Gestational diabetes: implications of variation in post-partum follow-up criteria.
OBJECTIVE
To compare the recommendations of the American Diabetes Association (ADA) with the World Health Organization (WHO) for evaluating women with gestational diabetes (GDM) after delivery.


METHODS
During a 5-year period, 549 patients underwent the 2h, 75 g oral glucose tolerance test (OGTT), 4-8 weeks after delivery. They were classified by the criteria of WHO (1985), the ADA [1997, fasting glucose (FPG)] and the revised WHO (1999).


RESULTS
The prevalence of diabetes by WHO-1985 and ADA-1997 were similar (8.2% versus 6.6%) but estimates of impaired glucose homeostasis varied widely (15.5% impaired glucose tolerance (IGT) versus 9.3% impaired fasting glucose, respectively). 118 (21.5%) women and 83 (15.1%) women showed a classification discrepancy between ADA-1997 with the WHO-1985 and -1999, respectively. The receiver-operating characteristic (ROC) curve area of the FPG was 0.94 for DM by the OGTT (WHO-1985 criteria) but only 0.59 for IGT by the 2h post-glucose.


CONCLUSIONS
The various guidelines for GDM follow-up after delivery, often based on expert opinion, produce similar estimates for diabetes prevalence but widely discordant results for glucose intolerance. Until more uniform evidence-based criteria become available, the various strategies for GDM follow-up will continue to cause confusion in clinical practice.
Agarwal
Mukesh M
MM
Department of Pathology, Faculty of Medicine, UAE University, PO Box 17666, Al Ain, United Arab Emirates. magarwal@uaeu.ac.ae
Punnose
John
J
Dhatt
Gurdeep S
GS
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology; D016640:Diabetes, Gestational; D005215:Fasting; D005260:Female; D018149:Glucose Intolerance / Q000175:diagnosis / Q000453:epidemiology; D005951:Glucose Tolerance Test; D006801:Humans; D009938:Organizations; D049590:Postpartum Period; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012372:ROC Curve; D014481:United States; D014944:World Health Organization
D001786:Blood Glucose