Original Title: Diagnóstico de la diabetes mellitus gestacional: evaluación de los nuevos criterios IADPSG

Authors' objectives: To evaluate the one-step gestational diabetes mellitus (GDM) screening test proposed by the International Association of Diabetes and Pregnancy Study Group (IADPSG) with respect to the most commonly used strategies and, in particular, the strategy used in Spain.

Authors' results and conclusions: The new IADPSG criteria identify a higher number of women with GDM. The prevalence rate is slightly higher when compared with the WHO criteria (12.4% vs. 9.4%), whereas it is threefold higher when compared with the former ADA criteria, which give a prevalence rate of 37%. The women diagnosed using the IADPSG criteria presented more adverse maternal/foetal results than those women with normal glucose tolerance using the same criteria, including a greater risk of caesarean birth, gestational hypertension, pre-eclampsia, premature birth, foetal macrosomy, large baby for gestational age, neonatal hypoglycaemia or neonatal intensive care. In contrast, there were no differences as regards the number of small babies for gestational age, neonatal mortality, shoulder dystocia and jaundice. In comparison with women with normal glucose tolerance according to the WHO criteria, women with GDM according to the IADPSG criteria also presented a higher risk of caesarean birth, gestational hypertension and preeclampsia, and their babies of being macrosomic, large for their gestational age or requiring neonatal intensive care, whereas no differences were found as regards premature birth, neonatal hypoglycaemia, shoulder dystocia and jaundice. In contrast, when women with normal glucose tolerance according to the WHO and IADPSG criteria were compared with women diagnosed with GDM according to the IADPSG criteria, the latter did not exhibit any greater risk of caesarean birth, gestational hypertension or pre-eclampsia. Moreover, babies from this group presented similar neonatal mortality rates and there were no differences as regards the risk of the baby being large for its gestational age, being admitted to intensive care or presenting jaundice, although a higher risk of premature birth or neonatal hypoglycaemia was observed. The results of the economic evaluation indicated that, from a social perspective, the strategy proposed by the IADPSG may be cost-effective with respect to that proposed by the ACOG if the number of patients diagnosed does not increase markedly, if the cost of the test and treatment is not high and the efficacy thereof is high. From a healthcare perspective, when compared with no screening or with a universal screening test, it is cost- effective provided it results in long-term benefits for the mother. Conclusions The new criteria established by the IADPSG group identify a higher number of women with GDM, with these women, and their foetuses, being at higher risk of suffering adverse results than women with normal glucose tolerance according to the same criteria. However, given that none of the studies identified has involved comparing the strategy proposed by the GEDE with the new IASPSG strategy, recommendations in favour of, or against, adoption of the new IADPSG criteria cannot be made for our context. As such, a study in our setting comparing the strategy proposed by the IADPSG group and that currently used in Spain is recommended.

Authors' methods: A literature search was conducted in the MEDLINE, EMBASE and EBM Reviews databases up until February 2014 for the systematic literature review. Moreover, a manual search was undertaken to locate additional articles in specialised journals, and the literature references in the studies selected were reviewed to find other relevant studies. Systematic reviews and original articles that compared the new diagnostic strategy proposed by the IADPSG group with one of the most widely used strategies internationally were included. The information was extracted from each of these studies using critical reading templates, with which evaluation of the quality of these studies was also performed. The literature search for the economic review was conducted in the MEDLINE, Ovid and NHS EED databases and other databases from bodies that make recommendations based on cost-effectiveness criteria. Full economic evaluations (cost-effectiveness, cost-utility, cost-benefit or costminimisation analyses) that compared the strategy proposed by the IADPSG with those proposed by ACOG, ADA, CDA, GEDE, NICE, OMS or SIGN were included. The quality of the studies was evaluated in the basis of a checklist proposed by Osteba.

Project Status: Completed

Year Published: 2014

URL for published report: https://www.ogasun.ejgv.euskadi.eus/r51-catpub/es/k75aWebPublicacionesWar/k75aObtenerPublicacionDigitalServlet?R01HNoPortal=true&N_LIBR=051592&N_EDIC=0001&C_IDIOM=es&FORMATO=.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government