Rudland Victoria L, Hibbert Emily, Flack Jeff, Wong Tang, Wong Vincent W, McLean Mark, Pasupathy Dharmintra, Simmons David, Cheung N Wah
Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW, 2050, Australia.
Nepean Hospital, Sydney, Australia.
Acta Diabetol. 2025 Jun 20. doi: 10.1007/s00592-025-02548-6.
The International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria for gestational diabetes (GDM) were widely implemented in Australia, despite limited evidence of better pregnancy outcomes compared to the Australasian Diabetes in Pregnancy Society 1998 (ADIPS1998) criteria. We aimed to evaluate the effect of treatment on pregnancy outcomes for women with 'mild' GDM, defined as GDM diagnosed by one, but not both, sets of criteria.
This multicentre, retrospective cohort study included 17,512 pregnant women in six neighbouring tertiary hospitals in Sydney, Australia, during 2016-2017, all of whom were screened for GDM using a three-point 75 g oral glucose tolerance test. Three hospitals diagnosed and treated GDM according to ADIPS1998 criteria, and three according to IADPSG criteria. For women with 'mild' GDM, we evaluated the effect of treatment versus no treatment on pregnancy outcomes. The primary outcome was large for gestational age. Secondary outcomes were small for gestational age, induction of labour, caesarean section, gestational hypertension, and preeclampsia.
2320 (13.2%) pregnant women had 'mild' GDM. Treatment of women with IADPSG-only GDM (i.e. fasting glucose 5.1-5.4 mmol/L (91-97 mg/dL) and/or 1-hour glucose ≥ 10.0 mmol/L (≥ 180 mg/dL)) was associated with less large for gestational age infants than no treatment (RR 0.66, 95%CI 0.49-0.88, p = 0.004) but more induction of labour (RR 1.55, 95%CI 1.03-2.34, p = 0.032). Treatment of women with ADIPS1998-only GDM (i.e. 2-hour glucose 8.0-8.4 mmol/L (144-151 mg/dL)) did not significantly change pregnancy outcomes compared with no treatment.
This study highlights the importance of treating even mild IADPSG-GDM to improve pregnancy outcomes.
国际妊娠糖尿病研究组（IADPSG）的妊娠糖尿病（GDM）诊断标准在澳大利亚广泛实施，尽管与1998年澳大利亚妊娠糖尿病协会（ADIPS1998）标准相比，其改善妊娠结局的证据有限。我们旨在评估治疗对“轻度”GDM女性妊娠结局的影响，“轻度”GDM定义为仅通过其中一套而非两套标准诊断出的GDM。
这项多中心回顾性队列研究纳入了2016 - 2017年期间澳大利亚悉尼六家相邻三级医院的17512名孕妇，所有孕妇均采用75克口服葡萄糖耐量试验三点法进行GDM筛查。三家医院根据ADIPS1998标准诊断和治疗GDM，另外三家根据IADPSG标准。对于“轻度”GDM女性，我们评估了治疗与未治疗对妊娠结局的影响。主要结局是大于胎龄儿。次要结局是小于胎龄儿、引产、剖宫产、妊娠高血压和子痫前期。
2320名（13.2%）孕妇患有“轻度”GDM。仅采用IADPSG标准诊断的GDM（即空腹血糖5.1 - 5.4 mmol/L（91 - 97 mg/dL）和/或1小时血糖≥10.0 mmol/L（≥180 mg/dL））女性接受治疗与未治疗相比，大于胎龄儿的发生率较低（风险比0.66，95%置信区间0.49 - 0.88，p = 0.004），但引产率较高（风险比1.55，95%置信区间1.03 - 2.34，p = 0.032）。仅采用ADIPS1998标准诊断的GDM（即2小时血糖8.0 - 8.4 mmol/L（144 - 151 mg/dL））女性接受治疗与未治疗相比，妊娠结局无显著变化。
本研究强调了治疗即使是轻度的IADPSG - GDM以改善妊娠结局的重要性。
