Perspectives on diagnostic strategies for HIP-dealing with the barriers and challenges: USA.

BACKGROUND: Gestational diabetes (GDM) affects up to 7-18% of pregnant women and is associated with several maternal and perinatal morbidities. International organizations suggest several different recommendations regarding how to screen and to manage hyperglycemia in pregnancy (HIP).

OBJECTIVE: We aimed to analyze the most important and employed guidelines about screening and management of HIP and we investigated existing related literature.

RESULTS: We found several different criteria for screening for HIP, with the main difference being between non-USA-based IADPSG (One-step) approach, and the USA-based (Two-step) approach. The use of IADPSG approach (One-step) is associated with an increase in the incidence of GDM, improvement of several maternal and perinatal outcomes, and cost-effectiveness, compared to the USA-based Two-step criteria.

CONCLUSIONS: As the One-Step approach endorsed by IADPSG, WHO, and FIGO is associated with maternal and perinatal benefits, it should be preferred to the Two-Step approach currently endorsed by the USA-based societies such as ACOG and SMFM. The hope is to approve universal screening guidelines based on the One-step approach to improve health care and reduce costs and adverse outcomes for women with GDM.