title: Screening for dysglycaemia during pregnancy: Proposals conciliating International Association of Diabetes and Pregnancy Study Group (IADPSG) and US National Institutes of Health (NIH) panels.
abstract: The International Association of Diabetes and Pregnancy Study Group (IADPSG) has proposed that blood glucose levels for the diagnosis of gestational diabetes mellitus (GDM) be the values associated with a 1.75-fold increase in the risk of neonatal complications in the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study. However, this recommendation was not adopted by the US National Institutes of Health (NIH) panel as it would have been responsible for a huge increase in the prevalence of GDM with no clear evidence of a reduction of events at such blood glucose values. Considering this aspect, we now propose the use of a blood glucose threshold combination associated with an odds-ratio of 2.0 for neonatal disorders [fasting plasma glucose (FPG)≥ 95 mg/dL, or a 1-h glucose value after a 75-g oral glucose tolerance test (OGTT)≥ 191 mg/dL or a 2-h glucose value ≥ 162 mg/dL] for GDM diagnosis. This would lead to a lower prevalence of GDM and concentrate medical resources on those with the highest risk of complications. This would also allow the use of a similar FPG value for both the diagnosis and therapeutic target of GDM. The IADPSG also proposed screening for dysglycaemia during early pregnancy, using FPG measurement with a similar threshold after 24 weeks of gestation. We propose the same strategy considering an FPG value ≥ 95 mg/dL as abnormal, but only after confirmatory measurements. We also believe that an OGTT should not be used before 24 weeks of gestation as normal values during that time are as yet unknown.
authors.affiliation: Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, AP-HP, Bondy, France; UMR U1143 Inserm/U1125 Inra/Cnam/Université Paris 13, Sorbonne Paris Cité, Bobigny, France. Electronic address: emmanuel.cosson@jvr.aphp.fr.
authors.forename: E
authors.initials: E
authors.lastname: Cosson
authors.affiliation: Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, AP-HP, Bondy, France.
authors.forename: P
authors.initials: P
authors.lastname: Valensi
authors.affiliation: Department of Gynaecology-Obstetrics, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, AP-HP, Bondy, France.
authors.forename: L
authors.initials: L
authors.lastname: Carbillon
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D016640:Diabetes, Gestational / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis*; D038622:Internationality; D009316:National Institutes of Health (U.S.); D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012016:Reference Values; D014481:United States
chemical_list: D001786:Blood Glucose
keywords: Gestational diabetes mellitus; Recommendations