{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T08:29:37Z","timestamp":1765960177200,"version":"3.41.2"},"reference-count":30,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,6,28]],"date-time":"2021-06-28T00:00:00Z","timestamp":1624838400000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Ramsay Research and Teaching Fund","award":["2018-19"],"award-info":[{"award-number":["2018-19"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2021,5,22]]},"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The incidence of gestational diabetes mellitus (GDM) is increasing in Australia, influenced by changed diagnostic criteria. We aimed to identify whether the diagnostic change was associated with improved outcomes and\/or increased obstetric interventions using state-wide data in New South Wales (NSW), Australia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>Perinatal and hospital data were linked for singleton births, 33\u201341 weeks\u2019 gestation, 2006\u20132015, NSW. An adjusted Poisson model was used to split pregnancies from 2011 onwards into those that would have been diagnosed under the old criteria (\u2018previous GDM\u2019) and newly diagnosed cases (\u2018additional GDM\u2019). We compared actual rates of total and early (&lt;39 weeks) planned births, cesareans, and maternal and neonatal adverse outcomes for GDM-diagnosed pregnancies using three predicted scenarios, where the \u2018additional GDM\u2019 group was assumed to have the same rates as: the \u2018previous GDM\u2019 group &lt;2011 (scenario A); the \u2018non-GDM\u2019 group &lt;2011 (scenario B); or the \u2018non-GDM\u2019 group \u22652011 (scenario C).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>GDM incidence more than doubled over the study period, with an inflection point observed at 2011. For those diagnosed with GDM since 2011, the actual incidence of interventions (planned births and cesareans) and macrosomia was consistent with scenario A, which meant higher intervention rates, but lower rates of macrosomia, than those with no GDM. Incidence of neonatal hypoglycemia was lower than scenario A and closer to the other scenarios. There was a reduction in perinatal deaths among those with GDM, lower than that predicted by all scenarios, indicating an improvement for all with GDM, not only women newly diagnosed. Incidence of maternal and neonatal morbidity indicators was within the confidence bounds for all three predicted scenarios.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our study suggests that the widely adopted new diagnostic criteria for GDM are associated with increased obstetric intervention rates and lower rates of macrosomic babies, but with no clear impacts on maternal or neonatal morbidity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2021-002277","type":"journal-article","created":{"date-parts":[[2021,6,28]],"date-time":"2021-06-28T13:01:10Z","timestamp":1624885270000},"page":"e002277","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Are newly introduced criteria for the diagnosis of gestational diabetes mellitus associated with improved pregnancy outcomes and\/or increased interventions in New South Wales, Australia? A population-based data linkage study"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5075-0227","authenticated-orcid":false,"given":"Deborah A","family":"Randall","sequence":"first","affiliation":[{"name":"The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, New South Wales, Australia"},{"name":"Northern Sydney Local Health District, Kolling Institute, St Leonards, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan M","family":"Morris","sequence":"additional","affiliation":[{"name":"The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, New South Wales, Australia"},{"name":"Northern Sydney Local Health District, Kolling Institute, St Leonards, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Kelly","sequence":"additional","affiliation":[{"name":"The University of Sydney, School of Public Health, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah J","family":"Glastras","sequence":"additional","affiliation":[{"name":"Northern Sydney Local Health District, Kolling Institute, St Leonards, New South Wales, Australia"},{"name":"Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia"},{"name":"The University of Sydney, Northern Clinical School, St Leonards, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,6,28]]},"reference":[{"key":"2025073112471843000_9.1.e002277.1","unstructured":"Australian Institute of Health and Welfare . Incidence of gestational diabetes in Australia Canberra. Autralia: AIHW, 2019. https:\/\/www.aihw.gov.au\/reports\/diabetes\/incidence-of-gestational-diabetes-in-australia\/data"},{"key":"2025073112471843000_9.1.e002277.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-011-2150-4"},{"key":"2025073112471843000_9.1.e002277.3","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1080\/17446651.2018.1476135","article-title":"Gestational diabetes risk factors and long-term consequences for both mother and offspring: a literature review","volume":"14","author":"Farahvar","year":"2019","journal-title":"Expert Rev Endocrinol Metab"},{"key":"2025073112471843000_9.1.e002277.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0707943"},{"key":"2025073112471843000_9.1.e002277.5","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-0719"},{"key":"2025073112471843000_9.1.e002277.6","doi-asserted-by":"crossref","first-page":"338","DOI":"10.5694\/j.1326-5377.2011.tb03001.x","article-title":"The impact of potential new diagnostic criteria on the prevalence of gestational diabetes mellitus in Australia","volume":"194","author":"Moses","year":"2011","journal-title":"Med J Aust"},{"key":"2025073112471843000_9.1.e002277.7","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1111\/ajo.12457","article-title":"Survey on testing for gestational diabetes mellitus in Australia","volume":"56","author":"Flack","year":"2016","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"2025073112471843000_9.1.e002277.8","unstructured":"World Health Organization . 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Available: https:\/\/apps.who.int\/iris\/handle\/10665\/85975"},{"key":"2025073112471843000_9.1.e002277.9","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/jog.13544","article-title":"Impact of new diagnostic criteria for gestational diabetes","volume":"44","author":"Sexton","year":"2018","journal-title":"J Obstet Gynaecol Res"},{"key":"2025073112471843000_9.1.e002277.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-023293","article-title":"Implications of the introduction of new criteria for the diagnosis of gestational diabetes: a health outcome and cost of care analysis","volume":"9","author":"Cade","year":"2019","journal-title":"BMJ Open"},{"key":"2025073112471843000_9.1.e002277.11","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.wombi.2013.10.001","article-title":"Australian women's experiences of living with gestational diabetes","volume":"27","author":"Morrison","year":"2014","journal-title":"Women Birth"},{"key":"2025073112471843000_9.1.e002277.12","unstructured":"Krassnitzer L , Willis E . Chapter 2: the public health sector and Medicare. In: Willis E , Reynolds L , Keleher H , eds. Understanding the Australian health care system 3rd edition. Sydney, Australia: Elsevier, 2016."},{"key":"2025073112471843000_9.1.e002277.13","unstructured":"Centre for Health Record Linkage . Quality assurance, 2018. Available: http:\/\/www.cherel.org.au\/quality-assurance"},{"key":"2025073112471843000_9.1.e002277.14","unstructured":"Centre for Epidemiology and Evidence . New South Wales mothers and babies 2015. Sydney: NSW Ministry of Health, 2016."},{"key":"2025073112471843000_9.1.e002277.15","first-page":"1381","article-title":"Reporting of gestational diabetes and other maternal medical conditions: validation of routinely collected hospital data from New South Wales, Australia","volume":"6","author":"Baldwin","year":"2021","journal-title":"Int J Popul Data Sci"},{"key":"2025073112471843000_9.1.e002277.16","unstructured":"Nankervis A , McIntyre HD , Moses R . ADIPS consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia. Australasian Diabetes in Pregnancy Society 2014."},{"key":"2025073112471843000_9.1.e002277.17","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1136\/bmj.319.7213.812","article-title":"Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study","volume":"319","author":"Perucchini","year":"1999","journal-title":"BMJ"},{"key":"2025073112471843000_9.1.e002277.18","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318178eae4"},{"key":"2025073112471843000_9.1.e002277.19","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-011-0797-6"},{"key":"2025073112471843000_9.1.e002277.20","first-page":"1337","article-title":"A composite neonatal adverse outcome indicator using population-based data: an update","volume":"5","author":"Todd","year":"2020","journal-title":"Int J Popul Data Sci"},{"key":"2025073112471843000_9.1.e002277.21","doi-asserted-by":"publisher","DOI":"10.5694\/mja11.11331"},{"key":"2025073112471843000_9.1.e002277.22","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1007\/s00125-018-4631-1","article-title":"Insights uncovered from experiencing a rise in the incidence of gestational diabetes at a Melbourne Hospital","volume":"61","author":"Ng","year":"2018","journal-title":"Diabetologia"},{"key":"2025073112471843000_9.1.e002277.23","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1056\/NEJMoa2026028","article-title":"A pragmatic, randomized clinical trial of gestational diabetes screening","volume":"384","author":"Hillier","year":"2021","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025073112471843000_9.1.e002277.24","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1097\/AOG.0000000000003790","article-title":"Effects of changing diagnostic criteria for gestational diabetes mellitus in Queensland, Australia","volume":"135","author":"Meloncelli","year":"2020","journal-title":"Obstet Gynecol"},{"key":"2025073112471843000_9.1.e002277.25","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042973"},{"key":"2025073112471843000_9.1.e002277.26","doi-asserted-by":"crossref","unstructured":"Owen K , Ibiebele I , Simpson J . A comparison of costs related to infant hospitalisations for spontaneous, induced and caesarean births: a population-based cohort study. 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