Tim Cundy, Evan Ackermann, Edmond A Ryan. BMJ. Doi: 10.1136/bmj.g1567
This analysis with the sub-title “we need to understand better how to identify high risk pregnancies, incorporating other important factors in addition to glucose concentration.” appeared in a BMJ series “Too Much Medicine” and so before you start, you know where it will end. The thrust of the article is that adopting suggested international current recommendations for diagnosing gestational diabetes could double or even more, the numbers of patients affected. This is because it is suggested a diagnosis can be made on a single raised glucose. Surprisingly despite the increased detection rate, there is no evidence that the all important end points are improved. Even worse, attracting a diagnosis of gestational diabetes will draw increased medical interest leading to an increased risk of intervention. Of course gestational diabetes is an important risk factor to pick up as it can be asymptomatic and is associated with possible adverse consequences to both mother and foetus. Over-diagnosis could cause unnecessary patient distress as they now have a “label” complicating their pregnancy. Furthermore coping with this increased demand will suck in resources which could be more successfully deployed elsewhere.