In Germany, the diagnosis of gestational diabetes is recognized in only 10% of the patients with gestational diabetes. Therefore 36,000 pregnant patients per year are undiagnosed. The reason is an insufficient screening system which plans only the determination of the glucosuria at each prenatal visit. Several studies have shown the low sensitivity of glucosuria in the detection of gestational diabetes. The majority of the gynecologists are under the assumption of having a healthy pregnant woman in front of them. Therefore a screening with the 50 g-glucose screening test or the 75 g-oral glucose tolerance test is necessary. Our observations have shown an influence of the previous meal on the 50 g-glucose screening test. Therefore we would prefer the one-step screening with the 75 g-oral glucose test. The costs of the one-step or two-step regimen are similar. Also a screening only of high risk pregnancies appears insufficient. Using an average age below 25 years and body-mass index below 25 kg/mg2, only 13.7% of our patients would not be screened. Of those, 3.1% have gestational diabetes. The decision to offer the screening as an individual health achievement, which has to be paid by the patients, does not take into consideration the importance of the illness. A general screening, preferably one-step screening should be offered to each pregnant woman.
