New IADPSG guidelines for screening and diagnosing diabetes in pregnancy
October - 18 - 2010
The International Association of Diabetes and Pregnancy Study Groups (IADPSG) has recently used data from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, two randomized controlled trials in patients with mild maternal hyperglycemia, and smaller nonrandomized studies to prepare new guidelines for the screening and diagnosis of diabetes in pregnancy. These guidelines recommend the screening of both high-risk women with pre-gestational diabetes at the first visit and of all women at 24-28 weeks of gestation. In addition, they recommend the 75-g oral glucose tolerance test to diagnose gestational diabetes and consider that abnormal fasting, 1-hour and 2-hour plasma glucose concentrations are suggestive of the disease. The guidelines also include diagnostic thresholds that are based on an arbitrarily defined odds ratio of 1.75 compared to the mean for adverse outcomes. They do not include recommendations for further evaluating patients with test results at borderline values; hence, they categorize patients as having either gestational diabetes or normal glucose tolerance. The authors expect that, if used, the guidelines will help improve the diagnosis of pre-gestational and gestational diabetes and double the number of pregnant women diagnosed with diabetes (Leary, J. et al. Best Pract Res Clin Endocrinol Metab 2010, 24(4): 673).