NICE'S latest guidelines on diabetes in pregnancy; getting the balance right

摘要

How to diagnose GDM is the most contentious issue the new guidance has tackled. HAPO was an observational study of 25 505 women in nine countries and confirmed a linear relationship between maternal glucose levels and adverse pregnancy outcomes.4 The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations" based on this dataset have now been adopted by WHO8 and the ADA9 and some centres in the UK. In this model the diagnostic thresholds following 75g oral glucose tolerance test at 0, 1 hour and 2 hours (5.1, 10 and 8.5mmol/L respectively) are the glucose thresholds at which risk increases 1.75-fold for three outcomes (birth weight, cord G-peptide and percent body fat over 90th percentile) in the HAPO study. There is widespread recognition that the IADPSG thresholds would increase the number of women diagnosed with GDM, based on the lower fasting glucose threshold.