Diagnosing Gestational Diabetes Mellitus: Rationed or Rationally Related to Risk?

Abstract

The much-anticipated, weather-plagued National Institutes of Health (NIH) Consensus Development Conference on Diagnosing Gestational Diabetes Mellitus, held in Bethesda, Maryland, 4–6 March 2013, led to publication of a consensus panel report (1) that essentially maintains and promotes the status quo regarding gestational diabetes mellitus (GDM) diagnosis. The panel report contradicts current American Diabetes Association (ADA) recommendations (2). This commentary addresses several areas of disagreement. The only constant is change, and this is most apparent with the demography of pregnancy. Perhaps the most disturbing omission from the NIH panel’s report (1) is the lack of clear acknowledgment of the importance of the increasing prevalence of prediabetes and undiagnosed type 2 diabetes, outside pregnancy, in women of childbearing age (2). This omission effectively precludes any strategy for early detection of these potentially serious problems in pregnancy. Much of the NIH report expresses grave concerns about the possibility of a two- to threefold increase in GDM prevalence from the current estimate of 5–6%. However, the National Health and Nutrition Examination Survey (NHANES) 2005–2008 data (3) regarding U.S. women aged 18–44 years report frank diabetes in 4.5% of participants (1.7% undiagnosed) and prediabetes in 26.4%. While the current ADA (2) criteria for the diagnosis of GDM are based primarily on considerations of fetopathy, they still have an important role in identifying women with current or future abnormalities of glucose metabolism. Given the NHANES prevalence estimates for impaired …