A proposal for the use of uniform diagnostic criteria for gestational diabetes in Europe: an opinion paper by the European Board & College of Obstetrics and Gynaecology (EBCOG)

Abstract

Screening and diagnostic criteria for gestational diabetes (GDM) are inconsistent across Europe, and the development of a uniform GDM screening strategy is necessary. Such a strategy would create opportunities for more women to receive timely treatment for GDM. Developing a consensus on screening for GDM in Europe is challenging, as populations are diverse and healthcare delivery systems also differ. The European Board & College of Obstetrics and Gynaecology (EBCOG) has responded to this challenge by appointing a steering committee, including members of the EBCOG and the Diabetic Pregnancy Study Group (DPSG) associated with the EASD, to develop a proposal for the use of uniform diagnostic criteria for GDM in Europe. A proposal has been developed and has now been approved by the Council of the EBCOG. The current proposal is to screen for overt diabetes at the first prenatal contact using cut-off values for diabetes outside pregnancy, with particular efforts made to screen high-risk groups. When screening for GDM is performed at 24 weeks' gestation or later, the proposal is now to use the 75 g OGTT with the new WHO diagnostic criteria for GDM. However, more research is necessary to evaluate the best GDM screening strategy for different populations in Europe. Therefore, no clear recommendation has been made on whether a universal one-step, two-step or a risk-factorbased screening approach should be used. The use of the same WHO diagnostic GDM criteria across Europe will be an important step towards uniformity.

Difference in the prevalence of gestational diabetes mellitus according to gestational age at 75‐g oral glucose tolerance test in Japan: The Japan Assessment of Gestational Diabetes Mellitus Screening trial

“…The American Diabetes Association also recommends the performance of a test for undiagnosed diabetes mellitus, rather than GDM at <24 weeks’ gestation. The American Diabetes Association proposed the criteria for the diagnosis of diabetes mellitus using fasting PG levels or a 75‐g OGTT, or glycated hemoglobin or random PG measurements at <24 weeks’ gestation. In the European Board and College of Obstetrics and Gynaecology and American Diabetes Association recommendations, GDM is not defined at <24 weeks’ gestation.…”

“…The American Diabetes Association proposed the criteria for the diagnosis of diabetes mellitus using fasting PG levels or a 75‐g OGTT, or glycated hemoglobin or random PG measurements at <24 weeks’ gestation. In the European Board and College of Obstetrics and Gynaecology and American Diabetes Association recommendations, GDM is not defined at <24 weeks’ gestation. It is not clear if GDM diagnosis and intervention initiation at <24 weeks’ gestation can improve perinatal outcomes.…”

Screening and diagnosis of gestational diabetes mellitus – relevance to low and middle income countries

“…Similar methods are followed in some parts of Europe, where Germany for example follows a 75 g OGTT of IADPSG criteria following a 50 g GCT [33]. It is to be noted however that this method of GCT followed by IADPSG criteria is currently not validated.…”

“…It is to be noted however that this method of GCT followed by IADPSG criteria is currently not validated. Ireland, France and some parts of Belgium have adopted the IADPSG criteria [33], but only in high risk individuals.…”

“…Due to lack of evidence on classifying GDM using FPG ≥92 mg/dl (5.1 mmol/l) in first trimester or first antenatal visit, the EBCOG states that no clear recommendations can be made on diagnostic criteria for GDM in early pregnancy [33]. …”