To start, discard the 1-hour glucose loading test and
the 3-hour OGTT, a global group says.
Are you going to sign on, orremain an “OBskeptitrician”?
Robert L. Barbieri, MD
Editor in Chief
To and fro, obstetricians and endocrinologists have long debated the relative value of diagnosing and treatinggestational diabetes mellitus (GDM). No doubt, significant health advantages can follow from identifying and treating women who have GDM, including:
• protecting the fetus from macrosomia and alifetime of excess body fat and obesity
• avoiding birth injury, such as shoulder dystocia, and life-long paralytic disability
• early recognition of a group of women at risk of type 2diabetes mellitus, which can result in cardiovascular disease and premature death when undertreated. 1 - 6
Setting thresholds is a key sticking point
A fundamental issue with establishing diagnosticcriteria for GDM, however, is that a continuum relationship exists between, on one hand, the maternal circulating glucose concentration below a level diagnostic of type 2 diabetes mellitus and, on theother hand, such outcomes as macrosomia, neonatal hyperglycemia, preeclampsia, preterm delivery, shoulder dystocia, birth injury, hyperbilirubinemia, and admission to a neonatal intensive carenursery. That is why there's been a need for an expert consensus panel to establish glucose cutoffs that separate a “normal” state from GDM, based on an analysis of benefits and risks.
In June 2008, theInternational Association of Diabetes and Pregnancy Study Group convened 225 experts, from 40 countries, to review data and establish new criteria for diagnosing GDM. 7 The panel decided that its targetfor detailed analysis should be a maternal glucose concentration that resulted in an increased risk of 1.75 for various adverse outcomes.
PART 1: New criteria for making a diagnosis of GDM...