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Clear threshold needed for diagnosing gestational diabetes

Study shows consistent association between high blood sugar levels during pregnancy and increased risk of complications – but there is no clear evidence of a threshold effect.
Pregnancy diabetes

Study shows consistent association between high blood sugar levels during pregnancy and increased risk of complications but there is no clear evidence of a threshold effect

There is an urgent need to work out the best threshold to balance the benefits and harms of treating women with high blood glucose levels during pregnancy, say researchers from the UK and Ireland.

To examine the association between blood glucose levels in pregnant women without pre-existing diabetes, and birth outcomes such as the need for a caesarean section, the researchers looked at 23 studies involving more than 200,000 women and their infants.

When the results from all studies were combined, there was a straight-line association between glucose levels and caesarean section, induction of labour, a heavy baby and shoulder dystocia where the baby gets stuck as

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Study shows consistent association between high blood sugar levels during pregnancy and increased risk of complications – but there is no clear evidence of a threshold effect


Testing for glucose level in urine. Picture: Alamy

There is an urgent need to work out the best threshold to balance the benefits and harms of treating women with high blood glucose levels during pregnancy, say researchers from the UK and Ireland.

To examine the association between blood glucose levels in pregnant women without pre-existing diabetes, and birth outcomes such as the need for a caesarean section, the researchers looked at 23 studies involving more than 200,000 women and their infants.

When the results from all studies were combined, there was a straight-line association between glucose levels and caesarean section, induction of labour, a heavy baby and shoulder dystocia – where the baby gets stuck as the mother gives birth.

For each blood glucose increase, the risk of these problems increased by a similar amount, but there was no clear evidence of a threshold effect. The results show there is no obvious level to diagnose gestational diabetes, the researchers said.

‘We need to work out the best threshold for balancing the benefit of preventing pregnancy and birth problems by detecting and treating women with high blood glucose levels against the costs of detection and treatment, and the problems of over-treating some women and causing problems,’ the study authors said.


Farrar D et al (2016) Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis. BMJ. doi: http://dx.doi.org/10.1136/bmj.i4694 

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