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Gestational diabetes mellitus.

A T Sweeney1, F M Brown

  • 1Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA.

Clinics in Laboratory Medicine
|April 27, 2001
PubMed
Summary
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The diagnosis and treatment of gestational diabetes mellitus (GDM) remain controversial. Current evidence does not strongly support one diagnostic criterion over another, highlighting the need for more research.

Area of Science:

  • Obstetrics and Gynecology
  • Endocrinology
  • Perinatal Medicine

Background:

  • Gestational diabetes mellitus (GDM) diagnosis and treatment are subjects of ongoing debate.
  • Existing diagnostic criteria, such as Carpenter and Coustan and NDDG, have limitations and varying impacts on patient identification and healthcare costs.
  • The precise relationship between maternal glucose intolerance and adverse pregnancy outcomes requires further elucidation.

Purpose of the Study:

  • To critically evaluate the evidence surrounding the diagnosis and treatment of GDM.
  • To compare the implications of different diagnostic criteria for GDM.
  • To identify knowledge gaps regarding the effects of varying glucose intolerance levels on maternal and fetal health.

Main Methods:

  • Review of existing literature and studies, including the Toronto Tri-Hospital Study.

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  • Analysis of univariate and multivariate data related to GDM diagnostic criteria and pregnancy outcomes.
  • Assessment of the potential impact of shifting diagnostic thresholds on patient populations and treatment costs.

    • Main Results:

    • Univariate analysis suggests a link between carbohydrate intolerance and increased rates of cesarean section, macrosomia, and preeclampsia, even in women not meeting NDDG criteria for GDM.
    • Multivariate analysis indicates that the contribution of these borderline cases to adverse outcomes is minor compared to nonmodifiable risk factors.
    • Adopting Carpenter and Coustan criteria would increase GDM identification and treatment costs, with uncertain benefits for cesarean section rates, though potential reduction in macrosomia exists.

    Conclusions:

    • There is insufficient evidence to definitively recommend Carpenter and Coustan criteria over NDDG criteria.
    • The continuous relationship between maternal hyperglycemia and perinatal risks necessitates further investigation.
    • Randomized intervention trials are crucial to establish clear thresholds for glucose intolerance that impact maternal and fetal morbidity and the risk of type 2 diabetes.