MINI CONFERENCE: Early gestational diabetes mellitus: what is it and does it matter?

Abstract

Over the last 30 years, the management of gestational diabetes mellitus (GDM) has evolved from an almost randomised controlled trial (RCT) “evidence-free” condition, based upon historical, clinical experience, to a much studied, and discussed, clinical entity with varied guidelines around the world. While the guidelines continue to converge, based upon RCTs and robust cohort studies, differences in views on “best practice” remain.

The Diabetes and Pregnancy Vitamin D And Lifestyle Intervention for Gestational Diabetes Mellitus Prevention (DALI) studies have now provided insight into reasons why the existing paradigm, that GDM largely commences at 24-28 weeks is seriously flawed. In fact, for many years, studies have shown that GDM diagnosed early in pregnancy is associated with worse outcomes than pregnancies with GDM developing later in pregnancy. Such early, “booking” or “prevalent” GDM is about 15-70% of all GDM1, and a new debate is how its diagnosis should take place. New evidence (eg diagnostic criteria, glucose action thresholds) is urgently required to ensure that this paradigm shift improves pregnancy outcomes while minimising the burden on the women affected.