In response to a question from the audience about fetal outcome, Dr. Morkrid responded that those data are available but have not yet been analyzed.
The IADPSG criteria have been adopted by some countries, including Japan and Germany, but not widely in the United States. In September 2010, the ACOG Committee on Obstetric Practice issued a committee opinion restating its recommendation for a "two-step" method that differs from both the IADPSG and WHO criteria, utilizing a 50-g, 1-hour "loading" test at 24-28 weeks’ gestation, followed by a confirmatory 100-g, 3-hour OGTT.
In addition to concerns regarding the dramatic increase in the number of women diagnosed with GDM that would occur with adoption of the IADPSG criteria – ACOG estimates the proportion would be 18% of all pregnant women – the ACOG committee opinion also cited the lack of evidence regarding impact on outcomes.
"There is no evidence that the identification and treatment of women based on the new [IADPSG] recommendations will lead to clinically significant improvements in maternal and neonatal outcomes, and it would lead to a significant increase in health care costs," the ACOG authors noted, adding that "significant questions remain regarding the implications on health care costs, the effect of GDM diagnosis on the pregnant woman and her family, the effect of diagnosis on obstetric interventions in pregnancy, and whether the identification and treatment of GDM will improve meaningful perinatal, neonatal, and maternal outcomes."
ACOG and other organizations are looking ahead to the National Institutes of Health’s Consensus Development Conference on Diagnosing Gestational Diabetes Mellitus, scheduled for October 29-31, 2012, to develop a uniform diagnostic standard. "Consensus regarding optimal diagnostic criteria among the many groups and professional organizations will further much needed research regarding the benefits and harms of screening and diagnosis of GDM," the ACOG opinion statement said.
The Norwegian study was funded by the Research Council of Norway, the South-Eastern Norway Regional Health Authority, and the Norwegian Directorate of Health. Neither Dr. Morkrid nor Dr. Diamant had any financial disclosures.