Dear Ruth,
Perhaps these article might help:
1) Jarrett RJ, et al. Should we screen for gestational diabetes? BMJ
1997;315:736-9.
(See also the comments in BMJ 1998;316:861.
2) Canadian Task Force on the Periodic Health Examination. Periodic health
examination, 1992 update: 1. Screening for gestational diabetes mellitus. Can
Med Assoc J 1992;147:435-43.
3) Santini DL, et al. The impact of universal screening for gestational
glucose intolerance on outcome of pregnancy. Surg Gynecol Obstet
1990;170:427-36.
4) Stephenson MJ. Screening for gestational diabetes mellitus: A critical
review. J Fam Pract 1993;37:277-83.
5) Feig DS, et al. Self-perceived health status of women three to five years
after the diagnosis of gestational diabetes: A survey of cases and matched
controls. Am J Obstet Gynecol 1998;178:386-93.
6) U.S. Preventive Services Task Force. Guide to clinical preventive
services, 2nd ed. Baltimore: Williams & Wilkins, 1996. (Chapter 19 Screening
for diabetes mellitus. Pgs 193-208.) [Also on the web: Start at
http://text.nlm.nih.gov/ftrs/tocview and select the appropriate chapter.]
7) Finally, the Cochrane library has a review: Dietary regulation for
"gestational diabetes." Its conclusion reads as follows:
Evidence from these trials does not support the value of primary dietary
treatment for pregnant women with impaired glucose tolerance. Other than
the currently
unpublished trial of Okum [Okum 1996], the trials are small and of
variable quality, and
do not truly address obstetric and neonatal issues. Aggressive management
as
described in the treatment arms of these trials is time and resource
consuming, and
places such women in a high risk pregnancy group. This leaves the way
open for a
potential cascade of obstetric intervention. Without good evidence that
important issues
such as Caesarean section rates are influenced by treatment, it seems
difficult to justify
such 'therapeutic' regimes. The issues of long term consequences to
mother and infant
of a diagnosis of gestational diabetes are beyond the scope of this
review. However, on
current evidence, such long term consequences are the only available
reasons for
continuation of medical management of this condition. Screening for
'gestational
diabetes' and all forms of 'treatment', including dietary modification,
should be
advocated only in the context of randomised trials to assess whether or
not they reduce
substantive adverse outcomes of pregnancy.
I hope these references help.
Cheers and Best Wishes,
Brian
......................................................
Brian Budenholzer, MD
Director, Clinical Enhancement & Development
CC16
Group Health Northwest
PO Box 204
Spokane, WA 99210-0204
USA
509/ 838-9100 X 7393
fax 509/ 458-0368
email: [log in to unmask]
.......................................................
>>> "Ruth Swarbrick" <[log in to unmask]> 09/14 3:56 AM >>>
I have just transferred to an idyllic country district general hospital on
rotation as part of my specialist registrar rotation in O and G and have
today sat, somewhat frustratedly through my first morbidity and mortality
meeting today. In this meeting it was suggested that we should be screening
everybody for gestational diabetes because if we wait for detection of
macrosomic babies on scan "we have missed the boat". I was acutley aware
that what was needed was some discussion of positive and negative predictive
values of random glucose levels and GTT, and the benefits of diagnosis(what
are they?) but I lacked the skills to present a logical rebuttal. Can anyone
point me in the right direction?
Many thanks,
Ruth
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