Gestational diabetes mellitus: Does one size fit all? A challenge to uniform worldwide diagnostic thresholds

Abstract

OBJECTIVE To define the prevalence and pregnancy outcomes related to elevated fasting venous plasma glucose (FVPG) in a Danish pregnancy cohort. RESEARCH DESIGN AND METHODS This was an observational cohort study including 1,516 women without gestational diabetes mellitus (GDM) by Danish criteria. FVPG measured at 28 weeks’ gestation was related to pregnancy outcomes. RESULTS With use of the World Health Organization (WHO) 2013 threshold of FVPG ‡5.1 mmol/L, 40.1% of the cohort qualified as having GDM. There was no evidence of excess fetal growth, hypertension in pregnancy, or cesarean delivery in women with FVPG <5.6 mmol/L. CONCLUSIONS The WHO 2013 FVPG threshold for GDM is unsuitable for Denmark. It inappropriately labels as having GDM an unmanageably large number of women who are at low absolute risk of pregnancy complications.