title: Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study.
abstract: OBJECTIVE
  The use of the new International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) for the diagnosis of gestational diabetes mellitus (GDM) results in an increased prevalence of GDM. Whether their introduction improves pregnancy outcomes has yet to be established. We sought to evaluate the cost-effectiveness of one-step IADPSGC for screening and diagnosis of GDM compared with traditional two-step Carpenter-Coustan (CC) criteria.
  
  
  METHODS
  GDM risk factors and pregnancy and newborn outcomes were prospectively assessed in 1,750 pregnant women from April 2011 to March 2012 using CC and in 1,526 pregnant women from April 2012 to March 2013 using IADPSGC between 24 and 28 weeks of gestation. Both groups received the same treatment and follow-up regimes.
  
  
  RESULTS
  The use of IADPSGC resulted in an important increase in GDM rate (35.5% vs. 10.6%) and an improvement in pregnancy outcomes, with a decrease in the rate of gestational hypertension (4.1 to 3.5%: -14.6%, P < 0.021), prematurity (6.4 to 5.7%: -10.9%, P < 0.039), cesarean section (25.4 to 19.7%: -23.9%, P < 0.002), small for gestational age (7.7 to 7.1%: -6.5%, P < 0.042), large for gestational age (4.6 to 3.7%: -20%, P < 0.004), Apgar 1-min score <7 (3.8 to 3.5%: -9%, P < 0.015), and admission to neonatal intensive care unit (8.2 to 6.2%: -24.4%, P < 0.001). Estimated cost savings was of €14,358.06 per 100 women evaluated using IADPSGC versus the group diagnosed using CC.
  
  
  CONCLUSIONS
  The application of the new IADPSGC was associated with a 3.5-fold increase in GDM prevalence in our study population, as well as significant improvements in pregnancy outcomes, and was cost-effective. Our results support their adoption.
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Duran
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Sofía
authors.initials: S
authors.lastname: Sáenz
authors.affiliation: Clinical Laboratory Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Torrejón
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Bordiú
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Del Valle
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Galindo
authors.affiliation: Gynecology and Obstetrician Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Noelia
authors.initials: N
authors.lastname: Perez
authors.affiliation: Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain Gynecology and Obstetrician Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Herraiz
authors.affiliation: Gynecology and Obstetrician Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Izquierdo
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Rubio
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Runkle
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: Pérez-Ferre
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Idalia
authors.initials: I
authors.lastname: Cusihuallpa
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Jiménez
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: García de la Torre
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: María D
authors.initials: MD
authors.lastname: Fernández
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Montañez
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Familiar
authors.affiliation: Endocrinology and Nutrition Department, Universidad Complutense de Madrid, Madrid, Spain Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain acallepascual@hotmail.com.
authors.forename: Alfonso L
authors.initials: AL
authors.lastname: Calle-Pascual
mesh_terms: D000328:Adult; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000191:economics / Q000517:prevention & control*; D008403:Mass Screening; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors