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Screening for hyperglycaemia in pregnancy: Consensus and controversy.
Norman Waugh1, Donald Pearson, Pamela Royle
1Department of Public Health Medical School Buildings, Foresterhill, Aberdeen, UK. n.r.waugh@abdn.ac.uk
Best Practice & Research. Clinical Endocrinology & Metabolism
|September 14, 2010
Summary
Screening for hyperglycaemia in pregnancy (HGP) is increasingly supported by new evidence, despite not meeting all WHO criteria. Recent studies highlight rising prevalence and broader adverse effects, justifying further evaluation of HGP screening strategies.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Public Health
Background:
- Screening programs require adherence to World Health Organization criteria.
- Screening for hyperglycaemia in pregnancy (HGP) currently does not meet all established criteria.
- Increasing maternal age and BMI contribute to a rising prevalence of HGP.
Purpose of the Study:
- To evaluate the evolving case for implementing screening programs for hyperglycaemia in pregnancy.
- To assess recent developments that strengthen the rationale for HGP screening.
- To address remaining uncertainties regarding HGP management and screening strategies.
Main Methods:
- Review of recent epidemiological data on HGP prevalence.
- Analysis of findings from the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study.
- Evaluation of evidence from large clinical trials on HGP treatment.
Main Results:
- Adverse effects of HGP are observed across a wider range of plasma glucose levels than previously recognized.
- Treatment of lesser degrees of HGP has demonstrated significant benefits in large trials.
- Metformin and glibenclamide show promise as safe and effective alternatives to insulin for HGP management.
Conclusions:
- Recent evidence strengthens the argument for HGP screening, despite not meeting all WHO criteria.
- Further research is needed to define optimal treatment thresholds and screening strategies for HGP.
- The findings support a re-evaluation of HGP screening program implementation.
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