AB031. Standardizing Gestational Diabetes Mellitus diagnostic criteria and systematic management in China

Objective: Type 2 diabetes has been dramatically increasing and becoming a major public issue in China. Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy causing severe complications both for the gravida and offspring without systematic management. Furthermore, GDM can also increase the risk of developing metabolic syndrome for the mother and offspring in the long-term. However, several issues regarding GDM are still controversial such as systematical screening, diagnosis strategy and management as well as postpartum follow up issues. Our study aimed to standardize GDM diagnostic criteria and systematic management in China.

Methods: We have conducted multiple studies to verify the adverse outcome of GDM and establish suitable screening and diagnostic criteria for GDM of our country. Such as Prospective case control study and large clinical researches, large clinical multicenter study and randomized controlled trial.

Results: Through a prospective case control study and large clinical researches, we confirmed it is beneficial to monitor and control blood glucose level during pregnancy. As early as 1993 we have reported blood glucose management playing important role in reducing adverse outcome, also proposed full term GDM patients can not routinely to promote fetal lung maturity before termination of pregnancy. After standardized management of GDM, the perinatal mortality and incidence of macrosomia had been significantly decreased. Through the research of threshold on 50 g Glucose Challenge Test (GCT) and the 75 g oral glucose tolerance test (OGTT), we gradually established suitable screening and diagnostic criteria for GDM of our country. We proposed to cancel 75 g OGTT 3 h value based on 535 GDM cases before the international new recommendation in 2010. According to the research of more than 16,000 cases of GDM multicenter study, principal investigator composed the national GDM clinical recommendations and published it in 2007. Ministry of health in China finally approved the new GDM diagnostic guideline we drafted. We initially cooperated with endocrinologists and pediatricians and opened the GDM postpartum follow up clinic as well as did early interventions to the offspring in order to decrease the Type 2 diabetes incidence later in their life. Furthermore, we opened GDM one-day clinic in 2011 and ultimately achieved national extension.

Conclusions: It is important to standardize GDM diagnostic criteria and systematic management in China. Controlled the incidence of GDM could reduce the prevalence of type 2 diabetes in China and decrease the adverse effects on the offspring. It is instant for the obstetrician, nutrition doctor, endocrinologist, and pediatrician making joint efforts to systematically manage GDM in China.

Keywords: Gestational diabetes mellitus (GDM); diagnostic criteria; systematic management; screen; gestational diabetes mellitus one-day clinic (GDM one-day clinic)