Screening and Diagnosis of Gestational Diabetes Mellitus: from Controversy to Consensus

Hyperglycemia in pregnancy is associated with adverse fetal and maternal outcomes. Even lower values of glucose intolerance have been shown to be detrimental and adverse effects are proportionate to the plasma glucose levels. However, defining glucose intolerance in pregnancy has been an issue of considerable debate, and has led to different recommendations by various authorities worldwide over the last three decades. Multitude of procedures have been described and glucose cut offs proposed for the diagnosis of glucose intolerance in pregnancy have led to considerable confusion. There are a number of controversies regarding significance of screening for gestational diabetes mellitus (GDM), universal/selective screening, when to screen and how to screen-using single or double step, how much should be the glucose load, how many samples to be taken, fasting or non fasting test to be used. No single test is superior to the other and the most appropriate test may be used as per the need and feasibility. These issues will be discussed in the article.