THE GESTATIONAL DIABETES-MELLITUS CONFERENCES - 3 ARE HISTORY - FOCUSON THE 4TH

This study reviews the summary and recommendations of the first three International Workshops Conferences on Gestational Diabetes Mellitus ( GDM) and highlights areas of controversy requiring further research an d discussion. The International Workshop Conferences on GDM held in 19 79, 1984, and 1990 established a definition of GDM, confirmed the valu e of universal screening with a 50-g oral glucose load, recommended us e of the 100-g oral glucose tolerance test with interpretation accordi ng to the diagnostic criteria of O'Sullivan and Mahan, and emphasized the importance of classification after pregnancy with a 75-g oral gluc ose tolerance test with classification according to the criteria of th e National Diabetes Data Group or the World Health Organization. Recom mendations for management have included nutritional counseling with li mitation of the intake of concentrated sweets, monitoring maternal glu cose levels to maintain the fasting plasma glucose < 105 mg/dl and the 2-h postprandial plasma glucose < 120 mg/dl, initiating insulin thera py if treatment with diet fails, and prohibiting the use of oral hypog lycemic agents. Antepartum fetal surveillance with emphasis on the eva luation of fetal growth using clinical and ultrasonographic techniques to detect macrosomia were also proposed. Although much has been accom plished in the first three conferences,areas of continued controversy include establishing a definition and method of detection for GDM that can be agreed on worldwide; defining the appropriate glucose levels t o initiate dietary and/or insulin therapy; preventing macrosomia, as w ell as detecting and managing it, to reduce the cesarean delivery rate ; and determining the long-term consequences for the mother with GDM a nd her infant through further studies.