Early gestational hyperglycemia in Bangladesh: Discordance between IADPSG and ADA diagnostic criteria

Abstract

Background: The American Diabetes Association (ADA) and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) both recommend a one-step 75-g oral glucose tolerance test (OGTT) for the diagnosis of gestational diabetes mellitus (GDM), but differ in their approach to hyperglycemia detected in early pregnancy. This study compared the diagnostic agreement and classification patterns between IADPSG and ADA criteria in a Bangladeshi cohort.

Objectives: To compare diagnostic agreement between IADPSG and ADA criteria for early gestational hyperglycemia.

Methods: In this cross-sectional study (May 2023–January 2025), pregnant women attending antenatal care at Bangladesh Medical University underwent a 75-g OGTT. Glycemic status was classified using IADPSG 2010 and ADA 2023 criteria. Agreement between criteria was assessed using Cohen’s kappa statistic.

Results: Among 753 participants (median age 27.0 years, median BMI 27.5 kg/m²), marked differences in classification were observed between the two criteria in early pregnancy. Before 15 weeks (n = 66), IADPSG identified 23 GDM and 8 diabetes in pregnancy (DIP) cases, whereas ADA classified most as normoglycemic or prediabetic. Between 15 and 23 weeks (n = 220), all 58 GDM cases identified by IADPSG were categorized as normoglycemic by ADA. Agreement was substantial overall (κ = 0.753, p < 0.001), but minimal between 15 and 23 weeks (κ = 0.091, p = 0.001), indicating considerable discordance in this gestational window.

Conclusions: Substantial discordance exists between IADPSG and ADA criteria for classifying hyperglycemia in early pregnancy. IADPSG criteria identify a larger proportion of women with early dysglycemia, whereas ADA criteria classify most as normoglycemic, particularly in early gestation.

[J Assoc Clin Endocrinol Diabetol Bangladesh, 2026;5(Suppl 1): S44]