Reassessment of the new diagnostic thresholds for gestational diabetes mellitus: an opportunity for improvement

To the Editor: With reference to d'Emden's recent article,1 we believe the value of an internationally agreed set of guidelines has not been considered.

The World Health Organization endorsed the new diagnostic criteria for the diagnosis of gestational diabetes mellitus (GDM) as suggested by the International Association of Diabetes in Pregnancy Study Groups (IADPSG), and adopted by the Australasian Diabetes in Pregnancy Society (ADIPS),2 the Royal Australian and New Zealand Society of Obstetrics and Gynaecology, the Australian College of Midwives, the Australian Diabetes Society, the Australian Diabetes Educators Association, Austria, Canada, China, Germany, Greece, Israel, Italy, Japan, Poland and some organisations in the United States.

The benefit of an internationally agreed set of guidelines for the diagnosis of GDM cannot be understated. It would allow for a consistent approach to the definition, and provide a consistent baseline on which to answer many of the unanswered questions about GDM. As with all consensus agreements, it is likely to change over time to reflect evolving research.

The potential increase in the number of women diagnosed with GDM has been considered by the IADPSG.3 Given the current diabetes epidemic, the prevalence of GDM should reflect the prevalence of glucose intolerance in the mature adult population.

The new guidelines have been carefully considered by the international community and are consistent with a large observational study and Level 1 evidence from two well conducted clinical trials,3 with controversies raised by d'Emden debated for several years.3 ADIPS supports the common understanding that will be enhanced by international consensus.