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
Autor(a) principal: | |
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Data de Publicação: | 2012 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://repositorio.unifesp.br/handle/11600/34722 http://dx.doi.org/10.1186/1471-2393-12-23 |
Resumo: | Background: Two criteria based on a 2 h 75 g OGTT are being used for the diagnosis of gestational diabetes (GDM), those recommended over the years by the World Health Organization ( WHO), and those recently recommended by the International Association for Diabetes in Pregnancy Study Group (IADPSG), the latter generated in the HAPO study and based on pregnancy outcomes. Our aim is to systematically review the evidence for the associations between GDM ( according to these criteria) and adverse outcomes.Methods: We searched relevant studies in MEDLINE, EMBASE, LILACS, the Cochrane Library, CINHAL, WHO-Afro library, IMSEAR, EMCAT, IMEMR and WPRIM. We included cohort studies permitting the evaluation of GDM diagnosed by WHO and or IADPSG criteria against adverse maternal and perinatal outcomes in untreated women. Only studies with universal application of a 75 g OGTT were included. Relative risks (RRs) and their 95% confidence intervals (CI) were obtained for each study. We combined study results using a random-effects model. Inconsistency across studies was defined by an inconsistency index (I-2) > 50%.Results: Data were extracted from eight studies, totaling 44,829 women. Greater risk of adverse outcomes was observed for both diagnostic criteria. When using the WHO criteria, consistent associations were seen for macrosomia (RR = 1.81; 95%CI 1.47-2.22; p < 0.001); large for gestational age ( RR = 1.53; 95%CI 1.39-1.69; p < 0.001); perinatal mortality (RR = 1.55; 95% CI 0.88-2.73; p = 0.13); preeclampsia (RR = 1.69; 95%CI 1.31-2.18; p < 0.001); and cesarean delivery (RR = 1.37; 95%CI 1.24-1.51; p < 0.001). Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I-2 >= 73%). Magnitudes of RRs and their 95%CIs were 1.73 (1.282.35; p = 0.001) for large for gestational age; 1.71 (1.38-2.13; p < 0.001) for preeclampsia; and 1.23 (1.01-1.51; p = 0.04) for cesarean delivery. Excluding either the HAPO or the EBDG studies minimally altered these associations, but the RRs seen for the IADPSG criteria were reduced after excluding HAPO.Conclusions: the WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes. Associations were of similar magnitude for both criteria. However, high inconsistency was seen for those with the IADPSG criteria. Full evaluation of the latter in settings other than HAPO requires additional studies. |
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Wendland, Eliana M.Torloni, Maria Regina [UNIFESP]Falavigna, MaiconTrujillo, JanetDode, Maria AliceCampos, Maria AmeliaDuncan, Bruce B.Schmidt, Maria InesFed Univ Hlth SciUniversidade Federal de São Paulo (UNIFESP)Univ Fed Rio Grande do SulUniv Fed PelotasConceicao Hosp2016-01-24T14:26:59Z2016-01-24T14:26:59Z2012-03-31Bmc Pregnancy and Childbirth. London: Biomed Central Ltd, v. 12, 13 p., 2012.1471-2393http://repositorio.unifesp.br/handle/11600/34722http://dx.doi.org/10.1186/1471-2393-12-23WOS000304308300001.pdf10.1186/1471-2393-12-23WOS:000304308300001Background: Two criteria based on a 2 h 75 g OGTT are being used for the diagnosis of gestational diabetes (GDM), those recommended over the years by the World Health Organization ( WHO), and those recently recommended by the International Association for Diabetes in Pregnancy Study Group (IADPSG), the latter generated in the HAPO study and based on pregnancy outcomes. Our aim is to systematically review the evidence for the associations between GDM ( according to these criteria) and adverse outcomes.Methods: We searched relevant studies in MEDLINE, EMBASE, LILACS, the Cochrane Library, CINHAL, WHO-Afro library, IMSEAR, EMCAT, IMEMR and WPRIM. We included cohort studies permitting the evaluation of GDM diagnosed by WHO and or IADPSG criteria against adverse maternal and perinatal outcomes in untreated women. Only studies with universal application of a 75 g OGTT were included. Relative risks (RRs) and their 95% confidence intervals (CI) were obtained for each study. We combined study results using a random-effects model. Inconsistency across studies was defined by an inconsistency index (I-2) > 50%.Results: Data were extracted from eight studies, totaling 44,829 women. Greater risk of adverse outcomes was observed for both diagnostic criteria. When using the WHO criteria, consistent associations were seen for macrosomia (RR = 1.81; 95%CI 1.47-2.22; p < 0.001); large for gestational age ( RR = 1.53; 95%CI 1.39-1.69; p < 0.001); perinatal mortality (RR = 1.55; 95% CI 0.88-2.73; p = 0.13); preeclampsia (RR = 1.69; 95%CI 1.31-2.18; p < 0.001); and cesarean delivery (RR = 1.37; 95%CI 1.24-1.51; p < 0.001). Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I-2 >= 73%). Magnitudes of RRs and their 95%CIs were 1.73 (1.282.35; p = 0.001) for large for gestational age; 1.71 (1.38-2.13; p < 0.001) for preeclampsia; and 1.23 (1.01-1.51; p = 0.04) for cesarean delivery. Excluding either the HAPO or the EBDG studies minimally altered these associations, but the RRs seen for the IADPSG criteria were reduced after excluding HAPO.Conclusions: the WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes. Associations were of similar magnitude for both criteria. However, high inconsistency was seen for those with the IADPSG criteria. Full evaluation of the latter in settings other than HAPO requires additional studies.World Health OrganizationFed Univ Hlth Sci, Porto Alegre, RS, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniv Fed Rio Grande do Sul, Porto Alegre, RS, BrazilUniv Fed Pelotas, Pelotas, BrazilConceicao Hosp, Porto Alegre, RS, BrazilUniversidade Federal de São Paulo, EPM, São Paulo, BrazilWorld Health Organization: 2010/119177-0World Health Organization: APW 200308151Web of Science13engBiomed Central LtdBmc Pregnancy and ChildbirthGestational 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 criteriainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESPORIGINALWOS000304308300001.pdfapplication/pdf471520${dspace.ui.url}/bitstream/11600/34722/1/WOS000304308300001.pdfc6963ec2bf3a85e175bfc51d079d3927MD51open accessTEXTWOS000304308300001.pdf.txtWOS000304308300001.pdf.txtExtracted texttext/plain47567${dspace.ui.url}/bitstream/11600/34722/2/WOS000304308300001.pdf.txt986f4bc7d0c5778680eba9bc1cefecf9MD52open access11600/347222022-06-02 09:27:10.917open accessoai:repositorio.unifesp.br:11600/34722Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652023-05-25T12:15:22.769059Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.en.fl_str_mv |
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 |
title |
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 |
spellingShingle |
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 Wendland, Eliana M. |
title_short |
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 |
title_full |
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 |
title_fullStr |
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 |
title_full_unstemmed |
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 |
title_sort |
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 |
author |
Wendland, Eliana M. |
author_facet |
Wendland, Eliana M. Torloni, Maria Regina [UNIFESP] Falavigna, Maicon Trujillo, Janet Dode, Maria Alice Campos, Maria Amelia Duncan, Bruce B. Schmidt, Maria Ines |
author_role |
author |
author2 |
Torloni, Maria Regina [UNIFESP] Falavigna, Maicon Trujillo, Janet Dode, Maria Alice Campos, Maria Amelia Duncan, Bruce B. Schmidt, Maria Ines |
author2_role |
author author author author author author author |
dc.contributor.institution.none.fl_str_mv |
Fed Univ Hlth Sci Universidade Federal de São Paulo (UNIFESP) Univ Fed Rio Grande do Sul Univ Fed Pelotas Conceicao Hosp |
dc.contributor.author.fl_str_mv |
Wendland, Eliana M. Torloni, Maria Regina [UNIFESP] Falavigna, Maicon Trujillo, Janet Dode, Maria Alice Campos, Maria Amelia Duncan, Bruce B. Schmidt, Maria Ines |
description |
Background: Two criteria based on a 2 h 75 g OGTT are being used for the diagnosis of gestational diabetes (GDM), those recommended over the years by the World Health Organization ( WHO), and those recently recommended by the International Association for Diabetes in Pregnancy Study Group (IADPSG), the latter generated in the HAPO study and based on pregnancy outcomes. Our aim is to systematically review the evidence for the associations between GDM ( according to these criteria) and adverse outcomes.Methods: We searched relevant studies in MEDLINE, EMBASE, LILACS, the Cochrane Library, CINHAL, WHO-Afro library, IMSEAR, EMCAT, IMEMR and WPRIM. We included cohort studies permitting the evaluation of GDM diagnosed by WHO and or IADPSG criteria against adverse maternal and perinatal outcomes in untreated women. Only studies with universal application of a 75 g OGTT were included. Relative risks (RRs) and their 95% confidence intervals (CI) were obtained for each study. We combined study results using a random-effects model. Inconsistency across studies was defined by an inconsistency index (I-2) > 50%.Results: Data were extracted from eight studies, totaling 44,829 women. Greater risk of adverse outcomes was observed for both diagnostic criteria. When using the WHO criteria, consistent associations were seen for macrosomia (RR = 1.81; 95%CI 1.47-2.22; p < 0.001); large for gestational age ( RR = 1.53; 95%CI 1.39-1.69; p < 0.001); perinatal mortality (RR = 1.55; 95% CI 0.88-2.73; p = 0.13); preeclampsia (RR = 1.69; 95%CI 1.31-2.18; p < 0.001); and cesarean delivery (RR = 1.37; 95%CI 1.24-1.51; p < 0.001). Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I-2 >= 73%). Magnitudes of RRs and their 95%CIs were 1.73 (1.282.35; p = 0.001) for large for gestational age; 1.71 (1.38-2.13; p < 0.001) for preeclampsia; and 1.23 (1.01-1.51; p = 0.04) for cesarean delivery. Excluding either the HAPO or the EBDG studies minimally altered these associations, but the RRs seen for the IADPSG criteria were reduced after excluding HAPO.Conclusions: the WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes. Associations were of similar magnitude for both criteria. However, high inconsistency was seen for those with the IADPSG criteria. Full evaluation of the latter in settings other than HAPO requires additional studies. |
publishDate |
2012 |
dc.date.issued.fl_str_mv |
2012-03-31 |
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2016-01-24T14:26:59Z |
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2016-01-24T14:26:59Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
Bmc Pregnancy and Childbirth. London: Biomed Central Ltd, v. 12, 13 p., 2012. |
dc.identifier.uri.fl_str_mv |
http://repositorio.unifesp.br/handle/11600/34722 http://dx.doi.org/10.1186/1471-2393-12-23 |
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1471-2393 |
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WOS000304308300001.pdf |
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10.1186/1471-2393-12-23 |
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WOS:000304308300001 |
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Bmc Pregnancy and Childbirth. London: Biomed Central Ltd, v. 12, 13 p., 2012. 1471-2393 WOS000304308300001.pdf 10.1186/1471-2393-12-23 WOS:000304308300001 |
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http://repositorio.unifesp.br/handle/11600/34722 http://dx.doi.org/10.1186/1471-2393-12-23 |
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eng |
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Biomed Central Ltd |
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Biomed Central Ltd |
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