Gestational diabetes—Staying with old or marrying new guidelines

THE ISSUE: Gestational diabetes mellitus is associated with increased neonatal morbidities and higher cesarean delivery rates; women with gestational diabetes mellitus are at increased risk for type II diabetes mellitus later in life. The current recommendation for screening includes a glucose tolerance test either early in pregnancy and/or at 24-28 weeks’ gestation followed by a diagnostic 100-g oral 3-hour glucose tolerance test with a rate of 5%. The results of a large prospective observational study (HAPO study) and 2 randomized trials lead the International Association of Diabetes in Pregnancy Study Group to recommend a 1-stage screening and diagnosis method that includes a 75-g 2-hour glucose tolerance test that will result in an 18% gestational diabetes mellitus rate. However, there is uncertainty about the clinical implications of the adoption of the latter recommendation.

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