Point: Universal Screening for Gestational Diabetes Mellitus
- Robert G. Moses, MD1 and
- N. Wah Cheung, PHD2
- 1Clinical Trial and Research Unit, South Eastern Sydney and Illawarra Area Health Service, Wollongong, New South Wales, Australia;
- 2Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Sydney, Australia.
- Corresponding author: Robert G. Moses, robert.moses{at}sesiahs.health.nsw.gov.au.
Gestational diabetes mellitus (GDM) is one of the most common medical disorders found in pregnancy. Rates can range from 2 to >10%, and sometimes much higher, depending on the population being tested and the diagnostic criteria being used (1). The prevalence of GDM ultimately reflects the background rate of type 2 diabetes. There has also been an increase in the rate of GDM over the last generation, possibly related to community lifestyle factors as well as better case ascertainment (2,3).
Significance of GDM
GDM is associated with a trilogy of risks. Significant pregnancy complications including increased perinatal morbidity and possibly mortality can occur (4,5). A diagnosis of GDM also identifies a mother at high risk for the future development of type 2 diabetes (1). The effects of maternal hyperglycemia (of any kind) are associated with the development of metabolic problems including type 2 diabetes in the offspring (6). It is, perhaps, for this effect of intrauterine programming that the disorder is most worthy of detection.
It has now been demonstrated that the treatment of GDM improves pregnancy outcomes. In the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS), the incidence of serious perinatal complications (a composite of death, shoulder dystocia, nerve palsy, and fracture) was 4% among women randomized to routine care compared with 1% among the intervention group (5). The number of GDM cases that needed to be treated to prevent one serious perinatal complication was 34. This indicates that excess serious perinatal complications will occur in 3% of cases of untreated or unrecognized GDM. This is a most compelling immediate argument for the screening of GDM given that the failure to identify a woman with GDM denies her the opportunity to have treatment for potentially preventable serious fetal complications.
Why conduct selective screening for GDM?
Therefore, if we accept that GDM is …
