Low vs. High Glycemic Criteria for Diagnosing Gestational Diabetes | NEJM – nejm.org



Treatment of gestational diabetes improves the health of the mother and the infant, although the diagnostic criteria remain unclear.


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We randomly assigned women at gestational age of 24 to 32 weeks in a 1:1 ratio to be evaluated for gestational diabetes using low or higher glycemic criteria for diagnosis. The lower criterion for glycemia was a fasting plasma glucose level of at least 92 mg/dL (> 153 mg/dL (≥8.5 mmol/L). The highest criterion for fasting plasma glucose was a fasting plasma glucose level of no). Below 99 mg/dL (≥5.5 mmol/L) or at least 2 hours level of 162 mg/dL (9.0 mmol/L) The primary outcome was a large-for-gestational baby (defined as a birth weight above the ratio) 90th centenary according to the WHO Fenton criteria. Secondary outcomes were maternal and child health.


A total of 4,061 women were randomized. Gestational diabetes was diagnosed in 310 of 2022 women (15.3%) in the group with low glycemic standards and in 124 of 2039 women (6.1%) in the group with high glycemic standards. Among the infants born to women in the low glycemic criteria group, 178 (8.8%) were significant for gestational age, and among the 2031 infants born to women in the high glycemic criteria group, 181 (8.9%) were significant for for gestational age. Gestational age (adjusted relative risk, 0.98; 95% confidence interval, 0.80 to 1.19; P=0.82). Induction of labor, use of health services, use of pharmacological agents, and neonatal hypoglycemia were more common in the lower glycemic criteria group than in the higher glycemic criteria group. Other secondary outcome outcomes were similar in the two trial groups, and there were no significant between-group differences in adverse events. Among the women in both groups who had glucose test results that fell between the lowest and highest glycemic criteria, the women treated for gestational diabetes (195 women), compared with the others (178 women), were healthy mothers and infants. Benefits, including fewer gestational age infants.


Using lower glycemic criteria to diagnose gestational diabetes did not result in a significantly lower risk of developing a significant infant at gestational age compared to using higher glycemic criteria. (Funded by the Health Research Council of New Zealand et al; GEMS Australian New Zealand Clinical Trial Registry Number, ACTRN12615000290594.)

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Low glycemic criteria for diagnosing gestational diabetes

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