Despite the growing prevalence of gestational diabetes, which is estimated to affect 7—18% of pregnancies in the USA, the routine practice of universal screening in pregnancy has been debated.

According to newly released US Preventive Services Task Force (USPSTF) draft guidelines, all asymptomatic pregnant women should be screened for the disorder after 24 weeks’ gestation. This recommendation is a departure from 2008 guidelines, which had concluded that there was insufficient evidence to either support or dismiss benefits of universal screening. The new guidelines acknowledge a “moderate” benefit for mother and baby, reflecting findings from two scientific literature reviews for screening and treatment that were published by the Annals of Internal Medicine on May 28. “Evidence that has been published since the last USPSTF statement in 2008 confirms that gestational diabetes is associated with more large-birthweight neonates, pregnancy-induced hypertension, and shoulder dystocia, and that treatment of gestational diabetes reduces the rate of these events”, says Lois Donovan (University of Calgary, AB, Canada) who coauthored both reviews.

Some specialists suggest that the guidelines don’t go far enough. “The authors seem to reluctantly admit a treatment benefit for mild gestational diabetes and seem to minimise findings, which include a reduction in macrosomia and shoulder dystocia, as if these are merely intermediate outcomes”, says Mark Landon (Ohio State University, Columbus, OH, USA). “However, the complications that may be associated with the delivery of large infants are hardly insignificant.” Landon says the USPSTF’s authors should also have acknowledged that “the effects seen with treatment of mild gestational diabetes may be even more pronounced in more significant cases, and that the benefits would potentially be greater as well”.

Lois Jovanovič (Sansum Diabetes Research Institute, Santa Barbara, CA, USA), who is an advocate of universal screening for hyperglycaemia in all pregnant women, explains that “although risk factors increase the likelihood of developing gestational diabetes, some women have no classic risk factors, yet manifest hyperglycaemia during pregnancy”. Also, gestational diabetes usually does not produce symptoms, so using symptoms is not a reliable method. Jovanovič adds, “detection is vital for reducing fetopathy and has the best fetal outcome the earlier the hyperglycaemia is normalised”.

Source: Lancet