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. 2017 Oct;60(10):1913-1921.
doi: 10.1007/s00125-017-4353-9. Epub 2017 Jul 12.

Epidemiology of gestational diabetes mellitus according to IADPSG/WHO 2013 criteria among obese pregnant women in Europe

Aoife M Egan  1 , Akke Vellinga  1 , Jürgen Harreiter  2 , David Simmons  3   4 , Gernot Desoye  5 , Rosa Corcoy  6   7 , Juan M Adelantado  6 , Roland Devlieger  8   9 , Andre Van Assche  8   9 , Sander Galjaard  8   9   10 , Peter Damm  11   12 , Elisabeth R Mathiesen  11   12 , Dorte M Jensen  13   14   15 , Liselotte Andersen  13   14   15 , Annuziata Lapolla  16 , Maria G Dalfrà  16 , Alessandra Bertolotto  17 , Urszula Mantaj  18 , Ewa Wender-Ozegowska  18 , Agnieszka Zawiejska  18 , David Hill  19 , Judith G M Jelsma  20 , Frank J Snoek  21 , Christof Worda  22 , Dagmar Bancher-Todesca  22 , Mireille N M van Poppel  23   24 , Alexandra Kautzky-Willer  2 , Fidelma P Dunne  25 ; DALI Core Investigator group
Affiliations

Epidemiology of gestational diabetes mellitus according to IADPSG/WHO 2013 criteria among obese pregnant women in Europe

Aoife M Egan et al. Diabetologia. 2017 Oct.

Abstract

Aims/hypothesis: Accurate prevalence estimates for gestational diabetes mellitus (GDM) among pregnant women in Europe are lacking owing to the use of a multitude of diagnostic criteria and screening strategies in both high-risk women and the general pregnant population. Our aims were to report important risk factors for GDM development and calculate the prevalence of GDM in a cohort of women with BMI ≥29 kg/m2 across 11 centres in Europe using the International Association of the Diabetes and Pregnancy Study Groups (IADPSG)/WHO 2013 diagnostic criteria.

Methods: Pregnant women (n = 1023, 86.3% European ethnicity) with a BMI ≥29.0 kg/m2 enrolled into the Vitamin D and Lifestyle Intervention for GDM Prevention (DALI) pilot, lifestyle and vitamin D studies of this pan-European multicentre trial, attended for an OGTT during pregnancy. Demographic, anthropometric and metabolic data were collected at enrolment and throughout pregnancy. GDM was diagnosed using IADPSG/WHO 2013 criteria. GDM treatment followed local policies.

Results: The number of women recruited per country ranged from 80 to 217, and the dropout rate was 7.1%. Overall, 39% of women developed GDM during pregnancy, with no significant differences in prevalence across countries. The prevalence of GDM was high (24%; 242/1023) in early pregnancy. Despite interventions used in the DALI study, a further 14% (94/672) had developed GDM when tested at mid gestation (24-28 weeks) and 13% (59/476) of the remaining cohort at late gestation (35-37 weeks). Demographics and lifestyle factors were similar at baseline between women with GDM and those who maintained normal glucose tolerance. Previous GDM (16.5% vs 7.9%, p = 0.002), congenital malformations (6.4% vs 3.3%, p = 0.045) and a baby with macrosomia (31.4% vs 17.9%, p = 0.001) were reported more frequently in those who developed GDM. Significant anthropometric and metabolic differences were already present in early pregnancy between women who developed GDM and those who did not.

Conclusions/interpretation: The prevalence of GDM diagnosed by the IADPSG/WHO 2013 GDM criteria in European pregnant women with a BMI ≥29.0 kg/m2 is substantial, and poses a significant health burden to these pregnancies and to the future health of the mother and her offspring. Uniform criteria for GDM diagnosis, supported by robust evidence for the benefits of treatment, are urgently needed to guide modern GDM screening and treatment strategies.

Keywords: Clinical diabetes; Clinical science and care; Epidemiology; Healthcare delivery; Pregnancy; Weight regulation and obesity.

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Conflict of interest statement

Data availability

Data are available on reasonable request from the corresponding authors.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

AME coordinated the manuscript drafts, AV completed the statistical analysis and FPD was the project supervisor. All authors made substantial contributions to the analysis and interpretation of data; revised the manuscript critically for important intellectual content; and approved the final version to be published. FPD is responsible for the integrity of the work as a whole.

References

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