An Appraisal of Screening Methods for Gestational Diabetes Mellitus.

ABSTRACT

The importance of screening and diagnosis of gestational diabetes mellitus (GDM) is universally accepted but there is controversy and uncertainty about the most suitable method of screening among various populations. The majority of the patients are asymptomatic. After nearly 60 years of research the screening and diagnosis of GDM, universal screening evades uniform acceptance and remains debatable. Multiple studies, numerous global consensus conferences and several multicenter trials had not identified the unique procedure. Surprisingly still there is uncertainty regarding the most effective method of screening among various populations. The prevalence of GDM varies from less than 1% to more than 10% It is increasing due to dietary habits, overweight, maternal age, ethnicity, family history and past history .Prevalence vary due to the use of a wide range of definitions and diagnostic test criteria, as well as variations across regions and ethnic groups. The merits of available screening methods such as urine testing for glycosuria, 50g glucose challenge test (GCT), random blood sugar testing, fasting blood glucose (FBS) , estimation of glycosylated haemoglobin , fructosamine ,75g oral Glucose Tolerance Test (75g OGTT) and two step approach (Combination of methods) are analysed. In countries where funds are limited, certainly the selective screening is cost effective compared to whole population screening. After many decades of research, only up-to-date considerations are Random blood glucose, O’Sullivan, 75g and Complete OGTT.