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Re: Gestational diabetes mellitus: screening in subsequent pregnancies

Dear Editor

I read with interest the report of an unusual case of gestational diabetes mellitus (GDM) in early pregnancy in two successive pregnancies by Shankar et al.[1] Authors have rightly emphasized the importance of the early screening of GDM at first antenatal visit in women with history of GDM in previous pregnancies or with a strong family history of diabetes mellitus. In fact, an early detection of GDM has been a matter of concern and debate at various international forums in last few decades. American college of obstetricians and gynecologists (1990) have recommended the universal screening for GDM between 24 –28 weeks of gestation in all pregnancies. Subsequently, these recommendations were revised in 1994 to include a much needed earlier screening for GDM in women with previous history of GDM.[2] In view of these recommendations, pregnant women with strong family history of diabetes mellitus and development of GDM in previous pregnancies with or without a poor obstetric outcome need to be screened at first antenatal visit. Although patients’ anxiety and the fear also needs to be addressed with a due consideration but this alone should not be the criteria guiding the treating physician to screen these women, as it apparently appears from this report.

References

(1) Shankar P, Sundarka MK, Sundarka A. An unusual case of Gestational diabetes mellitus. Post Grad Med J2002;78:562-563.

(2) American college of obstetricians and gynecologist: Diabetes and pregnancy. Technical Bulletin 1994, no.200, December 1994.