Carpenter-coustan compared with national diabetes data group criteria for diagnosing gestational diabetes

Lorie M. Harper, Lisa Mele, Mark B. Landon, Marshall W. Carpenter, Susan M. Ramin, Uma M. Reddy, Brian Casey, Ronald J. Wapner, Michael W. Varner, John M. Thorp, Anthony Sciscione, Patrick Catalano, Margaret Harper, George Saade, Steve N. Caritis, Yoram Sorokin, Alan M. Peaceman, Jorge E. Tolosa

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

OBJECTIVE: Use of Carpenter-Coustan compared with National Diabetes Data Group criteria increases the number of women diagnosed with gestational diabetes mellitus (GDM) by 30-50%, but whether treatment of this milder GDM reduces adverse outcomes is unknown. We explored the effects of the diagnostic criteria used on the benefits of GDM treatment. METHODS: This was a secondary analysis of a randomized trial for treatment of mild GDM diagnosed using Carpenter-Coustan criteria. We evaluated the effect of treatment within two mutually exclusive diagnostic groups: 1) women who met the stricter National Diabetes Data Group as well as Carpenter-Coustan criteria (National Diabetes Data Group), and 2) those diagnosed by Carpenter-Coustan but not meeting National Diabetes Data Group criteria (Carpenter-Coustan only). Maternal outcomes examined were pregnancy-induced hypertension, shoulder dystocia, maternal weight gain, and cesarean delivery. Neonatal outcomes were large for gestational age, macrosomia (greater than 4,000 g), fat mass, small for gestational age, and a composite outcome of perinatal death, birth injury, hypoglycemia, hyperbilirubinemia, and hyperinsulinemia. Analysis of variance or the Breslow-Day test, as appropriate, was used to test for the interaction between diagnostic criteria and GDM treatment on the outcomes of interest. RESULTS: Of 958 patients, 560 (58.5%) met National Diabetes Data Group criteria and 398 (41.5%) met Carpenter-Coustan only. Compared with untreated women, the direction of treatment effect did not differ by diagnostic criteria used and was consistent with the original trial. The P value for interaction between diagnostic criteria and treatment status was not significant for any outcome. CONCLUSION: The overall beneficial treatment effect on pregnancy-induced hypertension, shoulder dystocia, cesarean delivery, and macrosomia was seen in patients diagnosed by the higher National Diabetes Data Group and by the lower thresholds of the Carpenter-Coustan criteria.

Original languageEnglish (US)
Pages (from-to)893-898
Number of pages6
JournalObstetrics and gynecology
Volume127
Issue number5
DOIs
StatePublished - Apr 4 2016

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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    Harper, L. M., Mele, L., Landon, M. B., Carpenter, M. W., Ramin, S. M., Reddy, U. M., Casey, B., Wapner, R. J., Varner, M. W., Thorp, J. M., Sciscione, A., Catalano, P., Harper, M., Saade, G., Caritis, S. N., Sorokin, Y., Peaceman, A. M., & Tolosa, J. E. (2016). Carpenter-coustan compared with national diabetes data group criteria for diagnosing gestational diabetes. Obstetrics and gynecology, 127(5), 893-898. https://doi.org/10.1097/AOG.0000000000001383