Some professional groups, such as the American Congress of Obstetricians and Gynecologists (ACOG),7
have not endorsed these new diagnostic criteria. This can result in confusion regarding the pregnant
woman’s clinical status and treatment plan. ACOG notes that while the results of the HAPO
observational study show an association between mild hyperglycemia and adverse outcomes, they do
not demonstrate the clinical benefits of treating women diagnosed using these criteria. This raises
questions about the healthcare costs associated with this significant change in practice, as well as
possible harms that might result from identifying more women with GDM (e.g. via an increase in
obstetrical procedures). Reaching consensus on the optimal diagnostic criteria for GDM is a critical focus
of research in this area, though beyond the scope of work for the diabetes educator.
Although obesity contributes to the rising prevalence of diabetes during pregnancy,8,9 not all women
with GDM are overweight. Insulin resistance during pregnancy is a physiologic phenomenon driven by
the metabolic demands of the maternal-fetal unit, stress and pregnancy-induced hormonal changes, and
GDM presents diabetes educators and the entire health care team with tremendous opportunities and
challenges.
Some professional groups, such as the American Congress of Obstetricians and Gynecologists (ACOG),7
have not endorsed these new diagnostic criteria. This can result in confusion regarding the pregnant
woman’s clinical status and treatment plan. ACOG notes that while the results of the HAPO
observational study show an association between mild hyperglycemia and adverse outcomes, they do
not demonstrate the clinical benefits of treating women diagnosed using these criteria. This raises
questions about the healthcare costs associated with this significant change in practice, as well as
possible harms that might result from identifying more women with GDM (e.g. via an increase in
obstetrical procedures). Reaching consensus on the optimal diagnostic criteria for GDM is a critical focus
of research in this area, though beyond the scope of work for the diabetes educator.
Although obesity contributes to the rising prevalence of diabetes during pregnancy,8,9 not all women
with GDM are overweight. Insulin resistance during pregnancy is a physiologic phenomenon driven by
the metabolic demands of the maternal-fetal unit, stress and pregnancy-induced hormonal changes, and
GDM presents diabetes educators and the entire health care team with tremendous opportunities and
challenges.
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