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Controversy grows over redefinition of gestational diabetes

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To the Editor: Moynihan has recently suggested that gestational diabetes mellitus (GDM) is a “non-entity”1 and cited controversy regarding new diagnostic criteria, while McIntyre and Oats have defended the practice of screening for GDM.2 Robust data associate hyperglycaemia with adverse pregnancy outcomes;3 and randomised controlled trial data show a beneficial effect of screening and treatment on perinatal outcomes.4

However, it is short-sighted to consider only the immediate outcome of a pregnancy. GDM has very significant long-term consequences for mothers and their offspring. Half of all women diagnosed with GDM will later develop type 2 diabetes, and they also bear a substantially increased risk of future cardiovascular disease.5 Identification of GDM therefore provides an opportunity to intervene with a view to improving the long-term health of young women who are at risk. Furthermore, in-utero hyperglycaemia seems to cause fetal programming effects which increase the risk of type 2 diabetes in offspring — additive to the genetic transmission of diabetogenic traits from mother to child.

The newly proposed International Association…