TY - JOUR
T1 - Identification of gestational diabetes mellitus in European electronic healthcare databases
T2 - insights from the ConcePTION project
AU - Mølgaard-Nielsen, Ditte
AU - Mitter, Vera
AU - Lupattelli, Angela
AU - Hoxhaj, Vjola
AU - Andaur Navarro, Constanza L.
AU - Hayati, Saeed
AU - Lopez-Leon, Sandra
AU - Morris, Joan K.
AU - Geldof, Anja
AU - Jordan, Susan
AU - Leinonen, Maarit K.
AU - Martikainen, Visa
AU - Manfrini, Marco
AU - Cammarota, Luca
AU - Neville, Amanda
AU - Barrachina-Bonet, Laia
AU - Cavero-Carbonell, Clara
AU - García-Villodre, Laura
AU - Caillet, Anthony
AU - Beslay, Marie
AU - Damase-Michel, Christine
AU - van Gelder, Marleen M.H.J.
AU - Nordeng, Hedvig
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.
PY - 2025/10/5
Y1 - 2025/10/5
N2 - OBJECTIVE: To develop and compare algorithms for identifying gestational diabetes mellitus (GDM) across European electronic healthcare databases and evaluate their impact on the estimated prevalence. DESIGN: Multi-national cohort study using routinely collected electronic healthcare data SETTING: National and regional databases in five European countries (Norway, Finland, Italy, Spain and France), in primary and/or secondary care. PARTICIPANTS: Pregnancy cohorts resulting in stillbirths or live births between 2009 and 2020, comprising 602 897 pregnancies in Norway, 507 904 in Finland, 374 009 in Italy, 193 495 in Spain and 116 762 in France. PRIMARY AND SECONDARY OUTCOMES: The primary outcome was the prevalence of GDM identified using six algorithms: (1) Only diagnosis; (2) Diagnosis or prescription; (3) Two diagnoses or prescriptions (2DxRx); (4) Diagnosis including unspecified diabetes in pregnancy or prescription (DxRx broad); (5) Diagnosis excluding pre-existing diabetes in pregnancy or prescription; (6) Registration of GDM in a birth registry (BR). RESULTS: The strictest algorithm (2DxRx) resulted in the lowest GDM prevalence, while the broadest (DxRx broad) resulted in the highest, except in France where it was BR. In the Nordic countries, GDM prevalence varied only slightly by algorithm; greater variations were observed in other countries. The prevalence ranged from 3.5% (95% CI: 3.5% to 3.5%) to 4.6% (95% CI: 4.5% to 4.7%) in Norway; 12.1% (95% CI: 12.0% to 12.2%) to 15.8% (95% CI: 15.7% to 15.9%) in Finland, where prevalence was much higher than elsewhere. The prevalence ranged from 1.3% (95% CI: 1.3% to 1.3%) to 5.4% (95% CI: 5.3% to 5.5%) in Italy; 1.6% (95% CI: 1.5% to 1.7%) to 6.2% (95% CI: 6.1% to 6.3%) in Spain; and 1.7% (95% CI: 1.6% to 1.8%) to 5.8% (95% CI: 5.7% to 5.9%) in France. CONCLUSIONS: In this multinational study, GDM prevalence ranged from 1.3% to 15.8% depending on the algorithm and database. Nordic countries showed smaller differences in prevalence between algorithms, while the other countries showed larger variations, likely due to differences in coding practices, healthcare systems and database coverage.
AB - OBJECTIVE: To develop and compare algorithms for identifying gestational diabetes mellitus (GDM) across European electronic healthcare databases and evaluate their impact on the estimated prevalence. DESIGN: Multi-national cohort study using routinely collected electronic healthcare data SETTING: National and regional databases in five European countries (Norway, Finland, Italy, Spain and France), in primary and/or secondary care. PARTICIPANTS: Pregnancy cohorts resulting in stillbirths or live births between 2009 and 2020, comprising 602 897 pregnancies in Norway, 507 904 in Finland, 374 009 in Italy, 193 495 in Spain and 116 762 in France. PRIMARY AND SECONDARY OUTCOMES: The primary outcome was the prevalence of GDM identified using six algorithms: (1) Only diagnosis; (2) Diagnosis or prescription; (3) Two diagnoses or prescriptions (2DxRx); (4) Diagnosis including unspecified diabetes in pregnancy or prescription (DxRx broad); (5) Diagnosis excluding pre-existing diabetes in pregnancy or prescription; (6) Registration of GDM in a birth registry (BR). RESULTS: The strictest algorithm (2DxRx) resulted in the lowest GDM prevalence, while the broadest (DxRx broad) resulted in the highest, except in France where it was BR. In the Nordic countries, GDM prevalence varied only slightly by algorithm; greater variations were observed in other countries. The prevalence ranged from 3.5% (95% CI: 3.5% to 3.5%) to 4.6% (95% CI: 4.5% to 4.7%) in Norway; 12.1% (95% CI: 12.0% to 12.2%) to 15.8% (95% CI: 15.7% to 15.9%) in Finland, where prevalence was much higher than elsewhere. The prevalence ranged from 1.3% (95% CI: 1.3% to 1.3%) to 5.4% (95% CI: 5.3% to 5.5%) in Italy; 1.6% (95% CI: 1.5% to 1.7%) to 6.2% (95% CI: 6.1% to 6.3%) in Spain; and 1.7% (95% CI: 1.6% to 1.8%) to 5.8% (95% CI: 5.7% to 5.9%) in France. CONCLUSIONS: In this multinational study, GDM prevalence ranged from 1.3% to 15.8% depending on the algorithm and database. Nordic countries showed smaller differences in prevalence between algorithms, while the other countries showed larger variations, likely due to differences in coding practices, healthcare systems and database coverage.
KW - Diabetes in pregnancy
KW - Electronic Health Records
KW - Pregnancy
UR - https://www.scopus.com/pages/publications/105017833040
U2 - 10.1136/bmjopen-2025-102343
DO - 10.1136/bmjopen-2025-102343
M3 - Article
C2 - 41047268
AN - SCOPUS:105017833040
SN - 2044-6055
VL - 15
JO - BMJ Open
JF - BMJ Open
IS - 10
M1 - e102343
ER -