Diabetes Care, Vol 19, Issue 1 12-16, Copyright © 1996 by American Diabetes Association

ARTICLES

Variability in diagnostic evaluation and criteria for gestational diabetes

CG Solomon, WC Willett, J Rich-Edwards, DJ Hunter, MJ Stampfer, GA Colditz and JE Manson
Division of General Medicine, Brigham and Women's Hospital, Boston, MA 02115 USA. cgsolomon@bics.bwh.harvard.edu

OBJECTIVE: To determine the frequency of screening for gestational diabetes mellitus (GDM) among a population receiving regular prenatal care and to assess the extent to which National Diabetes Data Group (NDDG) criteria for the diagnosis of GDM are used by practicing obstetricians. RESEARCH DESIGN AND METHODS: We studied participants in the Nurses' Health Study II, a large prospective cohort study of 116,678 nurses aged 25-42 years in 1989. A total of 422 women who reported a first diagnosis of GDM between 1989 and 1991 were sent supplementary questionnaires regarding diagnosis and treatment, and medical records were requested for a subset of 120 to validate self-reported GDM and assess criteria used for diagnosis. A sample of 100 women who reported a pregnancy not complicated by GDM were sent questionnaires addressing GDM screening and prenatal care. RESULTS: Among a sample of 93 women who reported a pregnancy not complicated by GDM and responded to the supplementary questionnaire, 16 (17%) reported no glucose loading test; 69% of unscreened women had one or more risk factors for GDM. Among a sample of 114 women who self-reported GDM in a singleton pregnancy and whose medical records were available for review, a physician diagnosis of GDM was confirmed in 107 (94%). Records and supplementary questionnaires indicated that oral glucose tolerance tests (OGTTs) were performed in 96 (86%) of these women. Of women with a physician diagnosis of GDM whose OGTT results were available, 25% failed to meet NDDG criteria for this diagnosis, although all had evidence of abnormal glucose homeostasis. CONCLUSIONS: Screening for GDM is not universal, even among a group of health professionals in whom screening prevalence is likely to be higher than in the general population. Diagnostic criteria for GDM among obstetricians in practice remain nonstandard despite NDDG recommendations. Better understanding of the implications of differing degrees of glucose intolerance and of varying GDM screening and management strategies is required to make policy recommendations for appropriate and cost-effective care.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				T. M. Saldana, O. Basso, J. A. Hoppin, D. D. Baird, C. Knott, A. Blair, M. C.R. Alavanja, and D. P. Sandler Pesticide Exposure and Self-Reported Gestational Diabetes Mellitus in the Agricultural Health Study Diabetes Care, March 1, 2007; 30(3): 529 - 534. [Abstract] [Full Text] [PDF]

				C. Zhang, S. Liu, C. G. Solomon, and F. B. Hu Dietary Fiber Intake, Dietary Glycemic Load, and the Risk for Gestational Diabetes Mellitus Diabetes Care, October 1, 2006; 29(10): 2223 - 2230. [Abstract] [Full Text] [PDF]

				E. J. Mayer-Davis, S. L. Rifas-Shiman, L. Zhou, F. B. Hu, G. A. Colditz, and M. W. Gillman Breast-Feeding and Risk for Childhood Obesity: Does maternal diabetes or obesity status matter? Diabetes Care, October 1, 2006; 29(10): 2231 - 2237. [Abstract] [Full Text] [PDF]

				C. Zhang, C. G. Solomon, J. E. Manson, and F. B. Hu A prospective study of pregravid physical activity and sedentary behaviors in relation to the risk for gestational diabetes mellitus. Arch Intern Med, March 13, 2006; 166(5): 543 - 548. [Abstract] [Full Text] [PDF]

				A. M. Stuebe, J. W. Rich-Edwards, W. C. Willett, J. E. Manson, and K. B. Michels Duration of Lactation and Incidence of Type 2 Diabetes JAMA, November 23, 2005; 294(20): 2601 - 2610. [Abstract] [Full Text] [PDF]

				C. Ouzilleau, M.-A. Roy, L. Leblanc, A. Carpentier, and P. Maheux An observational study comparing 2-hour 75-g oral glucose tolerance with fasting plasma glucose in pregnant women: both poorly predictive of birth weight Can. Med. Assoc. J., February 18, 2003; 168(4): 403 - 409. [Abstract] [Full Text] [PDF]

				K. E. Innes, T. E. Byers, J. A. Marshall, A. Baron, M. Orleans, and R. F. Hamman Association of a Woman's Own Birth Weight With Subsequent Risk for Gestational Diabetes JAMA, May 15, 2002; 287(19): 2534 - 2541. [Abstract] [Full Text] [PDF]

				L. L. Moore, M. L. Bradlee, M. R. Singer, K. J. Rothman, and A. Milunsky Chromosomal Anomalies among the Offspring of Women with Gestational Diabetes Am. J. Epidemiol., April 15, 2002; 155(8): 719 - 724. [Abstract] [Full Text] [PDF]