POSITION STATEMENT
ABCD position statement on screening for gestational diabetes mellitus
Pract Diab Int May 2007 Vol. 24 No. 4 Copyright © 2007 John Wiley & Sons 195
sion to T2DM.17 Ideally, all mothersfollowing a GDM pregnancy shouldhave a six weeks’ fasting plasma glu-cose to ensure they do not haveT2DM; thereafter they should bescreened annually for T2DM in primary care. At the time of thisannual screening, lifestyle advice forthe prevention of T2DM should bereinforced.
ConclusionGestational diabetes mellitus is acause of morbidity for the motherand her child and is associated withan increased perinatal mortality rate.The optimum screening policy foran antenatal clinic should varyaccording to the background preva-lence of GDM and T2DM. The pre-cise level of glycaemia that predictsadverse outcome is not known. Onpresent evidence, a two-hour glucoselevel in a 75g OGTT >7.8mmol/Lbenefits from active treatment. Webelieve diabetes should be activelysought and treated in pregnancy andthat the original 2003 NICE ante-natal recommendations not to rou-tinely screen are now out dated. Weoffer a pragmatic approach for thedetection of glucose intolerance inpregnancy as we await the NICE 2007review of the original 2003 NICEantenatal recommendations.
Conflict of interest statementThere are no conflicts of interest.
References 1. World Health Organization, Depart-
ment of Noncommunicable DiseaseSurveillance. Definition, diagnosis andclassification of diabetes mellitus and itscomplications. Report of a WHO consul-tation. Part 1: diagnosis and classifica-tion of diabetes mellitus. Geneva: WorldHealth Organization, 1999.
2. O’Sullivan JB. Body weight and sub-sequent diabetes mellitus. JAMA1982; 248(8): 949–952.
3. Dornhorst A, Paterson CM, NichollsJS, et al. High prevalence of gesta-tional diabetes in women from ethnicminority groups. Diabetic Med 1992;9(9): 820–825.
4. Pederson J, Bojsen-Moller B, PoulsenH. Blood sugar in newborn infants ofdiabetic mothers. Acta Endocrinologica1954; 15: 33–52.
5. Maresh M, Beard RW, Bray CS, et al.Factors predisposing to and outcomeof gestational diabetes. Obstet Gynecol1989; 74(3 Pt 1): 342–346.
6. NICE recommendations. Antenatalcare for the healthy pregnant woman.http://www.rcog.org.uk/resources/Public/Antenatal_Care.pdf
7. Marquette GP, Klein VR, Niebyl JR.Efficacy of screening for gestationaldiabetes. Am J Perinatology 1985; 2:7–9.
8. Carpenter MW, Coustan DR. Criteriafor screening tests for gestational dia-betes. Am J Obstet Gynecol 1982;144(7): 768–773.
9. Report on gestational diabetes melli-tus. Diabetes Care 2004; 27(Suppl 1):S88–S90.
10.Crowther CA, Hilier J, Moss J, et al.Effect of treatment of gestational dia-
betes mellitus on pregnancy out-comes. N Engl J Med 2005; 352:2477–2486.
11.HAPO Study Cooperative ResearchGroup. The Hyperglycaemia andAdverse Pregnancy Outcome(HAPO) Study. Int J Gynaecol Obstet2002; 78: 69–77.
12.Major CA, Henry MJ, De Veciana M,et al. The effects of carbohydraterestriction in patients with diet con-trolled gestational diabetes. ObstetGynecol 1998; 91: 600–604.
13.De Veciana M, Major CA, MorganMA, et al. Postprandial versuspreprandial blood glucose monitor-ing in women with gestational dia-betes mellitus requiring insulin ther-apy. N Engl J Med 1995; 333:1237–1241.
14.Masson EA, Patmore JE, Brash PD, etal. Pregnancy outcome in type I dia-betes mellitus treated with insulintherapy (Humalog). Diabetic Med2003; 20: 46–50.
15.Langer O, Conway DL, Berkus MD, etal. A comparison of glyburide andinsulin in women with gestationaldiabetes mellitus. N Engl J Med 2000;343: 1134–1138.
16.Hughes RC, Rowan JA. Pregnancy inwomen with type II diabetes: whotakes Metformin and what is the out-come? Diabetic Med 2006; 23:318–322.
17.Knowler WC, Barrett-Connor E,Fowler SE, et al; Diabetes PreventionProgram Research Group. Reductionin the incidence of type 2 diabeteswith lifestyle intervention or met-formin. N Engl J Med 2002; 346:393–403.
RCN Paediatricand AdolescentDiabetes GroupThe Paediatric and Adolescent DiabetesSpecial Interest Group would like todraw readers’ attention to the recentlaunch (on 5 April) of the Departmentof Health report ‘Making Every YoungPerson with Diabetes Matter’. Membersof the PADSIG were part of the workinggroup that was set up in 2005. Thereport sets out the findings from the
working group that were established toexamine the current challenges andseek solutions to them. The report isaimed at everyone who has a part toplay in improving services for childrenand young people with diabetes up tothe age of 25. This includes commis-sioners and health professionals.
The report provides guidance andmakes recommendations in a numberof areas, including commissioning,organisation of care, provision of serv-ices and workforce.
This report is a must for all membersof the diabetes service who are involved
in providing diabetes care for children,young people and their families.
To obtain copies of the reportplease e-mail: [email protected].
Report by Marie Marshall, PaediatricDiabetes Nurse Specialist, and PublicityOfficer, RCN Paediatric and AdolescentDiabetes Special Interest Group
The Royal College of Nursing:The Voice of Nursing20 Cavendish Square, London W1M 0AB. Tel: 020 7409 3333 Fax: 020 7647 3435
ROYAL
COLLEGE OF
NURSING
RCN News
PS Robinson 10.07.qxp 23/4/07 17:25 Page 5
Recommended
