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Gestational diabetes needs to be managed

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To the Editor: McIntyre and Oats promote the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria for gestational diabetes mellitus (GDM) as being well reasoned.1 Derived from observational data and mathematical modelling in an attempt to provide a worldwide definition and to improve outcomes, these criteria will significantly increase the number of women diagnosed with GDM2 in health care systems that have limited resources. To help achieve cost savings, clinicians should be leaders in preventing interventions in circumstances where effectiveness or harm is unknown.3

The Australian Carbohydrate Intolerance Study in Pregnant Women trial4 and a US study on treatment for mild GDM5 reported similar outcomes in reducing the frequency of large-for-gestational-age babies, pre-eclampsia and shoulder dystocia despite different entry criteria. The IADPSG proposes more stringent criteria than are used in either of these studies, but without knowledge of additional benefit or harm.

The National Institutes of Health recently released draft guidelines on the diagnosis of GDM that reject…