Pregnancy outcome among women universally screened for gestational diabetes mellitus with a lime-flavoured drink

Screening for gestational diabetes mellitus: a Caribbean perspective

Gestational diabetes mellitus (GDM) is defined as a glucose intolerance first recognised in pregnancy. The World Health Organization (WHO) in 2015 revised the definition into either diabetes in pregnancy (DIP) which includes pre-existing diabetes (type 1 or type 2) that antedates pregnancy or diabetes diagnosed during pregnancy with the WHO diagnostic criteria for diabetes mellitus (DM) in the non-pregnant state, and GDM for milder forms of hyperglycaemia in pregnancy. The main purpose of the screening and diagnosis of GDM is to identify pregnancies in which the foetus is at a high risk of an adverse perinatal outcome, and the mother and the offspring are of serious long-term sequelae. This review of the literature provides an overview of associated prevalence, risk factors and diagnosis of GDM. It also addresses the benefits of screening with supportive evidence. Based on this review, we recommend especially in low-resourced countries such as the Caribbean, adoption of a universal screening with the two-step method.

Gestational diabetes: update of screening strategy and diagnostic criteria

PURPOSE OF REVIEW

To review recently published studies examining new data on screening strategies and diagnostic criteria for gestational diabetes (GDM).

RECENT FINDINGS

Professional organizations continue to have differing recommendations concerning the best screening strategy for GDM. An independent expert panel appointed by the National Institutes of Health has recently recommended to continue with the two-step approach for screening. Recent evidence shows that the glucose challenge test seems acceptable to screen for GDM but that an Hba1c measurement is not a good alternative. The International Association of Diabetes and Pregnancy Study Groups (IADPSG) screening strategy remains controversial with studies showing a high inconsistency in associations with adverse pregnancy outcome and cost-effectiveness analyses show conflicting results. To reduce the number of oral glucose tolerance tests needed, clinical prediction models may be implemented.

SUMMARY

It is now generally accepted that, especially in high-risk women, overt diabetes should be excluded at first prenatal visit. However, internationally the debate on the best screening strategy for GDM continues. In most populations the implementation of the IADPSG screening strategy will lead to an important increase in the prevalence of GDM and associated costs and workload. Risk stratification in IADPSG-positive women may reduce over-treatment. Using clinical prediction models may be a more cost-effective alternative.