Abstract
The incidence of gestational diabetes mellitus (GDM) is increasing worldwide. This has a significant effect on the health of the mother and offspring. There is no doubt that screening for GDM between 24 and 28 weeks is important to reduce the risk of adverse pregnancy outcomes. However, there is no consensus about diagnosis and treatment of GDM in early pregnancy. In this narrative review on the current evidence on screening for GDM in early pregnancy, we included 37 cohort studies and eight randomized controlled trials (RCTs). Observational studies have shown that a high proportion (15–70%) of women with GDM can be detected early in pregnancy depending on the setting, criteria used and screening strategy. Data from observational studies on the potential benefit of screening and treatment of GDM in early pregnancy show conflicting results. In addition, there is substantial heterogeneity in age and BMI across the different study populations. Smaller RCTs could not show benefit but several large RCTs are ongoing. RCTs are also necessary to determine the appropriate cut-off for HbA1c in pregnancy as there is limited evidence showing that an HbA1c ≥6.5% has a low sensitivity to detect overt diabetes in early pregnancy.
Highlights
IntroductionThe incidence of gestational diabetes mellitus (GDM) is increasing
Worldwide, the incidence of gestational diabetes mellitus (GDM) is increasing
There is no doubt that screening for GDM between 24 and 28 weeks is important to reduce the risk for adverse pregnancy outcomes such as large-for-gestational age infants (LGA) and preeclampsia [2,3]
Summary
The incidence of gestational diabetes mellitus (GDM) is increasing. This has a significant effect on the health of the mother and offspring. GDM is defined as diabetes diagnosed in the second or third trimester of pregnancy provided that overt diabetes early in pregnancy has been excluded [1]. There is no doubt that screening for GDM between 24 and 28 weeks is important to reduce the risk for adverse pregnancy outcomes such as large-for-gestational age infants (LGA) and preeclampsia [2,3]. There is a large variation in recommendations concerning screening for GDM in early pregnancy. The ADA does not provide any specific recommendations concerning screening for GDM in early pregnancy [4].
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