Alpesh Goyal1, Yashdeep Gupta2, Rajiv Singla3, Sanjay Kalra4, Nikhil Tandon1. 1. Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India. 2. Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India. yash_deep_gupta@yahoo.co.in. 3. Department of Endocrinology and Metabolism, Kalpavriksh Superspecialty Center, New Delhi, India. 4. Department of Endocrinology and Metabolism, Bharti Hospital, Karnal, India.
Abstract
INTRODUCTION: Gestational diabetes mellitus (GDM) is a major public health problem, affecting about one in every six pregnancies globally. The guidelines provided by the American Diabetes Association (ADA) on diagnosis and management of hyperglycemia in pregnancy are widely followed. We aim to provide a critical appraisal of the recently published ADA guidance document, highlighting its strength and limitations with regard to the diagnosis of GDM. METHODS AND RESULTS: We reviewed the recent ADA recommendations for the diagnosis and management of hyperglycemia in pregnancy. A periodic update in keeping with the emerging evidence, an inclusive diagnostic approach which increases generalizability, and a clear proposed approach for prenatal testing and postpartum follow-up are strengths of the ADA guidance document. On the other hand, its limitations are a lack of clarity on the applicability of diagnosis of GDM during early pregnancy, use of scientifically inaccurate terms such as "prediabetes" in the context of pregnancy and "overt diabetes prior to gestation" in the definition of GDM, and inconsistent use of terminology between successive publications. Certain issues which merit attention in future publications include a need for uniform global definition of GDM, demarcation of overt diabetes in pregnancy as a distinct entity, clarity on the diagnosis of GDM during early pregnancy, and clear delineation of timelines and appropriate testing strategy for the first prenatal visit. CONCLUSIONS: This article provides a critical appraisal of the recently published ADA guidance document with regard to the diagnosis of GDM. We also share our perspective on issues warranting attention in the future publications. Experts from various professional organizations should aim for a consensus document which can resolve existing controversies in this field, and help clinicians and researchers achieve better health for women in their care.
INTRODUCTION:Gestational diabetes mellitus (GDM) is a major public health problem, affecting about one in every six pregnancies globally. The guidelines provided by the American Diabetes Association (ADA) on diagnosis and management of hyperglycemia in pregnancy are widely followed. We aim to provide a critical appraisal of the recently published ADA guidance document, highlighting its strength and limitations with regard to the diagnosis of GDM. METHODS AND RESULTS: We reviewed the recent ADA recommendations for the diagnosis and management of hyperglycemia in pregnancy. A periodic update in keeping with the emerging evidence, an inclusive diagnostic approach which increases generalizability, and a clear proposed approach for prenatal testing and postpartum follow-up are strengths of the ADA guidance document. On the other hand, its limitations are a lack of clarity on the applicability of diagnosis of GDM during early pregnancy, use of scientifically inaccurate terms such as "prediabetes" in the context of pregnancy and "overt diabetes prior to gestation" in the definition of GDM, and inconsistent use of terminology between successive publications. Certain issues which merit attention in future publications include a need for uniform global definition of GDM, demarcation of overt diabetes in pregnancy as a distinct entity, clarity on the diagnosis of GDM during early pregnancy, and clear delineation of timelines and appropriate testing strategy for the first prenatal visit. CONCLUSIONS: This article provides a critical appraisal of the recently published ADA guidance document with regard to the diagnosis of GDM. We also share our perspective on issues warranting attention in the future publications. Experts from various professional organizations should aim for a consensus document which can resolve existing controversies in this field, and help clinicians and researchers achieve better health for women in their care.
Entities:
Keywords:
American Diabetes Association; Applicability; Diabetes in pregnancy; Diagnosis; Gestational diabetes mellitus; Hyperglycemia in pregnancy; Limitations; Standards of medical care 2020
Authors: Reyna Sámano; Gabriela Chico-Barba; María Eugenia Flores-Quijano; Estela Godínez-Martínez; Hugo Martínez-Rojano; Luis Ortiz-Hernandez; Oralia Nájera-Medina; María Hernández-Trejo; Cristopher Hurtado-Solache Journal: Int J Environ Res Public Health Date: 2021-12-28 Impact factor: 3.390
Authors: Dyuti Coomar; Jonathan M Hazlehurst; Frances Austin; Charlie Foster; Graham A Hitman; Nicola Heslehurst; Stamatina Iliodromiti; Ana Pilar Betran; Ngawai Moss; Lucilla Poston; Krishnarajah Nirantharakumar; Tracy Roberts; Sharon A Simpson; Helena J Teede; Richard Riley; John Allotey; Shakila Thangaratinam Journal: BMJ Open Date: 2021-06-11 Impact factor: 3.006