Earlier screening and early implementation of preventive measures may give the maternal-fetal unit more time to respond and might enable the avoidance of onset of fetal growth alterations. Decreased sedentary behavior implemented at 16 weeks of gestation has been found effective for reducing neonatal adiposity. More studies—in particular, randomized clinical trials that evaluate the long-term health outcomes of early screening, intervention, and treatment—are warranted to inform future recommendations.
In terms of early detection, the updated Evidence Report 6 correctly pointed out that there is inadequate evidence that commonly used screening tests can accurately detect glucose intolerance in early pregnancy earlier than 24 weeks of gestation. Data from observational studies and clinical trials in this area are clearly warranted. Most recently, with the advance of omics technology, metabolomics biomarkers in plasma and urine have shown great potential in predicting gestational diabetes.
For instance, in a study of US women of multiple races and ethnicities, levels of nonfasting plasma saturated fatty acids in early pregnancy weeks of gestation significantly improved prediction of gestational diabetes, beyond the usual clinical factors of gestational diabetes, including plasma glucose levels.
Although these findings certainly require replication and confirmation in other studies, they provide the first proof of the concept that an algorithm incorporating novel biomarkers and metabolomics profile in early pregnancy can accurately identify gestational diabetes.
These data provide encouragement to think beyond conventional biomarkers for early gestational diabetes screening and embrace new technologies. If confirmed, these approaches would be highly desirable, as are nonfasting biomarkers compared with the complex and burdensome oral glucose tolerance test. Similar new initiatives are ongoing. For example, in the GO MOMS study NCT , in addition to the oral glucose tolerance test, continuous glucose monitoring in early pregnancy and various other times in pregnancy will be evaluated as it relates to gestational diabetes diagnosis at 24 to 28 weeks and to large-for-gestational-age neonates.
In summary, diabesity ie, diabetes and obesity remains a major public health challenge. Gestational diabetes is at the center of the diabesity-begetting-diabesity transgenerational circle. The goal of breaking this vicious circle is not hopeless. Effective early screening to identify women at high risk for gestational diabetes and timely intervention may represent an important approach. Emerging data support the link between glycemia status in early pregnancy and fetal growth.
Yet direct evidence on the selection of tests for detecting gestational diabetes and the benefits of screening and treatment at earlier than 24 weeks of gestation remains limited. More studies in this regard are clearly warranted. Such studies may also integrate novel omics technology for building accurate prediction models for early detection of gestational diabetes. Conflict of Interest Disclosures: None reported. Disclaimer: The findings and conclusions in this comment are those of the authors and do not necessarily represent the official position of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Zhang C, Catalano P. Screening for Gestational Diabetes. Coronavirus Resource Center. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Save Preferences. In group 2, 68 patients 6. These incidences are not statistically different. Full text links Read article at publisher's site DOI : Smart citations by scite.
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Explore citation contexts and check if this article has been supported or disputed. Effectiveness of screening for gestational diabetes during the late gestational period among pregnant Turkish women. Screening for gestational diabetes mellitus: cost-utility of different screening strategies based on a woman's individual risk of disease. Establishing diagnosis of gestational diabetes mellitus: Impact of the hyperglycemia and adverse pregnancy outcome study.
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Funding Funders who supported this work. Joining Europe PMC. Tools Tools overview. ORCID article claiming. Journal list. Grant finder. External links service. Annotations submission service. Data on potential long-term benefits to the health of the mother and her offspring are still scarce. Apart from the debate on other issues, the first step should be the implementation of universal screening to identify more severe cases of GDM. This step will already be a major one in most countries.
The different viewpoints from experts and guidelines underscore the fact that there are data to support each strategy IADPSG vs Carpenter and Coustan criteria; one-step vs two-step screening. The decision on which strategy to implement must therefore be made on the basis of the relative role of cost considerations, and availability of infrastructure locally, nationally, and internationally.
In addition, patient preferences should be taken into account as part of any screening strategy. National Center for Biotechnology Information , U. Int J Womens Health. Published online May Author information Copyright and License information Disclaimer. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
This article has been cited by other articles in PMC. Abstract Gestational diabetes mellitus GDM is associated with an increased risk of complications for both mother and baby during pregnancy as well as in the postpartum period.
Introduction Gestational diabetes mellitus GDM has classically been defined as any glucose intolerance first identified during pregnancy. Increased rate of intervention and adverse effects The diagnosis of GDM, irrespective of the degree of glucose control achieved, per se leads to increased interventions, earlier delivery, an increased cesarean section rate even if birth weight is normalized by treatment , and a higher number of neonatal admissions to special care nurseries.
Consensus The relationship between hyperglycemia and adverse pregnancy outcomes is well defined through a large volume of congruent observational epidemiologic data, which were also considered for IADPSG recommendations. Universal testing for hyperglycemia in pregnancy in first trimester Pregnant women with overt diabetes and suboptimal blood glucose control in early pregnancy are at increased risk of having a fetus with congenital anomalies and are also at increased personal risk of worsening of diabetic retinopathy and nephropathy.
Arguments opposing two-step method Detractors opine that reproducibility was more of a problem with older methods of estimation of glucose, rather than with the current assays.
Table 1 Advantages and disadvantages of two-step and one-step testing for GDM. Open in a separate window. Role of HbA 1c in screening for gestational diabetes mellitus Although the HbA 1c reference intervals for the general population are well established, reference intervals for healthy pregnant women are not clearly defined. Universal screening for overt diabetes in pregnancy IADPSG recommends opportunistic screening of pregnant women for preexisting diabetes at the first antenatal visit either universally in all women or in high-risk ones.
HbA 1c in screening for gestational diabetes mellitus HbA 1c is not recommended for screening of GDM by any of the guidelines. Table 3 Recommendations on various aspects of screening. Pragmatic approach Screening for GDM is an essential part of obstetric care. Figure 1. Pragmatic approach to screen women for overt diabetes and GDM.
Table 4 Pragmatic indications for one- and two-step approaches based on biopsychosocial model. Missed or delayed diagnosis in such cases could increase the adverse effects. Two-step preferable : Medical or obstetrical contraindications for frequent travel. Future directions It is felt that most guidelines fail to address the need and constraints of low-resource settings, where the demand for clear and simple directions is the greatest. Summary Apart from the debate on other issues, the first step should be the implementation of universal screening to identify more severe cases of GDM.
Footnotes Disclosure The authors report no conflicts of interest in this work. References 1. American Diabetic Association Diagnosis and classification of diabetes mellitus. Diabetes Care. American Diabetic Association Classification and diagnosis of diabetes mellitus. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Gestational diabetes mellitus: risks and management during and after pregnancy.
Nat Rev Endocrinol. Diagnosis of GDM: a suggested consensus. Evolution of diagnostic criteria for gestational diabetes mellitus. Acta Obstet Gynecol Scand. Coustan DR. Diagnosis of gestational diabetes. Criteria for the oral glucose tolerance test in pregnancy. National Diabetes Data Group Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance.
Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. World Health Organization. Geneva, Switzerland: World Health Organization; Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. World Health Organization Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy.
Diabetes Res Clin Pract. Curr Diab Rep. Long H, Cundy T. Establishing consensus in the diagnosis of gestational diabetes following HAPO: where do we stand? Ryan EA. Diagnosing gestational diabetes. National Institutes of Health Consensus Development Conference Panel National Institutes of Health consensus development conference statement: diagnosing gestational diabetes mellitus, March 4—6, Obstet Gynecol.
Long H. Diagnosing gestational diabetes: can expert opinions replace scientific evidence? Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. A multicenter, randomized trial of treatment for mild gestational diabetes.
Effects of treatment in women with gestational diabetes mellitus: systemic review and meta-analysis. McIntyre HD. Diagnosing gestational diabetes mellitus: rationed or rationally related to risk?
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