In pursuit of consensus – a national review of gestational diabetes

Aims Approaches to screening, diagnosis and therapeutic practices for gestational diabetes (GDM) demonstrate great international heterogeneity. We sought to evaluate the clinical experience of GDM care provision from an Irish perspective.

Methods A web- based questionnaire was distributed to all Irish maternity units. Consultant obstetricians, consultant endocrinologists and midwives working in obstetric diabetes departments were consulted. Management pertaining to screening, diagnosis, prenatal surveillance, education delivery and future scope for telemedical approaches was evaluated.

Results Feedback was received from all 19 Irish maternity units. Selective risk factor based screening was practiced by all units with the majority (n=18; 95%) subsequently adopting a one-step 75g two hour oral glucose tolerance test (OGTT) to complete the screening process. WHO 2013 diagnostic criteria were followed by 15 (83%) of obstetric diabetes units. Glycaemic surveillance and treatment thresholds were equally disparate . A wide variation was noted in the involvement of specialised dieticians in GDM management. Overwhelmingly, a desire for national cohesion and adaptation of existing care delivery pathways for GDM was identified.

Discussion While the disparity in adopted clinical practice of GDM is not unique to Ireland it does highlight the need for a national strategic approach to the diagnosis and management of GDM ultimately aspiring to optimize maternal and neonatal outcomes.