Volume 198 - Issue 11
Gestational diabetes needs to be managed
Author: Adrian V G Taylor
Med J Aust 2013; 198 (11): 595-596. || doi: 10.5694/mja13.10195
Published online: 17 June 2013
Published online: 17 June 2013
To the Editor: McIntyre and Oats promote the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria for gestational diabetes mellitus (GDM) as being well reasoned.1 Derived from observational data and mathematical modelling in an attempt to provide a worldwide definition and to improve outcomes, these criteria will significantly increase the number
of women diagnosed with GDM2 in health care systems that have ...
To the Editor: McIntyre and Oats promote the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria for gestational diabetes mellitus (GDM) as being well reasoned.1 Derived from observational data and mathematical modelling in an attempt to provide a worldwide definition and to improve outcomes, these criteria will significantly increase the number of women diagnosed with GDM2 in health care systems that have limited resources. To help achieve cost savings, clinicians should be leaders in preventing interventions in circumstances where effectiveness or harm is unknown.3
The Australian Carbohydrate Intolerance Study in Pregnant Women trial4 and a US study on treatment for mild GDM5 reported similar outcomes in reducing the frequency of large-for-gestational-age babies, pre-eclampsia and shoulder dystocia despite different entry criteria. The IADPSG proposes more stringent criteria than are used in either of these studies, but without knowledge of additional benefit or harm.
The National Institutes of Health recently released draft guidelines on the diagnosis of GDM that reject IADPSG criteria,6 making a worldwide definition less likely. Many reasons for this decision have been considered, including the need for evidence that any new criteria should provide benefits that outweigh harm. Our colleagues at the National Institutes of Health seem to have a very good point. Surely it would be sensible to compare IADPSG criteria with established practice in Australia in a randomised controlled setting before redefining the management of GDM.
Competing interests
No relevant disclosures.
References
- McIntyre HD, Oats JJN. Gestational diabetes needs to be managed. Med J Aust 2013; 198: 78-79. CHDCJFAG
- Moses RG, Morris GJ, Petocz P, et al. The impact of potential new diagnostic criteria on the prevalence of gestational diabetes mellitus in Australia. Med J Aust 2011; 194: 338-340.
- Scott I. Only clinician leadership will save healthcare systems from insolvency. Mediscussion 2013; 6: 10-11. CBBEHCGD
- Crowther CA, Hiller JE, Moss JR, et al; Australian Carbohydrate Intolerance Study in Pregnant Women Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352: 2477-2486. i1142872
- Landon MB, Spong CV, Thom E, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. A multicenter, randomised trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361: 1339-1348.
- National Institutes of Health Consensus Development Conference: Diagnosing Gestational Diabetes Mellitus Conference [draft statement]. March 4–6, 2013. http://prevention. nih.gov/cdp/conferences/2013/gdm/files/DraftStatement.pdf (accessed May 2013).