Indian Journal of Endocrinology and Metabolism

: 2014  |  Volume : 18  |  Issue : 1  |  Page : 119--120

Hyperglycemia and adverse pregnancy outcome (HAPO) study: Should it show the other side of the coin?

Yashdeep Gupta1, Bharti Kalra2,  
1 Department of Medicine, Government Medical College and Hospital, Chandigarh, India
2 Department of Obstetrics and Gynaecology, Bharti Hospital, Karnal, Haryana, India

Correspondence Address:
Bharti Kalra
Department of Obstetrics and Gynaecology, Bharti Hospital, Kunjpura Road, Karnal, Haryana - 132 001

How to cite this article:
Gupta Y, Kalra B. Hyperglycemia and adverse pregnancy outcome (HAPO) study: Should it show the other side of the coin?.Indian J Endocr Metab 2014;18:119-120

How to cite this URL:
Gupta Y, Kalra B. Hyperglycemia and adverse pregnancy outcome (HAPO) study: Should it show the other side of the coin?. Indian J Endocr Metab [serial online] 2014 [cited 2021 Apr 17 ];18:119-120
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Full Text


Carrington et al. first coined the term "Gestational diabetes" in 1957. [1] Since then, the subject of gestational diabetes mellitus (GDM) has remained of considerable controversies. In 1964, O'Sullivan and Mahan proposed criteria for diagnosis of GDM to indicate a higher chance of developing type 2 diabetes mellitus for the mother. [2] They did not at that time, imply a higher risk for perinatal complications.

Subsequently hyperglycemia and adverse pregnancy outcomes (HAPO) study showed that there is an increase in adverse pregnancy outcomes even with hyperglycemia less severe than that diagnostic of overt diabetes mellitus. [3] Based on HAPO data, International Association of Diabetes Pregnancy Study Group (IADPSG) used the oral glucose tolerance test (OGTT) cut-offs that identified odds ratios of 1.75 (compared to median values) for the risk of fetal macrosomia, neonatal adiposity and fetal hyperinsulinemia (all defined as >90 th percentile). [3],[4] With new criteria the prevalence of GDM increased dramatically. The increase occurred more in women with a lesser degree of glucose intolerance. In the absence of clarity of treatment benefit in additional women diagnosed of IADPSG criteria, it generated new controversy. Furthermore, it took away attention completely from long-term maternal outcomes to short-term perinatal outcomes.

O'Sullivan and Mahan criteria and its subsequent modifications (the last being Carpenter and Coustan criteria) were validated for the outcome of future maternal diabetes, whereas IADPSG criteria is validated for perinatal outcomes. [2],[4] The two criteria shows the different side of the same coin, which may be the reason of un-satisfaction with either of the diagnostic criteria. Both short-term as well as long-term outcomes of GDM have its own importance and none can take a stepmother treatment. The validation of newer criteria as well as original 7 categories of glycemic levels in HAPO study in terms of future risk of maternal diabetes may solve the controversy. [3] Since, it is nearly 5 years since HAPO study has been published, follow-up of strong cohort of over 23,000 women across different countries to determine the conversion rates to diabetes or pre-diabetes will be valuable. [3] The cut-offs of OGTT during pregnancy, which determines a significant risk for these outcomes could be determined. The composite scenario taking perinatal outcomes as well as long-term future risk of diabetes for mother, may better determines the cut-off at which the interventions may be cost-effective.


1Carrington ER, Shuman CR, Reardon HS. Evaluation of the prediabetic state during pregnancy. Obstet Gynecol 1957;9:664-9.
2O'Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes 1964;13:278-85.
3HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991-2002.
4International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676-82.