(The following letter is in response to an article submitted by the Huron Perth Healthcare Alliance Diabetes Education Centre.)
I am writing in response to your article of November 28 entitled “Risks for gestational diabetes.” I am concerned that the article does not present complete information and is therefore not accurately informing pregnant women about the risks and benefits of screening for gestational diabetes.
While no one would argue that well-controlled blood sugar levels are important to the health of both a pregnant woman and her developing fetus, there is by no means good quality evidence, or even consensus among care-givers, to support a recommendation for universal screening of all pregnant women.
I would reference the Society and Obstetricians and Gynecologists of Canada’s clinical practice guideline entitled “Screening for Gestational Diabetes Mellitus.” Quoting from this guideline, “A single approach of testing for GDM cannot be recommended at the present as there is not enough evidence-based data proving the beneficial effect of a large screening program.”
Because of the lack of good evidence, the guideline goes on to say that any one of a number of approaches is considered acceptable, including an approach of non-screening adopted by a “small but significant number of Canadian obstetricians and centers.”
I think it is also important to note that while research does document a decrease in the incidence of larger babies when women are screened and treated for gestational diabetes, a decrease in birth trauma has not been well-documented and there is, in fact, some evidence of increased caesarean section rates. This demonstrates that an approach of universal screening for gestational diabetes is not without potential harm.
Women should also be informed that the screening test for gestational diabetes is far from perfect. It will sometimes misdiagnose women as either having gestational diabetes when they do not, or vice versa. So while your article is correct in saying that screening based on risk factors will not identify all women with gestational diabetes, it is important to note that, nor will universal screening.
What I would like to advocate is true informed choice for pregnant women. We know that women who feel fully-informed about their care and have the opportunity to make choices that are right for them are more satisfied and feel more empowered. I think it’s fair to assume that we would all see this as a beneficial outcome.
But if women and their families are not presented with complete and accurate information, they will not be afforded the opportunity to make a truly informed choice.