Gestational Diabetes Mellitus: Implications of an Increased Frequency With IADPSG Criteria

Abstract

My sermon on the meaning of the manna in the wilderness can be adapted to almost any occasion, joyful, or, as in the present case, distressing. I have preached it at harvest celebrations, christenings, confirmations, on days of humiliation and festal days.Dr. Chasuble from The Importance of Being Earnest . Oscar Wilde, 1895 And so, to a greater or lesser extent, gestational diabetes mellitus (GDM) continues to provide something for everyone. The implications of recent publications can be interpreted, argued, and adapted in many ways. The observational Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study (1) and the consensus agreement about new diagnostic criteria by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) (2) have made a significant step toward international consensus but in some respects have opened a Pandora’s box (3). In a recent publication, Ryan (4) calculated that the number of adverse perinatal events that could be hypothetically preventable with the new criteria would be relatively small and implied that a cost-benefit analysis may not be supportive. He also cogently argued that a raised maternal BMI could in most cases be the major predictive factor for large-for-gestational-age babies and that our approach has become too glucocentric. Using an OR of 2.0 rather than 1.75 for the diagnostic criteria would diagnose the same approximate number of women with gestational …