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Perspectives on the Proposed Gestational Diabetes Mellitus Diagnostic Criteria

Langer, Oded MD, PhD; Umans, Jason G. MD, PhD; Miodovnik, Menachem MD

doi: http://10.1097/AOG.0b013e31827711e5
Current Commentary

To date, The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria for the diagnosis of gestational diabetes mellitus (GDM) have not been analyzed systematically for medical, social, and economic ramifications if used in substitution for the current GDM diagnostic criteria. The IADPSG dependence on expert opinion and consensus rather than on rigorously obtained outcome measures is concerning given the dramatic changes in clinical intervention and medical-resource reallocation that would follow their wide adoption. This commentary attempts to highlight needed research as well as the key knowledge gaps that should prevent adoption of the revised criteria until their effect on perinatal outcomes and health care costs is determined. In light of the overall, ethnic, and regional variation in GDM prevalence and the demands of increased GDM diagnosis on clinical resources, it may not be realistic and practical to impose universal strategies and standards for diagnosis. The newly proposed criteria may affect medical care negatively, unnecessarily stigmatize patients with a “sick label,” and adversely affect health care costs without ensuring the desired improvements in maternal and neonatal outcomes. This commentary serves as a caution to not promote a new endeavor until it has been compared rigorously with current practice and its implications are understood fully.

Further research is needed to assess relevant clinical and social outcomes before The International Association of the Diabetes and Pregnancy Study Groups’ criteria are considered for adoption.

Cookeville Regional Medical Center, Cookeville, Tennessee; MedStar Health Research Institute, Hyattsville, Maryland; and Georgetown-Howard Universities Center for Clinical and Translational Science, and Department of Obstetrics and Gynecology, MedStar Washington Hospital Center Hospital and Georgetown University, Washington, DC.

Corresponding author: Oded Langer, MD PhD, Cookeville Regional Medical Center, Administrative Suite: 1 Medical Center Blvd, Cookeville, TN 38501; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.