The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus

Abstract

The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was performed in response to the need for internationally agreed upon diagnostic criteria for gestational diabetes, based upon their predictive value for adverse pregnancy outcome. Increases in each of the 3 values on the 75-g, 2-hour oral glucose tolerance test are associated with graded increases in the likelihood of pregnancy outcomes such as large for gestational age, cesarean section, fetal insulin levels, and neonatal fat content. Based upon an iterative process of decision making, a task force of the International Association of Diabetes and Pregnancy Study Groups recommends that the diagnosis of gestational diabetes be made when any of the following 3 75-g, 2-hour oral glucose tolerance test thresholds are met or exceeded: fasting 92 mg/dL, 1-hour 180 mg/dL, or 2 hours 153 mg/dL. Various authoritative bodies around the world are expected to deliberate the adoption of these criteria.

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Frequency of primary outcomes across the glucose categories. Reprinted, with permission, from the New England Journal of Medicine Fasting: Category 1 = < 75, 2 = 75-79, 3 = 80-84, 4 = 85-89, 5 = 90-94, 6 = 95-99, 7 = > 100 mg/dL One Hour OGTT: Category 1 = < 105, 2 = 106 – 132, 3 = 133 – 155, 4 = 156 – 171, 5 = 172 – 193, 6 = 194 – 211, 7 = > 212 mg/dL Two Hour OGTT: Category 1 = < 90, 2 = 91 – 108, 3 = 109 – 125, 4 = 126 – 139, 5 = 140 – 157, 6 = 158 – 177, 7 = > 178 mg/dL