Published online Jun 25, 2015. doi: 10.4239/wjd.v6.i6.782
Peer-review started: January 28, 2015
First decision: April 10, 2015
Revised: April 20, 2015
Accepted: May 16, 2015
Article in press: May 18, 2015
Published online: June 25, 2015
Processing time: 144 Days and 4.5 Hours
The approach to screening and diagnosis of gestational diabetes mellitus (GDM) around the world is disorderly. The protocols for diagnosis vary not only in-between countries, but also within countries. Furthermore, in any country, this disparity occurs in-between its hospitals and often exists within a single hospital. There are many reasons for these differences. There is the lack of an international consensus among preeminent health organizations (e.g., American College of Gynecologists and World Health Organization). Often there is a disagreement between the country’s national diabetes organization, its local health society and its regional obstetric organization with each one recommending a different option for approaching GDM. Sometimes the causes for following an alternate approach are very obvious, e.g., a resource strapped hospital is unable to follow the ivory-tower demanding recommendation of its obstetric organization. But more often than not, the rationale for following or not following a guideline, or following different guideline within the same geographic area is without any perceivable explanation. This review is an attempt to understand the problems afflicting the screening and diagnosis of GDM globally. It traces the major temporal changes in the diagnostic criteria of (1) some respected health organizations; and (2) a few selected countries. With an understanding of the reasons for this disparity, a way forward can be found to reach the ultimate goal: a single global guideline for GDM followed worldwide.
Core tip: Globally, the screening and diagnosis of gestational diabetes mellitus (GDM) is idiosyncratic. This disarray is independent of whether a country is affluent (e.g., Denmark) or relatively poor (e.g., Bangladesh). The reason is that not just the international but also the national medical and obstetric organizations in a country advise a multitude of approaches to GDM. This confuses the primary providers of obstetric care, who need one clear, evidence-based, global recommendation. Despite all the differences, in the near future, the light at the end of the tunnel for providing such a universal global GDM guideline is bright.