title: New guidelines for screening, diagnosing, and treating gestational diabetes - evaluation of maternal and neonatal outcomes in Finland from 2006 to 2012.
abstract: BACKGROUND
  In this study, we have assessed the changes in pregnancy outcomes following the implementation of national guidelines for gestational diabetes mellitus (GDM). These national guidelines changed the screening policy from risk-based to comprehensive screening.
  
  
  METHODS
  We designed a retrospective register-based cohort study based on the data from the Finnish Medical Birth Register and Hospital Discharge Register including 34 794 singleton births in 2006-2008 and 36 488 in 2010-2012. Maternal characteristics and pregnancy outcomes were analyzed.
  
  
  RESULTS
  Overall, 29.6% of mothers underwent an oral glucose tolerance test in 2006-2008 compared with 59.7% in 2010-2012. The prevalence of GDM increased from 7.2 to 11.3% and was highest among obese women (body mass index ≥30 kg/m2) (from 30.0 to 34.7%; p < 0.001). The proportion of insulin-treated women remained unchanged (12.5/12.3%; p = 0.70). The main pregnancy outcomes for the women with GDM were the increased usage of oxytocin (19.5/40.0%, p < 0.001), increased number of inductions (27.2/33.0%; p < 0.001) and reduced birthweight (mean ± SD: 3647 ± 575 g/3567 ± 575 g). Healthy and unscreened women displayed similar results. Children of both women with GDM and healthy screened women had fewer admissions to the neonatal intensive care unit (16.3%/12.1%; p < 0.001) and less asphyxia (11.3%/6.3%; p < 0.001). However, the rates of cesarean delivery (26.5%/25.4%, p = 0.31), resuscitation (2.6%/2.0%; p = 0.12), and perinatal mortality (1.2‰/3.1‰, p = 0.11) among women with GDM did not change, whereas the number of hypoglycemia cases increased (2.3%/5.2%; p < 0.001).
  
  
  CONCLUSIONS
  In conclusion, glucose tolerance tests were performed twice as often as a result of the implementation of the national GDM guidelines, but this comprehensive screening practice did not improve pregnancy and neonatal outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Anni
authors.identifier: http://orcid.org/0000-0001-7835-1378
authors.initials: A
authors.lastname: Ellenberg
authors.affiliation: Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Nanna
authors.identifier: http://orcid.org/0000-0001-7222-2540
authors.initials: N
authors.lastname: Sarvilinna
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Mika
authors.identifier: http://orcid.org/0000-0001-8254-7525
authors.initials: M
authors.lastname: Gissler
authors.affiliation: Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Veli-Matti
authors.identifier: http://orcid.org/0000-0002-5235-1668
authors.initials: VM
authors.lastname: Ulander
mesh_terms: D000293:Adolescent; D000328:Adult; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy; D005260:Female; D005387:Finland; D005951:Glucose Tolerance Test; D006801:Humans; D008427:Maternal Health Services; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000592:standards*; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult
keywords: Gestational diabetes; national guidelines; neonatal outcomes; pregnancy outcomes; screening