gestational diabetes was similar (3.6%–3.7%) in each of
the 3 groups. Assuming that the prevalence of GDM by
the new ADA criteria would be in the 16% range, the
cost per case of GDM diagnosed would presumably fall
from Can$3010 to Can$677, and in that sense the ADA
1-step approach would be considerably more cost
effective than either 2-step approach. A decision anal
ysis model (74) was used to compared no screening
with the current ACOG approach (13) and the
IADPSG/ADA approach (1). Compared to no screen
ing, the IADPSG/ADA strategy was equally as cost
effective as the current ACOG strategy only if treat
ment included postdelivery care, which reduces the
incidence of subsequent diabetes. It is to be expected
that more information about public health implica
tions will become available if and when the new criteria
are more widely adopted.
Regardless of the criteria used, gestational diabetes
is increasing in prevalence around the world in parallel
with the increasing prevalence of obesity and type 2
diabetes. All of these trends will no doubt stress the
healthcare systems both in the US and abroad. Hope
fully, more efficient and more scientifically based ap
proaches to diagnosis and treatment will evolve to keep
up with demands. Ultimately, prevention must be the
goal.