Oral Presentation Australian Diabetes in Pregnancy Society 2018

Introduction – Current Australian criteria / NZ criteria. Time for review? (#16)

David McIntyre

Since their initial publication in 2010, the IADPSG recommendations for detection and classification of hyperglycemia in pregnancy have drawn divergent responses from women, clinicians and policy makers around the world.  Despite endorsement from WHO (2013) and FIGO (2015), international consensus remains elusive and concerns about “overdiagnosis” persist.  ADIPS was involved in the international consensus process leading to these recommendations from the earliest stages and strongly participated in the national consensus process, led by RANZCOG, which led to predominant adoption of the “one step” IADPSG process across Australia.  This approach has been endorsed in current (2018) NHMRC guidelines for antenatal care.

Nonetheless, concerns regarding the high prevalence of GDM, especially in areas with a large proportion of women in the childbearing years from high risk ethnic groups, have so far prevented uniform adoption of IADPSG / WHO2013 diagnostic criteria for GDM across Australia.  Concerns include the potentially unmanageable workload posed by increasing numbers of GDM patients, doubts about “value” or risk / benefit and cost / benefit aspects of treatment and concerns from women that a GDM diagnosis may preclude them from continuing in their preferred model of care.

Further, some important stakeholder organizations including the RACGP have declined to endorse the current guidelines.  Proposals have been floated for a new consensus development process involving a broader spectrum of consumer and professional interest groups.   This symposium aims to present a range of views on the current status of GDM diagnosis, drawing on local and international experience from the endocrine, obstetric, midwifery and diabetes education perspectives.