Chapter 11. Gestational Diabetes Mellitus: A Commentary

  1. R. Williams2,
  2. W. Herman3,
  3. A.-L. Kinmonth5 and
  4. N. J. Wareham4
  1. Thomas A. Buchanan

Published Online: 9 APR 2003

DOI: 10.1002/0470846585.ch11

The Evidence Base for Diabetes Care

The Evidence Base for Diabetes Care

How to Cite

Buchanan, T. A. (2002) Gestational Diabetes Mellitus: A Commentary, in The Evidence Base for Diabetes Care (eds R. Williams, W. Herman, A.-L. Kinmonth and N. J. Wareham), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/0470846585.ch11

Editor Information

  1. 2

    Nuffield Institute for Health, University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK

  2. 3

    Department of Internal Medicine and Epidemiology, 1500 East Medical Center Drive, 3920 Taubman Center, Box 0345, Ann Arbor, MI 48109, USA

  3. 4

    Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

  4. 5

    General Practice and Primary Care Research Unit, Dept. of Public Health & Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

Author Information

  1. Medicine, Obstetrics and Gynaecology, and Physiology and Biophysics, USC Keck School of Medicine, 6602 General Hospital, 1200 N States Street, Los Angeles, CA 90089-9317, USA

Publication History

  1. Published Online: 9 APR 2003
  2. Published Print: 27 AUG 2002

ISBN Information

Print ISBN: 9780471988762

Online ISBN: 9780470846582



  • maternal glucose level;
  • perinatal complication;
  • long-term complication;
  • screening;
  • risk assessment;
  • obesity;
  • glucose threshold;
  • insulin resistance


The evidence from cross-sectional studies indicates that the risk of perinatal complications increases in a gradual, continuous fashion along with increasing glucose concentrations in the maternal circulation in human pregnancies. The absence of a threshold that distinguishes low-risk from high-risk pregnancies explains the controversies surrounding gestational diabetes. The options are to set low glucose thresholds for diagnosis, identifying large numbers of women as potentially at risk but including many false positives. The more specific approach would miss many women who would have abnormal pregnancies. No direct comparison of the two approaches has been made. Many questions await well designed studies that address perinatal outcome, not maternal glucose levels. For women who have had gestational diabetes, interventions to delay or prevent the onset of diabetes by ameliorating insulin resistance currently being tested include diet and exercise, biguanide therapy and thiazolidinedione therapy.