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

Helena Fadl, Maryam Saeedi, Scott Montgomery, Anders Magnuson, Erik Schwarcz, Kerstin Berntorp, Verena Sengpiel, Elisabeth Storck-Lindholm, Helena Strevens, Anna Karin Wikström, Sophia Brismar-Wendel, Martina Persson, Stefan Jansson, Fredrik Ahlsson, Carina Ursing, Linda Ryen, Kerstin Petersson, Ulla Britt Wennerholm, Karin Hildén, David Simmons

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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. Trial registration: CDC4G is listed on the ISRCTN registry with study ID ISRCTN41918550 (15/12/2017).

Original languageEnglish
Article number398
JournalBMC Pregnancy and Childbirth
Issue number1
Publication statusPublished - 2019

Subject classification (UKÄ)

  • Endocrinology and Diabetes
  • Obstetrics, Gynecology and Reproductive Medicine
  • Health Care Service and Management, Health Policy and Services and Health Economy


  • Diagnostic criteria
  • Gestational diabetes mellitus
  • Health economics
  • LGA
  • Obesity
  • Pregnancy outcomes
  • Stepped wedge cluster randomised controlled trial
  • WHO 2013 criteria


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