Ester Vitacolonna1,2,3, Elena Succurro4,5,6, Annunziata Lapolla4,5,7, Marina Scavini4,5,8, Matteo Bonomo4,5,9, Graziano Di Cianni4,5,10, Antonino Di Benedetto4,5,11, Angela Napoli4,5,12, Andrea Tumminia4,5,13, Camilla Festa4,5,12, Cristina Lencioni4,5,14, Elisabetta Torlone4,5,15, Giorgio Sesti6,16, Domenico Mannino4,5,17,18, Francesco Purrello13,19. 1. Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy. e.vitacolonna@unich.it. 2. Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy. e.vitacolonna@unich.it. 3. Department of Medicine and Aging, School of Medicine and Health Sciences, "G. d'Annunzio" University, Chieti-Pescara, Chieti, Italy. e.vitacolonna@unich.it. 4. Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy. 5. Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy. 6. Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy. 7. Department of Medicine, Diabetology and Dietetics Unit, Padova University, Padua, Italy. 8. Division of Immunology, Transplantation and Infectious Diseases, Diabetes Research Institute (DRI), IRCCS San Raffaele Scientific Institute, Milan, Italy. 9. SSD Diabetology, Ca'Granda Niguarda Hospital, Milan, Italy. 10. Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Leghorn, Italy. 11. Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy. 12. Department of Experimental Medicine, Faculty of Medicine and Dentistry, Sapienza University, Rome, Italy. 13. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy. 14. Diabetes Unit, Usl Nord Ovest Tuscany, Lucca, Italy. 15. Internal Medicine, Endocrinology and Metabolism, S. Maria della Misericordia Hospital, Perugia, Italy. 16. Italian Diabetes and Research Foundation, Italian Society of Diabetology (SID), Rome, Italy. 17. Section of Endocrinology and Diabetes, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy. 18. Italian Association of Diabetologists (AMD), Rome, Italy. 19. Italian Society of Diabetology (SID), Rome, Italy.
Abstract
AIMS: In 2010, Italian health professionals rapidly implemented the one-step screening for gestational diabetes mellitus (GDM) based on a 75 g OGTT, to comply with the diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). The change was promoted by the two main Italian scientific societies of diabetology, Associazione Medici Diabetologi (AMD) and Società Italiana di Diabetologia (SID), and it took just a few months for the Istituto Superiore di Sanità, together with several scientific societies, to revise the criteria and include them in the National Guidelines System. Over the last 9 years, the implementation of these guidelines has shown some benefits and some drawbacks. METHODS: In order to evaluate the critical issues arisen from the implementation of the current Italian guidelines for the diagnosis of GDM, the studies published on this topic have been reviewed. The search was performed using the following keywords: "gestational diabetes" AND "diagnostic criteria" OR screening AND Ital*. The study is an expert opinion paper, based on the relevant scientific literature published between 2010 and 2019. The databases screened for the literature review included PubMed, MEDLINE, and Scopus. RESULTS: The implementation of the Guidelines for Screening and Diagnosis of GDM in Italy present some strengths and some weaknesses. One of the positive aspects is that high-risk women are required to perform an OGTT early in pregnancy. By contrast, there are several aspects in need of improvement: (1) In spite of the current indications, only a minority of high-risk women perform OGTT early in pregnancy; (2) several low-risk women are screened for GDM; (3) in some low-risk women affected by GDM, the diagnosis might be missed with the application of the current guidelines; (4) there is a lack of homogeneity in the risk assessment data from different regions. CONCLUSIONS: In order to improve the current Italian GDM guidelines, some practical solutions have been suggested.
AIMS: In 2010, Italian health professionals rapidly implemented the one-step screening for gestational diabetes mellitus (GDM) based on a 75 g OGTT, to comply with the diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). The change was promoted by the two main Italian scientific societies of diabetology, Associazione Medici Diabetologi (AMD) and Società Italiana di Diabetologia (SID), and it took just a few months for the Istituto Superiore di Sanità, together with several scientific societies, to revise the criteria and include them in the National Guidelines System. Over the last 9 years, the implementation of these guidelines has shown some benefits and some drawbacks. METHODS: In order to evaluate the critical issues arisen from the implementation of the current Italian guidelines for the diagnosis of GDM, the studies published on this topic have been reviewed. The search was performed using the following keywords: "gestational diabetes" AND "diagnostic criteria" OR screening AND Ital*. The study is an expert opinion paper, based on the relevant scientific literature published between 2010 and 2019. The databases screened for the literature review included PubMed, MEDLINE, and Scopus. RESULTS: The implementation of the Guidelines for Screening and Diagnosis of GDM in Italy present some strengths and some weaknesses. One of the positive aspects is that high-risk women are required to perform an OGTT early in pregnancy. By contrast, there are several aspects in need of improvement: (1) In spite of the current indications, only a minority of high-risk women perform OGTT early in pregnancy; (2) several low-risk women are screened for GDM; (3) in some low-risk women affected by GDM, the diagnosis might be missed with the application of the current guidelines; (4) there is a lack of homogeneity in the risk assessment data from different regions. CONCLUSIONS: In order to improve the current Italian GDM guidelines, some practical solutions have been suggested.
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