COMPARING IADPSG AND NICE DIAGNOSTIC CRITERIA FOR GESTATIONAL DIABETES MELLITUS (GDM) IN PREDICTING ADVERSE PREGNANCY OUTCOMES, QUASI EXPERIMENTAL STUDY

Abstract

Background: Gestational Diabetes Mellitus (GDM) is a growing obstetric complication with significant risks for both mother and fetus. The lack of a universally accepted diagnostic standard, particularly between the more sensitive one-step International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and the more conservative two-step National Institute for Health and Care Excellence (NICE) criteria, leads to variations in diagnosis and management. This study aimed to compare the effectiveness of these two criteria in predicting adverse pregnancy outcomes within a local Pakistani population.

Objective: To compare the IADPSG and NICE diagnostic criteria for Gestational Diabetes Mellitus in predicting adverse pregnancy outcomes.

Methods: This quasi-experimental study was conducted in the Department of Gynaecology and Obstetrics at Benazir Bhutto Hospital, Rawalpindi. A total of 202 pregnant women were systematically sampled and divided into two cohorts based on their GDM diagnosis. The IADPSG criteria cohort included women with any positive value on a 75g oral glucose tolerance test (OGTT), while the NICE criteria cohort included women with a fasting glucose ≥5.6 mmol/L or a 2-hour glucose ≥7.8 mmol/L. Both groups received standardized GDM management. The primary outcomes, including macrosomia, neonatal hypoglycaemia, neonatal respiratory distress syndrome (RDS), and NICU admission, were compared between the two groups. Statistical analysis was performed using the independent samples t-test and Chi-square test, with a p-value of ≤0.05 considered significant.

Results: The IADPSG criteria identified a larger number of women with GDM, with a GDM prevalence of 16.8% compared to 10.4% using the NICE criteria. The IADPSG cohort demonstrated a higher incidence of adverse outcomes: macrosomia occurred in 22.8% of cases versus 11.9% in the NICE cohort (p=0.03), and neonatal hypoglycaemia was significantly more frequent (18.8% vs. 7.9%, p=0.04). The rates of neonatal respiratory distress syndrome (14.9% vs. 8.9%) and NICU admission (24.8% vs. 13.9%) were also higher in the IADPSG cohort, though these differences did not reach statistical significance.

Conclusion: The IADPSG diagnostic criteria identified a larger population of women with GDM who experienced a higher burden of adverse pregnancy outcomes compared to the NICE criteria. This suggests that the lower glucose thresholds of the IADPSG criteria may be more effective in identifying a high-risk group that warrants intervention. The study's findings support the use of the IADPSG criteria for GDM screening in our population to optimize maternal-fetal health and reduce the risk of adverse outcomes.