Background
IADPSG | NICE | Finnish current care guidelines | |
---|---|---|---|
Fasting plasma glucose, mmol/L | 5.1 | 5.6 | 5.3 |
1-h plasma glucose, mmol/L | 10.0 | - | 10.0 |
2-h plasma glucose, mmol/L | 8.5 | 7.8 | 8.6 |
Material and methods
Study design
Screening and diagnosis of GDM
Study population and GDM groups
Outcomes
Covariates
Statistical analysis
Results
Clinical characteristics
Controls | IADPSG | NICE | |||||||
---|---|---|---|---|---|---|---|---|---|
Untreated | Treated | Untreated | Treated | ||||||
pª | pb | pª | pb | ||||||
N (%) | 3031 (61.4) | 509 (10.3) | 1292 (26.2) | 166 (3.4) | 612 (12.4) | ||||
Maternal age, years, mean (SD) | 29.4 (5.29) | 30.1 (5.49) | 0.009 | 30.5 (5.56) | 0.157 | 30.0 (5.35) | 0.127 | 30.8 (5.74) | 0.110 |
Pre-pregnancy BMI, kg/m2, mean (SD) | 25.6 (4.47) | 27.3 (5.21) | < 0.001 | 28.4 (5.93) | < 0.001 | 25.9 (5.06) | 0.456 | 28.8 (6.03) | < 0.001 |
BMI categorized, n (%) | < 0.001 | < 0.001 | 0.600 | < 0.001 | |||||
< 18.5 kg/m2 | 61 (2.05) | 5 (1.00) | 16 (1.26) | 5 (3.03) | 6 (1.00) | ||||
18.5–24.9 kg/m2 | 1380 (46.3) | 180 (36.1) | 376 (29.6) | 72 (43.6) | 171 (28.6) | ||||
25.0–29.9 kg/m2 | 1092 (36.6) | 190 (38.1) | 425 (33.5) | 58 (35.2) | 185 (30.9) | ||||
30.0–34.9 kg/m2 | 341 (11.4) | 80 (16.0) | 283 (22.3) | 21 (12.7) | 144 (24.1) | ||||
≥ 35.0 kg/m2 | 107 (3.59) | 44 (8.82) | 170 (13.4) | 9 (5.45) | 92 (15.4) | ||||
Parity, n (%) | |||||||||
Primiparity | 1461 (48.2) | 213 (41.8) | 0.008 | 483 (37.4) | 0.086 | 83 (50.0) | 0.690 | 242 (39.5) | 0.017 |
P1 | 932 (30.7) | 162 (31.8) | 0.641 | 434 (33.6) | 0.505 | 39 (23.5) | 0.056 | 198 (32.4) | 0.029 |
P2 | 382 (12.6) | 74 (14.5) | 0.252 | 205 (15.9) | 0.515 | 28 (16.9) | 0.120 | 88 (14.4) | 0.461 |
P3 | 121 (4.0) | 35 (6.9) | 0.004 | 86 (6.7) | 0.917 | 10 (6.0) | 0.222 | 42 (6.9) | 0.732 |
P4 or more | 135 (4.5) | 25 (4.9) | 0.730 | 84 (6.5) | 0.228 | 6 (3.6) | 0.703 | 42 (6.9) | 0.146 |
Smoking during pregnancy, n (%) | 366 (12.1) | 65 (12.8) | 0.770 | 214 (16.6) | 0.042 | 16 (9.6) | 0.333 | 106 (17.3) | 0.015 |
Socioeconomic status, n (%) | 0.885 | 0.267 | 0.033 | 0.328 | |||||
Upperwhite-collar worker | 536 (17.7) | 85 (16.7) | 0.615 | 195 (15.1) | 0.427 | 17 (10.2) | 0.015 | 93 (15.2) | 0.131 |
Lowerwhite-collar worker | 1017 (33.6) | 167 (32.8) | 0.761 | 439 (34.0) | 0.658 | 56 (33.7) | 1.000 | 210 (34.3) | 0.927 |
Blue-collar worker | 399 (13.2) | 68 (13.4) | 0.944 | 211 (16.3) | 0.129 | 31 (18.7) | 0.047 | 99 (16.2) | 0.482 |
Other | 519 (17.1) | 93 (18.3) | 0.527 | 207 (16.0) | 0.261 | 30 (18.1) | 0.833 | 93 (15.2) | 0.401 |
OGTT performed < 24 weeks | 331 (10.9) | 119 (23.3) | < 0.001 | 403 (31.2) | < 0.001 | 38 (22.9) | < 0.001 | 204 (33.3) | 0.010 |
OGTT performed c / abnormal d, weeks (SD) | 26.7 (3.70) c | 25.8 (5.06) d | < 0.001 | 24.7 (6.48) d | < 0.001 | 26.7 (4.81) d | 0.999 | 24.9 (6.56) d | < 0.001 |
Insulin treatment, n (%) | - | - | - | 135 (10.4) | < 0.001 | 3 (1.8) | < 0.001 | 86 (14.1) | |
Caesarean section, n (%) | 453 (14.9) | 98 (19.3) | 0.015 | 271 (21.0) | 0.437 | 32 (19.3) | 0.148 | 136 (22.2) | 0.457 |
Maternal hypertension, n (%) | 225 (7.4) | 49 (9.6) | 0.089 | 151 (11.7) | 0.213 | 16 (9.6) | 0.364 | 82 (13.4) |
Controls | IADPSG | NICE | |||||||
---|---|---|---|---|---|---|---|---|---|
Untreated | Treated | Untreated | Treated | ||||||
pª | pb | pª | pb | ||||||
N (%) | 3031 (61.4) | 509 (10.3) | 1292 (26.2) | 166 (3.4) | 612 (12.4) | ||||
Composite adverse neonatal outcome, n (%) | 279 (9.2) | 51 (10.0) | 0.564 | 287 (22.2) | < 0.001 | 20 (12.0) | 0.272 | 164 (26.8) | < 0.001 |
Hypoglycaemia, n (%) | 74 (2.4) | 17 (3.3) | 0.288 | 187 (14.5) | < 0.001 | 6 (3.6) | 0.439 | 106 (17.3) | < 0.001 |
Hyperbilirubinaemia, n (%) | 172 (5.7) | 32 (6.3) | 0.607 | 108 (8.4) | 0.144 | 9 (5.4) | 1.000 | 62 (10.1) | 0.068 |
Birth trauma, n (%) | 39 (1.3) | 4 (0.8) | 0.393 | 21 (1.6) | 0.189 | 3 (1.8) | 0.723 | 13 (2.1) | 1.000 |
Perinatal mortality, n (%) | 6 (0.2) | 1 (0.2) | 1.000 | 5 (0.4) | 0.682 | 2 (1.2) | 0.061 | 4 (0.7) | 0.613 |
Birth weight, g, mean (SD) | 3572.7 (525.7) | 3632.9 (543.5) | 0.017 | 3561.5 (562.3) | 0.014 | 3499.9 (603.2) | 0.130 | 3539.9 (623.5) | 0.461 |
Birth weight < 2.5 kg, n (%) | 89 (2.9) | 18 (3.5) | 0.483 | 49 (3.8) | 0.890 | 9 (5.4) | 0.098 | 34 (5.6) | 1.000 |
Birth weight > 4.5 kg, n (%) | 94 (3.1) | 21 (4.1) | 0.279 | 36 (2.8) | 0.177 | 6 (3.6) | 0.818 | 21 (3.4) | 1.000 |
Birth weight SD score, mean (SD) | -0.047 (1.01) | 0.12 (1.05) | < 0.001 | 0.072 (1.08) | 0.434 | 0.011 (1.05) | 0.476 | 0.12 (1.19) | 0.293 |
LGA, n (%) | 267 (8.8) | 65 (12.8) | 0.005 | 147 (11.4) | 0.417 | 22 (13.3) | 0.069 | 82 (13.4) | 1.000 |
Gestational age at delivery in weeks, mean (SD) | 39.9 (1.57) | 39.8 (1.60) | 0.154 | 39.5 (1.81) | < 0.001 | 39.5 (1.93) | 0.002 | 39.2 (2.01) | 0.185 |
Preterm birth < 37 weeks, n (%) | 114 (3.8) | 21 (4.1) | 0.707 | 78 (6.0) | 0.135 | 12 (7.2) | 0.037 | 49 (8.0) | 0.751 |
Neonatal respiratory distress syndrome, n (%) | 15 (0.5) | 3 (0.6) | 1.000 | 9 (0.7) | 1.000 | 1 (0.6) | 1.000 | 5 (0.8) | 0.293 |
Newborn discharge status aged 7 days, n (%) | |||||||||
Home | 2895 (95.5) | 482 (94.7) | 0.423 | 1195 (92.5) | 0.099 | 152 (91.6) | 0.025 | 547 (89.4) | 0.470 |
Hospitalised | 130 (4.3) | 25 (4.9) | 0.558 | 91 (7.0) | 0.110 | 11 (6.6) | 0.170 | 61 (10.0) | 0.227 |
Hospitalisation in days, mean (SD) | 3.1 (2.61) | 3.2 (1.37) | 0.514 | 3.3 (2.09) | 0.157 | 3.3 (1.45) | 0.425 | 3.5 (2.71) | 0.315 |
Outcomes
Untreated IADPSG | Untreated NICE | ||||
---|---|---|---|---|---|
Comparison | Controls | Treated IADPSG | Controls | Treated NICE | |
Composite adverse neonatal outcome | Unadjusted OR | 1.10 (0.80–1.50) | 0.39 (0.28–0.53) | 1.35 (0.83–2.19) | 0.37 (0.23–0.62) |
Model I | 1.07 (0.77–1.48) | 0.39 (0.28–0.54) | 1.26 (0.75–2.09) | 0.35 (0.20–0.60) | |
Model II | 1.01 (0.71–1.44) | 0.38 (0.27–0.53) | 1.05 (0.60–1.85) | 0.32 (0.18–0.57) | |
Hypoglycaemia | Unadjusted OR | 1.38 (0.81–2.36) | 0.20 (0.12–0.34) | 1.50 (0.64–3.50) | 0.18 (0.08–0.41) |
Model I | 1.32 (0.76–2.31) | 0.20 (0.12–0.33) | 1.59 (0.68–3.76) | 0.21 (0.09–0.49) | |
Model II | 1.24 (0.70–2.20) | 0.19 (0.11–0.33) | 1.34 (0.55–3.28) | 0.21 (0.09–0.49) | |
Hyperbilirubinaemia | Unadjusted OR | 1.12 (0.76–1.65) | 0.74 (0.49–1.11) | 0.95 (0.48–1.90) | 0.51 (0.25–1.03) |
Model I | 1.11 (0.75–1.67) | 0.75 (0.49–1.14) | 0.87 (0.42–1.81) | 0.44 (0.20–0.95) | |
Model II | 1.04 (0.67–1.63) | 0.79 (0.51–1.23) | 0.61 (0.26–1.40) | 0.41 (0.17–0.98) | |
Perinatal mortality | Unadjusted OR | 1.0 (0.12–8.26) | 0.51 (0.06–4.35) | 6.15 (1.23–30.7) | 1.85 (0.34–10.00) |
Model I | - | 4.02 (0.44–36.4) | 1.05 (0.10–11.11) | ||
Model II | - | 3.69 (0.24–57.9) | - | ||
Birth trauma | Unadjusted OR | 0.61 (0.22–1.71) | 0.41 (0.16–1.41) | 1.41 (0.43–4.62) | 0.85 (0.24–3.03) |
Model I | 0.58 (0.20–1.65) | 0.46 (0.16–1.37) | 1.46 (0.44–4.83) | 0.86 (0.17–2.27) | |
Model II | 0.57 (0.20–1.63) | 0.45 (0.15–1.37) | 1.51 (0.46–5.02) | 0.65 (0.17–2.44) |