Materiały źródłowe

• #1 Diagnosis and Management of Gestational Diabetes Mellitus | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0701/p57.html

  Gestational diabetes occurs in 5 to 9 percent of pregnancies in the United States and is growing in prevalence. […] Diagnosis is made using a sequential model of universal screening with a 50-g one-hour glucose challenge test, followed by a diagnostic 100-g three-hour oral glucose tolerance test for women with a positive screening test. […] Evidence for screening, diagnosing, and managing gestational diabetes mellitus has continued to accrue over the past several years. […] Gestational diabetes is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. […] For women with a positive screening test, the 100-g three-hour oral glucose tolerance test is used to diagnose gestational diabetes. […] Gestational diabetes is diagnosed if two or more plasma glucose measurements meet or exceed the following thresholds: fasting level of 95 mg per dL (5.25 mmol per L), one-hour level of 180 mg per dL (10.00 mmol per L), two-hour level of 155 mg per dL (8.60 mmol per L), or three-hour level of 140 mg per dL.

• #2 Diabetes Mellitus and Pregnancy: Practice Essentials, Gestational Diabetes, Maternal-Fetal Metabolism in Normal Pregnancy

  https://emedicine.medscape.com/article/127547-overview

  Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy. […] Gestational diabetes mellitus accounts for 90% of cases of diabetes mellitus in pregnancy, while preexisting type 2 diabetes accounts for 8% of such cases. […] The US Preventive Services Task Force (USPSTF) recommends screening for gestational diabetes mellitus after 24 weeks of pregnancy. The recommendation applies to asymptomatic women with no previous diagnosis of type 1 or type 2 diabetes mellitus. […] Women with prediabetes identified before pregnancy should be considered at extremely high risk for developing gestational diabetes mellitus during pregnancy. As such, they should receive early (first-trimester) diabetic screening. […] Once the diagnosis of diabetes is established in a pregnant woman, continued testing for glycemic control and diabetic complications is indicated for the remainder of the pregnancy.

• #3 Screening and diagnosis of gestational diabetes | The BMJ

  https://www.bmj.com/content/381/bmj-2022-071920

  Gestational diabetes may affect up to 30% of pregnancies, depending on the population, screening strategy and diagnostic criteria. […] Screening and diagnosis, with subsequent treatment of gestational diabetes after 24 weeks gestation, reduces maternal, fetal, and newborn complications. […] In the absence of international consensus, offer screening and diagnosis using local hospital, national, or international guidelines, taking into account available resources. […] Women who have experienced gestational diabetes are at higher risk of developing type 2 diabetes and are therefore a key group for targeted diabetes prevention support. […] There are three key tests that may be used alone or in combination for the screening and diagnosis of gestational diabetes: risk factors by clinical history to determine need for testing, glucose challenge test, and.

• #4 Patient education: Gestational diabetes (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/gestational-diabetes-beyond-the-basics/print

  Gestational diabetes is a type of diabetes that can develop during pregnancy in individuals who don’t already have diabetes. The Centers for Disease Control and Prevention (CDC) estimates that gestational diabetes affects between 2 and 10 percent of pregnancies in the United States. It usually goes away after delivery. […] Diagnosis and treatment of gestational diabetes is important to minimize the risk of complications from the disorder. […] We recommend that all pregnant individuals get tested for gestational diabetes. […] Testing for gestational diabetes is usually done once between 24 and 28 weeks of pregnancy. […] There are a few ways to test for gestational diabetes. […] Gestational diabetes is diagnosed if you have two or more elevated blood sugar values during the GTT, although some doctors may recommend treatment after a single elevated value, especially if you have other signs of gestational diabetes (a big fetus or extra fluid around your fetus).

• #5 Gestational diabetes – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/diagnosis-treatment/drc-20355345

  If you’re at average risk of gestational diabetes, you’ll likely have a screening test during your second trimester between 24 and 28 weeks of pregnancy. […] If you’re at high risk of diabetes for example, if you’re overweight or obese before pregnancy; you have a mother, father, sibling or child with diabetes; or you had gestational diabetes during a previous pregnancy your health care provider may test for diabetes early in pregnancy, likely at your first prenatal visit. […] Screening tests may vary slightly depending on your health care provider, but generally include: […] Initial glucose challenge test. You’ll drink a syrupy glucose solution. One hour later, you’ll have a blood test to measure your blood sugar level. A blood sugar level of 190 milligrams per deciliter (mg/dL), or 10.6 millimoles per liter (mmol/L), indicates gestational diabetes.

• #6 Tests & Diagnosis for Gestational Diabetes – NIDDK

  https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/gestational/tests-diagnosis

  Testing for gestational diabetes usually occurs between 24 and 28 weeks of pregnancy. […] If you have an increased chance of developing gestational diabetes, your doctor may test for diabetes during the first visit after you become pregnant. […] Doctors use blood tests to diagnose gestational diabetes. You may have the glucose challenge test, the oral glucose tolerance test, or both. These tests show how well your body uses glucose. […] You may have the glucose challenge test first. Another name for this blood test is the glucose screening test. In this test, a health care professional will draw your blood 1 hour after you drink a sweet liquid containing glucose. […] If your blood glucose is too high140 or moreyou may need to return for an oral glucose tolerance test while fasting. […] The OGTT measures blood glucose after you fast for at least 8 hours. […] High blood glucose levels at any two or more blood test timesfasting, 1 hour, 2 hours, or 3 hoursmean you have gestational diabetes.

• #7 Screening For Gestational Diabetes – FOGSI

  https://www.fogsi.org/screening-for-gestational-diabetes/

  Insulin is detectable in the fetal pancreas as early as 9 weeks after conception. […] This necessitates performing the test procedures to diagnose GDM in the first trimester itself. […] By following the usual recommendation for screening between 24 and 28 weeks of gestation, the chance of detecting unrecognized type 2 diabetes before pregnancy (pre-GDM) is likely to be missed. […] A pregnant woman found to have normal glucose tolerance [NGT], in the first trimester, should be tested for GDM again around 24th 28th week and finally around 32nd 34th week.

• #8 Gestational Diabetes Mellitus: Screening and Management – The ObG Project

  https://www.obgproject.com/2023/01/02/acog-releases-updated-guidance-gestational-diabetes/

  Gestational diabetes mellitus (GDM) has become increasingly prevalent worldwide. Class A1GDM refers to diet-controlled GDM. Class A2GDM refers to the clinical scenario where medications are required. The following synopsis highlights key practice points from various professional organizations. […] ACOG supports the ‘2 step’ approach (24 to 28 week 1 hour venous glucose measurement following 50g oral glucose solution), followed by a 100g 3 hour oral glucose tolerance test (OGTT) if positive. […] Note: Diagnosis of GDM is based on 2 abnormal values on the 3 hour OGTT. […] ACOG recommends that currently there is insufficient evidence to diagnose GDM based on only one abnormal value. […] The USPSTF recommends screening for gestational diabetes in asymptomatic pregnant persons at ≥24 weeks of gestation or after (B recommendation).

• #9 Recommendation: Gestational Diabetes: Screening | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/gestational-diabetes-screening

  Several factors increase a person’s risk for developing gestational diabetes, including obesity, increased maternal age, history of gestational diabetes, family history of diabetes, and belonging to a racial/ethnic group that is at increased risk for developing type 2 diabetes. […] Screening for gestational diabetes in asymptomatic persons involves either a 2-step (screening test followed by a diagnostic test) or 1-step (diagnostic test used for all patients) approach. […] A diagnosis of gestational diabetes is made when 2 or more glucose values fall at or above the specified glucose thresholds. […] Initial treatment generally includes moderate physical activity, dietary changes, support from diabetes educators and nutritionists, and glucose monitoring. […] Treatment of gestational diabetes at 24 weeks of gestation or after was associated with decreased risk of primary cesarean deliveries and preterm deliveries.

• #10 Diagnosed With Gestational Diabetes – CHRISTUS Health

  https://www.christushealth.org/connect/your-health/childrens-health-and-wellness-stories/diagnosed-with-gestational-diabetes

  Every year, 2 to 10 percent of pregnancies in the United States are affected by gestational diabetes. What exactly is it, and how can it be managed effectively? We recently sat down with Dr. Shad Deering to talk about gestational diabetes and what women need to know. […] Gestational diabetes is a type of diabetes that occurs during pregnancy. Its usually diagnosed when a woman is between 24 to 28 weeks pregnant with a one-hour glucose tolerance test. […] There are certain risk factors that predispose a woman to develop gestational diabetes. First, if you had it before with another pregnancy and specifically if your baby weighed more than nine pounds, the likelihood of you developing gestational diabetes is greater. Also, if you have polycystic ovarian syndrome (PCOS), you are also at risk. Other risk factors include being Hispanic or Black, having a family member with diabetes, having hypertension, or having a body mass index (BMI) of over 25.

• #11 Screening, Diagnosis, and Management of Gestational Diabetes Mellitus | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0401/p460.html

  Gestational diabetes mellitus (GDM) affects approximately 6% of pregnancies in the United States, and it is increasing in prevalence. Pregnant women without known diabetes mellitus should be screened for GDM after 24 weeks of gestation. […] Women with GDM should be screened at six to 12 weeks postpartum, and every three years thereafter, for abnormal glucose metabolism. […] In 2014, the U.S. Preventive Services Task Force updated its 2008 statement to recommend that asymptomatic pregnant women be screened for GDM after 24 weeks of gestation (B recommendation). Most clinicians in the United States use a two-step approach, first administering a 50-g non-fasting oral glucose challenge test at 24 to 28 weeks, followed by a 100-g fasting test for women who have a positive screening result. […] The optimal screening approach is controversial. Although women with elevated glucose levels on the 75-g test have an increased risk of adverse pregnancy outcomes, no trials have demonstrated that treatment of GDM in these women improves outcomes. Most, but not all, U.S. guidelines favor a two-step approach.

• #12 Diabetes Mellitus and Pregnancy: Practice Essentials, Gestational Diabetes, Maternal-Fetal Metabolism in Normal Pregnancy

  https://emedicine.medscape.com/article/127547-overview

  The following 2-step screening system for gestational diabetes is currently recommended in the United States: 50-g, 1-hour glucose challenge test (GCT) and 100-g, 3-hour oral glucose tolerance test (OGTT) – For patients with an abnormal GCT result. […] A study by Stuebe et al found that gestational diabetes mellitus and impaired glucose tolerance during pregnancy are associated with persistent metabolic dysfunction at 3 years after delivery, separate from other clinical risk factors. […] A study by Benhalima et al indicated that in the early postpartum period, glucose intolerance is frequently present in women diagnosed with gestational diabetes mellitus. […] The excessive fetal and neonatal morbidity attributable to diabetes in pregnancy should be considered preventable with early diagnosis and effective treatment therapies. […] Education is the cornerstone of effective metabolic management of the patient with diabetes during pregnancy.

• #13 Gestational Diabetes Mellitus: Screening and Management – The ObG Project

  https://www.obgproject.com/2023/01/02/acog-releases-updated-guidance-gestational-diabetes/

  Gestational diabetes mellitus (GDM) has become increasingly prevalent worldwide. Class A1GDM refers to diet-controlled GDM. Class A2GDM refers to the clinical scenario where medications are required. The following synopsis highlights key practice points from various professional organizations. […] ACOG supports the ‘2 step’ approach (24 to 28 week 1 hour venous glucose measurement following 50g oral glucose solution), followed by a 100g 3 hour oral glucose tolerance test (OGTT) if positive. […] Note: Diagnosis of GDM is based on 2 abnormal values on the 3 hour OGTT. […] ACOG recommends that currently there is insufficient evidence to diagnose GDM based on only one abnormal value. […] The USPSTF recommends screening for gestational diabetes in asymptomatic pregnant persons at ≥24 weeks of gestation or after (B recommendation).

• #14 Diagnosis and Management of Gestational Diabetes Mellitus | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0701/p57.html

  Gestational diabetes occurs in 5 to 9 percent of pregnancies in the United States and is growing in prevalence. […] Diagnosis is made using a sequential model of universal screening with a 50-g one-hour glucose challenge test, followed by a diagnostic 100-g three-hour oral glucose tolerance test for women with a positive screening test. […] Evidence for screening, diagnosing, and managing gestational diabetes mellitus has continued to accrue over the past several years. […] Gestational diabetes is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. […] For women with a positive screening test, the 100-g three-hour oral glucose tolerance test is used to diagnose gestational diabetes. […] Gestational diabetes is diagnosed if two or more plasma glucose measurements meet or exceed the following thresholds: fasting level of 95 mg per dL (5.25 mmol per L), one-hour level of 180 mg per dL (10.00 mmol per L), two-hour level of 155 mg per dL (8.60 mmol per L), or three-hour level of 140 mg per dL.

• #15 Gestational Diabetes | InfantRisk Center

  https://www.infantrisk.com/content/gestational-diabetes

  Therefore, it is imperative for clinicians to diagnose and treat GDM in pregnant women as soon as possible to prevent perinatal complications and to identify patients who may benefit from early interventions such as improved nutrition, weight loss, and a regular exercise program to prevent development of NIDDM and associated complications later in life. […] The American College of Obstetricians and Gynecologists (ACOG) recommends screening pregnant patients with a 50 gram oral glucose tolerance test (OGTT) between 24-28 weeks gestation. Patients with plasma glucose levels 135 mg/dL after the oral glucose load should be evaluated with a diagnostic 3-hour OGTT. The 3-hour OGTT is conducted with a 100 gram glucose load. Subsequent blood samples are taken at 1, 2, and 3 hours. Based on the Carpenter and Coustan criteria, abnormal values are 95 for fasting, 180 mg/dL for 1-hour glucose concentration, 155 mg/dL for 2-hour, and 140 mg/dL for 3-hour. Two or more abnormal values confirm the diagnosis of gestational diabetes.

• #16 Screening and diagnosis of gestational diabetes mellitus – relevance to low and middle income countries | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-016-0031-y

  The ADA endorses the Carpenter and Coustan criteria and recommends that women with high risk of GDM undergo glucose testing as early as possible during pregnancy. […] In 1999, a WHO Expert Group recommended that pregnant women who met the WHO criteria for impaired glucose tolerance (IGT) in the non-pregnant state be classified as GDM. […] The major conclusion of the HAPO study was that the risk of adverse pregnancy outcomes continuously increased as a result of elevated maternal fasting or post load glycemia measured at 2428 weeks gestation. […] On the basis of the HAPO data, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) panel suggested a single step 75 g OGTT to be done in all pregnant women at 2428 weeks of gestation. […] The IADPSG recommends a threshold of 92 mg/dl (5.1 mmol/l) to diagnose GDM in early pregnancy.

• #17 How is gestational diabetes diagnosed?

  https://www.diabinfo.de/en/living-with-diabetes/gestational-diabetes/diagnosis.html

  Gestational diabetes is diagnosed when one of the 3 blood sugar levels is reached or exceeded: Fasting: 92 mg/dl (5.1 mmol/l), After 1 hour: 180 mg/dl (10.0 mmol/l), After 2 hours: 153 mg/dl (8.5 mmol/l). […] If the fasting blood glucose value is 126 mg/dl (7.0 mmol/l) or blood glucose is 200 mg/dl (11.1 mmol/l) after 2 hours, it is not called gestational diabetes. The woman then has newly developed diabetes during her pregnancy. […] If there is an increased risk, a blood glucose test should be carried out in the 1st term of pregnancy, so right at the start of the pregnancy. […] If the fasting blood glucose is over 92 mg/dl (5.1 mmol/l), a second measurement should be taken the following day. If the result is between 92 mg/dl (5.1 mmol/l) and 125 mg/dl (6.9 mmol/l), the diagnosis of gestational diabetes is confirmed. […] If the HbA1c values are between 5.9 and 6.4 percent (41 and 46.5 mmol/mol) the diagnostic test is carried out with 75 grams of glucose to confirm or reject suspected gestational diabetes.

• #18 How is gestational diabetes diagnosed?

  https://www.diabinfo.de/en/living-with-diabetes/gestational-diabetes/diagnosis.html

  Gestational diabetes is diagnosed when one of the 3 blood sugar levels is reached or exceeded: Fasting: 92 mg/dl (5.1 mmol/l), After 1 hour: 180 mg/dl (10.0 mmol/l), After 2 hours: 153 mg/dl (8.5 mmol/l). […] If the fasting blood glucose value is 126 mg/dl (7.0 mmol/l) or blood glucose is 200 mg/dl (11.1 mmol/l) after 2 hours, it is not called gestational diabetes. The woman then has newly developed diabetes during her pregnancy. […] If there is an increased risk, a blood glucose test should be carried out in the 1st term of pregnancy, so right at the start of the pregnancy. […] If the fasting blood glucose is over 92 mg/dl (5.1 mmol/l), a second measurement should be taken the following day. If the result is between 92 mg/dl (5.1 mmol/l) and 125 mg/dl (6.9 mmol/l), the diagnosis of gestational diabetes is confirmed. […] If the HbA1c values are between 5.9 and 6.4 percent (41 and 46.5 mmol/mol) the diagnostic test is carried out with 75 grams of glucose to confirm or reject suspected gestational diabetes.

• #19 Refining the diagnosis of gestational diabetes mellitus: a systematic review and meta-analysis | Communications Medicine

  https://www.nature.com/articles/s43856-023-00393-8

  Maternal overweight/obesity is associated with greater risk of offspring macrosomia or LGA in women with GDM. […] Pregnancy insulin resistance or hypertriglyceridemia may be useful in GDM risk stratification. […] GDM traditionally refers to abnormal glucose tolerance with onset or first recognition during pregnancy, typically diagnosed between 24 and 28 weeks gestation. […] Although treating hyperglycemia lowers the risk of maternal and neonatal morbidity, some women with GDM likely would not have had perinatal complications even if left untreated, while others still go on to develop complications despite adequate glycemic control. […] Maternal GDM with obesity (BMI30kg/m2) vs. GDM without obesity is associated with a 2- to 4-fold greater risk of macrosomia. […] While the diagnostic criteria for GDM detect dysregulation of glucose metabolism, GDM is increasingly recognized as a heterogeneous condition, which may include sub-phenotypes.

• #20 How is gestational diabetes diagnosed?

  https://www.diabinfo.de/en/living-with-diabetes/gestational-diabetes/diagnosis.html

  Gestational diabetes is diagnosed when one of the 3 blood sugar levels is reached or exceeded: Fasting: 92 mg/dl (5.1 mmol/l), After 1 hour: 180 mg/dl (10.0 mmol/l), After 2 hours: 153 mg/dl (8.5 mmol/l). […] If the fasting blood glucose value is 126 mg/dl (7.0 mmol/l) or blood glucose is 200 mg/dl (11.1 mmol/l) after 2 hours, it is not called gestational diabetes. The woman then has newly developed diabetes during her pregnancy. […] If there is an increased risk, a blood glucose test should be carried out in the 1st term of pregnancy, so right at the start of the pregnancy. […] If the fasting blood glucose is over 92 mg/dl (5.1 mmol/l), a second measurement should be taken the following day. If the result is between 92 mg/dl (5.1 mmol/l) and 125 mg/dl (6.9 mmol/l), the diagnosis of gestational diabetes is confirmed. […] If the HbA1c values are between 5.9 and 6.4 percent (41 and 46.5 mmol/mol) the diagnostic test is carried out with 75 grams of glucose to confirm or reject suspected gestational diabetes.

• #21

  https://journals.lww.com/obgynsurvey/fulltext/2021/06000/diagnosis_and_management_of_gestational_diabetes.20.aspx

  Gestational diabetes mellitus (GDM) represents one of the most frequent complications of pregnancy and is associated with increased maternal and neonatal morbidity. Its incidence is rising, mostly due to an increase in maternal age and maternal obesity rate. […] The aim of this study was to review and compare the recommendations of the most recently published guidelines on the diagnosis and management of this condition. […] The NICE guideline recommends targeted screening only for women with risk factors, whereas the International Federation of Gynecology and Obstetrics, ADIPS, SOGC, and the ACOG recommend screening for all pregnant women at 24 to 28 weeks of gestation in order to diagnose and effectively manage GDM; they also state that women with additional risk factors should be screened earlier (ie, in the first trimester) and retested at 24 to 28 weeks, if the initial test is negative.

• #22

  https://journals.lww.com/obgynsurvey/fulltext/2021/06000/diagnosis_and_management_of_gestational_diabetes.20.aspx

  Gestational diabetes mellitus (GDM) represents one of the most frequent complications of pregnancy and is associated with increased maternal and neonatal morbidity. Its incidence is rising, mostly due to an increase in maternal age and maternal obesity rate. […] The aim of this study was to review and compare the recommendations of the most recently published guidelines on the diagnosis and management of this condition. […] The NICE guideline recommends targeted screening only for women with risk factors, whereas the International Federation of Gynecology and Obstetrics, ADIPS, SOGC, and the ACOG recommend screening for all pregnant women at 24 to 28 weeks of gestation in order to diagnose and effectively manage GDM; they also state that women with additional risk factors should be screened earlier (ie, in the first trimester) and retested at 24 to 28 weeks, if the initial test is negative.

• #23 Recommendation: Gestational Diabetes: Screening | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/gestational-diabetes-screening

  The USPSTF recommends screening for gestational diabetes in asymptomatic pregnant persons at 24 weeks of gestation or after. […] The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for gestational diabetes in asymptomatic pregnant persons before 24 weeks of gestation. […] The US Preventive Services Task Force (USPSTF) concludes with moderate certainty that there is a moderate net benefit to screening for gestational diabetes at 24 weeks of gestation or after to improve maternal and fetal outcomes. […] The USPSTF concludes that the evidence on screening for gestational diabetes before 24 weeks of gestation is insufficient, and the balance of benefits and harms of screening cannot be determined. […] During pregnancy, insulin resistance increases, leading to higher glucose intolerance and development of gestational diabetes in some pregnant persons.

• #24 Diagnosis and Management of Gestational Diabetes

  https://www.contemporaryobgyn.net/view/diagnosis-and-management-of-gestational-diabetes

  Results from multiple studies have demonstrated that although a larger number of women (nearly double) may be identified as having GDM using IADPSG 1-step criteria compared with 2-step criteria; importantly, this does not result in a decrease in adverse neonatal outcomes, including macrosomia. […] The challenge is that at least 1 in 4 women with GDM do not respond to lifestyle intervention, including diet and exercise, and require pharmacotherapy to achieve euglycemia. […] Both the ACOG and ADA recommend insulin as first-line therapy because it does not cross the placenta and improves perinatal outcomes. […] Women with well-controlled GDM are at low risk of intrauterine fetal demise, and hence routine antepartum fetal testing is generally not initiated for uncomplicated diet-controlled class A1 GDM.

• #25 1 in 6 women are diagnosed with gestational diabetes. But this diagnosis may not benefit them or their babies – School of Public Health – University of Queensland

  https://public-health.uq.edu.au/article/2023/08/1-6-women-are-diagnosed-gestational-diabetes-diagnosis-may-not-benefit-them-or-their-babies

  1 in 6 women are diagnosed with gestational diabetes. But this diagnosis may not benefit them or their babies. […] About one in six pregnant women in Australia are now diagnosed with gestational diabetes. […] New criteria were developed in 2010 which dropped an initial screening test and lowered the diagnostic set-points. Gestational diabetes diagnoses have since more than doubled. […] But recent studies cast doubt on the ways we diagnose and manage gestational diabetes, especially for women like Sophie with only mildly elevated glucose. […] The test used to diagnose gestational diabetes the oral glucose tolerance test has poor reproducibility. This means subsequent tests may give a different result. […] Much of the increase in the incidence of gestational diabetes after the introduction of new diagnostic criteria was due to the switch from using two tests to only using a single test for diagnosis.

• #26 Gestational diabetes – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/diagnosis-treatment/drc-20355345

  If you’re at average risk of gestational diabetes, you’ll likely have a screening test during your second trimester between 24 and 28 weeks of pregnancy. […] If you’re at high risk of diabetes for example, if you’re overweight or obese before pregnancy; you have a mother, father, sibling or child with diabetes; or you had gestational diabetes during a previous pregnancy your health care provider may test for diabetes early in pregnancy, likely at your first prenatal visit. […] Screening tests may vary slightly depending on your health care provider, but generally include: […] Initial glucose challenge test. You’ll drink a syrupy glucose solution. One hour later, you’ll have a blood test to measure your blood sugar level. A blood sugar level of 190 milligrams per deciliter (mg/dL), or 10.6 millimoles per liter (mmol/L), indicates gestational diabetes.

• #27 Gestational Diabetes – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545196/

  Gestational diabetes mellitus (GDM) is a form of hyperglycemia that develops during pregnancy and poses risks to both mother and fetus. The diagnostic criteria for GDM have evolved over decades, reflecting advancements in glucose testing methods and a deeper understanding of associated risks. Various diagnostic approaches have been used, including the 2-step procedure combining a glucose challenge test and oral glucose tolerance test (OGTT), and more recently, a 1-step 75-g 2-hour OGTT recommended by the American Diabetes Association. […] The American College of Obstetricians and Gynecologists (ACOG) recommends targeted evaluation for type 2 diabetes early in pregnancy with a 75-g or 50-g oral glucose tolerance test at the initial prenatal visit in patients who have a BMI of 30 kg/m2 or more and 1 of the following risk factors:

• #28 Gestational diabetes mellitus: A pragmatic approach to diagnosis and management

  https://www1.racgp.org.au/ajgp/2018/july/gestational-diabetes-mellitus

  Gestational diabetes mellitus (GDM) is a common condition with risks for mother and baby. […] New diagnostic criteria have greatly increased the prevalence of GDM. […] Women are entering pregnancy at an older age, are more likely to be obese or overweight and are often from a high-risk ethnic background. […] In addition, new diagnostic criteria, now widely adopted in Australia, have greatly increased diagnosis of GDM. […] According to the IADPSG recommendations, diagnosis of GDM is made on a 75 g oral glucose tolerance test (OGTT) performed at 24-28 weeks gestation in all women not previously diagnosed with diabetes. […] The IADPSG diagnostic criteria for this time frame may also provide a reasonable guide to glycaemic status between 16 weeks and full term. […] The diagnosis of diabetes in pregnancy is made if World Health Organization (WHO) criteria for the diagnosis of diabetes outside of pregnancy are met. […] Diagnosis and effective management of GDM improve maternal and fetal outcomes. […] Early diagnosis of diabetes in pregnancy enables prompt evaluation and treatment.

• #29 Gestational Diabetes – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545196/

  Gestational diabetes mellitus (GDM) is a form of hyperglycemia that develops during pregnancy and poses risks to both mother and fetus. The diagnostic criteria for GDM have evolved over decades, reflecting advancements in glucose testing methods and a deeper understanding of associated risks. Various diagnostic approaches have been used, including the 2-step procedure combining a glucose challenge test and oral glucose tolerance test (OGTT), and more recently, a 1-step 75-g 2-hour OGTT recommended by the American Diabetes Association. […] The American College of Obstetricians and Gynecologists (ACOG) recommends targeted evaluation for type 2 diabetes early in pregnancy with a 75-g or 50-g oral glucose tolerance test at the initial prenatal visit in patients who have a BMI of 30 kg/m2 or more and 1 of the following risk factors:

• #30 How is gestational diabetes diagnosed?

  https://www.diabinfo.de/en/living-with-diabetes/gestational-diabetes/diagnosis.html

  Gestational diabetes is diagnosed when one of the 3 blood sugar levels is reached or exceeded: Fasting: 92 mg/dl (5.1 mmol/l), After 1 hour: 180 mg/dl (10.0 mmol/l), After 2 hours: 153 mg/dl (8.5 mmol/l). […] If the fasting blood glucose value is 126 mg/dl (7.0 mmol/l) or blood glucose is 200 mg/dl (11.1 mmol/l) after 2 hours, it is not called gestational diabetes. The woman then has newly developed diabetes during her pregnancy. […] If there is an increased risk, a blood glucose test should be carried out in the 1st term of pregnancy, so right at the start of the pregnancy. […] If the fasting blood glucose is over 92 mg/dl (5.1 mmol/l), a second measurement should be taken the following day. If the result is between 92 mg/dl (5.1 mmol/l) and 125 mg/dl (6.9 mmol/l), the diagnosis of gestational diabetes is confirmed. […] If the HbA1c values are between 5.9 and 6.4 percent (41 and 46.5 mmol/mol) the diagnostic test is carried out with 75 grams of glucose to confirm or reject suspected gestational diabetes.

• #31 Gestational diabetes | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/maternity/gestational-diabetes

  Diagnosis of GDM is based on results of the fasting 75 g OGTT. […] One elevated plasma glucose level is sufficient for a diagnosis. […] If a fasting glucose test has been performed for other reasons and shows an elevated value, this may be accepted as diagnostic of GDM. […] HbA1c of 41–48 mmol/mol (5.9–6.5%) in early pregnancy may be sufficient to diagnose pre-existing (overt) diabetes and requires review by an endocrinologist. […] Type 1 diabetes can present in pregnancy.

• #32 Patient education: Gestational diabetes (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/gestational-diabetes-beyond-the-basics/print

  After you are diagnosed with gestational diabetes, you will need to make changes in what you eat and learn to check your blood sugar level. […] Approximately 15 percent of patients with gestational diabetes will require insulin. […] Most pregnant individuals who develop gestational diabetes have more frequent prenatal visits (eg, once every week or two), especially if insulin is used. […] After giving birth, most individuals with gestational diabetes have normal blood sugar levels and do not require further treatment with insulin. […] However, your doctor may check your blood sugar level the day after delivery to be sure that it is normal or near normal. […] Individuals with gestational diabetes have an increased risk of developing type 2 diabetes later in life, especially if they have other risk factors (eg, family history of type 2 diabetes). […] The American Diabetes Association (ADA) recommends that all persons with a history of gestational diabetes have testing for type 2 diabetes every one to three years after their initial post-pregnancy test for diabetes.

• #33 Recommendations | Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE

  https://www.nice.org.uk/guidance/ng3/chapter/recommendations

  1.2.5 Use the 75-g 2-hour oral glucose tolerance test (OGTT) to test for gestational diabetes in women with risk factors (see recommendation 1.2.2). […] 1.2.8 Diagnose gestational diabetes if the woman has either: […] a fasting plasma glucose level of 5.6 mmol/litre or above […] a 2-hour plasma glucose level of 7.8 mmol/litre or above. […] 1.2.9 When women are diagnosed with gestational diabetes: […] offer a review with the joint diabetes and antenatal clinic within 1 week. […] 1.2.10 Explain to women with gestational diabetes: […] that good blood glucose control throughout pregnancy will reduce the risk of fetal macrosomia, trauma during birth (for her and her baby), induction of labour and/or caesarean section, neonatal hypoglycaemia, and perinatal death […] 1.2.11 Teach women with gestational diabetes how to selfmonitor their blood glucose.

• #34 Gestational Diabetes: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9012-gestational-diabetes

  Gestational diabetes is a type of diabetes that develops exclusively in pregnancy when blood sugar levels get too high (hyperglycemia). […] Your pregnancy care provider will order a blood test to check for gestational diabetes. […] Your healthcare provider tests for gestational diabetes around weeks 24 to 28 of your pregnancy. […] Your healthcare provider will test your blood sugar during pregnancy with a blood test. […] If you have gestational diabetes, you’ll need more frequent checkups during your pregnancy. […] Your pregnancy care provider will want to monitor the growth of the fetus. […] Your healthcare provider will test you for diabetes after your baby is born (usually between six and 12 weeks postpartum) to see if you still have it. […] Having gestational diabetes may make your pregnancy high risk. […] Healthcare providers consider a pregnancy high risk when either you or the fetus (or both) has health conditions that increase your chances of having a pregnancy complication. […] Your pregnancy care provider will want to monitor the growth of the fetus.

• #35 Recommendations | Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE

  https://www.nice.org.uk/guidance/ng3/chapter/recommendations

  1.2.12 Use the same capillary plasma glucose target levels for women with gestational diabetes as for women with preexisting diabetes. […] 1.2.14 When women are diagnosed with gestational diabetes, offer advice about changes in diet and exercise. […] 1.2.20 If blood glucose targets are not met with diet and exercise changes plus metformin, offer insulin as well. […] 1.2.22 For women with gestational diabetes who have a fasting plasma glucose level of 7.0 mmol/litre or above at diagnosis, offer: […] immediate treatment with insulin, with or without metformin […] diet and exercise changes. […] 1.2.23 For women with gestational diabetes who have a fasting plasma glucose level of between 6.0 and 6.9 mmol/litre and complications such as macrosomia or hydramnios, consider: […] immediate treatment with insulin, with or without metformin […] diet and exercise changes.

• #36 Gestational Diabetes Mellitus: Screening and Management – The ObG Project

  https://www.obgproject.com/2023/01/02/acog-releases-updated-guidance-gestational-diabetes/

  Current evidence is insufficient to assess the balance of benefits and harms of screening for gestational diabetes in asymptomatic pregnant persons <24 weeks of gestation (I statement). [...] ACOG and ADA prefer use of Carpenter and Coustan vs national Diabetes Data Group (NDDG) criteria because the higher NDDG thresholds may result in missed opportunities to treat patients would would benefit from GDM diagnosis. [...] ACOG suggests screening women who had GDM between 4 and 12 weeks postpartum for Diabetes and Pre-Diabetes. [...] Screening with the 75-g OGTT for type 2 diabetes during the delivery hospitalization “is a reasonable alternative in lieu of performing the 75-g OGTT at 4–12 weeks postpartum and may increase the rate of postpartum testing.” [...] ACOG recommends the following target levels to reduce risk of macrosomia: Fasting or preprandial blood glucose values < 95 mg/dL.

• #37 Diagnosis and Management of Gestational Diabetes Mellitus | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0701/p57.html

  Pharmacotherapy is indicated when medical nutritional therapy results in inadequate glucose control, lack of expected weight gain (as a result of calorie restriction), or when patients are consistently hungry. […] Insulin is the first-line pharmacologic therapy for gestational diabetes. […] A safe and effective oral agent for the treatment of gestational diabetes is highly desired. […] Metformin may be another option for women with gestational diabetes. […] Fetal surveillance can be divided into screening for congenital anomalies, monitoring for fetal well-being, and ultrasound assessment for estimated fetal weight and macrosomia. […] Monitoring for fetal well-being is generally based on local practice. […] Patients with diet-controlled gestational diabetes typically do not require active glucose management in labor; however, it is advisable to measure blood glucose levels on admission.

• #38 Patient education: Gestational diabetes (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/gestational-diabetes-beyond-the-basics/print

  After you are diagnosed with gestational diabetes, you will need to make changes in what you eat and learn to check your blood sugar level. […] Approximately 15 percent of patients with gestational diabetes will require insulin. […] Most pregnant individuals who develop gestational diabetes have more frequent prenatal visits (eg, once every week or two), especially if insulin is used. […] After giving birth, most individuals with gestational diabetes have normal blood sugar levels and do not require further treatment with insulin. […] However, your doctor may check your blood sugar level the day after delivery to be sure that it is normal or near normal. […] Individuals with gestational diabetes have an increased risk of developing type 2 diabetes later in life, especially if they have other risk factors (eg, family history of type 2 diabetes). […] The American Diabetes Association (ADA) recommends that all persons with a history of gestational diabetes have testing for type 2 diabetes every one to three years after their initial post-pregnancy test for diabetes.

• #39 Gestational diabetes diagnosis criteria – Norton Healthcare Provider Louisville, Ky.

  https://nortonhealthcareprovider.com/news/gestational-diabetes-diagnosis-criteria/

  Insulin is the gold standard for treatment for diabetes in pregnancy. Insulin does not cross the placenta but does reduce maternal blood sugar and transplacental transport of glucose to the fetus. […] The American Association of Clinical Endocrinology recommends a preconception A1C goal of less than 6.5 to mitigate congenital anomaly risks. […] Even with excellent glycemic control, mothers with diabetes are at higher risk for hypertension, preeclampsia, cesarean delivery, preterm birth and maternal mortality. […] Norton Children’s Maternal-Fetal Medicine initiates antenatal fetal surveillance at 32 weeks or earlier in cases of poor glycemic control, conducting twice-weekly testing. […] Delivery timing typically is recommended in the 39th week of pregnancy, if on medication, according to Dr. Stephens.

• #40 Recommendations | Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE

  https://www.nice.org.uk/guidance/ng3/chapter/recommendations

  1.2.12 Use the same capillary plasma glucose target levels for women with gestational diabetes as for women with preexisting diabetes. […] 1.2.14 When women are diagnosed with gestational diabetes, offer advice about changes in diet and exercise. […] 1.2.20 If blood glucose targets are not met with diet and exercise changes plus metformin, offer insulin as well. […] 1.2.22 For women with gestational diabetes who have a fasting plasma glucose level of 7.0 mmol/litre or above at diagnosis, offer: […] immediate treatment with insulin, with or without metformin […] diet and exercise changes. […] 1.2.23 For women with gestational diabetes who have a fasting plasma glucose level of between 6.0 and 6.9 mmol/litre and complications such as macrosomia or hydramnios, consider: […] immediate treatment with insulin, with or without metformin […] diet and exercise changes.

• #41 Diagnosis and Management of Gestational Diabetes Mellitus | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0701/p57.html

  Pharmacotherapy is indicated when medical nutritional therapy results in inadequate glucose control, lack of expected weight gain (as a result of calorie restriction), or when patients are consistently hungry. […] Insulin is the first-line pharmacologic therapy for gestational diabetes. […] A safe and effective oral agent for the treatment of gestational diabetes is highly desired. […] Metformin may be another option for women with gestational diabetes. […] Fetal surveillance can be divided into screening for congenital anomalies, monitoring for fetal well-being, and ultrasound assessment for estimated fetal weight and macrosomia. […] Monitoring for fetal well-being is generally based on local practice. […] Patients with diet-controlled gestational diabetes typically do not require active glucose management in labor; however, it is advisable to measure blood glucose levels on admission.

• #42 Gestational diabetes diagnosis criteria – Norton Healthcare Provider Louisville, Ky.

  https://nortonhealthcareprovider.com/news/gestational-diabetes-diagnosis-criteria/

  Insulin is the gold standard for treatment for diabetes in pregnancy. Insulin does not cross the placenta but does reduce maternal blood sugar and transplacental transport of glucose to the fetus. […] The American Association of Clinical Endocrinology recommends a preconception A1C goal of less than 6.5 to mitigate congenital anomaly risks. […] Even with excellent glycemic control, mothers with diabetes are at higher risk for hypertension, preeclampsia, cesarean delivery, preterm birth and maternal mortality. […] Norton Children’s Maternal-Fetal Medicine initiates antenatal fetal surveillance at 32 weeks or earlier in cases of poor glycemic control, conducting twice-weekly testing. […] Delivery timing typically is recommended in the 39th week of pregnancy, if on medication, according to Dr. Stephens.

• #43 Patient education: Gestational diabetes (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/gestational-diabetes-beyond-the-basics/print

  After you are diagnosed with gestational diabetes, you will need to make changes in what you eat and learn to check your blood sugar level. […] Approximately 15 percent of patients with gestational diabetes will require insulin. […] Most pregnant individuals who develop gestational diabetes have more frequent prenatal visits (eg, once every week or two), especially if insulin is used. […] After giving birth, most individuals with gestational diabetes have normal blood sugar levels and do not require further treatment with insulin. […] However, your doctor may check your blood sugar level the day after delivery to be sure that it is normal or near normal. […] Individuals with gestational diabetes have an increased risk of developing type 2 diabetes later in life, especially if they have other risk factors (eg, family history of type 2 diabetes). […] The American Diabetes Association (ADA) recommends that all persons with a history of gestational diabetes have testing for type 2 diabetes every one to three years after their initial post-pregnancy test for diabetes.

• #44 Screening & diagnosis for gestational diabetes – Diabetes Canada

  https://diabetes.ca/about-diabetes/gestational/screening-diagnosis

  Gestational diabetes puts you at increased risk of developing type 2 diabetes. […] If you received a diagnosis of gestational diabetes while pregnant, you should be tested (screened) for type 2 diabetes: six weeks to six months after giving birth (with a glucose tolerance test) […] Early diagnosis and management of type 2 diabetes is crucial for the health of you and your baby. […] A glucose tolerance test is used to screen for type 2 diabetes, and very often, it is used to diagnose gestational diabetes. […] If your results are abnormal, arrange to discuss this further with your health care provider. […] Here are some links to support you as you navigate screening and diagnosis of gestational diabetes. […] For additional information about gestational diabetes, the risks, early diagnosis and management.

• #45 Gestational Diabetes – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545196/

  ACOG and the United States Preventive Services Task Force (USPSTF), as well as other professional societies, recommend that laboratory studies for gestational diabetes be performed in all pregnant individuals between 24 and 28 weeks gestation. However, the screening method and cut-off thresholds vary among experts. […] The presence of 2 abnormal results establishes the diagnosis of gestational diabetes. […] In the postpartum period, 24 to 72 hours after the delivery, glucose monitoring is recommended. […] Given these risks, guidelines recommend postpartum screening for all women who have GDM, ideally between 4 to 12 weeks after delivery. […] Early detection through postpartum screening can benefit women with impaired fasting glucose or impaired glucose tolerance by enabling preventative interventions (eg, lifestyle modifications) and more intensive therapy for those diagnosed with diabetes.

• #46 Screening, Diagnosis, and Management of Gestational Diabetes Mellitus | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0401/p460.html

  An elevated blood glucose level despite lifestyle modifications is an indication for pharmacologic therapy. […] Insulin is required in women who have uncontrolled blood glucose levels despite lifestyle changes and use of oral medications, and in women who elect to avoid a trial of oral medications. […] Women with GDM should undergo screening at six to 12 weeks postpartum with a fasting glucose measurement or 75-g two-hour glucose tolerance test; up to 36% of women with GDM may have persistently abnormal glucose tolerance.

• #47 Patient education: Gestational diabetes (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/gestational-diabetes-beyond-the-basics/print

  After you are diagnosed with gestational diabetes, you will need to make changes in what you eat and learn to check your blood sugar level. […] Approximately 15 percent of patients with gestational diabetes will require insulin. […] Most pregnant individuals who develop gestational diabetes have more frequent prenatal visits (eg, once every week or two), especially if insulin is used. […] After giving birth, most individuals with gestational diabetes have normal blood sugar levels and do not require further treatment with insulin. […] However, your doctor may check your blood sugar level the day after delivery to be sure that it is normal or near normal. […] Individuals with gestational diabetes have an increased risk of developing type 2 diabetes later in life, especially if they have other risk factors (eg, family history of type 2 diabetes). […] The American Diabetes Association (ADA) recommends that all persons with a history of gestational diabetes have testing for type 2 diabetes every one to three years after their initial post-pregnancy test for diabetes.

• #48 Gestational diabetes | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/gestational-diabetes/

  Gestational diabetes usually goes away after birth and therefore you will be advised to stop taking all diabetes medications immediately after your baby is born. Before you go home, your blood glucose level will be tested to make sure that it has returned to normal. […] You should be offered a fasting blood glucose test 6 – 13 weeks after the birth of your baby. A small number of women continue to have high blood glucose levels and will be offered further tests for diabetes. […] Up to 50% of women who have had gestational diabetes develop type 2 diabetes within the following 5 years. You will therefore be advised to have a test for this every year. […] As soon as you find out you’re pregnant, contact your healthcare team for advice about your antenatal care as there is a chance you may develop gestational diabetes again (more than 1 in 3 women will get gestational diabetes again).

• #49 Gestational Diabetes – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545196/

  ACOG and the United States Preventive Services Task Force (USPSTF), as well as other professional societies, recommend that laboratory studies for gestational diabetes be performed in all pregnant individuals between 24 and 28 weeks gestation. However, the screening method and cut-off thresholds vary among experts. […] The presence of 2 abnormal results establishes the diagnosis of gestational diabetes. […] In the postpartum period, 24 to 72 hours after the delivery, glucose monitoring is recommended. […] Given these risks, guidelines recommend postpartum screening for all women who have GDM, ideally between 4 to 12 weeks after delivery. […] Early detection through postpartum screening can benefit women with impaired fasting glucose or impaired glucose tolerance by enabling preventative interventions (eg, lifestyle modifications) and more intensive therapy for those diagnosed with diabetes.

• #50 Screening and diagnosis of gestational diabetes mellitus – relevance to low and middle income countries | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-016-0031-y

  Gestational diabetes mellitus (GDM) is one of the most common metabolic complications of pregnancy. Ever since the first systematic evaluation of the oral glucose tolerance test by OSullivan and colleagues was carried out in 1964, there has been controversy with respect to the optimal screening and diagnostic criteria to detect GDM. The recently proposed International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for GDM has found fairly widespread acceptance, but it is still debated by several societies. This review intends to provide an overview of the evolution of the screening and diagnostic criteria for GDM. […] The criteria for diagnosing diabetes outside of pregnancy, has evolved over time and have been largely accepted by major diabetes organizations worldwide. However, the screening and diagnosis of gestational diabetes mellitus (GDM) continues to be a contentious issue. Notwithstanding decades of research and several international workshops devoted to GDM, there is still no consensus among international bodies on a uniform global approach to screening and diagnosis of GDM.

• #51

  https://journals.lww.com/obgynsurvey/fulltext/2021/06000/diagnosis_and_management_of_gestational_diabetes.20.aspx

  Of note, the NICE only assesses the fasting and the 2-hour postprandial glucose levels for the diagnosis of GDM. […] The Endocrine Society alone, on the other hand, recommends the universal testing of all pregnant women for diabetes before 13 weeks of gestation or as soon as they attend the antenatal service and retesting at 24 to 28 weeks if the initial results are normal. […] There is also agreement that lifestyle modifications should be the first-line treatment; however, the reviewed guidelines disagree on the medical management of GDM. […] However, all the guidelines state that all women in pregnancies complicated by GDM should undergo a glycemic test at around 6 to 12 weeks after delivery. […] As GDM is an increasingly common complication of pregnancy, it is of paramount importance that inconsistencies between national and international guidelines should encourage research to resolve the issues of controversy and allow uniform international protocols for the diagnosis and management of GDM, in order to safely guide clinical practice and subsequently improve perinatal and maternal outcomes.

• #52 Screening and diagnosis of gestational diabetes mellitus – relevance to low and middle income countries | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-016-0031-y

  The terms screening and diagnosis are often used interchangeably. A screening test for GDM identifies women at greater or lower risk of GDM depending on a particular glucose threshold. Those exceeding the threshold in the screening test should then proceed to a definitive diagnostic test, which provides a definitive answer to the presence or absence of GDM. […] There has been a lot of controversy in literature with respect to almost all aspects of screening for GDM. These include many fundamental questions such as why and how to screen for GDM, universal screening or selective screening, one step procedure or two step procedure, early (first trimester) screening or second trimester screening etc. […] The OSullivan and Mahan criteria formed the basis for the majority of criteria that subsequently evolved. OSullivan and Mahan suggested the use of a 50 g 1 h glucose challenge test (GCT) to screen for GDM followed by a diagnostic (confirmatory) test in those who were GCT positive using 100 g 3-h oral glucose tolerance test (OGTT).

• #53 1 in 6 women are diagnosed with gestational diabetes. But this diagnosis may not benefit them or their babies

  https://theconversation.com/1-in-6-women-are-diagnosed-with-gestational-diabetes-but-this-diagnosis-may-not-benefit-them-or-their-babies-205919

  When Sophie was pregnant with her first baby, she had an oral glucose tolerance blood test. A few days later, the hospital phoned telling her she had gestational diabetes. […] About one in six pregnant women in Australia are now diagnosed with gestational diabetes. […] New criteria were developed in 2010 which dropped an initial screening test and lowered the diagnostic set-points. Gestational diabetes diagnoses have since more than doubled. […] But recent studies cast doubt on the ways we diagnose and manage gestational diabetes, especially for women like Sophie with only mildly elevated glucose. […] The test used to diagnose gestational diabetes the oral glucose tolerance test has poor reproducibility. This means subsequent tests may give a different result. […] Much of the increase in the incidence of gestational diabetes after the introduction of new diagnostic criteria was due to the switch from using two tests to only using a single test for diagnosis.

• #54 1 in 6 women are diagnosed with gestational diabetes. But this diagnosis may not benefit them or their babies

  https://theconversation.com/1-in-6-women-are-diagnosed-with-gestational-diabetes-but-this-diagnosis-may-not-benefit-them-or-their-babies-205919

  Despite little evidence of benefit for either women or babies, the current Australian criteria diagnose women with only mildly abnormal results as having gestational diabetes. […] Recent studies have shown this doesnt benefit women and may cause harms. […] However, the trial found several harms, including more neonatal hypoglycaemia (low blood sugar in newborns), induction of labour, use of diabetic medications including insulin injections, and use of health services. […] For women diagnosed using the higher glucose thresholds, dietary advice, glucose monitoring and, where necessary, insulin therapy has been shown to reduce complications during delivery and the post-natal period. […] Recent evidence from both randomised controlled trials and from qualitative studies with women diagnosed with gestational diabetes suggest we need to reassess how we currently diagnose and manage gestational diabetes, particularly for women with only slightly elevated levels.

• #55 1 in 6 women are diagnosed with gestational diabetes. But this diagnosis may not benefit them or their babies

  https://theconversation.com/1-in-6-women-are-diagnosed-with-gestational-diabetes-but-this-diagnosis-may-not-benefit-them-or-their-babies-205919

  When Sophie was pregnant with her first baby, she had an oral glucose tolerance blood test. A few days later, the hospital phoned telling her she had gestational diabetes. […] About one in six pregnant women in Australia are now diagnosed with gestational diabetes. […] New criteria were developed in 2010 which dropped an initial screening test and lowered the diagnostic set-points. Gestational diabetes diagnoses have since more than doubled. […] But recent studies cast doubt on the ways we diagnose and manage gestational diabetes, especially for women like Sophie with only mildly elevated glucose. […] The test used to diagnose gestational diabetes the oral glucose tolerance test has poor reproducibility. This means subsequent tests may give a different result. […] Much of the increase in the incidence of gestational diabetes after the introduction of new diagnostic criteria was due to the switch from using two tests to only using a single test for diagnosis.

• #56 Refining the diagnosis of gestational diabetes mellitus: a systematic review and meta-analysis | Communications Medicine

  https://www.nature.com/articles/s43856-023-00393-8

  Our systematic review of 137 studies and 432,825 women with GDM demonstrates that perinatal outcomes vary substantially related to factors that extend beyond glycemia. […] In a meta-analysis of 10 studies of LGA and 13 studies of macrosomia, we found that the co-occurrence of pre-pregnancy overweight/obesity with GDM was associated with a 2 to 3-fold greater risk of LGA or macrosomia. […] Furthermore, independent of maternal BMI, those with higher triglycerides or insulin resistance may be at higher risk of having an offspring born LGA or with macrosomia. […] Overall, our systematic review identified critical gaps and future research areas for precision GDM diagnosis and highlighted promising biomarkers that may open the door to non-glycemic treatment targets in GDM.

• #57 Gestational diabetes mellitus: A pragmatic approach to diagnosis and management

  https://www1.racgp.org.au/ajgp/2018/july/gestational-diabetes-mellitus

  Gestational diabetes mellitus (GDM) is a common condition with risks for mother and baby. […] New diagnostic criteria have greatly increased the prevalence of GDM. […] Women are entering pregnancy at an older age, are more likely to be obese or overweight and are often from a high-risk ethnic background. […] In addition, new diagnostic criteria, now widely adopted in Australia, have greatly increased diagnosis of GDM. […] According to the IADPSG recommendations, diagnosis of GDM is made on a 75 g oral glucose tolerance test (OGTT) performed at 24-28 weeks gestation in all women not previously diagnosed with diabetes. […] The IADPSG diagnostic criteria for this time frame may also provide a reasonable guide to glycaemic status between 16 weeks and full term. […] The diagnosis of diabetes in pregnancy is made if World Health Organization (WHO) criteria for the diagnosis of diabetes outside of pregnancy are met. […] Diagnosis and effective management of GDM improve maternal and fetal outcomes. […] Early diagnosis of diabetes in pregnancy enables prompt evaluation and treatment.

• #58 Recommendations | Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE

  https://www.nice.org.uk/guidance/ng3/chapter/recommendations

  1.2.5 Use the 75-g 2-hour oral glucose tolerance test (OGTT) to test for gestational diabetes in women with risk factors (see recommendation 1.2.2). […] 1.2.8 Diagnose gestational diabetes if the woman has either: […] a fasting plasma glucose level of 5.6 mmol/litre or above […] a 2-hour plasma glucose level of 7.8 mmol/litre or above. […] 1.2.9 When women are diagnosed with gestational diabetes: […] offer a review with the joint diabetes and antenatal clinic within 1 week. […] 1.2.10 Explain to women with gestational diabetes: […] that good blood glucose control throughout pregnancy will reduce the risk of fetal macrosomia, trauma during birth (for her and her baby), induction of labour and/or caesarean section, neonatal hypoglycaemia, and perinatal death […] 1.2.11 Teach women with gestational diabetes how to selfmonitor their blood glucose.

• #59 Diagnosed With Gestational Diabetes – CHRISTUS Health

  https://www.christushealth.org/connect/your-health/childrens-health-and-wellness-stories/diagnosed-with-gestational-diabetes

  When women receive a diagnosis of gestational diabetes, they immediately think, what can I eat instead of what should I stop eating, which is the more important question. Reducing soda intake as well as processed baked goods like crackers and chips can be effective in lowering blood sugar levels. […] When its determined that a woman has gestational diabetes, they are often only given a handout providing some limited information on what they should or should not eat. But, if we are asking women to make significant changes in their eating habits for the health of their pregnancy, we think they deserve more. […] A diagnosis of gestational diabetes can cause multiple issues during pregnancy. One of them is having a large baby, which increases the likelihood of needing a C-section. Women with gestational diabetes are also prone to developing preeclampsia, a dangerous pregnancy complication which manifests with high blood pressure and can progress to eclampsia, or seizures. The risk of stillbirth also goes up substantially, especially if youre not controlling your sugars.

• #60 Gestational Diabetes Test: Preparation, Procedure, and More

  https://www.healthline.com/health/pregnancy/gestational-diabetes-test

  It’s important to keep gestational diabetes under control. If it’s left untreated, possible complications include high blood pressure, also known as preeclampsia, premature birth, shoulder dystocia, which occurs when the baby’s shoulders get stuck in the birth canal during delivery, slightly higher rates of fetal and neonatal death. […] Gestational diabetes usually goes away after delivery. Your doctor will have you do another glucose tolerance test 6 to 12 weeks after you deliver your baby to make sure you no longer have diabetes. […] Lifestyle changes may help prevent gestational diabetes or reduce its impact.

• #61 Gestational diabetes – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339

  Gestational diabetes is diabetes diagnosed for the first time during pregnancy (gestation). […] Once you’re pregnant, your health care provider will check you for gestational diabetes as part of your prenatal care. […] If you develop gestational diabetes, you may need checkups more often. […] Gestational diabetes that’s not carefully managed can lead to high blood sugar levels. […] If you have gestational diabetes, you’re more likely to get it again during a future pregnancy. […] You also have a higher risk of developing type 2 diabetes as you get older.

• #62 Gestational Diabetes-Causes & Treatment | ADA

  https://diabetes.org/living-with-diabetes/pregnancy/gestational-diabetes

  Exercise plays a vital role in managing GDM. […] Women with a history of GDM have an increased risk for recurrent diabetes in subsequent pregnancies and a 10-fold risk of developing type 2 diabetes (compared to women without GDM). […] To address this growing problem, the ADA offers a free online continuing education (CE) course and supporting resources essential for care professionals on screening, treating, and monitoring GDM.

• #63 Screening & diagnosis for gestational diabetes – Diabetes Canada

  https://diabetes.ca/about-diabetes/gestational/screening-diagnosis

  Gestational diabetes puts you at increased risk of developing type 2 diabetes. […] If you received a diagnosis of gestational diabetes while pregnant, you should be tested (screened) for type 2 diabetes: six weeks to six months after giving birth (with a glucose tolerance test) […] Early diagnosis and management of type 2 diabetes is crucial for the health of you and your baby. […] A glucose tolerance test is used to screen for type 2 diabetes, and very often, it is used to diagnose gestational diabetes. […] If your results are abnormal, arrange to discuss this further with your health care provider. […] Here are some links to support you as you navigate screening and diagnosis of gestational diabetes. […] For additional information about gestational diabetes, the risks, early diagnosis and management.

• #64 Diagnosis and Management of Gestational Diabetes Mellitus | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0701/p57.html

  Gestational diabetes occurs in 5 to 9 percent of pregnancies in the United States and is growing in prevalence. […] Diagnosis is made using a sequential model of universal screening with a 50-g one-hour glucose challenge test, followed by a diagnostic 100-g three-hour oral glucose tolerance test for women with a positive screening test. […] Evidence for screening, diagnosing, and managing gestational diabetes mellitus has continued to accrue over the past several years. […] Gestational diabetes is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. […] For women with a positive screening test, the 100-g three-hour oral glucose tolerance test is used to diagnose gestational diabetes. […] Gestational diabetes is diagnosed if two or more plasma glucose measurements meet or exceed the following thresholds: fasting level of 95 mg per dL (5.25 mmol per L), one-hour level of 180 mg per dL (10.00 mmol per L), two-hour level of 155 mg per dL (8.60 mmol per L), or three-hour level of 140 mg per dL.

• #65 Screening and diagnosis of gestational diabetes | The BMJ

  https://www.bmj.com/content/381/bmj-2022-071920

  Gestational diabetes may affect up to 30% of pregnancies, depending on the population, screening strategy and diagnostic criteria. […] Screening and diagnosis, with subsequent treatment of gestational diabetes after 24 weeks gestation, reduces maternal, fetal, and newborn complications. […] In the absence of international consensus, offer screening and diagnosis using local hospital, national, or international guidelines, taking into account available resources. […] Women who have experienced gestational diabetes are at higher risk of developing type 2 diabetes and are therefore a key group for targeted diabetes prevention support. […] There are three key tests that may be used alone or in combination for the screening and diagnosis of gestational diabetes: risk factors by clinical history to determine need for testing, glucose challenge test, and.

• #66 Screening and diagnosis of gestational diabetes mellitus – relevance to low and middle income countries | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-016-0031-y

  The WINGS project suggests that ideally, and whenever feasible, a single step 75 g OGTT using the IADPSG criteria should be done in the fasting state and that VPG still remains the gold standard. However, in resource limited settings, especially in the rural areas of developing countries where getting all pregnant women to come in a fasting state may be difficult, the well validated two step procedure using the 50 g OGCT in the non-fasting state as the screening test followed by fasting OGTT for a definitive diagnosis can be continued. […] Ultimately it is ideal that all countries should use criteria that are internationally accepted. All things considered, the IADPSG criteria seems to be the most suitable at present for screening and diagnosis of GDM.

• #67 Screening, Diagnosis, and Management of Gestational Diabetes Mellitus | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0401/p460.html

  An elevated blood glucose level despite lifestyle modifications is an indication for pharmacologic therapy. […] Insulin is required in women who have uncontrolled blood glucose levels despite lifestyle changes and use of oral medications, and in women who elect to avoid a trial of oral medications. […] Women with GDM should undergo screening at six to 12 weeks postpartum with a fasting glucose measurement or 75-g two-hour glucose tolerance test; up to 36% of women with GDM may have persistently abnormal glucose tolerance.

• #68 Patient education: Gestational diabetes (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/gestational-diabetes-beyond-the-basics/print

  After you are diagnosed with gestational diabetes, you will need to make changes in what you eat and learn to check your blood sugar level. […] Approximately 15 percent of patients with gestational diabetes will require insulin. […] Most pregnant individuals who develop gestational diabetes have more frequent prenatal visits (eg, once every week or two), especially if insulin is used. […] After giving birth, most individuals with gestational diabetes have normal blood sugar levels and do not require further treatment with insulin. […] However, your doctor may check your blood sugar level the day after delivery to be sure that it is normal or near normal. […] Individuals with gestational diabetes have an increased risk of developing type 2 diabetes later in life, especially if they have other risk factors (eg, family history of type 2 diabetes). […] The American Diabetes Association (ADA) recommends that all persons with a history of gestational diabetes have testing for type 2 diabetes every one to three years after their initial post-pregnancy test for diabetes.

• #69 Screening & diagnosis for gestational diabetes – Diabetes Canada

  https://diabetes.ca/about-diabetes/gestational/screening-diagnosis

  Gestational diabetes puts you at increased risk of developing type 2 diabetes. […] If you received a diagnosis of gestational diabetes while pregnant, you should be tested (screened) for type 2 diabetes: six weeks to six months after giving birth (with a glucose tolerance test) […] Early diagnosis and management of type 2 diabetes is crucial for the health of you and your baby. […] A glucose tolerance test is used to screen for type 2 diabetes, and very often, it is used to diagnose gestational diabetes. […] If your results are abnormal, arrange to discuss this further with your health care provider. […] Here are some links to support you as you navigate screening and diagnosis of gestational diabetes. […] For additional information about gestational diabetes, the risks, early diagnosis and management.

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