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Changing diagnostic criteria for gestational diabetes in Sweden-a stepped wedge national cluster randomised controlled trial-the CDC4G study protocol

Journal article
Authors H. Fadl
M. Saeedi
S. Montgomery
A. Magnuson
E. Schwarcz
K. Berntorp
Verena Sengpiel
E. Storck-Lindholm
H. Strevens
A. K. Wikstrom
S. Brismar-Wendel
M. Persson
S. Jansson
F. Ahlsson
C. Ursing
L. Ryen
K. Petersson
Ulla-Britt Wennerholm
K. Hilden
D. Simmons
Published in Bmc Pregnancy and Childbirth
Volume 19
Issue 1
Pages 11
Publication year 2019
Published at Institute of Clinical Sciences, Department of Obstetrics and Gynecology
Pages 11
Language en
Keywords Gestational diabetes mellitus, Pregnancy outcomes, Diagnostic criteria, WHO 2013 criteria, Stepped wedge cluster randomised controlled trial, LGA, Health economics, Obesity, international association, pregnancy outcomes, cost-effectiveness, mellitus, prevalence, hyperglycemia, women, population, parallel, trends
Subject categories Health Sciences


Background The optimal criteria to diagnose gestational diabetes mellitus (GDM) remain contested. The Swedish National Board of Health introduced the 2013 WHO criteria in 2015 as a recommendation for initiation of treatment for hyperglycaemia during pregnancy. With variation in GDM screening and diagnostic practice across the country, it was agreed that the shift to new guidelines should be in a scientific and structured way. The aim of the Changing Diagnostic Criteria for Gestational Diabetes (CDC4G) in Sweden () is to evaluate the clinical and health economic impacts of changing diagnostic criteria for GDM in Sweden and to create a prospective cohort to compare the many long-term outcomes in mother and baby under the old and new diagnostic approaches. Methods This is a stepped wedge cluster randomised controlled trial, comparing pregnancy outcomes before and after the switch in GDM criteria across 11 centres in a randomised manner. The trial includes all pregnant women screened for GDM across the participating centres during January-December 2018, approximately two thirds of all pregnancies in Sweden in a year. Women with pre-existing diabetes will be excluded. Data will be collected through the national Swedish Pregnancy register and for follow up studies other health registers will be included. Discussion The stepped wedge RCT was chosen to be the best study design for evaluating the shift from old to new diagnostic criteria of GDM in Sweden. The national quality registers provide data on the whole pregnant population and gives a possibility for follow up studies of both mother and child. The health economic analysis from the study will give a solid evidence base for future changes in order to improve immediate pregnancy, as well as long term, outcomes for mother and child.

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