Download PDF
Am J Perinatol 2016; 33(13): 1262-1265
DOI: 10.1055/s-0036-1585579
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ethical Dimensions of Counseling about the Clinical Management of Gestational Diabetes

Shari E. Gelber
1   Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, New York
,
Laurence B. McCullough
2   Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
,
Frank A. Chervenak
1   Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, New York
› Author Affiliations
Further Information

Publication History

28 February 2016

31 May 2016

Publication Date:
21 July 2016 (online)

    Permissions and Reprints

Abstract

Gestational diabetes is associated with both short- and long-term adverse outcomes for the mother and the child. Glycemic control to improve perinatal outcomes is consistent with the best available evidence and should be recommended. The evidence for interventions to improve long-term outcomes is less robust. Therefore, patients need to be informed of the data, have the limitations explained, and be supported in decision-making. Theoretical risks do not need to be revealed to patients. Enthusiasm for interventions not supported by evidence should not be promoted. This article provides an ethical framework for counseling patients about the management of gestational diabetes.

Keywords

counseling - ethics - respect for autonomy - gestational diabetes
 

  • References

  • 1 Committee on Practice Bulletins--Obstetrics. Practice Bulletin No. 137: gestational diabetes mellitus. Obstet Gynecol 2013; 122 (2 Pt 1) 406-416
    CrossrefPubMedGoogle Scholar
  • 2 Metzger BE, Lowe LP, Dyer AR , et al; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358 (19) 1991-2002
    CrossrefPubMedGoogle Scholar
  • 3 Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS ; Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352 (24) 2477-2486
    CrossrefPubMedGoogle Scholar
  • 4 Landon MB, Spong CY, Thom E , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361 (14) 1339-1348
    CrossrefPubMedGoogle Scholar
  • 5 Mpondo BCT, Ernest A, Dee HE. Gestational diabetes mellitus: challenges in diagnosis and management. J Diabetes Metab Disord 2015; 14: 42
    CrossrefPubMedGoogle Scholar
  • 6 Barbour LA. Unresolved controversies in gestational diabetes: implications on maternal and infant health. Curr Opin Endocrinol Diabetes Obes 2014; 21 (4) 264-270
    CrossrefPubMedGoogle Scholar
  • 7 Chervenak FA, McCullough LB. Ethics in obstetrics and gynecology. An overview. Eur J Obstet Gynecol Reprod Biol 1997; 75 (1) 91-94
    CrossrefPubMedGoogle Scholar
  • 8 Chervenak FA, McCullough LB. The Professional Responsibility Model of Perinatal Ethics. Berlin: Walter de Gruyter; 2014
    Google Scholar
  • 9 Chervenak FA, McCullough LB. An ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide. Am J Obstet Gynecol 2009; 201 (6) 560.e1-560.e6
    CrossrefPubMedGoogle Scholar
  • 10 Moyer VA ; U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 160 (6) 414-420
    PubMedGoogle Scholar
  • 11 Nicholson W, Bolen S, Witkop CT, Neale D, Wilson L, Bass E. Benefits and risks of oral diabetes agents compared with insulin in women with gestational diabetes: a systematic review. Obstet Gynecol 2009; 113 (1) 193-205
    CrossrefPubMedGoogle Scholar
  • 12 Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzales O. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med 2000; 343 (16) 1134-1138
    CrossrefPubMedGoogle Scholar
  • 13 Garabedian C, Deruelle P. Delivery (timing, route, peripartum glycemic control) in women with gestational diabetes mellitus. Diabetes Metab 2010; 36 (6 Pt 2) 515-521
    CrossrefPubMedGoogle Scholar
  • 14 American College of Obstetricians and Gynecologists. Fetal macrosomia. ACOG Practice Bulletin Number 22. Washington DC: ACOG; 2000
    Google Scholar
  • 15 Kjos SL, Peters RK, Xiang A, Henry OA, Montoro M, Buchanan TA. Predicting future diabetes in Latino women with gestational diabetes. Utility of early postpartum glucose tolerance testing. Diabetes 1995; 44 (5) 586-591
    CrossrefPubMedGoogle Scholar
  • 16 England LJ, Dietz PM, Njoroge T , et al. Preventing type 2 diabetes: public health implications for women with a history of gestational diabetes mellitus. Am J Obstet Gynecol 2009; 200 (4) 365.e1-365.e8
    CrossrefPubMedGoogle Scholar
  • 17 American Diabetes Association. Gestational diabetes mellitus. Diabetes Care 2004; 27 (Suppl. 01) S88-S90
    CrossrefPubMedGoogle Scholar
  • 18 Dabelea D, Pettitt DJ. Intrauterine diabetic environment confers risks for type 2 diabetes mellitus and obesity in the offspring, in addition to genetic susceptibility. J Pediatr Endocrinol Metab 2001; 14 (8) 1085-1091
    PubMedGoogle Scholar
  • 19 McLean M, Chipps D, Cheung NW. Mother to child transmission of diabetes mellitus: does gestational diabetes program type 2 diabetes in the next generation?. Diabet Med 2006; 23 (11) 1213-1215
    CrossrefPubMedGoogle Scholar
  • 20 Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 2005; 115 (3) e290-e296
    CrossrefPubMedGoogle Scholar
  • 21 Sacks FM, Bray GA, Carey VJ , et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009; 360 (9) 859-873
    CrossrefPubMedGoogle Scholar
  • 22 The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 1994; 330 (15) 1029-1035
    CrossrefPubMedGoogle Scholar