Gestational diabetes: implications of variation in post-partum follow-up criteria Mukesh M. Agarwal a,* , John Punnose b , Gurdeep S. Dhatt c a Department of Pathology, Faculty of Medicine, UAE University, P.O. Box 17666, Al Ain, United Arab Emirates b Department of Medicine, Al Ain Hospital, Al Ain, United Arab Emirates c Depatrment of Pathology, Tawam Hospital, Al Ain, United Arab Emirates Received 4 July 2003; received in revised form 1 August 2003; accepted 5 September 2003 Abstract Objective: To compare the recommendations of the American Diabetes Association (ADA) with the World Health Organization (WHO) for evaluating women with gestational diabetes (GDM) after delivery. Study design: During a 5-year period, 549 patients underwent the 2 h, 75 g oral glucose tolerance test (OGTT), 4–8 weeks after delivery. They were classified by the criteria of WHO (1985), the ADA [1997, fasting glucose (FPG)] and the revised WHO (1999). Results: The prevalence of diabetes by WHO-1985 and ADA-1997 were similar (8.2% versus 6.6%) but estimates of impaired glucose homeostasis varied widely (15.5% impaired glucose tolerance (IGT) versus 9.3% impaired fasting glucose, respectively). 118 (21.5%) women and 83 (15.1%) women showed a classification discrepancy between ADA-1997 with the WHO- 1985 and -1999, respectively. The receiver-operating characteristic (ROC) curve area of the FPG was 0.94 for DM by the OGTT (WHO-1985 criteria) but only 0.59 for IGT by the 2 h post-glucose. Conclusions: The various guidelines for GDM follow-up after delivery, often based on expert opinion, produce similar estimates for diabetes prevalence but widely discordant results for glucose intolerance. Until more uniform evidence-based criteria become available, the various strategies for GDM follow-up will continue to cause confusion in clinical practice. # 2003 Elsevier Ireland Ltd. All rights reserved. Keywords: Postpartum OGTT; WHO; ADA 1. Introduction Gestational diabetes (GDM) was originally defined to identify pregnant women who were at a higher risk for developing diabetes mellitus (DM) later in life. It is now being used to predict increased maternal and fetal complica- tions in index pregnancy. Women with GDM have a risk of up to 2.6–70% for developing type 2 diabetes (DM) after delivery, depending on the duration of follow-up [1]. The 75 g oral glucose tolerance test (OGTT) as recommended by the World Health Organization (WHO) [2] was the corner- stone of this DM risk assessment after delivery in women with GDM. However, in 1997, the American Diabetes Asso- ciation (ADA) suggested that the simpler fasting plasma glucose (FPG) with a lower threshold be used instead of the cumbersome OGTT [3]. In 1999, the WHO modified the diagnostic cut-off values for the OGTT by incorporating the ADA criteria for FPG [4]. The current American College of Obstetricians and Gynecologists (ACOG) recommendation [5] for GDM post-partum follow-up is a hybrid of the ADA and WHO guidelines. The OGTT, 6–8 weeks post-partum, as advocated by the WHO, is preferred for the initial follow-up after delivery with the FPG for subsequent follow-ups. Other expert panels, e.g. Australia [6] and Canada, have their own guidelines for GDM follow-up. In Europe, the WHO guide- lines continue to remain popular. The United Arab Emirates (UAE) is a multiethnic com- munity with a very high prevalence of GDM, obesity and multi-parity [7]. An accurate estimate of the prevalence rate of GDM among the expatriate Arabs and Indian subconti- nent residents is not available [8]. Our multinational obste- tric staff follow, the two-step approach of ADA for screening (50 g glucose challenge test) and diagnosis (3 h, 100 g OGTT) of GDM. However, the ADA approach of using only the FPG is not used for following-up patients after delivery. Instead, the 75 g OGTT has continued to remain popular amongst our obstetricians. There is confusion about the best approach for GDM follow-up after delivery due to the various guidelines and European Journal of Obstetrics & Gynecology and Reproductive Biology 113 (2004) 149–153 * Corresponding author. Tel.: þ971-3-7672000; fax: þ971-3-7671966. E-mail address: magarwal@uaeu.ac.ae (M.M. Agarwal). 0301-2115/$ – see front matter # 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2003.09.021