History of Gestational Diabetes as a Clinical Entity
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Short History of Gestational Diabetes as a Clinical
as a clinical entity officially began in 1979 when the National Diabetes Data
Group (NDDG) issued an updated classification of diabetes types, including one
that was present only during pregnancy. In
1979, the First International Workshop-Conference on Gestational Diabetes
Mellitus also met, essentially declared GD a disease, finding it a significant
health risk that needed treatment. Instead
of the more neutral “Carbohydrate Intolerance of Pregnancy”, the term
“Gestational Diabetes Mellitus” was used (often shortened in various
resources to Gestational Diabetes, GD, or GDM). Authorities felt that if the term ‘diabetes’ was used,
women would be more likely to take the diagnosis seriously and insurance
companies would be much more likely to cover treatment for it.
the idea of subclinical glucose levels in pregnancy affecting mother or baby (or
being an early sign of future full-blown diabetes) had been discussed
previously. Hadden (1998) reports
incidents in the medical literature appearing as early as 1823 where
diabetic-like conditions presented during pregnancy but seemed to disappear
afterwards. However, greater
attention to the concept that lesser degrees of hyperglycemia might negatively
affect a pregnancy began to appear in the 1940s and 1950s. In these studies, researchers found increased perinatal
mortality among the babies of women who developed diabetes years later, leading
to the coining of the term “prediabetes in pregnancy.”
researcher J.P. Hoet published a study on “Carbohydrate Metabolism During
Pregnancy” and first used the term, “metagestational diabetes” in 1954.
His investigations sparked a series of investigations in the 50s and 60s.
Jorgen Pedersen probably was the first to use the modern term
“gestational diabetes” in 1967, and this was the term promoted by Dr.
Norbert Freinkel and associates, later adopted by the First International
Workshop-Conference on Gestational Diabetes Mellitus.
first major prospective study was established in Boston in 1954, and the 1-hour
50-gram glucose screening test was first used there. However, the emphasis was on criteria that established risk
for future diabetes, not on risk to the fetus.
The results from this Boston study were presented by O’Sullivan and
Mahan in 1964, and showed that higher blood glucose values in pregnancy
correlated with the development of diabetes later in life.
study is usually seen as the main beginning of the examination of the effects of
decreased glucose tolerance in pregnancy. O’Sullivan
and others followed up with further studies in the late 60s and 70s that showed
an increased rate of perinatal mortality associated with abnormal glucose
tolerance. However, critics charge
that rather than showing that abnormal Glucose Tolerance Tests (GTTs) correlated
with poor pregnancy outcomes, it instead showed that the indication for testing
correlated with poor outcome. In other words, women with big babies or prior pregnancy
losses were more likely to have similar outcomes in future pregnancies, no
matter what the GTTs showed.
October 1979, Dr. Norbert Freinkel (representing the American Diabetes
Association) and Dr. John Josimovich (representing the American College of
Obstetricians and Gynecologists) met in Chicago at the First International
Workshop Conference on Gestational Diabetes Mellitus. They gathered together experts from around the world to share
their clinical experience, research, and opinions about GDM.
Between this conference and the re-classifications from the National
Diabetes Data Group, Gestational Diabetes as an official clinical entity was
born. It is now defined as, “Carbohydrate
intolerance of variable severity with onset or first recognition during the
present pregnancy. The definition
applies whether insulin is used for treatment or the condition persists after
pregnancy but does not exclude the possibility that the glucose intolerance may
have antedated the pregnancy.”
Workshop Conferences have been held every few years (October 1984, November
1990, and March 1997). At each
conference, participants endeavor to hammer out agreements on the proper testing
protocols and care for women and babies of GD pregnancies.
However, significant disagreement about these care protocols still
exists, particularly between the policies of most US doctors and those of the
international community. Although most doctors present GD as a well-established
and non-controversial diagnosis, there remains a great deal of medical
controversy even within the GD community itself, let alone among the critics of
Hadden, DR. A Historical Perspective on Gestational Diabetes. From the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. August 1998. Volume 21 (Supplement 2), text available at the following website, http://www.diabetes.org/DiabetesCare/Supplement298/B161.htm.
Goer, Henci. Obstetric Myths vs. Research Realities. Westport, Connecticut: Bergin and Garvey, 1995. Can be ordered online from http://www.efn.org/~djz/birth/obmyth/
Goer, Henci. "Gestational Diabetes: The Emperor Has No Clothes." Birth Gazette. Spring 1996: Volume 12, Number 2. www.fensende.com/Users/swnypmph/Midwife/GDhgoer.html.
Understanding Diagnostic Tests in the Childbearing Year.
Sixth Edition. Portland,
Oregon: Labrys Press, 1997.
Holistic Midwifery: Volume I (Care During Pregnancy). Revised.
Portland, Oregon: Labrys Press, 1995.
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