Gestational Diabetes — On Broadening the Diagnosis

This editorial examines the ongoing debate over diagnostic approaches for gestational diabetes mellitus (GDM), contrasting the traditional two step screening method (50g non fasting followed by 100g fasting test) with the single step 75g fasting oral glucose tolerance test proposed by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG). Citing a large pragmatic trial by Hillier et al., the author notes that while the single step approach doubled GDM diagnoses (16.5% vs. 8.5%), it showed no significant improvement in perinatal outcomes (e.g., large for gestational age infants, cesarean delivery, or hypertensive disorders). The editorial concludes that broadening diagnostic criteria without clear clinical benefits may unnecessarily increase healthcare costs and patient burdens, advocating instead for focused interventions in high risk women.

This editorial examines the ongoing debate over diagnostic approaches for gestational diabetes mellitus (GDM), contrasting the traditional two step screening method (50g non fasting followed by 100g fasting test) with the single step 75g fasting oral glucose tolerance test proposed by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG). Citing a large pragmatic trial by Hillier et al., the author notes that while the single step approach doubled GDM diagnoses (16.5% vs. 8.5%), it showed no significant improvement in perinatal outcomes (e.g., large for gestational age infants, cesarean delivery, or hypertensive disorders). The editorial concludes that broadening diagnostic criteria without clear clinical benefits may unnecessarily increase healthcare costs and patient burdens, advocating instead for focused interventions in high risk women.