Gestational diabetes and ethics

According to the National Institute for Health and Care Excellence (NICE) around 700 000 women give birth in England and Wales annually; up to 5% of these women have either pre-existing diabetes or gestational diabetes mellitus (GDM); and the incidence of GDM is rising because of higher obesity rates in the general population and more pregnancies in older women (NICE, 2015).

In a UK study, Barker et al (2017) identified 3 033 women with GDM, reporting that the strongest risk factor for GDM was obesity, and that other significant risk factors included Asian ethnicity, previous GDM and pharmacological treatment for GDM; Sukumar et al (2016) conducted the first UK study to show that maternal blood vitamin B12 concentrations are associated with body mass index, risk of GDM and may have an independent effect on macrosomia; and Stacey et al (2019) reported that optimal screening and diagnosis of GDM mitigate ‘the higher risks of late stillbirth in women “at risk” of GDM and/or with raised fasting plasma glucose (FPG). Failure to diagnose GDM leaves women with raised FPG exposed to avoidable risk of late stillbirth.’