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During a teleconference about the panel’s statement, Dr. VanDorsten said it operationally makes sense to get in line with what others are doing in using the 75-g one-time glucose challenge, the same test used in the nonpregnant population – but not yet.
"Until we have evidence that the benefits of extending the possible diagnosis outweigh the harms," he said, the panel did not find it is appropriate to recommend the single-step approach currently.
"We left the door ajar for reconsideration should these data be forthcoming," Dr. VanDorsten added. He noted that funding agencies will often follow with money for research after the NIH has identified research that is needed.
The panel agreed that "a single standard for screening and diagnostic thresholds for GDM should be established by professional organizations" but identified nine major research gaps that must be addressed in determining what this standard should be. These areas include the following:
• Defining the best strategy in developing a diagnostic approach that aligns more closely with international approaches in the most cost-effective manner possible.
• Determining whether women who would be diagnosed with GDM in the single-step – but not two-step – approach would gain benefit from the diagnosis and treatment.
• Understanding the cost-benefit implications of changing the diagnostic standard.
• Understanding the psychological consequences of a GDM diagnosis on women.
• Conducting cohort studies to show the "real-world" impact that GDM treatment has on practices and care utilization.
• Determining what lifestyle interventions might improve outcomes for pregnant women and their children.
• Assessing long-term impacts of changing the GDM diagnostic criteria.
• Understanding the "long-term metabolic, cardiovascular, developmental, and epigenetic impact on offspring whose mothers have been treated for GDM."
• Assessing what interventions might decrease GDM-diagnosed women’s risk of metabolic syndrome, diabetes, and cardiovascular disease.
Dr. VanDorsten did not define a specific timeline regarding when the NIH would revisit this issue, but he noted that as more evidence becomes available from cohort studies and randomized trials reassessing diagnostic screening methods, a recommendation of the single-step method is possible in the future.
The 15 members of the panel include experts from maternal-fetal medicine, obstetrics and gynecology, endocrinology and infertility, pediatrics, nutrition, epidemiology, economics, and statistics. The panel is an independent group whose members’ travel expenses are paid for by the NIH but who do not receive other compensation for serving on the panel.