The gestational diabetes mellitus conferences. Three are history: focus on the fourth

This study reviews the summary and recommendations of the first three International Workshops Conferences on Gestational Diabetes Mellitus (GDM) and highlights areas of controversy requiring further research and discussion. The International Workshop Conferences on GDM held in 1979, 1984, and 1990 established a definition of GDM, confirmed the value of universal screening with a 50-g oral glucose load, recommended use of the 100-g oral glucose tolerance test with interpretation according to the diagnostic criteria of O'Sullivan and Mahan, and emphasized the importance of classification after pregnancy with a 75-g oral glucose tolerance test with classification according to the criteria of the National Diabetes Data Group or the World Health Organization. Recommendations for management have included nutritional counseling with limitation of the intake of concentrated sweets, monitoring maternal glucose levels to maintain the fasting plasma glucose < 105 mg/dl and the 2-h postprandial plasma glucose < 120 mg/dl, initiating insulin therapy if treatment with diet fails, and prohibiting the use of oral hypoglycemic agents. Antepartum fetal surveillance with emphasis on the evaluation of fetal growth using clinical and ultrasonographic techniques to detect macrosomia were also proposed. Although much has been accomplished in the first three conferences, areas of continued controversy include establishing a definition and method of detection for GDM that can be agreed on worldwide; defining the appropriate glucose levels to initiate dietary and/or insulin therapy; preventing macrosomia, as well as detecting and managing it, to reduce the cesarean delivery rate; and determining the long-term consequences for the mother with GDM and her infant through further studies.