Progressing towards standard outcomes in gestational diabetes Cochrane reviews and randomised trials

Outcomes in gestational diabetes Cochrane protocols and reviews before and after development of 'standard outcomes' by WOMBAT (WOMen and Babies health and well-being: Action through Trials) were surveyed. An increase in 'common' outcomes (those prespecified by ≥50% of the protocols and reviews) over time was observed (2001-2009: 27 vs 2010-2014: 46). There were discrepancies in outcomes prespecified in reviews and reported by randomised trials. Efforts are needed to develop a core outcome set, to reduce research waste and improve health outcomes.Emily Bain, Philippa Middleton and Caroline A. Crowthe

Impact of new diagnostic criteria for gestational diabetes

Background: In January 2015, the diagnostic and therapeutic criteria for gestational diabetes changed, with the goal of increasing the sensitivity of diagnosis and improving overall glycaemic control, and thus reducing adverse pregnancy outcomes. Aim: Our primary aim was to evaluate the effect of the new guidelines on the incidence of diagnosis of gestational diabetes and the incidence of therapeutic interventions. Our secondary aim was to look at the incidence of adverse pregnancy outcomes. Materials and Methods: A retrospective clinical audit was conducted at a regional hospital to compare the incidence of gestational diabetes, and specific maternal and neonatal outcomes before and after the change in guidelines was implemented. Data were collected via chart review for a six month period before and after the change in guidelines in January 2015. Data collected included demographics, neonatal and maternal outcomes and the treatment type used for patients diagnosed with gestational diabetes. Results: There was a significant increase in the incidence of diagnosis of gestational diabetes (9.8% to 19.6%) p<0.001, and an overall increase in the use of pharmacological treatments for gestational diabetes. There was no significant difference in the incidence of the adverse outcomes measured, including caesarean delivery and incidence of macrosomia. There was no significant change in mean fetal weight. Conclusions: Despite a doubling of the incidence of diagnosis of gestational diabetes, and a consequent increase in pharmacological interventions, the change in diagnostic and therapeutic criteria did not significantly reduce the neonatal or maternal adverse outcomes measured

Survey on testing for gestational diabetes mellitus in Australia

We surveyed members of National Association of Diabetes Centres (NADC) assessing use of new Australasian Diabetes In Pregnancy Society (ADIPS) and Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Gestational Diabetes Mellitus (GDM) diagnostic guidelines in Australia. We found piecemeal adoption of recommended changes, with cessation of the 50 g glucose challenge test (GCT) universal, early screening implementation common, but by varied methodologies, and new diagnostic criteria acceptance far from complete with significant workload increases almost universal

The prevalence of hyperglycaemia in pregnancy in Australia

Background: The Australasian Diabetes in Pregnancy Society (ADIPS) has recently endorsed the World Health Organization (WHO) terminology and classification of hyperglycaemia in pregnancy. The prevalence is likely to increase, but no prospective data are available for a representative Australian population. Aims: To determine the prevalence of hyperglycaemia in pregnancy (HIP) using results from both the public and private sectors in a population that has a similar ethnicity to the overall Australian population. Material and Methods: The results of all pregnancy oral glucose tolerance tests (POGTT) in the public sector and by a dominant private pathology provider in a major city have been prospectively collected for a three-year period and analysed using the ADIPS (WHO) criteria. Results: The prevalence of hyperglycaemia in pregnancy (HIP) was 13.1% with diabetes mellitus in pregnancy (DIP) being 0.4% and gestational diabetes mellitus (GDM) being 12.7%. Conclusion: The new criteria will diagnose about one-third more women with GDM than the previous ADIPS criteria. This will have resource and health implications. Focussed local health economic data will be important