Schering, B. (Bertine) (2015) Diagnostiek van diabetes gravidarum: is het tijd voor verandering? thesis, Medicine.
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Abstract
Background Gestational diabetes mellitus (GDM) is a condition in which patients suffer from glucose intolerance that starts or is first recognised during pregnancy. GDM results in an increasing risk of maternal and neonatal complications, such as caesarean section, perinatal death and macrosomia. Treatment of GDM reduces this risk. GDM is diagnosed with the use of a 75-g oral glucose tolerance test (OGTT). However there is no international consensus about the diagnostic criteria. In the Netherlands the criteria from the Dutch Society of Obstetrics and Gynaecology (NVOG 2010) are used, while there are new thresholds generated by the World Health Organization (WHO 2013) based on landmark studies. In comparison with the criteria of the NVOG 2010, the new criteria have a lower fasting glucose value and an elevated 2-h glucose level. The question now arises what this does to the prevalence of GDM and if it is save to adopt the WHO 2013 thresholds in the Netherlands. Methods This retrospective cohort study was separated into two parts. For part 1. of the study the data of all OGTTs, performed between 3 January 2011 and 1 August 2014, were collected from Certe. A total of 6130 OGTTs were eligible for evaluation. The primary outcome was the prevalence of GDM according to the NVOG 2010 and the WHO 2013. For part 2. of the study the data of all GDM patients who gave birth in the University Medical Center Groningen or Martini Hospital, in the period of 9 January 2011 till 1 September 2014, were collected. A total of 761 women were included in the study. The data of their pregnancies were acquired from patient records. A comparison was made between patients with a 2-h glucose level of 7,8-8,5 mmol/L (group 1) and patients with a 2-h glucose level of ≥ 8,5 mmol/L (group 2). The primary outcome was the level of the OGTT values with the results on the neonatal outcomes (such as macrosomia), maternal complications (such as secondary caearean section) and neonatal complications (such as birth trauma and neonatal hypoglycemia). Results The use of WHO 2013 criteria resulted in an increase in GDM rate (30% vs. 19%). GDM was diagnosed mostly on the fasting glucose level in contrast to the diagnoses by the NVOG 2010 (64% vs. 1%). The children in group 2 were more often diagnosed with hypoglycemia than the children in group 1 (P=0,013). Except for this result, there were no other significant differences shown between the two groups as to neonatal outcomes, maternal and neonatal complications. The percentage of macrosomia was in both groups 21%. Conclusions The results of our study show that the application of the WHO 2013 criteria was associated with a 1,5-fold increase in GDM prevalence in our study population. Furthermore, they suggest that it seems unsafe to raise the 2-h glucose level to 8,5 mmol/L, because there were maternal and neonatal complications in the group with the 2-h glucose level between 7,8 and 8,5 mmol/L.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Lutgers, Dr. H.L. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:01 |
| Last Modified: | 25 Jun 2020 11:01 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2129 |
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