Gestational Diabetes Mellitus: Implications for Pre-Screening and

Gestational Diabetes Mellitus: Implications for Pre-Screening and Type II Diabetes Gestational Diabetes Mellitus Implications for Pre-Screening in Type II Screening of patients for the condition of "gestational diabetes mellitus" is considered to be an extravagance from the perspective of Lepercq (2004) who considered Universal Screening to be "contentious." However due to the 6.4% mortality rate due to untreated diabetes mellitus as well as the know birth defects and maternal health effects there are those who consider pre-screening for GDM to be vital in terms of the health of the expected mother and expected child.

There exist implications for the lack of prescreening in terms of ethical responsibility as well as in terms of costs realized in universal screening. Systemic study of this subject is necessary in understanding what the best practice in pre-screening actually is.

Gestational Diabetes Mellitus Implications for Pre-Screening in Type II - Type 1 and Type 2 Statement of Thesis: Screening of patients for gestational diabetes mellitus stated to be "contentious" Lepercq (2004) however it is an excellent method for detection of type 2 gestational diabetes mellitus which is a condition with serious implications of adverse effects upon both the maternal and fetal health. Chapter One Introduction: Gestational diabetes mellitus (GDM) is a condition characterized by glucose intolerance that varies in severity and is characterized by onset during pregnancy.

Nutritional intervention is the best management solution for the condition of GDM which incidentally is one of the most common complications in pregnancy in terms of medical complications. However, lack of treatment places both mother and child at risk screening for GDM is the current practice in medicine. There is a stated 6.4% mortality rate for untreated GDM in pregnancies of women over the age of 25 years old compared to the rate of 1.5% in women with normal glucose tolerance.

This condition is one that develops as a result of the woman's pancreases failing to produce enough insulin for her needs.

Brief Historical Overview of GDM Screening: In the review entitled "Screening for Gestational Diabetes Mellitus" stated is that: "Consideration has been given to the existing screening practices for GDM, including universal screening, risk factor-based screening, and the option of not screening for GDM." Berger (2003) The outcome of this study stated that "The short- and long-term maternal -fetal outcomes in GDM were reviewed with emphasis given to examination of the data regarding the effect of diagnosis and treatment of GDM on these outcomes." Recommendations of the study state that "A single approach of testing for GDM cannot be recommended at the present time" because stated the study, "there is not enough evidence-based data proving the beneficial effect of a large screening program." Berger (2003) Diagnostic criteria from the National Diabetes Data Group (NDDG) are the criteria most commonly used however there are others that utilize the Carpenter and Coustan criteria which is the authority for setting the cutoff for normal at lower values than previously applied.

Turok (2004) Literature Review: Clinical discussions (1993) states that "In cases where metabolic control is poor (HgA1C>8.5%), patients will be counseled regarding the risks of fetal abnormality and miscarriage ..

" (DIPT Clinical Discussions, 1993) In this discussion the fact is stated that the "optimum time for the study" (of gestational diabetes mellitus) "is 22 -- 26 weeks." A systemic evidence review conducted by Research Triangle Institute found that: "No well-conducted RCT provides direct evidence for the health benefits of screening for GDM .the evidence is unclear about the optimal screening and reference diagnostic test and cutpoint for GDM." (HSTAT 2004) A study conducted in Africa had findings that were adverse to the previous stated findings.

In a cohort study at Mulago Hospital antenatal clinics ninety mothers with gestational ages between that of 24 to 32 weeks were recruited for the study. The WHO criterion for GDM diagnosis was used. The conclusion of this study is stated as being: "Gestational Diabetes mellitus exists in Uganda and is associated with adverse maternal and fetal outcomes there is need to routinely screen mothers for gestational diabetes.