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Screening and Diagnosis of Gestational Diabetes Mellitus

RUSSELL, MICHELLE A. MD, MPH* †; CARPENTER, MARSHALL W. MD; COUSTAN, DONALD R. MD

Clinical Obstetrics & Gynecology: December 2007 - Volume 50 - Issue 4 - pp 949-958
doi: 10.1097/GRF.0b013e31815a5510
Diabetes Mellitus in Pregnancy

Screening, diagnosis, and treatment of gestational diabetes mellitus (GDM) are common practice, despite controversy regarding benefits. A review of the literature from 1950 to 2006 revealed 3 randomized controlled trials evaluated the treatment of GDM but 2 of these studies lacked power to detect a difference in outcomes. The single trial with sufficient power showed a 67% lower rate of serious perinatal complication (a composite of shoulder dystocia, nerve injury, fracture, and death) and a 53% lower rate of macrosomia with treatment of GDM. There are no well-designed studies evaluating screening or diagnostic strategies. Treatment of GDM may improve some neonatal and obstetric outcomes, but there is limited evidence useful for determining the best screening method or diagnostic test, strategy, and criteria. Ongoing studies may provide some evidence to guide future research and clinical practice.

*Dartmouth Medical School and Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire

VA Outcomes Group, White River Junction, Vermont

Brown Medical School, Women and Infants' Hospital, Providence, Rhode Island

Correspondence: Dr Michelle A. Russell, MD, MPH, VA Outcomes Group, (111B) Department of Veteran's Affairs Medical Center, White River Junction, VT, 05009. E-mail: Michelle.A.Russell@dartmouth.edu

The views expressed herein do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.

Disclosure: There are no conflicts of interest or financial support to report.

© 2007 by Lippincott Williams & Wilkins.