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Gestational diabetes. Can epidemiology help?

H Keen1

  • 1United Medical School, Guy's Hospital, University of London, United Kingdom.

Diabetes
|December 1, 1991
PubMed
Summary
This summary is machine-generated.

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This review examines diagnostic criteria for diabetes mellitus (DM) and impaired glucose tolerance in pregnancy. It questions the benefit of treating milder glucose intolerance due to limited evidence of harm.

Area of Science:

  • Endocrinology
  • Obstetrics
  • Epidemiology

Background:

  • Diagnostic criteria for diabetes mellitus (DM) and impaired glucose tolerance (IGT) in adults are reviewed.
  • Existing differences between World Health Organization (WHO) and National Diabetes Data Group (NDDG) criteria for diagnosing gestational diabetes are highlighted.

Purpose of the Study:

  • To review epidemiological context of DM and IGT diagnostic criteria in pregnancy.
  • To assess the evidence linking lesser degrees of glucose intolerance with adverse pregnancy outcomes.
  • To evaluate the detriment-to-benefit ratio of detecting and treating IGT in pregnancy.

Main Methods:

  • Review of epidemiological data and diagnostic criteria for DM and IGT.
  • Analysis of confounding variables (maternal age, adiposity, parity) in relation to glucose intolerance and pregnancy outcomes.

Related Experiment Videos

  • Proposal for a population-based, multiethnic, multicultural inquiry and potential controlled clinical trial.

    • Main Results:

    • The diagnostic value of DM (WHO/NDDG criteria) in pregnancy is not disputed.
    • There is a paucity of evidence linking lesser degrees of glucose intolerance with significant disturbances in pregnancy outcome after accounting for confounders.
    • Serious questions arise regarding the detriment-to-benefit ratio for detecting and treating milder glucose intolerance in pregnancy.

    Conclusions:

    • Further research is needed to clarify the impact of milder glucose intolerance on pregnancy outcomes.
    • A proposed multiethnic inquiry and clinical trial aim to refine diagnostic methodologies and criteria for gestational diabetes.
    • The findings suggest a need to re-evaluate the clinical utility and potential harms of interventions for IGT in pregnancy.