–24.PubMedPubMed CentralView ArticleGoogle Scholar
  32. Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of pre-existing diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005. Diabetes Care. 2008;31:899–904.PubMedView ArticleGoogle Scholar
  33. Leng J, Liu G, Zhang C, Xin S, Chen F, Li B, et al. Physical activity, sedentary behaviors and risk of gestational diabetes mellitus: a population-based cross-sectional study in Tianjin, China. Eur J Endocrinol. 2016;174:763–73.PubMedView ArticleGoogle Scholar
  34. Magee MS, Walden CE, Benedetti TJ, Knopp RH. Influence of diagnostic criteria on the incidence of gestational diabetes and perinatal morbidity. JAMA. 1993;269:609–15.PubMedView ArticlePubMed CentralGoogle Scholar
  35. Mizuno S, Nishigori H, Sugiyama T, Takahashi F, Iwama N, Watanabe Z, et al. Association between social capital and the prevalence of gestational diabetes mellitus: an interim report of the Japan Environment and Children’s Study. Diabetes Res Clin Pract. 2016;120:132–41.PubMedView ArticlePubMed CentralGoogle Scholar
  36. Lindqvist M, Persson M, Lindkvist M, Mogren I. No consensus on gestational diabetes mellitus screening regimes in Sweden: pregnancy outcomes in relation to different screening regimes 2011 to 2012, a cross-sectional study. BMC Pregnancy Childbirth. 2014;14:185.PubMedPubMed CentralView ArticleGoogle Scholar
  37. Bhavadharini B, Mahalakshmi MM, Anjana RM, Maheswari K, Uma R, Deepa M, et al. Prevalence of gestational diabetes mellitus in urban and rural Tamil Nadu using IADPSG and WHO 1999 criteria (WINGS 6). Clin Diabetes Endocrinol. 2016;2:8.PubMedPubMed CentralView ArticleGoogle Scholar
  38. Pu J, Zhao B, Wang EJ, Nimbal V, Osmundson S, Kunz L, et al. Racial/ethnic differences in gestational diabetes prevalence and contribution of common risk factors. Paediatr Perinat Epidemiol. 2015;29:436–43.PubMedView ArticleGoogle Scholar
  39. Schmidt MI, Duncan BB, Reichelt AJ, Branchtein L, Matos MC, e Forti AC, et al. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care. 2001;24:1151–5.PubMedView ArticleGoogle Scholar
  40. Sella T, Shalev V, Elchalal U, Chovel-Sella A, Chodick G, et al. Screening for gestational diabetes in the 21st century: a population-based cohort study in Israel. J Matern Fetal Neonatal Med. 2013;26:412–6.PubMedView ArticleGoogle Scholar
  41. Shand AW, Bell JC, McElduff A, Morris J, Roberts CL. Outcomes of pregnancies in women with pre-gestational diabetes mellitus and gestational diabetes mellitus; a population-based study in New South Wales, Australia, 1998–2002. Diabet Med. 2008;25:708–15.PubMedView ArticleGoogle Scholar
  42. Sommer C, Mørkrid K, Jenum AK, Sletner L, Mosdøl A, Birkeland KI. Weight gain, total fat gain and regional fat gain during pregnancy and the association with gestational diabetes: a population-based cohort study. Int J Obes. 2014;38:76–81.View ArticleGoogle Scholar
  43. Tan HLE, Luu J, Caswell A, Holliday E, Attia J, Acharya S. Impact of new International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria on perinatal outcomes in a regional tertiary hospital in New South Wales, Australia. Diabetes Res Clin Pract. 2017;134:191–8.PubMedView ArticleGoogle Scholar
  44. Wang Y, Chen L, Xiao K, Horswell R, Besse J, Johnson J, et al. Increasing incidence of gestational diabetes mellitus in Louisiana, 1997–2009. J Womens Health. 2012;21:319–25.View ArticleGoogle Scholar
  45. Yang H, Wei Y, Gao X, Xu X, Fan L, He J, et al. Risk factors for gestational diabetes mellitus in Chinese women—a prospective study of 16 286 pregnant women in China. Diabet Med. 2009;26:1099–104.PubMedView ArticleGoogle Scholar
  46. Yeung RO, Savu A, Kinniburgh B, Lee L, Dzakpasu S, Nelson C, et al. Prevalence of gestational diabetes among Chinese and South Asians: a Canadian population-based analysis. J Diabetes Complicat. 2017;31:529–36.PubMedView ArticleGoogle Scholar
  47. Zhang F, Dong L, Zhang CP, Li B, Wen J, Gao W, et al. Increasing prevalence of gestational diabetes mellitus in Chinese women from 1999 to 2008. Diabet Med. 2011;28:652–7.PubMedView ArticleGoogle Scholar
  48. Aljohani N, Rempel BM, Ludwig S, Morris M, McQuillen K, Cheang M, et al. Gestational diabetes in Manitoba during a twenty-year period. Clin Invest Med. 2008;31:E131–7.PubMedView ArticleGoogle Scholar
  49. Arora GP, Thaman RG, Prasad RB, Almgren P, Brøns C, Groop LC, et al. Prevalence and risk factors of gestational diabetes in Punjab, north India—results from a population screening program. Eur J Endocrinol. 2015;173:257–67.PubMedView ArticleGoogle Scholar
  50. Moses RG, Morris GJ, Petocz P, San Gil F, Garg D, et al. The impact of potential new diagnostic criteria on the prevalence of gestational diabetes mellitus in Australia. Med J Aust. 2011;194:338–40.PubMedGoogle Scholar
  51. Ferrara A, Kahn HS, Quesenberry CP, Riley C, Hedderson MM. An increase in the incidence of gestational diabetes mellitus: Northern California, 1991–2000. Obstet Gynecol. 2004;103:526–33.PubMedView ArticleGoogle Scholar
  52. Gao XL, Wei YM, Yang HX, Xu XM, Fan L, He J, et al. Difference between 2 h and 3 h 75 g glucose tolerance test in the diagnosis of gestational diabetes mellitus (GDM): results from a national survey on prevalence of GDM. Front Med China. 2010;4:303–7.PubMedView ArticleGoogle Scholar
  53. Ignell C, Claesson R, Anderberg E, Berntorp K. Trends in the prevalence of gestational diabetes mellitus in southern Sweden, 2003–2012. Acta Obstet Gynecol Scand. 2014;93:420–4.PubMedView ArticleGoogle Scholar
  54. Ishak M, Petocz P. Gestational diabetes among Aboriginal Australians: prevalence, time trend, and comparisons with non-Aboriginal Australians. Ethn Dis. 2003;13:55–60.PubMedGoogle Scholar
  55. Janghorbani M, Stenhouse E, Jones RB, Millward A. Gestational diabetes mellitus in Plymouth, UK: prevalence, seasonal variation and associated factors. J Reprod Med. 2006;51:128–34.PubMedGoogle Scholar
  56. Jesmin S, Akter S, Akashi H, Al-Mamun A, Rahman MA, Islam MM, et al. Screening for gestational diabetes mellitus and its prevalence in Bangladesh. Diabetes Res Clin Pract. 2014;103:57–62.PubMedView ArticleGoogle Scholar
  57. Kalamegham R, Nuwayhid BS, Mulla ZD. Prevalence of gestational fasting and postload single dysglycemia in Mexican–American women and their relative significance in identifying carbohydrate intolerance. Am J Perinatol. 2010;27:697–704.PubMedView ArticleGoogle Scholar
  58. McCarthy AD, Curciarello R, Castiglione N, Tayeldín MF, Costa D, Arnol V, et al. Universal versus selective screening for the detection, control and prognosis of gestational diabetes mellitus in Argentina. Acta Diabetol. 2010;47:97–103.PubMedView ArticleGoogle Scholar
  59. Melchior H, Kurch-Bek D, Mund M. The prevalence of gestational diabetes: a population-based analysis of a nationwide screening program. Dtsch Arztebl Int. 2017;114:412–8.PubMedPubMed CentralGoogle Scholar
  60. Murphy NJ, Bulkow LR, Schraer CD, Lanier AP. Prevalence of diabetes mellitus in pregnancy among Yup’ik Eskimos, 1987–1988. Diabetes Care. 1993;16:315–7.PubMedView ArticleGoogle Scholar
  61. Ostlund I, Hanson U. Occurrence of gestational diabetes mellitus and the value of different screening indicators for the oral glucose tolerance test. Acta Obstet Gynecol Scand. 2003;82:103–8.PubMedView ArticleGoogle Scholar
  62. O’Sullivan EP, Avalos G, O’Reilly M, Dennedy MC, Gaffney G, Dunne F, et al. Atlantic diabetes in pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria. Diabetologia. 2011;54:1670–5.PubMedView ArticleGoogle Scholar
  63. Schmidt MI, Matos MC, Reichelt AJ, Forti AC, de Lima L, Duncan BB. Prevalence of gestational diabetes mellitus—do the new WHO criteria make a difference? Diabet Med. 2000;17:376–80.PubMedView ArticleGoogle Scholar
  64. Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Arthi T, Thamizharasi M, et al. Gestational diabetes mellitus manifests in all trimesters of pregnancy. Diabetes Res Clin Pract. 2007;77:482–4.PubMedView ArticleGoogle Scholar
  65. Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Arthi T, Thamizharasi M, et al. Prevalence of gestational diabetes mellitus in South India (Tamil Nadu): a community based study. J Assoc Physicians India. 2008;56:329–33.PubMedGoogle Scholar
  66. Seyoum B, Kiros K, Haileselase T, Leole A. Prevalence of gestational diabetes mellitus in rural pregnant mothers in northern Ethiopia. Diabetes Res Clin Pract. 1999;46:247–51.PubMedView ArticleGoogle Scholar
  67. Sudasinghe BH, Ginige PS, Wijeyaratne CN. Prevalence of gestational diabetes mellitus in a suburban district in Sri Lanka: a population based study. Ceylon Med J. 2016;61:149–53.PubMedView ArticleGoogle Scholar
  68. Tamayo T, Tamayo M, Rathmann W, Potthoff P. Prevalence of gestational diabetes and risk of complications before and after initiation of a general systematic two-step screening strategy in Germany (2012–2014). Diabetes Res Clin Pract. 2016;115:1–8.PubMedView ArticleGoogle Scholar
  69. Trujillo J, Vigo A, Duncan BB, Falavigna M, Wendland EM, Campos MA, et al. Impact of the International Association of Diabetes and Pregnancy Study Groups criteria for gestational diabetes. Diabetes Res Clin Pract. 2015;108:288–95.PubMedView ArticleGoogle Scholar
  70. Wahabi H, Fayed A, Esmaeil S, Mamdouh H, Kotb R. Prevalence and complications of pregestational and gestational diabetes in Saudi women: analysis from Riyadh Mother and Baby cohort study (RAHMA). Biomed Res Int. 2017;2017:6878263.PubMedPubMed CentralView ArticleGoogle Scholar
  71. Zhu WW, Yang HX, Wang C, Su RN, Feng H, Kapur A. High prevalence of gestational diabetes mellitus in Beijing: effect of maternal birth weight and other risk factors. Chin Med J. 2017;130:1019–25.PubMedPubMed CentralView ArticleGoogle Scholar
  72. Marchetti D, Carrozzino D, Fraticelli F, Fulcheri M, Vitacolonna E. Quality of life in women with gestational diabetes mellitus: a systematic review. J Diabetes Res. 2017;2017:7058082.PubMedPubMed CentralView ArticleGoogle Scholar
  73. World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva: World Health Organization; 2013.Google Scholar
  74. American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2017;40:S11–24.View ArticleGoogle Scholar
  75. National Institute for Health and Care Excellence. NICE guideline. Diabetes in pregnancy: management from preconception to the postnatal period (NG3). London: NICE. http://www.nice.org.uk/guidance/ng3/resources/diabetesin-pregnancy-management-of-diabetes-and-itscomplications-from-preconception-to-the-postnatal-period-51038446021. Accessed 23 July 2017.
  76. Hoffman L, Nolan C, Wilson JD, Oats JJ, Simmons D. Gestational diabetes mellitus-management guidelines—The Australasian Diabetes in Pregnancy Society. Med J Aust. 1998;169:93–7.PubMedGoogle Scholar
  77. ACOG. Committee on practice bulletins—obstetrics. ACOG Practice Bulletin No. 190: gestational diabetes mellitus. Obstet Gynecol. 2018;131:e49–64.View ArticleGoogle Scholar
  78. American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes Care. 2018;41:S13–27.View ArticleGoogle Scholar
  79. Blumer I, Hadar E, Hadden DR, Jovanovič L, Mestman JH, Murad MH, et al. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2013;98:4227–49.PubMedView ArticleGoogle Scholar
  80. National Collaborating Centre for Women’s and Children’s Health (UK). Health, Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. 2015.Google Scholar
  81. Gillespie P, O’Neill C, Avalos G, Dunne FP, ALANTIC DIP Collaborators. New estimates of the costs of universal screening for gestational diabetes mellitus in Ireland. Ir Med J. 2012;105(5 Suppl):15–8.PubMedGoogle Scholar
  82. Brown FM, Wyckoff J. Application of one-step IADPSG versus two-step diagnostic criteria for gestational diabetes in the real world: impact on health services, clinical care, and outcomes. Curr Diab Rep. 2017;17:85.PubMedPubMed CentralView ArticleGoogle Scholar
  83. Kalra B, Gupta Y, Baruah MP. Renaming gestational diabetes mellitus: a psychosocial argument. Indian J Endocrinol Metab. 2013;17:S593–5.PubMedPubMed CentralView ArticleGoogle Scholar
  84. Kalra S, Baruah MP, Gupta Y, Kalra B. Gestational diabetes: an onomastic opportunity. Lancet Diabetes Endocrinol. 2013;1:91.PubMedView ArticleGoogle Scholar
  85. Eades CE, Cameron DM, Evans JMM. Prevalence of gestational diabetes mellitus in Europe: a meta-analysis. Diabetes Res Clin Pract. 2017;129:173–81.PubMedView ArticleGoogle Scholar
  86. Collins J. Global epidemiology of multiple birth. Reprod Biomed Online. 2007;15:45–52.PubMedView ArticleGoogle Scholar
  87. Heino A, Gissler M, Hindori-Mohangoo AD, Blondel B, Klungsøyr K, Verdenik I, et al. Variations in multiple birth rates and impact on perinatal outcomes in Europe. PLoS ONE. 2016;11:e0149252.PubMedPubMed CentralView ArticleGoogle Scholar

Copyright

© The Author(s) 2019

Advertisement