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• W2135669669 abstract "The International Association of the Diabetes and Pregnancy Study Groups has proposed new thresholds for oral glucose tolerance tests that are based on the large observational Hyperglycemia and Adverse Pregnancy Outcomes study. By using these criteria about 18% of pregnant women will be diagnosed as having gestational diabetes mellitus. The question arises if we are ready for such an enormous increase in gestational diabetes mellitus patients, if outcome would really improve by using these criteria, and if additional studies are necessary before deciding on new diagnostic thresholds. In this clinical opinion, the pros and cons will be discussed. The International Association of the Diabetes and Pregnancy Study Groups has proposed new thresholds for oral glucose tolerance tests that are based on the large observational Hyperglycemia and Adverse Pregnancy Outcomes study. By using these criteria about 18% of pregnant women will be diagnosed as having gestational diabetes mellitus. The question arises if we are ready for such an enormous increase in gestational diabetes mellitus patients, if outcome would really improve by using these criteria, and if additional studies are necessary before deciding on new diagnostic thresholds. In this clinical opinion, the pros and cons will be discussed. In 2008, the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study group published the results of a large international observational study on the relationship between second-trimester oral glucose tolerance test (OGTT) values and outcome.1HAPO Study Cooperative Research GroupHyperglycemia and adverse pregnancy outcomes.N Engl J Med. 2008; 358: 1991-2002Crossref PubMed Scopus (3708) Google Scholar Unfortunately, but not surprisingly, there was a linear relationship among fasting, 1-hour and 2-hour glucose values, and the frequency of primary cesarean delivery, fetal macrosomia (birthweight >90th centile), clinical neonatal hypoglycemia, and cord blood C-peptide. The absence of clear cutoff values for normal or abnormal test results implies that threshold values will by definition be arbitrary. Based on the HAPO results new thresholds for OGTT have been proposed by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG). These are based on a 1.75-fold increase in incidence of fetal macrosomia.2Metzger B.E. Gabbe S.G. Persson B. et al.International Association of Diabetes and Pregnancy Study Groups Consensus PanelInternational association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy.Diabetes Care. 2010; 33: 676-682Crossref PubMed Scopus (2952) Google Scholar By using these criteria, the frequency of gestational diabetes mellitus (GDM) may differ between countries from about 10% in Israel to 24% in areas in southeast Asia and from 17-25% in areas of the United States; overall mean incidence is 17.8%.3Sacks D.A. Hadden D.R. Maresh M. et al.Frequency of gestational diabetes mellitus in collaborating centers based on IADPSG consensus panel recommended criteria.Diabetes Care. 2012; 35: 526-528Crossref PubMed Scopus (485) Google Scholar Following publication of these newly proposed thresholds, numerous articles have been published on their advantages and disadvantages, with an article by Ryan4Ryan E.A. Diagnosing gestational diabetes.Diabetologia. 2011; 54: 480-486Crossref PubMed Scopus (164) Google Scholar as the most eloquent. Arguments in favor or against the IADPSG thresholds are summarized in Table 1 and will be discussed below.TABLE 1Arguments in favor and against use of IADPSG threshold OGTT values for diagnosing GDMArguments in favor - Previous OGTT thresholds were set in such a way that about 2.5% of population would classify as GDM, irrespective of relationship of glucose values with perinatal outcome - Striking increase in obesity and type 2 diabetes in general population may well correspond to GDM incidence of about 20% - Treatment of GDM improves perinatal outcome - Treatment of GDM is generally easy with insulin treatment in only 8-20% of women - Adequate diagnosis is cost-effectiveArguments against - OGTT has poor reproducibility - Even with very strict threshold values, only a minority of fetal macrosomia will be identified - GDM is related to childhood obesity, but mainly in case of maternal obesity - Overdiagnosis of GDM may well result in overtreatment - Stricter OGTT criteria will result in increasing workloadGDM, gestational diabetes mellitus; IADPSG, International Association of Diabetes and Pregnancy Study Groups; OGTT, oral glucose tolerance test.Visser. Is evidence strong enough to change diagnostic GDM criteria? Am J Obstet Gynecol 2013. Open table in a new tab Arguments in favorThe diagnosis of GDM has traditionally been made by using OGTTs that were originally designed in such a way that about 2.5% of the pregnant population (>2 SD) had values exceeding the normal range or were simply based on criteria used in nonpregnant individuals.5Coustan D.R. Lowe L.P. Metzger B.E. Dyer A.R. The hyperglycemia and adverse pregnancy outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus.Am J Obstet Gynecol. 2010; 202: 654.e1-654.e6Abstract Full Text Full Text PDF PubMed Scopus (255) Google Scholar, 6O'Sullivan J.B. Mahan C.B. Criteria for the oral glucose tolerance test in pregnancy.Diabetes. 1964; 13: 278-285PubMed Google Scholar GDM was therefore a laboratory-based diagnosis and not one that was related to perinatal outcome characteristics. The HAPO results provide data on the relation between OGTT values and perinatal outcome and are therefore better suited to identify abnormalities in metabolism than the previous criteria, although the exact cut-off levels remain uncertain.A recent survey of prevalence of GDM by country showed a median incidence of GDM of about 5% in all world regions except southeast Asia (median 8%).7Jiwani A. Marseille E. Lohse N. Damm P. Hod M. Kahn J.G. Gestational diabetes mellitus: results from a survey of country prevalence and practices.J Matern Fetal Neonatal Med. 2012; 25: 600-610Crossref PubMed Scopus (192) Google Scholar Obesity rates have doubled in the last 15 years in many countries, including the United States (presently about 30%8Centers for Disease Control and PreventionCDC Division of Diabetes Translation. Diabetes data and trends.http://www.cdc.gov/diabetes/statisticsGoogle Scholar). The odds ratio (OR) for GDM in obese women with a body mass index (BMI) >30 is 3.5-4.9Sebire N.J. Jolly M. Harris J.P. et al.Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London.Int J Obes. 2011; 25: 1175-1182Crossref Scopus (1254) Google Scholar, 10Baeten J.M. Bukusi E.A. Lambe M. Pregnancy complications and outcomes among overweight and obese nulliparous women.Am J Public Health. 2001; 91: 436-440Crossref PubMed Scopus (597) Google Scholar Therefore a higher incidence of GDM than the reported 5% seems likely.Two randomized studies have shown that treatment of GDM improves outcome, by lowering the incidence of fetal macrosomia, mortality, birth trauma, and–in one study–cesarean deliveries.11Crowther C.A. Hiller Je Moss J.R. McPhee A.J. Jeffries W.S. Robinson J.S. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.N Engl J Med. 2005; 352: 2477-2486Crossref PubMed Scopus (2378) Google Scholar, 12Landon M.B. Spong C.Y. Thom E. et al.A multicenter randomized trial of treatment for mild gestational diabetes.N Engl J Med. 2009; 361: 1339-1348Crossref PubMed Scopus (1508) Google Scholar These results make treatment and screening programs for GDM mandatory. However, criteria for GDM differed from the new proposed diagnostic criteria and were likely to include the more severe cases. Benefits for diagnosing and treating minor glucose abnormalities have, therefore, not yet been proven. In October 2012, Bodmer-Roy et al13Bodmer-Roy S. Morin L. Cousineau J. Rey E. Pregnancy outcomes in women with and without diabetes mellitus according to the international association of the diabetes and pregnancy study groups criteria.Obstet Gynecol. 2012; 120: 746-752Crossref PubMed Scopus (70) Google Scholar published data indicating that women classified as nondiabetic by the Canadian Diabetes Association Criteria but considered to have GDM according to the IADPSG criteria (study group) had similar pregnancy outcomes as women without GDM. However, the data were not conclusive since there was a higher incidence of fetal macrosomia and preeclampsia in the study group, which was, however, not significant (the series reported only 186 cases and 372 controls).Treatment of GDM is usually relatively easy, with insulin requirement in only 8-20% of women. This argument would favor identification of all women with minor hyperglycemia, but it does not take into account that overdiagnosis might result in other actions like labor inductions or cesarean deliveries without proven benefit (see below).Thus far 2 studies have addressed cost-effectiveness of GDM screening according to the IADPSG criteria using decision analysis models. One study showed that the IADPSG recommendations are cost-effective only when postdelivery care would reduce the frequency of diabetes in these women.14Werner E.F. Pettker C.M. Zuckerwise L. et al.Screening for gestational diabetes mellitus: are the criteria proposed by the international association of the diabetes and pregnancy study groups cost-effective?.Diabetes Care. 2012; 35: 529-535Crossref PubMed Scopus (145) Google Scholar In a second study, the cost-effectiveness of the current US screening, 1-hour glucose challenge test followed by a 3-hour OGTT, was compared with the new IADPSG guidelines for the 2-hour OGTT. In the latter study, treatment according to the new guidelines would be effective if treatment would result in decreased preeclampsia >0.55% and decreased cesarean delivery >2.7%.15Mission J.F. Ohno M.S. Cheng Y.W. Caughey A.B. Gestational diabetes screening with new IADPSG guidelines: a cost-effectiveness analysis.Am J Obstet Gynecol. 2012; 207 (326e1-9)Abstract Full Text Full Text PDF PubMed Scopus (78) Google ScholarThe arguments againstThe OGTT has poor reproducibility, with about 30% of patients having a negative test result after a previous positive result.16Catalano P.M. Avallone D.A. Drago N.M. Amini S.B. Reproducibility of the oral glucose tolerance test in pregnant women.Am J Obstet Gynecol. 1993; 169: 874-881Abstract Full Text PDF PubMed Scopus (65) Google Scholar, 17Neiger R. Coustan D.R. The role of repeat glucose tolerance tests in the diagnosis of gestational diabetes.Am J Obstet Gynecol. 1991; 165: 787-790Abstract Full Text PDF PubMed Scopus (36) Google Scholar Reproducibility is even poorer with minor degrees of glucose elevations.18Eriksson K.F. Lindgarde F. Impaired glucose tolerance in a middle-aged male urban population: a new approach for identifying high-risk cases.Diabetologia. 1990; 33: 526-531Crossref PubMed Scopus (78) Google Scholar, 19Balion C.M. Raina P.S. Gerstein H.C. et al.Reproducibility of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) classification: a systematic review.Clin Chem Lab Med. 2007; 45: 1180-1185Crossref PubMed Scopus (80) Google Scholar In other words, the stricter the threshold values the more patients will be diagnosed by chance as having GDM.It is questionable if a birthweight >90th centile is an adequate endpoint for defining OGTT threshold values. Even with the strict IADPSG threshold criteria, only about 22% of all large-for-gestational-age pregnancies occur in patients with GDM.4Ryan E.A. Diagnosing gestational diabetes.Diabetologia. 2011; 54: 480-486Crossref PubMed Scopus (164) Google Scholar It is unknown if this will be the subgroup of infants with an increased risk for obesity and metabolic syndrome later in life. Growth characteristic for type 1 diabetes, type 2 diabetes, and GDM is characterized by disproportionate fetal growth with a large abdominal circumference as compared to the head circumference, both in appropriate- and large-for-gestational-age infants.20Hammoud N.M. Visser G.H.A. Peters S.A. Graatsma E.M. Pistorius L. de Valk H.W. Fetal growth profiles of macrosomic and non-macrosomic infants of women with pregestational or gestational diabetes.Ultrasound Obstet Gynecol. 2012 June 29; ([Epub ahead of print])https://doi.org/10.1002/uog.11.221Crossref Google Scholar A better description/definition of macrosomia will therefore be necessary.Moreover and as has been pointed out before,4Ryan E.A. Diagnosing gestational diabetes.Diabetologia. 2011; 54: 480-486Crossref PubMed Scopus (164) Google Scholar GDM is related to childhood obesity, but mainly in case of coexisting maternal obesity. A Finnish study has recently shown that overweight and abdominal obesity in 16-year-old adolescents was related to maternal obesity and especially to the combination of maternal obesity and GDM, but not to GDM alone.21Pirkola J, Pouta A, Bloigu A, et al. Risks of overweight and abdominal obesity at age 16 years associated with prenatal exposures to maternal prepregnancy overweight and gestational diabetes mellitus. Diabetes Care 1010;33:1115-21.Google Scholar In a systematic review on the association between GDM and childhood overweight and obesity it was found that there is currently inconsistent evidence of an association due to methodological limitations of existing studies.22Kim S.Y. England J.L. Sharma J.A. Njoroge T. Gestational diabetes mellitus and risk of childhood overweight and obesity in offspring: a systematic review.Exp Diabetes Res. 2011; 2011: 541308Crossref PubMed Scopus (131) Google Scholar In another recent metaanalysis it was found that there is an association between all types of diabetes in pregnancy with childhood obesity, but that this association disappeared after adjustment for maternal BMI in the 3 studies in which this was reported.23Philips L.H. Santhakumuran S. Gale C. et al.The diabetic pregnancy and offspring BMI in childhood: a systematic review and meta-analysis.Diabetologia. 2011; 54: 1957-1966Crossref PubMed Scopus (125) Google Scholar The Finnish study by Pirkola et al21Pirkola J, Pouta A, Bloigu A, et al. Risks of overweight and abdominal obesity at age 16 years associated with prenatal exposures to maternal prepregnancy overweight and gestational diabetes mellitus. Diabetes Care 1010;33:1115-21.Google Scholar had not yet been included in this analysis. So there is considerable doubt as to the independent effect of GDM on obesity in offspring, but data corrected for maternal BMI are limited. Absence of long-term risks of GDM for the offspring would weaken the need for diagnosing very mild cases.From the HAPO data, we know that both obesity and GDM are independent risk factors with synergistic effects regarding preeclampsia, primary cesarean deliveries, macrosomia, increased cord C-peptide levels, and newborn body fat.24Catalano P.M. McIntyre H.D. Cruickshank J.K. et al.The hyperglycemia and adverse pregnancy outcome study; associations of GDM and obesity with pregnancy outcomes.Diabetes Care. 2012; 35: 780-786Crossref PubMed Scopus (637) Google Scholar Follow-up studies of these infants will be important to assess the risk factors for metabolic syndrome during childhood and thereafter, ie, maternal obesity and/or GDM. Given the synergistic effects of GDM and obesity on direct and later outcome in the offspring, it might prove useful to use stricter threshold criteria for obese women than for nonobese women, instead of using the same thresholds for everyone.Earlier this year Moynihan et al25Moynihan R. Doust J. Henry D. Preventing overdiagnosis: how to stop harming the healthy.BMJ. 2012; 344: e3502Crossref PubMed Scopus (449) Google Scholar addressed the problem of overmedicalization in an article entitled “Preventing overdiagnosis: how to stop harming the healthy.” As drivers for overdiagnosis they mentioned: (1) technological changes detecting even smaller abnormalities; (2) commercial and professional vested interests; (3) conflicted panels producing expanded disease definitions and writing guidelines; (4) legal incentives that punish underdiagnosis but not overdiagnosis; (5) health system incentives favoring more tests and treatments; and (6) cultural beliefs that more is better, ie, faith in early detection unmodified by its risks. Many of these drivers may be present regarding GDM screening and GDM was indeed mentioned as an example. Quoting Moynihan et al25Moynihan R. Doust J. Henry D. Preventing overdiagnosis: how to stop harming the healthy.BMJ. 2012; 344: e3502Crossref PubMed Scopus (449) Google Scholar and an earlier article by Black26Black W. Advances in radiology and the real versus apparent effects of early diagnosis.Eur J Radiol. 1998; 27: 116-122Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar: “The ability to detect smaller abnormalities axiomatically tends to increase the prevalence of any given disease. In turn this leads to overestimation of the benefits of therapies, as milder forms of the disease are treated and improvements in health are wrongly ascribed to treatment success, creating a ‘false feedback’ loop fuelling a ‘cycle of increased testing and treatment, which may eventually cause more harm than benefit.'” Risks of overdiagnosing GDM may include earlier intervention and subsequent iatrogenic preterm delivery, increase in elective cesarean deliveries (presumed large baby), and inductions of labor and in secondary cesarean deliveries (failed inductions). Long-term risks of a slightly earlier delivery of the infant are largely unknown. Risks of an increasing cesarean delivery rate may include an increase in childhood autoimmune diseases like asthma and type 1 diabetes.27Thavagnanam S. Fleming J. Bromley A. Shields M.D. Cardwell C.R. A meta-analysis of the association between cesarean section and childhood asthma.Clin Exp Allergy. 2008; 38: 629-633Crossref PubMed Scopus (476) Google Scholar, 28Cardwell C.R. Stene L.C. Joner G. et al.Cesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies.Diabetologia. 2008; 51: 726-735Crossref PubMed Scopus (411) Google ScholarMore GDM will generate a greater workload for obstetrician, endocrinologist, and dietician services. For 2 units in Australia it was conservatively estimated that overall workload would increase by 20-30% but possibly by 60%, which might require a structural change in services.29Flack J.R. Ross G.P. Ho S. McElduff A. Recommended changes to diagnostic criteria for gestational diabetes: impact on workload.Aust N Z J Obstet Gynaecol. 2010; 50: 439-443Crossref PubMed Scopus (62) Google ScholarCommentsIn the article “Preventing overdiagnosis: how to stop harming the healthy,”25Moynihan R. Doust J. Henry D. Preventing overdiagnosis: how to stop harming the healthy.BMJ. 2012; 344: e3502Crossref PubMed Scopus (449) Google Scholar the issue on GDM was summarized as follows: “Proponents for lowering the diagnostic thresholds argue that universal screening with the new definition will reduce health problems, including babies being large for gestational age. Critics, however, are calling for an urgent debate before the new expanded definition is more widely adopted, because they fear many women may be overmedicalised and overdiagnosed, that the screening test has poor reproducibility for mild cases, the evidence of benefit for newly diagnosed pregnant women is weak, and the benefit modest at best.”2Metzger B.E. Gabbe S.G. Persson B. et al.International Association of Diabetes and Pregnancy Study Groups Consensus PanelInternational association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy.Diabetes Care. 2010; 33: 676-682Crossref PubMed Scopus (2952) Google Scholar, 4Ryan E.A. Diagnosing gestational diabetes.Diabetologia. 2011; 54: 480-486Crossref PubMed Scopus (164) Google Scholar, 30Cundy T. Proposed new diagnostic criteria for gestational diabetes–a pause for thought?.Diabet Med. 2012; 29: 176-180Crossref PubMed Scopus (40) Google Scholar The arguments of both groups seem right. There is a linear relationship between OGTT values and impaired outcome and threshold values will, therefore, by definition be arbitrarily. Benefits regarding minor glucose abnormalities will be small and most likely smaller than in the randomized controlled trials (RCTs) on effects of treatment, increasing the possible burden of overdiagnosis. Before “marrying the new guidelines,”31Blackwell S.C. Rouse D.J. Gestational diabetes–staying with old or marrying new guidelines.Am J Obstet Gynecol. 2011; 371: 371-372Abstract Full Text Full Text PDF Scopus (6) Google Scholar there might be “a pause for thought.”30Cundy T. Proposed new diagnostic criteria for gestational diabetes–a pause for thought?.Diabet Med. 2012; 29: 176-180Crossref PubMed Scopus (40) Google ScholarEvidence that treatment of minor glucose elevations improves outcome is lacking. Therefore RCTs should be conducted on the efficacy of treatment of those minor OGTT elevations. Alternatively, one may decide to adopt the less stringent threshold values as suggested by Ryan,4Ryan E.A. Diagnosing gestational diabetes.Diabetologia. 2011; 54: 480-486Crossref PubMed Scopus (164) Google Scholar values that are based on a 2-fold increased incidence of fetal macrosomia, which would result in an overall incidence of GDM of 10% and not of 18% as with the IADPSG. This acknowledges the fact that the incidence of GDM is likely to have increased due to the higher incidence of maternal obesity. Subsequently (large) RCTs should study the effect of treatment in women with OGTT values in between the IADPSG criteria and those proposed by Ryan,4Ryan E.A. Diagnosing gestational diabetes.Diabetologia. 2011; 54: 480-486Crossref PubMed Scopus (164) Google Scholar including cost-effectiveness analyses. One way or the other, more research seems necessary before the IADPSG guidelines may be introduced.Given the possibility of a larger effect of maternal obesity on offspring outcome and the synergistic effect of obesity and GDM, one may also consider using different OGTT thresholds for obese and nonobese patients, respectively. Obese women are more likely to benefit from strict glucose control and diet and from reducing weight gain in pregnancy. Subanalysis of the Israeli contribution to the HAPO data set has shown that the use of the IADPSG criteria would double the incidence of GDM.32Kalter-Leibovici O. Freedman L.S. Olmer L. et al.Screening and diagnosis of gestational diabetes mellitus: critical appraisal of the new international association of diabetes in pregnancy study group recommendations at a national level.Diabetes Care. 2012; 35: 1894-1896Crossref PubMed Scopus (32) Google Scholar One-third of these women were found to be at low risk for adverse outcomes. Fasting plasma glucose >88 mg/dL at 28-32 weeks of gestation or maternal BMI >33.5 in IADPSG-positive women were able to detect adverse outcome similar to IADPSG criteria, with a reduction of the number of women needing treatment. So, these authors also conclude that risk stratification may reduce overtreatment.Other aspects to be studied include the timing of OGTT, at this moment 24-28 weeks of gestation, and the question of whether glucose testing should be repeated later in pregnancy. Our own anecdotal experience suggests the development of GDM during the third trimester is not rare in women with a normal OGTT at 24-28 weeks. This is understandable in light of the fact that the OGTT has poor reproducibility and that insulin resistance increases with advancing gestation due to rising placental hormones. A second screening test, for instance at 34 weeks, may identify cases that had been falsely negative at earlier testing or that developed GDM only later in pregnancy. Such a policy might be more (cost-)effective than diagnosing very mild glucose elevations. Alternatively and in line with the suggestions by the Israeli HAPO group,32Kalter-Leibovici O. Freedman L.S. Olmer L. et al.Screening and diagnosis of gestational diabetes mellitus: critical appraisal of the new international association of diabetes in pregnancy study group recommendations at a national level.Diabetes Care. 2012; 35: 1894-1896Crossref PubMed Scopus (32) Google Scholar such a second screening may be restricted to women with risk factors such as maternal obesity, fetal macrosomia, or polyhydramnios.By waiting for results from the RCTs as suggested before, many benefits may be obtained by the implementation of universal screening. Apparently universal GDM screening never has been endorsed by the US Preventive Services Task Force.14Werner E.F. Pettker C.M. Zuckerwise L. et al.Screening for gestational diabetes mellitus: are the criteria proposed by the international association of the diabetes and pregnancy study groups cost-effective?.Diabetes Care. 2012; 35: 529-535Crossref PubMed Scopus (145) Google Scholar From 47 countries replying to a questionnaire on GDM prevalence and practices, 74% reported to have national GDM guidelines or recommendations.7Jiwani A. Marseille E. Lohse N. Damm P. Hod M. Kahn J.G. Gestational diabetes mellitus: results from a survey of country prevalence and practices.J Matern Fetal Neonatal Med. 2012; 25: 600-610Crossref PubMed Scopus (192) Google Scholar In the countries where universal screening was recommended the percentage of women screened ranged from 10–90%. So, there is still a lot to gain by expanding the population to be tested, instead of starting to use stricter thresholds. Alternatively, clinical prediction models for GDM may be implemented. A recent study has shown that if an OGTT could be performed in all women with a predicted probability of ≥2%, 43% of all women would be tested and 75% of women with GDM would be identified.33Van Leeuwen M. Opmeer B.C. Zweers E.J.K. et al.Estimating the risk of gestational diabetes mellitus: a clinical prediction model based on patient characteristics and medical history.BJOG. 2010; 117: 69-75Crossref PubMed Scopus (89) Google Scholar However, GDM diagnosed by screening results in a better outcome as compared to GDM diagnosed following symptoms.34Hammoud N.M. de Valk H.W. Biesma D.H. Visser G.H.A. Gestational diabetes mellitus diagnosed by screening or symptoms: does it matter?.J Matern Fetal Neonatal Med. 2012 Sept 25; ([Epub ahead of print])PubMed Google ScholarA vast increase in GDM may result in an increase in the use of oral antidiabetic drugs. The Food and Drug Administration has categorized glyburide as class C. It crosses the placenta in only a low concentration, but some recent studies have described neonatal hypoglycemia indicative of fetal hyperinsulinemia following glyburide, including a study in which more big babies were found with higher doses of glyburide. Recent data on a large retrospective cohort from California of 10,000 women with GDM, of whom 2000 were treated with glyburide, indicated that the use of glyburide was associated with a significantly higher incidence of birthweight >4000 g (adjusted OR, 1.29) and a significantly higher incidence of admission to neonatal intensive care (adjusted OR, 1.46).35Cheng Y.W. Chung J.H. Block-Kurbisch I. Inturrisi M. Caughey A.B. Treatment of gestational diabetes mellitus: glyburide compared to subcutaneous insulin therapy and associated perinatal outcomes.J Matern Fetal Neonatal Med. 2012; 25: 379-384Crossref PubMed Scopus (42) Google Scholar That would leave metformin as the drug of choice. It rapidly crosses the placenta but no embryonic, fetal, or infant side effects have been reported to date.36Rowan J.A. Rush E.C. Obolonkin V. Battin M. Wouldes T. Hague W.M. Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition at 2 years of age.Diabetes Care. 2011; 34: 2279-2284Crossref PubMed Scopus (252) Google Scholar However, metformin is a remarkable drug and its use may be associated with a reduced risk of cancer,37Libby G. Donnelly L.A. Donnan P.T. Alessi D.R. Morris A.D. Evans J.M.M. New users of metformin are at low risk of incident cancer.Diabetes Care. 2009; 32: 1620-1625Crossref PubMed Scopus (844) Google Scholar most likely by killing tumor-initiating stem cells, with antiangiogenetic effects, antiinflammatory effects, growth inhibitory effects, and antioxidative effects.38Martin-Castillo B. Vazquez-Martin A. Oliveras-Ferraros C. Menendez J.A. Metformin and cancer.Cell Cycle. 2010; 9: 1057-1064Crossref PubMed Scopus (195) Google Scholar, 39Tan B.K. Adya R. Chen J. Lehnert H. Saint Cassia L.J. Randeva H.S. Metformin treatment exerts antiinvasive and antimetastatic effects in human endometrial carcinoma cells.J Clin Endocrinol Metab. 2011; 96: 808-816Crossref PubMed Scopus (104) Google Scholar, 40Ersoy C. Kiyici S. Budak F. et al.The effect of metformin treatment on VEGF and PAI-1 levels in obese type-2 diabetic patients.Diab Rev Clin Pract. 2008; 81: 56-60Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar, 41Dowling R.J.O. Goodwin P.J. Stambolic V. Understanding the benefit of metformin use in cancer treatment.BMC Med. 2011; 9: 33Crossref PubMed Scopus (311) Google Scholar That appears to be good for the prevention and/or treatment of cancer, but what about a 9-month exposition to the fetus? Earlier we have pointed out that we do not know enough about possible adverse effects of this drug in the embryo and fetus.42Visser G.H.A. de Valk H.W. Gestational diabetes: screening for all, which test and which treatment?.Expert Rev Endocrinol Metab. 2012; 7: 165-167Crossref Scopus (6) Google Scholar Therefore animal and basic human studies seem mandatory before it might be consider" @default.
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• W2135669669 title "Is the evidence strong enough to change the diagnostic criteria for gestational diabetes now?" @default.
• W2135669669 cites W1588059342 @default.
• W2135669669 cites W1592674309 @default.
• W2135669669 cites W1978967787 @default.
• W2135669669 cites W1986160011 @default.
• W2135669669 cites W1986439966 @default.
• W2135669669 cites W1991414014 @default.
• W2135669669 cites W1998782696 @default.
• W2135669669 cites W2000357287 @default.
• W2135669669 cites W2001429209 @default.
• W2135669669 cites W2003722855 @default.
• W2135669669 cites W2014659953 @default.
• W2135669669 cites W2019018422 @default.
• W2135669669 cites W2039580567 @default.
• W2135669669 cites W2042008937 @default.
• W2135669669 cites W2049340829 @default.
• W2135669669 cites W2051908899 @default.
• W2135669669 cites W2057139536 @default.
• W2135669669 cites W2063955121 @default.
• W2135669669 cites W2064436685 @default.
• W2135669669 cites W2074307717 @default.
• W2135669669 cites W2085331940 @default.
• W2135669669 cites W2087398692 @default.
• W2135669669 cites W2102307174 @default.
• W2135669669 cites W2103467021 @default.
• W2135669669 cites W2109574002 @default.
• W2135669669 cites W2110595724 @default.
• W2135669669 cites W2111660544 @default.
• W2135669669 cites W2113769636 @default.
• W2135669669 cites W2114819974 @default.
• W2135669669 cites W2132578529 @default.
• W2135669669 cites W2142110618 @default.
• W2135669669 cites W2146649590 @default.
• W2135669669 cites W2156484467 @default.
• W2135669669 cites W2165387067 @default.
• W2135669669 cites W2169869070 @default.
• W2135669669 cites W2170514854 @default.
• W2135669669 cites W2170843315 @default.
• W2135669669 cites W2171826023 @default.
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