Diagnostic criteria for gestational hyperglycemia in women from a public maternity hospital in Brazil

Bernardo, Thais Mantovani; Damaso, Ênio Luis; Gomes, Patrícia Moreira; Moisés, Elaine Christine Dantas

doi:10.20945/2359-4292-2026-0054

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original • Arch. Endocrinol. Metab. 70 (4) • 2026 • https://doi.org/10.20945/2359-4292-2026-0054 linkcopy

Diagnostic criteria for gestational hyperglycemia in women from a public maternity hospital in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: This study aimed to determine the prevalence of hyperglycemia using different diagnostic criteria for gestational diabetes mellitus.

Subjects and methods: This cross-sectional study evaluated parturients attending a hospital complex from January to December 2017. Data were obtained retrospectively from medical records. Fasting glucose and 75-g oral glucose tolerance test results were used to assess the prevalence of hyperglycemia during pregnancy. The diagnostic criteria evaluated were: 1998 World Health Organization (WHO98), 2003 American Diabetes Association (ADA03), 2015 National Institute for Health and Care Excellence (NICE15), and 2015 International Federation of Gynecology and Obstetrics (FIGO15). The overall kappa coefficient was used to analyze agreement among the four sets of diagnostic criteria. All analyses were performed using SAS 9.2, and a significance level of 5% was adopted for all tests.

Results: Data from 2,262 women were analyzed. The prevalence of hyperglycemia differed depending on the diagnostic criteria: 10.3% (FIGO15), 7.34% (NICE15), 3.1% (ADA03), and 5.7% (WHO98). The overall kappa coefficient of agreement was 0.61. Individual analysis of each set of diagnostic criteria showed a kappa coefficient indicating moderate agreement, with FIGO15 used as the gold standard.

Conclusion: In this population of pregnant women, the prevalence of hyperglycemia varied according to the diagnostic criteria used, with the prevalence of the disease being lower as the criteria became stricter. Lastly, the criteria showed moderate agreement when compared collectively and individually to FIGO15.

Keywords:
Pregnancy; gestational diabetes mellitus; prevalence; diagnostic criteria

Variable	n	%	Variable	n	%
Maternal age (years)			Prenatal (≥ 6 visits)
Mean (SD)	26.41	(6.60)	No	83	3.67
Median (min–max)	26	(13-47)	Yes	2,112	93.37
Maternal age (years)			Not reported	67	2.96
< 20	372	16.44	Total number of pregnancies
20–34	1589	70.25	1	777	34.35
> 34	301	13.31	2	642	28.38
Skin color			3	420	18.57
White	1,474	65.16	4	237	10.48
Black	776	34.31	≥ 5	86	8.22
Brown	7	0.31	Parity
Yellow	2	0.09	0	885	39.12
Not reported	3	0.13	1	703	31.08
Drug use			2	393	17.37
Yes	254	11.23	3	175	7.74
No	2,008	88.77	4	58	2.56
Maternal diseases			≥ 5	48	2.12
None	1,371	60.6	Previous cesarean section
Hypertensive disorders of pregnancy	244	10.78	0	1,742	77.01
Hypertensive disorders of pregnancy	244	10.78	1	370	16.36
HIV	14	0.62	2	115	5.08
Others	632	27.93	3	32	1.41
Not reported	1	4	≥ 4	3	0.13

Criteria	Fasting glucose and all 75g OGTT values		Individual fasting glucose and fasting glucose value extracted from 75-g OGTT		Three 75g OGTT values
Criteria	n (%)	95% CI (%)	n (%)	95% CI (%)	n (%)	95% CI (%)
FIGO15
No	2,029 (89.70)	88.45; 90.95	2,082 (92.04)	90.93; 93.16	1,615 (91.14)	89.82; 92.46
Yes	233 (10.30)	9.05; 11.55	180 (7.96)	6.84; 9.07	157 (8.86)	7.54; 10.18
NICE15
No	2,096 (92.66)	91.59; 93.74	2,184 (96.55)	95.8; 97.3	1,641 (92.61)	91.39; 93.83
Yes	166 (7.34)	6.26; 8.41	78 (3.45)	2.7; 4.2	131 (7.39)	6.17; 8.61
ADA03
No	2,191 (96.90)	96.19; 97.62	-	-	1,711 (96.56)	95.71; 97.41
Yes	71 (3.10)	2.38; 3.81	-	-	61 (3.44)	2.59; 4.29
WHO98
No	2,133 (94.30)	93.34; 95.25	2,245 (99.25)	98.89; 99.6	1,657 (93.51)	92.36; 94.66
Yes	129 (5.70)	4.75; 6.66	17 (0.75)	0.4; 1.11	115 (6.49)	5.34; 7.64
GDM diagnosis by some of the criteria
No	1,998 (88.33)	87.01; 89.65	2,082 (92.04)	90.93; 93.16	1,586 (89.50)	88.08; 90.93
Yes	264 (11.67)	10.35; 12.99	180 (7.96)	6.84; 9.07	186 (10.50)	9.07; 11.92

Variable	Diagnostic criteria	Prevalence of hyperglycemia	n	Absolute error (pp)
Fasting glucose and all 75-g OGTT values	FIGO15	233 (10.3%)	2,262	1.25
	NICE15	166 (7.34%)	2,262	1.07
	ADA03	70 (3.1%)	2,261	0.71
	WHO98	129 (5.7%)	2,262	0.96
	S-GDM	264 (11.67%)	2,262	1.32
Individual fasting glucose and fasting glucose value extracted from 75-g OGTT	FIGO15	180 (7.96%)	2,262	1.12
	NICE15	78 (3.45%)	2,262	0.75
	WHO98	17 (0.75%)	2,262	0.36
	S-GDM	180 (7.96%)	2,262	1.12
Three 75-g OGTT values	FIGO15	157 (8.86%)	1,772	1.32
	NICE15	131 (7.39%)	1,772	1.22
	ADA03	61 (3.44%)	1,772	0.85
	WHO98	115 (6.49%)	1,772	1.15
	S-GDM	186 (10.5%)	1,772	1.43

Variable	Not screened (n = 260)	Screened (n = 2,262)	p*
Maternal age (years)
< 20	25 (9.62%)	314 (13.88%)	<0.01
20–34	166 (63.85%)	1,600 (70.73%)
> 34	69 (26.54%)	348 (15.38%)
Skin color‡
White	191 (73.46%)	1,474 (65.25%)	0.05
Black	69 (26.54%)	776 (34.35%)
Brown	0 (0%)	7 (0.31%)
Yellow	0 (0%)	2 (0.09%)
Drug use
No	44 (16.92%)	2,008 (88.77%)	<0.01
Yes	216 (83.08%)	254 (11.23%)	<0.01
Maternal diseases
None	157 (60.38%)	1,371 (60.64%)	0.45
Hypertensive disorders of pregnancy	24 (9.23%)	244 (10.79%)
HIV	0 (0%)	14 (0.62%)
Others	79 (30.38%)	632 (27.95%)
Prenatal (≥ 6 visits)
No	37 (14.23%)	83 (3.78%)	<0.01
Yes	223 (85.77%)	2,112 (96.22%)	<0.01
Total number of pregnancies
1	85 (32.69%)	777 (34.35%)	0.04
2	75 (28.85%)	642 (28.38%)
3	35 (13.46%)	420 (18.57%)
4	32 (12.31%)	237 (10.48%)
≥ 5	33 (12.69%)	186 (8.22%)
Parity
0	107 (41.15%)	885 (39.12%)	0.01
1	74 (28.46%)	703 (31.08%)
2	34 (13.08%)	393 (17.37%)
3	20 (7.69%)	175 (7.74%)
4	14 (5.38%)	58 (2.56%)
≥ 5	11 (4.23%)	48 (2.12%)
Previous cesarean section
0	200 (76.92%)	1,742 (77.01%)	<0.01
1	36 (13.85%)	370 (16.36%)
2	14 (5.38%)	115 (5.08%)
3	6 (2.31%)	32 (1.41%)
≥ 4	4 (1.54%)	3 (0.13%)

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[TN1] ^*
Chi-square test;

[TN2] ^‡
Fisher’s exact test.