Gestational diabetes: a review

Gestational diabetes mellitus is a relatively common complication of pregnancy. The incidence varies from 1.6% to 13%, depending on the criteria used for evaluating glucose tolerance in studies where universal screening was employed. The glucose-challenge screening test produces many false-positive results; the patients thus identified are then subjected to further unpleasant oral glucose-tolerance tests to make the diagnosis. The diagnosis labels many pregnant patients as "high risk" and exposes them to a cascade of interventions. The author examines the basis in the literature for universal screening practices. The recommendations of the Second International Workshop-Conference on Gestational Diabetes Mellitus are presented. The author discusses risks and benefits of alternative screening approaches, diagnosis, control, and reviews the current literature.