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Glucose Tolerance ScreenFrom: Arthurfree@aol.comFri Apr 5 19:50:23 1996
Sorry to have let the string pass by before replying, but I moved recently and it took some time to find the references. In the ACOG/AAP "Guidelines for Perinatal Care" pp 53-4 (1992, the new one has been "just around the corner" for a while now): "Certain risk factors for diabetes mandate maternal glucose screening: -Family history of diabetes -Previous macrosomic, malformed, or stillborn infant -Hypertension -Glycosuria -Maternal age 30 years or older" Note, this reference is silent on universal screening (neither supports nor refutes). And in the second edition of the "Guide to Clinical Preventive Services" (Report of the US Preventive Services Task Force, published 1/96) Chapter 19 contains an extensive review of the literature and concludes: "There is . . . insufficient evidence to recommend for or against routine screening for GDM <gestational diabetes> ('C' recommendation)." The sense was that screening and subsequent treatment would decrease the incidence of macrosomia somewhat, but that other measure of perinatal outcome (death, shoulder dystocia, operative delivery) had not been proven to be affected significantly. The cites are quite complete, and would be a good place to start for anyone wanting to look into the subject on their own. It is more likely this latter recommendation (by substance, source, and timing) which led the Pennsylvania HMO to begin denying routine one hour glucose screens. Arthur Freeland, MD Centerville, Iowa
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