Screening for gestational diabetes mellitus

A simple test may make it easier to study whether screening is worthwhile

Papers p 812

Gestational diabetes mellitus is a concept that arouses considerable controversy. It is defined as “carbohydrate intolerance of varying degrees of severity with onset or first recognition during pregnancy.”1 Rather than predicting the development of diabetes later in life, as proposed originally,2 the main purpose of identifying gestational diabetes is to detect women at risk of adverse perinatal outcomes, such as macrosomia, neonatal metabolic abnormalities, birth trauma, and caesarean section.1 3 4 Evidence of the effectiveness of universal screening for gestational diabetes on these outcomes is still lacking.5 However, recent randomised studies indicate that women who are intensively managed can achieve near normal rates of macrosomia and neonatal hypoglycaemia.5^–7

Those who do not favour screening for gestational diabetes claim, among other things, that the current screening and diagnostic strategies are cumbersome. In this issue of the BMJ Perucchini et al propose a protocol which could counter this argument: they suggest using a fasting glucose value as a screen for gestational diabetes (p812).8 This protocol …