Economical and evidence-based procedure to diagnose gestational diabetes mellitus in the community

Abstract

exceed the above figures is diagnosed as GDM. These values were recommended based on the predictive value of the subsequent risk of diabetes in the mother and not specifically on the fetal outcome. NDDG also has the same deficiency. To clarify the associations of levels of maternal glucose lower than those diagnostic of diabetes with perinatal outcome, Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was initiated. The objective was accomplished by performing a 75 g OGTT directly without screening in diverse cohort of 23,316 women in third trimester of gestation. Gestational diabetes mellitus (GDM) is associated with a significant incidence of diabetes in the later life of the mother and an increase in the fetal, neonatal morbidity, and future development of obesity and diabetes in the offspring. Studies conducted in different populations and with different methodologies consistently reported an increase in GDM in all ethnic groups, suggesting that there is an increase in GDM prevalence. (1) A true increase in the prevalence of GDM aside from its adverse consequences for the infant in the newborn period might reflect or contribute to the ongoing pattern of increasing diabetes and obesity. (1) The existing diagnostic criteria except World Health Organization (WHO) are country specific, e.g., American Diabetes Association, Canadian Diabetes in Pregnancy Study Group (CanDIPS), National Diabetes Data Group (NDDG) criteria, Australasian criteria, Japan Diabetes Association, German Diabetes Association, and Diabetes UK. These diagnostic criteria require the pregnant woman to visit the prenatal clinic twice, (1) for screening and (2) then to undergo diagnostic oral glucose tolerance test (OGTT). The pregnant woman resents undergoing the present diagnostic procedure, as she has to allot 2 days to attend the prenatal clinic and in addition, the numbers of blood samples drawn are too many. These observations emphasize the need for an appropriate tool to diagnose GDM and to incorporate them into the local health service strategies. Diagnostic Criteria American Diabetes Association (Carpenter and Coustan) criteria: The diagnostic criteria for GDM suggested by O'Sullivan and Mahan were based on whole blood glucose values. Carpenter and Coustan by applying conversion formula switched from whole blood glucose to venous plasma glucose values and suggested that normal glucose level during pregnancy with 100 g OGTT as fasting plasma glucose (FPG) ≤ 95 mg/dL, 1 h PG ≤ 180 mg/dL, 2 h PG ≤ 155 mg/dL, and 3 h ≤ 140 mg/dL, respectively. Any two values meet or