Poster Presentation Society of Obstetric Medicine of Australia and New Zealand and Australasian Diabetes in Pregnancy Society Joint Scientific Meeting 2017

The impact of adapting to the new diagnostic criteria for gestational diabetes (#163)

Elisabeth Ng 1 , Dilan Seneviratne Epa 1 , Madeleine Neff 2 , Shoshana Sztal-Mazer 3 4
  1. Department of Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
  2. Department of Nutrition, The Alfred Hospital, Melbourne, Victoria, Australia
  3. Department of Endocrinology & Diabetes, Alfred Health, Melbourne, Australia
  4. Monash University, Melbourne, Victoria, Australia

Gestational diabetes mellitus (GDM) is defined as the onset of abnormal glucose tolerance during pregnancy. Diagnostic criteria for GDM, as guided by the Australasian Diabetes in Pregnancy Society, were updated in 2012 to mirror those of the International Association of Diabetes and Pregnancy Study Group (now endorsed by WHO). Lower diagnostic thresholds were recommended based on the correlation between maternal hyperglycaemia and adverse perinatal outcomes1. Since the change in criteria, GDM rates have increased worldwide by 20-62%2-4 although some centres have not experienced the increase predicted5.

We aimed to describe the change in GDM incidence since our transition to the new diagnostic criteria in January 2015. Of note, we moved from the glucose challenge to the pregnancy oral glucose tolerance test (pOGTT) in April 2013. We performed a single-centre retrospective observational study at a multiethnic metropolitan maternity hospital, documenting the number of GDM diagnoses between 2012 and 2016. The absolute number of new GDM diagnoses increased from 121 in 2014 to 167 in 2015, a rise of 38% as compared to 3.4% from 2013 to 2014. We noted a 29.7% increase in our incidence of GDM over the first year after transitioning to the new criteria (from 2014 to 2015) and a 41.7% increase over the first two years. Of interest, there was a 6% increase from 2013 to 2014 corresponding to the switch to the pOGTT.

This absolute increase in GDM and incidence overall is consistent with other reports2-4. The consequential demand on medical, dietetic, and nursing educator services, has necessitated the implementation of compensatory measures such as doubling medical staff numbers and modifying our model of care. Our presentation will summarise these measures and estimate their economic impact. These increasing demands highlight the need for strategic restructuring of resources to maintain a high standard of care.

  1. HAPO Collaborative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991–2002.
  2. Moses RG, Morris G, Petocz P, SanGil F, Garg D. Impact of the potential new diagnostic criteria on the prevalence of gestational diabetes mellitus in Australia. Med J Aust 2011;194:338–40.
  3. Ekeroma AJ, Chandran GS, McCowan L, Ansell D, Eagleton C and Kenealy T. Impact of using the international association of diabetes and pregnancy study groups criteria in South Auckland: prevalence, interventions and outcomes. Aust N Z J Obstet Gynaecol. 2015;55:34-41.
  4. Laafira A, White SW, Griffin CJ, Graham D. Impact of the new IADPSG gestational diabetes diagnostic criteria on pregnancy outcomes in Western Australia. Aust N Z J Obstet Gynaecol. 2016;56(1):36-41.
  5. Sibartie P, Quinlivan J. Implementation of the International Association of Diabetes and Pregnancy Study Groups Criteria: Not Always a Cause for Concern. J pregnancy. 2015;2015:754085