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Fulltext A cost-effectiveness comparison of the NICE 2015 and WHO 2013 diagnostic criteria for women with gestational diabetes with and without risk factors

Jacklin PB, Maresh MJ, Patterson CC, Stanley KP, Dornhorst A, Burman-Roy S, et al.

BMJ Open, 2017 Aug 11;7(8):e016621.
PMID: 28801424 DOI: 10.1136/bmjopen-2017-016621

OBJECTIVES: To compare the cost-effectiveness (CE) of the National Institute for Health and Care Excellence (NICE) 2015 and the WHO 2013 diagnostic thresholds for gestational diabetes mellitus (GDM).
SETTING: The analysis was from the perspective of the National Health Service in England and Wales.
PARTICIPANTS: 6221 patients from four of the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study centres (two UK, two Australian), 6308 patients from the Atlantic Diabetes in Pregnancy study and 12 755 patients from UK clinical practice.
PRIMARY AND SECONDARY OUTCOME MEASURES PLANNED: The incremental cost per quality-adjusted life year (QALY), net monetary benefit (NMB) and the probability of being cost-effective at CE thresholds of £20 000 and £30 000 per QALY.
RESULTS: In a population of pregnant women from the four HAPO study centres and using NICE-defined risk factors for GDM, diagnosing GDM using NICE 2015 criteria had an NMB of £239 902 (relative to no treatment) at a CE threshold of £30 000 per QALY compared with WHO 2013 criteria, which had an NMB of £186 675. NICE 2015 criteria had a 51.5% probability of being cost-effective compared with the WHO 2013 diagnostic criteria, which had a 27.6% probability of being cost-effective (no treatment had a 21.0% probability of being cost-effective). For women without NICE risk factors in this population, the NMBs for NICE 2015 and WHO 2013 criteria were both negative relative to no treatment and no treatment had a 78.1% probability of being cost-effective.
CONCLUSION: The NICE 2015 diagnostic criteria for GDM can be considered cost-effective relative to the WHO 2013 alternative at a CE threshold of £30 000 per QALY. Universal screening for GDM was not found to be cost-effective relative to screening based on NICE risk factors.

Matched MeSH terms: Diabetes, Gestational/etiology
Fulltext Independent and combined effects of age, body mass index and gestational weight gain on the risk of gestational diabetes mellitus

Yong HY, Mohd Shariff Z, Mohd Yusof BN, Rejali Z, Tee YYS, Bindels J, et al.

Sci Rep, 2020 May 22;10(1):8486.
PMID: 32444832 DOI: 10.1038/s41598-020-65251-2

This study aimed to identify the independent and combined effects of age, BMI at first prenatal visit and GWG on the risk of GDM. A retrospective cohort study of 1,951 pregnant women in Seremban district, Negeri Sembilan, Malaysia. GDM was defined as fasting plasma glucose (FPG) ≥5.6 mmol/l and/or 2-hour postprandial plasma glucose (2hPPG) ≥7.8 mmol/l. A higher percentage of women with GDM had 2 risk factors (29.0%) or >2 risk factors (8.6%) compared to non-GDM women (2 risk factors: 25.5%; >2 risk factors: 5.0%). In general, women with ≥2 risk factors were respectively 1.36-2.06 times more likely to have GDM compared to those without risk factors. Older maternal age and being overweight/obese were significantly associated with risk of GDM. Overweight/obese women with age ≥35 years had 2.45 times higher risk of GDM and having excessive GWG at second trimester further increased the risk of GDM. Age and BMI are independent risk factors for GDM but not GWG in the first and second trimester. The findings emphasize the need to focus on a healthy BMI before pregnancy and optimal GWG during pregnancy to improve pregnancy outcomes.

Matched MeSH terms: Diabetes, Gestational/etiology*
Risk factor screening for abnormal glucose tolerance in pregnancy

Shamsuddin K, Mahdy ZA, Siti Rafiaah I, Jamil MA, Rahimah MD

Int J Gynaecol Obstet, 2001 Oct;75(1):27-32.
PMID: 11597616 DOI: 10.1016/s0020-7292(01)00468-4

OBJECTIVES: To assess the prevalence and association of frequently used screening risk factors for gestational diabetes mellitus (GDM) and to compare the validity and cost of universal screening with risk factor screening.

METHOD: A cross-sectional survey of 768 pregnant women at > or = 24 weeks' gestation who were attending the antenatal clinic at the Hospital Universiti Kebangsaan Malaysia (HUKM) was made. Risk factors were determined using a questionnaire. An abnormal oral glucose tolerance test was defined as a 2-h post-prandial blood sugar level of > or = 7.8 mmol/l.

RESULTS: A total of 191 pregnant mothers (24.9%) had GDM. The most commonly identified screening factors were positive family history of diabetes mellitus (31.4%), history of spontaneous abortion (17.8%), vaginal discharge and pruritus vulvae in current pregnancy (16.0%), and maternal age greater than 35 years (14.7%). Five hundred and thirteen mothers (66.8%) had at least one risk factor. All screening risk factors, except past history of diabetes mellitus in previous pregnancy and maternal age, were not significantly associated with abnormal glucose tolerance (GT). Risk factor screening gave a sensitivity of 72.2% and a specificity of 35.0%. Universal screening would cost RM 12.06 while traditional risk factor screening would cost RM 11.15 per identified case and will have missed 53 of the 191 cases.

CONCLUSIONS: Risk factor screening scored poorly in predicting GDM. Cost analysis of universal compared with traditional risk factor screening showed a negligible difference. Thus universal screening appears to be the most reliable method of diagnosing GDM.

Matched MeSH terms: Diabetes, Gestational/etiology*
Sleep Quality and Nocturnal Sleep Duration in Pregnancy and Risk of Gestational Diabetes Mellitus

Cai S, Tan S, Gluckman PD, Godfrey KM, Saw SM, Teoh OH, et al.

Sleep, 2017 Feb 01;40(2).
PMID: 28364489 DOI: 10.1093/sleep/zsw058

STUDY OBJECTIVES: To examine the influence of maternal sleep quality and nocturnal sleep duration on risk of gestational diabetes mellitus (GDM) in a multiethnic Asian population.
METHODS: A cohort of 686 women (376 Chinese, 186 Malay, and 124 Indian) with a singleton pregnancy attended a clinic visit at 26-28 weeks of gestation as part of the Growing Up in Singapore Towards healthy Outcomes mother-offspring cohort study. Self-reported sleep quality and sleep duration were assessed using the Pittsburgh Sleep Quality Index (PSQI). GDM was diagnosed based on a 75-g oral glucose tolerance test administered after an overnight fast (1999 WHO criteria). Multiple logistic regression was used to model separately the associations of poor sleep quality (PSQI score > 5) and short nocturnal sleep duration (<6 h) with GDM, adjusting for age, ethnicity, maternal education, body mass index, previous history of GDM, and anxiety (State-Trait Anxiety Inventory score).
RESULTS: In the cohort 296 women (43.1%) had poor sleep quality and 77 women (11.2%) were categorized as short sleepers; 131 women (19.1%) were diagnosed with GDM. Poor sleep quality and short nocturnal sleep duration were independently associated with increased risk of GDM (poor sleep, adjusted odds ratio [OR] = 1.75, 95% confidence interval [CI] 1.11 to 2.76; short sleep, adjusted OR = 1.96, 95% CI 1.05 to 3.66).
CONCLUSIONS: During pregnancy, Asian women with poor sleep quality or short nocturnal sleep duration exhibited abnormal glucose regulation. Treating sleep problems and improving sleep behavior in pregnancy could potentially reduce the risk and burden of GDM.

Matched MeSH terms: Diabetes, Gestational/etiology*
Fulltext Risk factors and adverse maternal and perinatal outcomes for women with dichorionic twin pregnancies complicated by gestational diabetes mellitus: A retrospective cross-sectional study

Hung TH, Hsieh TT, Shaw SW, Kok Seong C, Chen SF

J Diabetes Investig, 2021 Jun;12(6):1083-1091.
PMID: 33064935 DOI: 10.1111/jdi.13441

AIMS/INTRODUCTION: The association between gestational diabetes mellitus (GDM) and adverse maternal and perinatal outcomes in twin pregnancies remains unclear. This study was undertaken to highlight risk factors for GDM in women with dichorionic (DC) twins, and to determine the association between GDM DC twins and adverse maternal and perinatal outcomes in a large homogeneous Taiwanese population.
MATERIALS AND METHODS: A retrospective cross-sectional study was carried out on 645 women with DC twins, excluding pregnancies complicated by one or both fetuses with demise (n = 22) or congenital anomalies (n = 9), who gave birth after 28 complete gestational weeks between 1 January 2001 and 31 December 2018. Univariable and multiple logistic regression analyses were carried out.
RESULTS: Maternal age >34 years (adjusted odds ratio 2.52; 95% confidence interval 1.25-5.07) and pre-pregnancy body mass index >24.9 kg/m2 (adjusted odds ratio 2.83, 95% confidence interval 1.47-5.46) were independent risk factors for GDM in women with DC twins. Newborns from women with GDM DC twins were more likely to be admitted to the neonatal intensive care unit (adjusted odds ratio 1.70, 95% confidence interval 1.06-2.72) than newborns from women with non-GDM DC twins. Other pregnancy and neonatal outcomes were similar between the two groups.
CONCLUSIONS: Advanced maternal age and pre-pregnancy overweight or obesity are risk factors for GDM in women with DC twins. Except for a nearly twofold increased risk of neonatal intensive care unit admission of newborns, the pregnancy and neonatal outcomes for women with GDM DC twins are similar to those for women with non-GDM DC twins.

Matched MeSH terms: Diabetes, Gestational/etiology