Gestational diabetes mellitus (GDM) is on the rise globally and is expected to rise further due to obesity, inactivity, unhealthy eating and older age of pregnant mothers. Many women are entering their pregnancy unaware of their glucose tolerance.

Consequences to the mother in the short and long term and the fetus and newborn are many. Treatment of GDM has resulted in better outcomes in terms of baby weight, operative deliveries, birth trauma and lowered perinatal morbidity. Also screening for GDM identifies women who are at risk for future diabetes. The ideal method for screening and diagnosis is still debated though there is a trend towards a consensus. The HAPO study and the subsequent recommendations from IADPSG have given for the first time an outcome based recommendations. Feasibility of adopting these recommendations in resource limited settings is a concern for some countries. Management of GDM has also been debated with the conflicts between insulin vs oral hypoglycemic agents, emerging evidence on the safety concerns with Glyburide and lack of long term effects of the oral agents on the baby. The followup after pregnancy has been particularly disappointing.

What are the screening and diagnostic methods that you use and the challenges or limitations with those ?

Information about the moderators

Dr Usha Sriram is director of ACEERhealth, an organization involved in providing clinical services to people with diabetes and endocrine disorder based in Chennai, India. She is also the director of Women2women.

Dr Belma Malanda is a MD and the project manager of IDF Policy and Programmes Department. He coordinates the Women and Diabetes Programme with an initial focus on a project aimed at improving care for women with gestational diabetes (WINGS) in India.

References

1. ADA standards of care 2016.
2. International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. DIABETES CARE, VOLUME 33, NUMBER 3, MARCH 2010
3. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on Gestational Diabetes Mellitus: A Pragmatic Guide for Diagnosis, Management, and Care. 
4. FIGO Info-graphics
5. Introduction of IADPSG Criteria for the Screening and Diagnosis of Gestational Diabetes Mellitus Results in Improved Pregnancy Outcomes at a Lower Cost in a Large Cohort of Pregnant Women. St. Carlos Gestational Diabetes Study Diabetes Care Volume 37, September 2014
6. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Catalano PM, McIntyre HD, Cruickshank JK, McCance DR, HAPO Study Cooperative Research Group, Diabetes Care. 2012;35(4):780
7. Treatment with insulin and its analogs in pregnancies complicated by diabetes. Jovanovic L, Pettitt DJ Diabetes Care. 2007;30 Suppl 2:S220.
8. Comparison of glyburide and insulin in women with gestational diabetes mellitus. Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzales O N Engl J Med. 2000;343(16):1134.
9. Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition at 2 years of age. Rowan JA, Rush EC, Obolonkin V, Battin M, Wouldes T, Hague WM Diabetes Care. 2011 Oct;34(10):2279-84.
10. Maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in 310 pregnant women with type 1 diabetes. Mathiesen ER, Hod M, Ivanisevic M, Duran Garcia S, Brøndsted L, Jovanovic L, Damm P, McCance DR, Detemir in Pregnancy Study Group; Diabetes Care. 2012;35(10):2012
11. Increased risk of cardiovascular disease in young women following gestational diabetes mellitus. Shah BR, Retnakaran R, Booth GL Diabetes Care. 2008;31(8):1668