National Diabetes Data Group vs Carpenter-Coustan criteria to diagnose gestational diabetes

OBJECTIVE: The objective of the study was to compare perinatal outcomes among women diagnosed with gestational diabetes by the National Diabetes Data Group (NDDG) criteria with women meeting only Carpenter-Coustan criteria. STUDY DESIGN: This was a 14 year retrospective cohort. Women who screened positive with 1 hour glucose load 140 mg/dL or greater underwent a diagnostic 3 hour oral glucose tolerance test. We report adjusted prevalence ratios (aPRs) of perinatal outcome risk. RESULTS: Of the 4659 screen-positive women with diagnostic testing, 1082 (3.3%, of 33,179) met NDDG criteria; 1542 (4.6%, of 33,179), or 460 more, met Carpenter-Coustan criteria. These 460 untreated women had greater risk of preeclampsia than women diagnosed by NDDG criteria (aPR, 1.70; 95% confidence interval [CI], 1.23-2.35). They had a greater risk of cesarean delivery (aPR, 1.16; 95% CI, 1.04-1.30) and infants greater than 4000 g (aPR, 1.25; 95% CI, 1.01-1.56) than women not meeting either diagnostic criteria. CONCLUSION: The 42.5% additional women diagnosed only by Carpenter-Coustan criteria are at greater risk for some adverse outcomes. Cost-effectiveness of a change remains to be determined.