Experts will examine available scientific evidence and draft a consensus statement on how to diagnose GDM
GDM is a condition that occurs when a pregnant woman who did not have previously diagnosed diabetes has high blood glucose levels. It is among the most common disorders of pregnancy, affecting between 2% and 10% of pregnancies in the United States, according to the Centers for Disease Control and Prevention (CDC).
GDM increases risk of pregnancy complications for both the mother and baby, including preeclampsia (high blood pressure, excess protein in the urine), cesarean delivery, macrosomia (large birth weight), shoulder dystocia (when a baby's shoulders get stuck during delivery), and birth injuries. In addition, the newborn may have hypoglycemia (low blood sugar) and jaundice.
GDM also poses long-term health risks to both mother and baby. Women who had GDM are at risk for developing type 2 diabetes. Current statistics from the CDC suggest that up to one-half of women who had GDM will develop type 2 diabetes. Infants whose mothers had GDM may also be at higher risk for health conditions later in life, including overweight/obesity and type 2 diabetes.
Understanding GDM is an active area of research for the NICHD. Select a link below to learn more about the conference and the Institute’s efforts related GDM.
To better understand the best method to diagnose gestational diabetes, the NICHD and the NIH Office of Disease Prevention are co-sponsoring a 3-day consensus development conference titled Diagnosing Gestational Diabetes Mellitus from March 4–6, 2013.
At this conference, independent experts will use the collected evidence to address the following key questions:
- What are the current screening and diagnostic approaches for GDM, what are the glycemic thresholds for each approach, and how were these thresholds chosen?
- What are the effects of various GDM screening and diagnostic approaches on patients, providers, and U.S. healthcare systems?
- In the absence of treatment, how do health outcomes of mothers who meet various criteria for GDM and their offspring compare with those who do not?
- Does treatment modify the health outcomes of mothers who meet various criteria for GDM and their offspring?
- What are the harms of treating GDM, and do they vary by diagnostic approach?
- Given all of the above, what diagnostic approach(es) for GDM should be recommended, if any?
- What are the key research gaps in the diagnostic approach of GDM?
Consensus conferences are distinctive because the resulting consensus statement comes from an independent and unbiased expert panel. The 12 to 16 panel members have no conflicts of interest, or financial or career (research) interests related to the topic. They are experts in their own fields, reflect a variety of perspectives, and are knowledgeable on the subject.
A draft statement will be disseminated to attendees on the last day of the conference for open discussion. Following this public comment period, the panel issues its consensus statement, which is an independent report of the panel and not a policy statement of NIH. The final consensus statement from the conference will be widely distributed to health care providers, policy makers, patients, researchers, members of the public, and the media.
Examples of NICHD activities in this area include (but are not limited to) the following:
- The Institute’s Pediatric Growth and Nutrition Branch (PGNB), supports multiple projects related to GDM. One of the largest was the international Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, which was also supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This large observational study examined the health effects of hyperglycemia in women and their offspring at 15 sites in nine countries. The focus of the study was on pregnant women whose blood sugar levels were higher than normal when fasting or at 2 hours after a glucose challenge test, but who did not reach levels to be diagnosed with GDM. The HAPO study found that, as maternal glucose levels increase, so do risks of certain complications, such as cesarean delivery, macrosomia, and neonatal hypoglycemia. The NICHD has joined with NIDDK to support the HAPO Follow-up Study of 7,000 mother-child pairs. Results and scientific articles related to HAPO are available through PubMed.
- The NICHD Pregnancy & Perinatology Branch (PPB) supports efforts to understand GDM, its symptoms, and its outcomes through the Maternal-Fetal Medicine Units (MFMU) Network. The MFMU Network studies various types of high-risk pregnancies and pregnancy outcomes, including GDM, preterm labor and birth, and preeclampsia. The Network’s landmark trial on gestational diabetes demonstrated that treatment of mild gestational diabetes reduced macrosomia by 50%, as well as neonatal fat mass, shoulder dystocia, cesarean delivery, and preeclampsia and gestational hypertension. Only 12 to 40 women with mild gestational diabetes need to be treated to prevent one case of macrosomia. For more on these findings, visit http://www.ncbi.nlm.nih.gov/pubmed/19797280.
- The NICHD Division of Epidemiology Statistics and Prevention Research (DESPR) has several ongoing efforts related to GDM.
- GDM: Epidemiology, Etiology, and Health Consequences aims to identify risk factors, investigate the pathogenesis of GDM using prospectively and longitudinally collected biospecimens from pregnancy cohorts, and determine the impact and underlying mechanisms of how a hyperglycemic intrauterine environment affects short-term and long-term health outcomes.
- DESPR’s Diabetes and Women’s Health Study is enrolling 4,500 women to understand and discover novel pathways and determinants underlying the progression from GDM to type 2 diabetes and various complications.
For more information, select one of the links below:
- NIH Consensus Development Conference: Diagnosing Gestational Diabetes Mellitus (Rescheduled)
- NICHD Resources
- NICHD brochure: Am I At Risk for Gestational Diabetes?
- Pediatric Growth and Nutrition Branch (PGNB)
- PGNB Branch Report to the NACHHD Council, June 2009 (Note: This is a scientific document geared toward an audience of researchers and scientists.)
- Division of Epidemiology, Statistics, and Prevention Research (DESPR)
- DESPR Report to the NACHHD Council, January 2010 (Note: This is a scientific document geared toward an audience of researchers and scientists.)
- Pregnancy & Perinatology Branch (PPB)
- PP Branch Report to the NACHHD Council, September 2008 (Note: This is a scientific document geared toward an audience of researchers and scientists.)
- Maternal Fetal Medicine Unit (MFMU) Network
- NICHD A to Z Health Topic: Gestational Diabetes
- News Releases on Gestational Diabetes
- NIH Office of Disease Prevention
- American Congress of Obstetricians and Gynecologists: GDM Screening/Diagnosis Recommendations
- American Diabetes Association: Summary and Recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus
Originally posted: October 26, 2012
Updated: November 28, 2012