Towards a global consensus on GDM diagnosis: Light at the end of the tunnel?

Kapur, Anil; McIntyre, H. David; Divakar, Hema; Renzo, Gian Carlo Di; Kihara, Anne Beatrice; McAuliffe, Fionnuala M.; Hanson, Mark A.; Ronald, C.; Hod, Moshe

doi:10.1002/ijgo.13149

Cited by 20 publications

(22 citation statements)

References 40 publications

(63 reference statements)

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“…Early identification and treatment of pregnancy complications can help lessen their impact on immediate and longer‐term maternal and child health 27 . All pregnant women should be screened for gestational diabetes according to local and organizational practice guidelines 26,105 . For more information on the identification, diagnosis, and management of diabetes in pregnancy and GDM, see the FIGO initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care 26 .…”

Section: Figo Guidance For Pregnancy Obesitymentioning

confidence: 99%

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

McAuliffe

Killeen

Jacob

et al. 2020

Intl J Gynecology & Obste

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114

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Obstetricians and gynecologists are well positioned to influence population health through maternity and women's health services. Obesity is common in women of reproductive age and the prevalence is rising in both low-/middle-income and high-income countries 1. Obesity affects requirements for assessment, monitoring, and intervention and can impact maternal and child outcomes. Obstetricians and gynecologists require guidance on the care of women of reproductive age with obesity at all time points related to pregnancy, including how to address modifiable risk factors such as diet and physical activity. Many guidelines have been developed to date, although they vary in scope, methodology, and individual recommendations. FIGO's Committee Guideline for the Management of Prepregnancy, Pregnancy, and Postpartum Obesity (Table 1) reviews good clinical practice recommendations (Table 2-4) from previously published international documents. It serves as a practical resource to support obstetricians and gynecologists in the management of This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Section: Figo Guidance For Pregnancy Obesitymentioning

confidence: 99%

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

McAuliffe

Killeen

Jacob

et al. 2020

Intl J Gynecology & Obste

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114

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“…The FIGO pragmatic guidelines for hyperglycemia in pregnancy/GDM 6 provide a workable framework for accommodating differing diagnostic and therapeutic approaches to GDM across a variety of countries and healthcare systems. A FIGO group including many of the authors of the current article have also recently published a proposed strategy for moving toward a global consensus regarding GDM diagnosis, accommodating many of the fine print differences currently seen between the USA and other countries 45 . We believe that this pluralistic and inclusive approach, adapted to local circumstances, continues to provide the best opportunity to effectively manage GDM in the current global context, whilst hoping for a more consensus‐driven process in the future 45,46 .…”

Section: Summary and Future Directionsmentioning

confidence: 99%

Update on diagnosis of hyperglycemia in pregnancy and gestational diabetes mellitus from FIGO’s Pregnancy & Non‐Communicable Diseases Committee

McIntyre

Oats

Kihara

et al. 2021

Intl J Gynecology & Obste

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The optimal process for detecting and treating gestational diabetes mellitus (GDM) remains controversial, with wide variances in practice within and between countries. A recent pragmatic randomized controlled trial (RCT) undertaken by Hillier et al. 1 in the USA has raised renewed worldwide interest in and discussion of GDM diagnosis.The study reported no benefit at a population level in frequency of large-for-gestational-age (LGA) infants, hypertensive disorders of pregnancy, primary cesarean delivery, or a predefined composite perinatal outcome using a "one-step" diagnostic process and diagnostic criteria (primary diagnostic 75 g oral glucose tolerance test [OGTT]) as suggested in 2010 by the International Association of Diabetes in Pregnancy Study Groups (IADPSG) 2 as compared to current dominant USA-based criteria, 3 which employ a "two-step" process (initial nonfasting glucose challenge test [GCT] followed by a full OGTT if threshold glucose values are exceeded on the GCT).It should be noted that the USA criteria use very similar OGTT diagnostic thresholds to the IADPSG criteria, but require two elevated values for a GDM diagnosis. This time-honored practice lies contrary to the large body of evidence, confirmed in a recent USA-based systematic review, demonstrating that women with one abnormal value on their diagnostic OGTT carry substantially higher risks of LGA babies, cesarean delivery, pregnancy-induced hypertension, Apgar score <7, neonatal intensive care unit admission, and respiratory distress syndrome. 4 Since the IADPSG criteria classified 16.5% of women as GDM compared to an 8.5% frequency using the dominant USA criteria in the Hillier et al. study, 1 an accompanying editorial by Casey 5 concluded that the IADPSG approach offered "no apparent maternal or perinatal benefit overall." While we applaud the efforts of Hillier et al. 1 in conducting such an important study, we consider that the interpretation of the trial's results merits detailed scrutiny. | CONSIDERATIONS REGARDING THE HILLIER ET AL. 1 TRIAL PROTOCOL AND RESULTSThe study by Hillier et al. 1 was designed and conducted as a "pragmatic RCT." The major advantages of this approach were that the study was integrated into standard care across the two Kaiser Permanente health systems involved and recruited a very substantial number of women (23 792 randomized). The investigators obtained

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“…Over the next two decades, the American Diabetes Association (ADA) and the American Association of Obstetricians and Gynecologists (ACOG) followed this trend by updating their guidelines for GDM and HIP; similarly, the World Health Organization (WHO) classifications of 1980, 1985, 1999 and 2013 have changed over time; and the National Institute for Health and Care Excellence (NICE) in United Kingdom, The Canadian Diabetes Association (CDA), and the Australian Diabetes in Pregnancy Society (ADIPS) were some of the major organizations (among others) of which the criteria were updated using local and global research. Therefore, due to tremendous global efforts, coupled with extensive research and international consensus conferences over the last six decades, the treatment of GDM shows much more agreement in terms of screening, diagnosis, management, and post-partum follow-up [26,27]. Thus, for instance, the segregation of GDM from DIP under the umbrella of HIP has clarified the definition and its relation to HIP is now more defined [28].…”

Section: India: a Microcosm Of Global Gdm Trendsmentioning

confidence: 99%

Negotiating Gestational Diabetes Mellitus in India: A National Approach

Thanawala¹,

Divakar

Jain

et al. 2021

Medicina

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The worldwide epidemic of diabetes mellitus and hyperglycemia in pregnancy (HIP) presents many challenges, some of which are country-specific. To address these specific problems, parochial resolutions are essential. In India, the government, by working in tandem with (a) national groups such as the Diabetes in Pregnancy Study Group of India, and (b) global organizations such as the International Diabetes Federation, has empowered the medical and paramedical staff throughout the country to manage HIP. Additionally, despite their academic university backgrounds, Indian health planners have provided practical guidelines for caregivers at the ground level, who look up to these experts for guidance. This multipronged process has helped to negotiate some of the multiple problems that are indigenous and exclusive to India. This review traces the Indian journey to manage and prevent HIP with simple, constructive, and pragmatic solutions.

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Towards a global consensus on GDM diagnosis: Light at the end of the tunnel?

Abstract: The diagnostic criteria for GDM continue to be debated. The arguments presented here may help to dissipate confusion and help build global consensus.

Cited by 20 publications

References 40 publications

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

Update on diagnosis of hyperglycemia in pregnancy and gestational diabetes mellitus from FIGO’s Pregnancy & Non‐Communicable Diseases Committee

Negotiating Gestational Diabetes Mellitus in India: A National Approach

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