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 GDM’s unfinished business - can you help?

Dr Chee L Khoo

Controversies continue over screening, management and follow up for women with gestational diabetes mellitus (GDM), with various professional organisations internationally and experts in the field suggesting different strategies or not making specific recommendations at all.

What is NOT controversial is the evidence that even mild increases in maternal blood sugar are associated with adverse pregnancy outcomes – both maternal and foetal and that reducing blood sugar improves outcomes. Whenever you have many different definitions of a disease and many different guidelines for its management internationally, it usually means our data is not complete and more studies are needed.

There are still uncertainties on:

  1. What the diagnostic criteria should be? In particular, is the diagnostic criterion in early booking different from that at 24-28 weeks?
  2. When to start medical therapy? In particular, does early treatment reduce LGA, neonatal hypoglycaemia and other complications due to GDM?
  3. What should target glucose levels be? Does early treatment increase the risk of treatment related complications such as small for gestational age (SGA). We have to consider risk of hypoglycaemia, effects of non-well-controlled GDM, and women compliance.

The TREATMENT OF BOOKING GESTATIONAL DIABETES MELLITUS STUDY (TOBOGM) is designed to answer some of those questions. WSU is leading a large collaborative undertaking the study here. If you have women who are < 20 weeks gestation and have any of the following

    • Previous Gestational Diabetes (GDM)
    • Previous baby >4.5 kg or >90th centile
    • Previously elevated blood glucose
    • Random blood glucose >7.0 mmol/L
    • Known polycystic ovarian syndrome
    • Medications: corticosteroids or antipsychotics
    • European descent and BMI >35 kg/m2
    • Non-European descent AND BMI > 25 kg/m2
    • Parent or sibling with diabetes, or a sister with/has had GDM
    • Age > 40 years

Please do not organise an OGTT. Refer them immediately to the Campbelltown Antenatal Clinic for booking-preferably under 14 weeks gestation, although any woman <20 weeks is eligible for inclusion. These women may qualify for the study. Contact details for more information:

Phone: 02 46344593, Fax: 4620 3116 email



The views expressed are views of the authors and do not necessarily represent the views of the board of SSW GP Link