The juxtaposition of the new IADPSG diagnostic criteria, increasing maternal obesity, advancing age at conception and background ethnic predisposition to diabetes has led to a significant increase in women being diagnosed with gestational diabetes.
The HAPO Study published in 2008 has provided us with the largest database on fetal outcomes in pregnancies complicated by hyperglycaemia of varying degrees of severity. On the basis of this the IADPSG recommended the formulation of new consensus guidelines for the diagnosis of GDM.
These recommendations were endorsed by WHO and ADIPS as well as ADS but not by SOMANZ or ESA. In November 2013 RANZCOG convened a multidisciplinary working party to discuss the proposed pathway and criteria for diagnosis of GDM. Although invited, representation from ESA and RACGP was declined. This meeting recommended:
The increased workload has led some Obstetricians to question the validity of the GTT cut-offs determined by a RR of 1.75 based on the HAPO data. The concerns expressed include: