Drawing the Line on Glycemia in Pregnancy

This editorial critiques the diagnostic thresholds for gestational diabetes mellitus (GDM) in light of the randomized trial by Crowther et al. (2022), which compared lower vs. higher glycemic criteria for GDM diagnosis using a 75g OGTT. Key findings:

• No difference in outcomes: Lower thresholds (diagnosing 15.3% of women) and higher thresholds (6.1%) yielded similar rates of large for gestational age infants (8.8% vs. 8.9%) and neonatal complications.

• Increased interventions: Lower thresholds led to more maternal interventions (e.g., labor induction, hypoglycemic therapy) without improving perinatal outcomes.

• Clinical implications: The study challenges the utility of stricter glycemic criteria, suggesting current thresholds may not optimally balance benefits and harms.

The author concludes that the "perfect line" for GDM diagnosis remains undefined, urging further research to refine screening protocols.

This editorial critiques the diagnostic thresholds for gestational diabetes mellitus (GDM) in light of the randomized trial by Crowther et al. (2022), which compared lower vs. higher glycemic criteria for GDM diagnosis using a 75g OGTT. Key findings:

• No difference in outcomes: Lower thresholds (diagnosing 15.3% of women) and higher thresholds (6.1%) yielded similar rates of large for gestational age infants (8.8% vs. 8.9%) and neonatal complications.

• Increased interventions: Lower thresholds led to more maternal interventions (e.g., labor induction, hypoglycemic therapy) without improving perinatal outcomes.

• Clinical implications: The study challenges the utility of stricter glycemic criteria, suggesting current thresholds may not optimally balance benefits and harms.

The author concludes that the "perfect line" for GDM diagnosis remains undefined, urging further research to refine screening protocols.