Gestational Diabetes Testing: Making Sense of the Controversy

Evidence has demonstrated that even mild increases in maternal blood sugar are associated with worsening pregnancy outcomes, particularly macrosomia, and that reducing blood sugar improves outcomes. Euglycemia can often be achieved with dietary modification and exercise without a need for medication. Despite this evidence, there continues to be controversy over exactly who, when, and how to test for gestational diabetes mellitus (GDM), with various professional organizations and experts in the field suggesting different strategies or not making specific recommendations at all. Potential sources of this controversy may include differences in opinion about the clinical importance of the consequences of GDM and the benefits of available interventions. Further, dichotomously diagnosing disease when the disease-defining characteristic is linear requires drawing a somewhat arbitrary line in the sand for diagnosis, which is likely to fall in a different place for different providers. Finally, given the resources and effort needed by both women and providers to address GDM, the availability of resources is likely to impact providers' perspectives on the ideal testing strategy. Given the differences among patient characteristics and available resources that exist in different health care settings, identifying one best strategy for GDM testing is not necessarily appropriate. However, given the potential benefits of identifying pregnant women with hyperglycemia, providers should use the most sensitive testing strategy that their patient population and resources allow.