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October 21, 2015

For this test, the pregnant woman has to attend her doctor's surgery in the morning, having fasted overnight, and drink a concentrated glucose solution. Three blood samples are subsequently taken within 2 hours. The diagnosis is confirmed if at least one of the blood sugar level measurements is too high.

Some experts consider this test of several hours' duration to be too cumbersome to be introduced for all pregnant women. They propose a pre-selection process. Consequently, the second proposal for a test strategy is that only those women undergo an oGTT who display specific risk factors for gestational diabetes, such as older age, overweight or diabetes in the family.

The third proposal is to introduce a short version of the glucose tolerance test in the pre-selection. As part of a routine appointment, the pregnant woman would drink a smaller amount of glucose solution and have only one blood sample taken after 1 hour. Only those women whose blood sugar levels were then above a pre-determined threshold would be given an appointment for a full tolerance test.

Other screening strategies were directly compared in studies

One result of the report is that those pregnant women for whom the relevant therapy studies have shown a benefit were selected by undergoing a short glucose test as the first step. "As long as good screening studies are lacking, we find it difficult to recommend other strategies", says Sawicki.

Consequently, many tests for gestational diabetes that are already being offered to pregnant women should be viewed critically. "These tests label many pregnant women as being at risk, without it being clear whether they would actually profit from having treatment", explains Sawicki. A harm is particularly likely if a woman with a mild metabolic disorder during pregnancy is recommended to have treatment which is too strong.

In IQWiG's opinion, therefore, a study that directly compares the advantages and disadvantages of different screening strategies for mother and child is overdue. According to Sawicki, "In view of the number of pregnancies per year in Germany (more than 600,000), such a study could be carried out relatively quickly."

Source: Institute for Quality and Efficiency in Health Care