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Diabetes Care 30:S251-S260, 2007
DOI: 10.2337/dc07-s225
© 2007 by the American Diabetes Association
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Original Article

Summary and Recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus

Boyd E. Metzger, MD1, Thomas A. Buchanan, MD2, Donald R. Coustan, MD3, Alberto de Leiva, MD, PHD4, David B. Dunger, MBBS, MD, FRCP5, David R. Hadden, MD, FRCP6, Moshe Hod, MD7, John L. Kitzmiller, MD8, Siri L. Kjos, MD9, Jeremy N. Oats, DM10, David J. Pettitt, MD11, David A. Sacks, MD12 and Christos Zoupas, MD13

1 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
2 Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
3 Brown Medical School, Women and Infant's Hospital of Rhode Island, Providence, Rhode Island
4 Department of Endocrinology, Hospital de la Santa Creui Sant Pau, Universitat Autònoma, Barcelona, Spain
5 Department of Pediatrics, University of Cambridge, Addenbrooke's Hospital, Cambridge, U.K.
6 Regional Endocrinology and Diabetes Centre, Royal Victoria Hospital, Belfast, U.K.
7 Perinatal Division, Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
8 Division of Maternal-Fetal Medicine, Santa Clara County Health System, San Jose, California
9 Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, California
10 Division of Maternity Services, The Royal Women's Hospital, Carlton, Victoria, Australia
11 Sansum Diabetes Research Institute, Santa Barbara, California
12 Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, Bellflower, California
13 Diabetes Center, Hygeia General Hospital, Athens, Greece

Address correspondence and reprint requests to Boyd E. Metzger, MD, Northwestern University Feinberg School of Medicine, Tarry Building 15-735, 303 East Chicago Ave., Chicago, IL 60611. E-mail: bem@northwestern.edu

Abbreviations: CVD, cardiovascular disease • GDM, gestational diabetes mellitus • IGT, impaired glucose tolerance • MNT, medical nutrition therapy • SMBG, self-monitoring of blood glucose

The first 300 words of the full text of this article appear below.


   INTRODUCTION
 
The Fifth International Workshop-Conference on Gestational Diabetes Mellitus (GDM) was held in Chicago, IL, 11–13 November 2005 under the sponsorship of the American Diabetes Association. The meeting provided a forum for review of new information concerning GDM in the areas of pathophysiology, epidemiology, perinatal outcome, long-range implications for mother and her offspring, and management strategies. New information and recommendations related to each of these major topics are summarized in the report that follows.

The issues regarding strategies and criteria for the detection and diagnosis of GDM were not reviewed or discussed in detail, since it is anticipated that the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study will provide data in mid-2007 that will foster the development of criteria for the diagnosis of GDM that are based on perinatal outcomes. Thus, for the interim, the participants of the Fifth International Workshop-Conference on GDM endorsed a motion to continue use of the definition, classification criteria, and strategies for detection and diagnosis of GDM that were recommended at the Fourth Workshop-Conference. Those guidelines are reproduced (with minor modifications) in this article in APPENDIX Tables 1 and 2.


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  		Table 1— Screening strategy for detecting GDM

 

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  		Table 2— Diagnosis of GDM by an oral glucose tolerance test

 

   SUMMARY AND RECOMMENDATIONS—
 
The invited lectures, topical discussions, and posters presented at the conference and the invited manuscripts that appear in this issue of Diabetes Care served as the basis for the following summary and recommendations.


   PANEL I: PATHOPHYSIOLOGY AND EPIDEMIOLOGY
 
Pathophysiology
General considerations.
Current diagnostic criteria assign the diagnosis of GDM to women with glucose levels in the upper ~5–10% of the population distribution. The hyperglycemia varies in severity from glucose concentrations that would be diagnostic of diabetes outside of pregnancy to concentrations that are asymptomatic and only slightly above normal, but associated with some increased risk of fetal morbidity.

Like all forms of hyperglycemia, GDM is characterized by insulin levels . . . [Full Text of this Article]

GDM and insulin resistance.
GDM and pancreatic ß-cell function.
Genetics of GDM.
The placenta in GDM
Recommendations for future research.
Epidemiology
Current observations.
Recommendations for the future

   PANEL II: THERAPEUTIC INTERVENTIONS DURING PREGNANCY
 
Perinatal implications
Metabolic management during pregnancy
Goals and surveillance
Maternal glycemia.
Ultrasound measurement of fetal abdominal circumference.
Other methods of surveillance.
MNT and planned physical activity
Intensified metabolic therapy
Human insulin.
Oral antihyperglycemic agents.
Obstetric management
Fetal surveillance.
Maternal surveillance.
Timing and route of delivery
Recommendations for the future

   PANEL III: OFFSPRING
 
Clinical implications
Recommendations for the future

   PANEL IV: MATERNAL FOLLOW-UP
 
Clinical implications
Status of glucose metabolism
Post-delivery.
Postpartum.
Long term.
CVD risk factor assessment
Breastfeeding
Contraception or pregnancy planning
Diabetes prevention
Recommendations for the future

   APPENDIX
 
Panel members
Panel I.
Panel II.
Panel III.
Panel IV.

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