New criteria for diagnosing gestational diabetes could overlook around 4,000 women at risk of the disease, according to a new report.
The study, conducted at Cambridge University, comes after the National Institute for Health and Care Excellence reduced their original guidelines, insists that even the updated guidelines are too strict.
The World Health Organisation (WHO) has its own guidelines for gestational diabetes, which places the threshold for gestational diabetes much lower than the guidelines of NICE.
The NICE guidelines
NICE introduced its new gestational diabetes guidelines in February. According to those guidelines, pregnant women should be given an oral glucose tolerance test. This involves having their blood sugar tested, then drinking a high-glucose drink, then having their blood glucose tested again two hours later. If the reading is 5.6mmol/L or higher, the patient can be diagnosed with gestational diabetes.
According to the report from Cambridge, this threshold is too high.
The WHO guidelines
The WHO guidelines are slightly different. Patients must take three blood tests, and any reading of 5.1mmol/L or higher is enough for a diagnosis of gestational diabetes.
According to Dr. Claire Meek, author of the study, there is a significant difference between the two guidelines:
“The international criteria are based on minimising the risk of harm to the mother and baby, whereas the NICE criteria have been based upon reducing costs to the NHS.
“While cost-effectiveness is important in any healthcare system, we must not forget the psychological and emotional distress that complications can cause.”
How was the study conducted?
The researchers examined 25,000 women, all of whom gave birth at the Rosie Hospital in Cambridge.
In particular, they focused on women with fasting blood glucose levels between 5.1 and 5.6mmol/L – those who represent the difference between the two guidelines – and found that they had double the risk of a number of pregnancy complications. These included the need for an emergency Caesarean section, a baby with high birth weight, and a high risk of excessive amniotic fluid.
According to the study, the stricter threshold applied to pregnant mothers in the UK could mean a lack of treatment for as many as 4,000 pregnant women with gestational diabetes.
Gestational diabetes guidelines: two sides to the debate
Dr. Meek admitted that there is not “a great amount of evidence,” to support either side of the debate, but stressed the importance of directing “resources to people who would really benefit.” In other words, if there is any indication that the current guidelines are placing mothers and babies at risk, then they need to be updated.
Professor Mark Baker, director of clinical practice at NICE, is somewhat sceptical about the WHO guidelines.
“The expert NICE guideline development group undertook careful analysis with an economic model that showed the WHO 2013 criteria were not cost-effective; their criteria did not provide enough benefit in relation to the increased costs.
“In addition, the WHO recommendation was weak and the WHO noted that their 2013 criteria may need rapid revision as economic data becomes available.
“We welcome new research in this important area and will keep the guideline under surveillance.”
The Cambridge study was published in Diabetologia.

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