Goedegebure, E.A.R. (Eva) (2017) Diabetes gravidarum: gevolgen van nieuwe internationale criteria voor de Nederlandse setting. thesis, Medicine.
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Abstract
Background Gestational diabetes mellitus (GDM) is defined as glucose intolerance first detected during pregnancy and increases the rate of neonatal and obstetric complications. In 2013 the World Health Organization (WHO) published new diagnostic criteria for GDM based on the results of multiple large international studies. Women with mild hyperglycaemia are additionally diagnosed with GDM using these new WHO 2013 criteria. No consensus is reached about implementation of these new criteria in the Netherlands. Studies have shown that the new criteria would lead to an increase in the prevalence of GDM and a higher burden to obstetric healthcare and costs, apart from the beneficial effect on perinatal outcomes which is not sufficiently proved. In 2012 the Deventer Ziekenhuis was the first Dutch hospital implementing the new diagnostic criteria. The aim of this study is to explore the effect of the implementation of the new WHO criteria on neonatal and obstetric outcomes in women with GDM in the Netherlands. Methods In this retrospective cohort, all pregnant women with GDM in the Deventer region diagnosed between January 2012 and September 2016 with the new WHO 2013 criteria are compared with all pregnant women with GDM in the Groningen region diagnosed with the old WHO criteria during the same period. Both groups were treated based on the national guideline ‘Diabetes en Zwangerschap’ from the Dutch Society of Obstetrics and Gynaecology (1). Results In the Deventer region 437 pregnant women with GDM according to the new criteria were compared with 949 pregnant women with GDM according to the old criteria from the Groningen region. Women in the Deventer region were older and had higher BMI. GDM was diagnosed at an earlier gestational age and less women received insulin treatment to reach target glucose levels in this group (15,6 vs 43,4%). Less neonates in the WHO 2013 group were large for gestational age (16,5 vs 18,5%). Neonatal hypoglycemia was more frequently presented in the WHO 2013 group which was explained by a difference in detecting between both hospitals, whereby an active screening policy was used in the Deventer Ziekenhuis in contrary with the Groningen region. More spontaneous deliveries and less planned caesarean sections were performed in the Deventer region. Conclusion Introduction of the new WHO 2013 criteria leads to a decrease in risk for large for gestational age and an increase in spontaneous deliveries. Comparable risks for the other neonatal and obstetric complications are seen. Whether these results are related to the introduction of the stricter new diagnostic criteria is unclear, nevertheless the results of this study seem to support the introduction of the new WHO criteria in the Netherlands. A large randomised trial should evaluate the effect of treatment of GDM in this particular population.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Linden, dr. PJQ van der and gynaecoloog |
| Supervisor name: | Tweede begeleider: and Zwart, dr. JJ gynaecoloog and Deventer Ziekenhuis, afdeling Gynaecologie en Obstetrie |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:06 |
| Last Modified: | 25 Jun 2020 11:06 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2602 |
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