title: Historical facts of screening and diagnosing diabetes in pregnancy.
abstract: Diabetes is the most common metabolic disorder affecting pregnancy. Its prevalence seems to be growing in parallel with the epidemics of overweight and obesity. Recognizing and treating diabetes or any degree of glucose intolerance in pregnancy results in lowering maternal and fetal complications. These patients present higher risk for excessive weight gain, preeclampsia, cesarean sections, a high risk of developing type 2 diabetes and cardiovascular disease in the future. Infants born to these mothers are at higher risk for macrosomia and birth trauma, and after delivery, these infants have a higher risk of developing hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress syndrome, polycythemia and subsequent obesity and type 2 diabetes. Despite several international workshops and a lot of research there is still no unique approach to diagnose and treat diabetes in pregnancy. Who, when and how to screen and diagnose diabetes in pregnancy has been debated in the literature for so many decades and this debate seems to be endless. We present the evolution that screening and diagnosing diabetes in pregnancy has had over time. Besides many evidence of the benefits these procedures bring, health care providers still often prefer to use alternate criteria for this purpose. The myriad of maternal and fetal complications that could be avoided with an appropriate and simple screening procedure are ignored. Robust clinical trials such as the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study have shown how harmful can even slightly altered blood glucose levels be, but it has been found a resistance in the adoption of the new criteria proposed after this and other trials by many diabetes organizations. These organizations state that these new criteria would increase the incidence of diabetes in pregnancy, would imply in longer term follow-up of these patients and would pose an economic problem; they also state that alerting too many people in order to benefit a relatively few potential diabetics would arise psychologic ill-effects. We think that health care providers should look for an uniformity in the screening and diagnosing diabetes in pregnancy based on evidence based medicine and not on specialists consensus.
authors: Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, 17012-433, Brazil. carlosnegrato@uol.com.br.
authors: Carlos Antonio
authors: CA
authors: Negrato
authors: Marilia Brito
authors: MB
authors: Gomes
references: Proc R Soc Med. 1924;17(Obstet Gynaecol Sect):102-4
references: 19983832
references: Diabetes Care. 2011 Jan;34 Suppl 1:S62-9
references: 21193628
references: Proc R Soc Med. 1928 Jan;21(3):377-85
references: 19986239
references: Diabetes Care. 2002 May;25(5):943-4
references: 11978704
references: Diabetol Metab Syndr. 2010 Apr 24;2:27
references: 20416099
references: Ann Intern Med. 1951 Mar;34(3):678-91
references: 14811291
references: Diabetes Care. 1998 Aug;21 Suppl 2:B161-7
references: 9704245
references: Diabetes. 1964 May-Jun;13:278-85
references: 14166677
references: Diabetes. 1979 Dec;28(12):1039-57
references: 510803
references: Diabet Med. 1998 Jul;15(7):539-53
references: 9686693
references: Diabetes. 1958 Nov-Dec;7(6):455-61
references: 13597739
references: Diabetes. 1957 Jul-Aug;6(4):324-9
references: 13447761
references: JAMA. 2001 Nov 28;286(20):2516-8
references: 11722247
references: Diabetes. 1954 Jan-Feb;3(1):1-12
references: 13141877
references: N Engl J Med. 2008 May 8;358(19):1991-2002
references: 18463375
references: Am J Med. 1949 Nov;7(5):609-16
references: 15396063
references: Am J Obstet Gynecol. 1982 Dec 1;144(7):768-73
references: 7148898
references: Diabetes Care. 1980 May-Jun;3(3):399-501
references: 6104569
references: Diabetes. 1985 Jun;34 Suppl 2:1-130
references: 3996762
references: Diabetes Care. 2007 Jul;30 Suppl 2:S251-60
references: 17596481
references: Obstet Gynecol. 1957 Jun;9(6):664-9
references: 13431126
references: Am J Med. 1961 Dec;31:839-50
references: 13880869
references: Diabetes Care. 2010 Mar;33(3):676-82
references: 20190296
references: Diabetes. 1991 Dec;40 Suppl 2:197-201
references: 1748259
references: Diabetes. 1960 Sep-Oct;9:373-8
references: 13718517
references: S Afr Med J. 1953 Sep 12;27(37):795-7
references: 13101907
references: Lancet. 1956 May 5;270(6923):607-10
references: 13320819