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The study, which has been published in the journal Diabetologia and involved a team from the University of Cambridge and Cambridge University Hospitals Foundation Trust, discovered the proposed new thresholds are less effective at identifying women adversely affected by high blood sugar levels during pregnancy than those established by the World Health Organisation (WHO).
Gestational diabetes (diabetes that arises during pregnancy) is becoming more common in the UK, but there is a lack of consensus regarding the best way to identify women with the condition. Left untreated, gestational diabetes can create a risk to the health of both mother and baby and may be associated with pre-eclampsia, excessive amniotic fluid, birth defects, high birthweight, emergency Caesarean section, and low blood sugar levels in the babies after birth. However, identifying the condition during pregnancy allows treatment and dietary advice to be given that reduces the risk of adverse outcomes.
Currently, international criteria – recommended by WHO – require three blood tests to be taken altogether to diagnose gestational diabetes. One test is taken in the fasting state, while the others are taken one and two hours after a drink containing sugar. These criteria consider that women with high fasting blood sugars have gestational diabetes, with a 75% increased risk of pregnancy complications.
In February of this year, NICE introduced new guidelines requiring only two blood tests; fasting and two hours after a sugary drink. It also recommended a less strict fasting blood sugar threshold for the diagnosis of gestational diabetes. However, it has been said that these criteria were identified based on cost effectiveness estimates alone, using old NHS hospital payment data, and have not been tested in clinical practice.
Dr Claire Meek and a team of doctors and scientists looked at the risks related to high blood sugar in over 25,000 women who gave birth at the Rosie Hospital in Cambridge between 2004 and 2008. They found that women who had borderline levels of fasting blood sugar were at much higher risk of having a high birthweight baby compared to the healthy population. The mothers were also twice as likely to have had an emergency Caesarean section and seven times more likely to develop excessive amniotic fluid. These women would be missed using the new NICE criteria, the study has claimed. For example, using the WHO guidelines instead of the NICE guidelines for the data would have resulted in 126 more diagnoses of gestational diabetes over five years.
Although this accounts for less than one in 200 pregnancies, overall, the researchers estimate that this issue is likely to affect 3,000 to 4,000 women each year in the UK.
"There is a fundamental difference between the international criteria and the new NICE 2015 criteria: the international criteria are based on minimising the risk of harm to the mother and baby, whereas the NICE criteria have been based upon reducing costs to the NHS," explained Dr Meek from the Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge. "While cost effectiveness is important in any health care system, we must not forget the psychological and emotional distress that complications can cause. This cannot be measured in economic terms alone."
"The new NICE guidelines contain many different recommendations for the management of diabetes in pregnancy and almost all of these recommendations are beneficial and based upon up-to-date evidence," adds Dr David Simmons from Cambridge University Hospitals. "This is not the case with the diagnostic criteria for gestational diabetes. These should aim to improve health for all pregnant women and their babies by identifying those at greatest risk of complications, and who may benefit the most from dietary changes or other forms of treatment."
The study can be found in full here.
(JP/MH)
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New Diabetes Threshold Misses 'At-Risk' Women
A new report has found that the new threshold for diabetes in pregnancy – which was recently introduced by the UK's National Institute for Health and Care Excellence (NICE) – could miss thousands of women each year who are at risk of serious complications.The study, which has been published in the journal Diabetologia and involved a team from the University of Cambridge and Cambridge University Hospitals Foundation Trust, discovered the proposed new thresholds are less effective at identifying women adversely affected by high blood sugar levels during pregnancy than those established by the World Health Organisation (WHO).
Gestational diabetes (diabetes that arises during pregnancy) is becoming more common in the UK, but there is a lack of consensus regarding the best way to identify women with the condition. Left untreated, gestational diabetes can create a risk to the health of both mother and baby and may be associated with pre-eclampsia, excessive amniotic fluid, birth defects, high birthweight, emergency Caesarean section, and low blood sugar levels in the babies after birth. However, identifying the condition during pregnancy allows treatment and dietary advice to be given that reduces the risk of adverse outcomes.
Currently, international criteria – recommended by WHO – require three blood tests to be taken altogether to diagnose gestational diabetes. One test is taken in the fasting state, while the others are taken one and two hours after a drink containing sugar. These criteria consider that women with high fasting blood sugars have gestational diabetes, with a 75% increased risk of pregnancy complications.
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In February of this year, NICE introduced new guidelines requiring only two blood tests; fasting and two hours after a sugary drink. It also recommended a less strict fasting blood sugar threshold for the diagnosis of gestational diabetes. However, it has been said that these criteria were identified based on cost effectiveness estimates alone, using old NHS hospital payment data, and have not been tested in clinical practice.
Dr Claire Meek and a team of doctors and scientists looked at the risks related to high blood sugar in over 25,000 women who gave birth at the Rosie Hospital in Cambridge between 2004 and 2008. They found that women who had borderline levels of fasting blood sugar were at much higher risk of having a high birthweight baby compared to the healthy population. The mothers were also twice as likely to have had an emergency Caesarean section and seven times more likely to develop excessive amniotic fluid. These women would be missed using the new NICE criteria, the study has claimed. For example, using the WHO guidelines instead of the NICE guidelines for the data would have resulted in 126 more diagnoses of gestational diabetes over five years.
Although this accounts for less than one in 200 pregnancies, overall, the researchers estimate that this issue is likely to affect 3,000 to 4,000 women each year in the UK.
"There is a fundamental difference between the international criteria and the new NICE 2015 criteria: the international criteria are based on minimising the risk of harm to the mother and baby, whereas the NICE criteria have been based upon reducing costs to the NHS," explained Dr Meek from the Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge. "While cost effectiveness is important in any health care system, we must not forget the psychological and emotional distress that complications can cause. This cannot be measured in economic terms alone."
"The new NICE guidelines contain many different recommendations for the management of diabetes in pregnancy and almost all of these recommendations are beneficial and based upon up-to-date evidence," adds Dr David Simmons from Cambridge University Hospitals. "This is not the case with the diagnostic criteria for gestational diabetes. These should aim to improve health for all pregnant women and their babies by identifying those at greatest risk of complications, and who may benefit the most from dietary changes or other forms of treatment."
The study can be found in full here.
(JP/MH)
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