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Gestational diabetes guidelines: use with caution. (Patients Who Don't Need Screening).
LAKE TAHOE, NEV. -- Physicians need to be careful about using recently released guidelines to identify low-risk patients who can avoid screening for gestational diabetes, Dr. Andrew Combs warned at an obstetrics and gynecology conference sponsored by the University of California, Davis.
The new guidelines, which were issued in September by the American College of Obstetricians and Gynecologists, can weed out about 10% of patients who do not need the screening, but the guidelines also pose a liability risk, said Dr. Combs, director of maternal-fetal medicine at the Regional Medical Center, San Jose, Calif.
Six criteria have to be met for a patient to be identified as low risk. (See box.) "The practitioner has to document all six criteria identifying a low-risk patient, because if you end up with a mom and a big baby with a shoulder dystocia, you are in trouble if you haven't documented this," he said in an interview.
The trouble with the criteria is that they are not all straightforward. Determining that a patient is under age 25 and in a low-risk ethnic group is not problematic, but the other four criteria are more complicated, he said.
"They need to have a body mass index of 25 or less. This means remembering and doing a mathematical calculation. Next, you have to determine that they have no history of abnormal glucose tolerance, which may involve relying on their memory. Then you need to determine that they have no history of a gestational diabetic--type pregnancy outcome, which is not defined in the guidelines, and finally, that there is no diabetes in their first-degree relatives. This is a hard list to remember and get through with a patient, and my sense is that it might just be easier to send them off for the lab work," he said.
"It's reasonable to follow the ACOG guidelines and to skip the lab work in low-risk patients, but I think you need to develop a quick chart instrument to identify the patients. Otherwise, it's hard to remember," he added.
Dr. Combs recommends that patients diagnosed with ...
- Gestational Diabetes
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- Gestational Diabetes.
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- Magazine article from: OB GYN News Boschert, Sherry September 1, 2009 700+ words
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- Magazine article from: Family Practice News Zoler, Mitchel L. August 1, 2007 700+ words
...for managing women with gestational diabetes [for] everyone...significantly more cases of gestational diabetes (24% of patients using the 100-g test...of Identified Cases Of Gestational Diabetes 100-g test (n = 550...
- Researchers from Medical University of Bialystok, Department of Pathophysiology...
- Newspaper article from: Obesity & Diabetes Week September 22, 2008 700+ words
...in 32 women with abnormal results of a 50-g glucose challenge test, and in 57 patients with gestational diabetes mellitus. Patients with gestational diabetes had significantly higher IL-6 (median 1.0 [0.7-1.5] vs. 0.7 [0...
Source: HighBeam Research, Gestational diabetes guidelines: use with caution. (Patients Who...