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    Unifying the diagnosis of gestational diabetes mellitus: Introducing the NPRP criteria

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    Date
    2021-08-19
    Author
    Suhail A.R., Doi
    Bashir, Mohammed
    Sheehan, Michael T.
    Onitilo, Adedayo A.
    Chivese, Tawanda
    Ibrahim, Ibrahim M.
    Beer, Stephen F.
    Furuya-Kanamori, Luis
    Abou-Samra, Abdul-Badi
    McIntyre, H. David
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    Abstract
    AimsDisagreement about the appropriate criteria for the diagnosis of gestational diabetes mellitus (GDM) persists. This study examines an alternative approach which combines information from all time-points on the glucose tolerance test (GTT) into a single index and expands the GDM spectrum into four categories using data from three geographically and ethnically distinct populations. MethodsA retrospective observational study design was used. Data from Wisconsin, USA (723 women) was used in derivation of the criterion and data from Doha, Qatar (1284 women) and Cape Town, South Africa (220 women) for confirmation. Pregnant women without pre-existing diabetes with a GTT done between 23 and 30 weeks gestation were included. A novel index was derived from the GTT termed the weighted average glucose (wAG). This was categorized into four pre-defined groups (henceforth National Priorities Research Program (NPRP) criterion); i) normal gestational glycemia (NGG), ii) impaired gestational glycemia (IGG), iii) GDM and iv) high risk GDM (hGDM). ResultsIn the Doha cohort, compared to the NGG group, the odds of large for gestational age babies increased 1.33 fold (P = 0.432), 2.86 fold (P < 0.001) and 3.35 fold (P < 0.001) in the IGG, GDM and hGDM groups respectively. The odds of pregnancy induced hypertension increased 2.10 fold (P = 0.024) in GDM & hGDM groups compared to the IGG and NGG groups. In the Cape Town cohort, a third of women in the GDM group and two-thirds in the hGDM group progressed to T2DM at 5 years. ConclusionsThe NPRP categorization identifies four distinct risk clusters of glycemia in pregnancy which may aid better decision making in routine management, avoid potential over-diagnosis of women at lower risk of complications and assist with diabetes prevention in women at high-risk after an index pregnancy with GDM.
    URI
    https://www.sciencedirect.com/science/article/pii/S1751991821001406
    DOI/handle
    http://dx.doi.org/10.1016/j.pcd.2021.08.006
    http://hdl.handle.net/10576/23189
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    • Medicine Research [‎1819‎ items ]

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