Screening and Diagnosis of Gestational DiabetesMellitus Critical appraisal of the new International Association of Diabetes in Pregnancy Study Group recommendations on a national level

Gestational diabetes mellitus (GDM) is associated with a high risk of immediate and late adverse outcomes for mothers and their offspring (1–4). This risk correlates with the level ofmaternal hyperglycemia (5), and glucose-lowering interventions were reported to decrease the risk of some of these adverse outcomes (6). In many countries, including Israel, a two-step approach for GDM screening is used: pregnant women undergo a 50-g oral glucose challenge test, followed by a 100-g oral glucose tolerance test (OGTT) for women who test positive on the first text (7). This practice is based on little evidence. Furthermore, the glucose thresholds used for GDM diagnosis have been set according to maternal risk of later developing type 2 diabetes rather than the immediate risk of adverse pregnancy outcomes (8). The Hyperglycemia and Adverse PregnancyOutcomes (HAPO)prospective study addressed the debate about the best screening practice and diagnostic criteria for GDM. Of 25,505 pregnant women recruited, 3,345 were from Israel. The results showed an association between fasting and postload plasma glucose levels and adverse pregnancy outcomes, even in the range previously considered normal (9). These results motivated the International Association of Diabetes in Pregnancy Study Group (IADPSG) to recommend a new screening practice and diagnostic criteria for GDM (10). The yield and practicality of screening methodsmaydiffer according to prevalence of risk factors and availability of health care resources. The current analysis was conducted to evaluate the effect of endorsing the IADPSG recommendations in Israel and to explore alternative methods for detecting women at risk for adverse pregnancy outcomes.