Should We Screen for Gestational Diabetes?-Reply

In Reply.  —As Dr Clemenson indicates, there is ongoing debate about screening for GDM. Recent letters in Lancet illustrate that this issue also excites controversy outside North America.^1,2 As so often occurs in medicine, this heated debate is partly an epiphenomenon of incomplete evidence. For example, like the United States Preventive Services Task Force, the Canadian Task Force on the Periodic Health Examination³ has concluded that the evidence is insufficient to recommend for or against screening. However, a 1991 survey completed by 206 academic leaders in US obstetrics showed that 97% undertook universal screening for GDM using a 50-g glucose challenge test. There was definite consistency in criteria for diagnosis and for treatment with insulin.⁴ In contrast, screening and diagnostic practices in the United Kingdom are much more variable, with limited acceptance of the glucose challenge test.⁵We suspect that controversy, along with widespread variations in practice, will