Screening for gestational diabetes mellitus: Does one size fit all?

Gestational diabetes mellitus (GDM) is estimated to complicate between 1% and 5%, but the figure may be as high as around 14%, of pregnancies and the prevalence varies in direct proportion with the rate of prevalence of type 2 diabetes (T2DM) in a given population or ethnic group and may also vary with the type of diagnostic tests used. Whilst the short term risks to the fetus and mother have been extensively described it is often not recognized that long-term complications to the offspring exposed to maternal diabetes in utero include an increased risk of glucose intolerance, diabetes, and obesity. GDM is a risk factor for the later development of T2DM in the mother. The pandemic of diabetes and its related complications continues unabated in spite of strides which have been made in the understanding of diabetes and the availability of new therapeutic interventions. If one is to put in place initiatives which are preventive in nature, then women with a history of GDM as well as offspring exposed to maternal diabetes in utero should be a major area of focus. Unfortunately, there is no universally accepted "gold standard" for diagnosis of GDM and the commonly utilised methods and threshold criteria for diagnosing GDM in themselves give disparate results. The question also arises whether ethnogenecity makes a difference in the prevalence of GDM and if so, would this translate into differing methodology and threshold values for the diagnosis of GDM in different ethnogenetic groups. This is not just an academic question as one must not only optimally manage the short term risks but as importantly, postpartum, put into place strategies for averting long-term consequences. Any such methodology must not only be effective, but as the vast majority of people with T2DM live in poor and transitional countries, one has to keep the health economic angle in mind as the presence of standardized methodology and threshold criteria would remain "academic" if the people were not in a position to afford them. (C) 2008 Diabetes India. Published by Elsevier Ltd. All rights reserved.