Gestational diabetes: update of screening strategy and diagnostic criteria

To review recently published studies examining new data on screening strategies and diagnostic criteria for gestational diabetes (GDM).

Professional organizations continue to have differing recommendations concerning the best screening strategy for GDM. An independent expert panel appointed by the National Institutes of Health has recently recommended to continue with the two-step approach for screening. Recent evidence shows that the glucose challenge test seems acceptable to screen for GDM but that an Hba1c measurement is not a good alternative. The International Association of Diabetes and Pregnancy Study Groups (IADPSG) screening strategy remains controversial with studies showing a high inconsistency in associations with adverse pregnancy outcome and cost-effectiveness analyses show conflicting results. To reduce the number of oral glucose tolerance tests needed, clinical prediction models may be implemented.

It is now generally accepted that, especially in high-risk women, overt diabetes should be excluded at first prenatal visit. However, internationally the debate on the best screening strategy for GDM continues. In most populations the implementation of the IADPSG screening strategy will lead to an important increase in the prevalence of GDM and associated costs and workload. Risk stratification in IADPSG-positive women may reduce over-treatment. Using clinical prediction models may be a more cost-effective alternative.