Share the load: opportunities for international collaboration

We are all constantly exposed to guidelines: writing them, reviewing them and hopefully following their recommendations. However, we are also all aware that many of these guidelines are based on inadequate or ever-changing evidence. Many guidelines appear to be written by lawyers with so many exceptions or options that the advice becomes virtually useless. The process of guideline development is now well established and is designed to reflect uncertainty where it exists. The grading of evidence and the acceptance of minority or non-unanimous points of view better reflects the reality of clinical decision-making but makes implementation of such guidelines problematic. The enormous task of collating, reviewing, and distilling the evidence in an area such as obstetric medicine is daunting. For historical reasons we have tended to approach these tasks regionally. For example, there are guidelines for recommended weight gain in pregnancy from the USA1 but in the UK the National Institute for Health and Clinical Excellence (NICE) Guidelines provide no formal recommendation on what constitutes appropriate weight gain during pregnancy.2 Currently, many countries are grappling with the recommendations from the International Association of Diabetes Pregnancy Study Groups (IADPSG) regarding the diagnosis and classification of hyperglycaemia in pregnancy.3 In this case, a complex and time-consuming formal process has led to recommendations which then need to be implemented in each country. The argument for International Guidelines in Obstetric Medicine is obvious: harness global expertise to produce a uniform guideline and if necessary amend with local protocols that reflect any minor regional differences. In this edition of Obstetric Medicine, Linda Barbour presents a review of the Institute of Medicine (IOM) weight gain in pregnancy guidelines from the point of view of both mother and baby. Our research articles this month are on the related topics of gestational diabetes and weight. We also have a review on the common subject of antihypertensive therapy in pregnancy and this is complemented by a journal watch addressing a new analysis of angiotensin-converting enzyme inhibitors and their effects in early pregnancy. This edition of Obstetric Medicine will be published just prior to the Sixth International Scientific Meeting of ISOM (the International Society of Obstetric Medicine) to be held in Oxford on 7–8 July 2012.4 This promises to be an informative and stimulating meeting. It also offers the opportunity to meet with colleagues in the field of obstetric medicine and discover what guidelines they have already developed. We should also take the time to consider subjects which might be suitable for an international guideline. As an organization, ISOM can play a role in helping us share knowledge and experience along with other useful information.