Screening Pregnant Women for Gestational Diabetes

Gestational diabetes mellitus (GDM) is diabetes that occurs during pregnancy. When left untreated it increases the risk of preeclampsia, premature birth, delivery problems requiring cesarean section, and neonatal hypoglycemia.

A study by Quest Diagnostics (Madison, N.J., USA) of 924,873 pregnant women between the ages of 25 and 40 suggested that a large number of women are not being screened according to medical guidelines and they may unknowingly put themselves and their babies at risk for complications from GDM. The study also found that maternal weight was a stronger predictor of gestational diabetes but that ethnicity was even stronger.

Study investigator Jon M. Nakamoto, M.D., Ph.D., medical director, Quest Diagnostics commented, "We were particularly alarmed to find that women who develop the condition [GDM] while pregnant are not being screened for diabetes postpartum, despite overwhelming evidence that they are at great risk for developing diabetes later in life. Considering the diabetes public health crisis, the failure to test these women after their pregnancy is a major concern."

The Quest study is now online and expected to appear in the January 2011 print issue of the journal Obstetrics and Gynecology, the official publication of ACOG.

Current medical guidelines are based in part on results of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) trial, which found that even subtle defects in maternal glucose metabolism during pregnancy led to health problems for both mother and baby.

An estimated 40% to 60% of women with gestational diabetes develop type 2 diabetes within ten years. At present, the American College of Obstetricians and Gynecologists and the American Diabetes Association recommend screening pregnant women for gestational diabetes, and retesting women who do develop pregnancy-related diabetes 6 to 12 weeks after delivering their babies.

Prof. Moshe Hod and Dr. Eran Hadar from the Perinatal Division, Helen Schneider's Hospital for Women, Rabin Medical Center, (Petah-Tiqva, Israel) reviewed the establishment of consensus criteria for the diagnosis of diabetes in pregnancy following the HAPO study. The review appeared in the September 2010 Annals of the New York Academy of Sciences. The authors wrote," A consensus report by the [International Association of Diabetes and Pregnancy Study Groups] IADPSG, based on a vigorous assessment of the HAPO results and other studies, recommended an endorsement of risk-based, internationally accepted criteria for the diagnosis and classification of diabetes in pregnancy."

Related Links:
Quest Diagnostics
American College of Obstetricians and Gynecologists
American Diabetes Association
Rabin Medical Center