History of GD

A Short History of Gestational Diabetes as a Clinical Entity

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A Short History of Gestational Diabetes as a Clinical Entity

GD as a clinical entity officially began in 1979 when the National Diabetes Data Group (NDDG) issued an updated classification of diabetes types, including one that was present only during pregnancy. In 1979, the First International Workshop-Conference on Gestational Diabetes Mellitus also met, essentially declared GD a disease, finding it a significant health risk that needed treatment. Instead of the more neutral “Carbohydrate Intolerance of Pregnancy”, the term “Gestational Diabetes Mellitus” was used (often shortened in various resources to Gestational Diabetes, GD, or GDM). Authorities felt that if the term ‘diabetes’ was used, women would be more likely to take the diagnosis seriously and insurance companies would be much more likely to cover treatment for it.

However, the idea of subclinical glucose levels in pregnancy affecting mother or baby (or being an early sign of future full-blown diabetes) had been discussed previously. Hadden (1998) reports incidents in the medical literature appearing as early as 1823 where diabetic-like conditions presented during pregnancy but seemed to disappear afterwards. However, greater attention to the concept that lesser degrees of hyperglycemia might negatively affect a pregnancy began to appear in the 1940s and 1950s. In these studies, researchers found increased perinatal mortality among the babies of women who developed diabetes years later, leading to the coining of the term “prediabetes in pregnancy.”

Belgian researcher J.P. Hoet published a study on “Carbohydrate Metabolism During Pregnancy” and first used the term, “metagestational diabetes” in 1954. His investigations sparked a series of investigations in the 50s and 60s. Jorgen Pedersen probably was the first to use the modern term “gestational diabetes” in 1967, and this was the term promoted by Dr. Norbert Freinkel and associates, later adopted by the First International Workshop-Conference on Gestational Diabetes Mellitus.

The first major prospective study was established in Boston in 1954, and the 1-hour 50-gram glucose screening test was first used there. However, the emphasis was on criteria that established risk for future diabetes, not on risk to the fetus. The results from this Boston study were presented by O’Sullivan and Mahan in 1964, and showed that higher blood glucose values in pregnancy correlated with the development of diabetes later in life.

This study is usually seen as the main beginning of the examination of the effects of decreased glucose tolerance in pregnancy. O’Sullivan and others followed up with further studies in the late 60s and 70s that showed an increased rate of perinatal mortality associated with abnormal glucose tolerance. However, critics charge that rather than showing that abnormal Glucose Tolerance Tests (GTTs) correlated with poor pregnancy outcomes, it instead showed that the indication for testing correlated with poor outcome. In other words, women with big babies or prior pregnancy losses were more likely to have similar outcomes in future pregnancies, no matter what the GTTs showed.

In October 1979, Dr. Norbert Freinkel (representing the American Diabetes Association) and Dr. John Josimovich (representing the American College of Obstetricians and Gynecologists) met in Chicago at the First International Workshop Conference on Gestational Diabetes Mellitus. They gathered together experts from around the world to share their clinical experience, research, and opinions about GDM. Between this conference and the re-classifications from the National Diabetes Data Group, Gestational Diabetes as an official clinical entity was born. It is now defined as, “Carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy. The definition applies whether insulin is used for treatment or the condition persists after pregnancy but does not exclude the possibility that the glucose intolerance may have antedated the pregnancy.”

Further Workshop Conferences have been held every few years (October 1984, November 1990, and March 1997). At each conference, participants endeavor to hammer out agreements on the proper testing protocols and care for women and babies of GD pregnancies. However, significant disagreement about these care protocols still exists, particularly between the policies of most US doctors and those of the international community. Although most doctors present GD as a well-established and non-controversial diagnosis, there remains a great deal of medical controversy even within the GD community itself, let alone among the critics of GD.

References

Hadden, DR. A Historical Perspective on Gestational Diabetes. From the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. August 1998. Volume 21 (Supplement 2), text available at the following website, http://www.diabetes.org/DiabetesCare/Supplement298/B161.htm.

Goer, Henci. Obstetric Myths vs. Research Realities. Westport, Connecticut: Bergin and Garvey, 1995. Can be ordered online from http://www.efn.org/~djz/birth/obmyth/

Goer, Henci. "Gestational Diabetes: The Emperor Has No Clothes." Birth Gazette. Spring 1996: Volume 12, Number 2. www.fensende.com/Users/swnypmph/Midwife/GDhgoer.html.

Frye, Anne. Understanding Diagnostic Tests in the Childbearing Year. Sixth Edition. Portland, Oregon: Labrys Press, 1997.

Frye, Anne. Holistic Midwifery: Volume I (Care During Pregnancy). Revised. Portland, Oregon: Labrys Press, 1995.

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