- Click here for explanation of classification scheme.

The purpose of this position statement is to convey recommendations regarding gestational diabetes mellitus.

Article inclusion methods not described. The recommendations in this paper are based on the evidence reviewed in the following publications:  Diabetes Care 21 (Suppl. 1):S5-S19, 1998; and the Proceedings of the 4th International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 21 (Suppl. 2):B1-B167, 1998.

Not described.

Recruitment:

The recommendations in this paper are based on the evidence reviewed in the following publications:  Diabetes Care 21 (Suppl. 1):S5-S19, 1998; and the Proceedings of the 4th International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 21 (Suppl. 2):B1-B167, 1998.

Design:

Consensus Report.

Blinding Used (If applicable):

Not applicable.

Intervention (If applicable):

Not applicable.

Statistical Analysis:

Not stated

Timing of Measurements:

Not stated

Dependent Variables:

Not applicable

Independent Variables:

Not applicable

Control Variables:

Not applicable

Initial N:  5 references cited.

Attrition (Final N):  5

Age:  Not applicable.

Ethnicity: Not applicable

Other Relevant Demographics:

Anthropometrics:

Location:

 

Definition:

GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.

Detection & diagnosis:

High Risk:

Risk assessment for GDM should be undertaken at the first prenatal visit. Women with clinical characteristics consistent with a high risk for GDM should undergo glucose testing as soon as feasible:

If GDM is not present with initial screening, they should be retested 24-28 wk gestation.

Marked obesity

Personal history of GDM

Glycosuria

Strong family history of Diabetes

Low-risk:

Women meeting ALL these characteristics:

Age <25 yr

Weight normal before

   Pregnancy

   Member of ethnic group with low prevalence of GDM

   No known diabetes in 1^st  degree relatives.

   No history of abnormal glucose tolerance

   No history of poor obstetrical outcome

Diagnosis of GDM:

If confirmed on the following day precludes the need for a glucose challenge:

OGTT needed if diagnosis is not made by above method.

FPG:  >126 mg/dl (7.0 mmol/L)

Random plasma glucose:  >200 mg/dl

(11.1 mmol/L)

One-Step Approach:

Perform OGTT without prior screening.

May be cost-effective in high-risk patients or populations such as Native-Americans.

Two-Step Approach:

Screening 1-hr after 50-g glucose load  >140 gm/dl (7.8 mmol/L) identifies ~80% of women with GDM

  >130 gm/dl (7.2 mmol/L) identifies ~90% of women with GDM

Perform a diagnostic OGTT on subset of women exceeding glucose threshold value.

Diagnosis of GDM with a 100-g or 75-g glucose load:

Plasma glucose (mg/dl)

	100-g	75-g
Fasting	>95	>95
1-hr	>180	>180
2-hr	>155	>155
3-hr	>140
Diagnosis is made when >2 values are abnormal.

Obstetrical & Perinatal considerations:

FBG >105 mg/dl (5.8 mmol/L) is associated with an increased risk of intrauterine fetal death during the last 4-8 wk gestation. 

GDM increases the risk for:

    Fetal macrosomia

    Neonatal hypoglycemia

    Jaundice

    Polycythemia

    Hypocalcemia

    Maternal hypertensive disorders

    Need for cesarean delivery

Monitoring:

Daily SBGM superior to intermittent office monitoring of plasma glucose.

Limited evidence that postprandial monitoring is superior to preprandial monitoring.

Urine ketone monitoring is helpful to detect insufficient kcal.

Maternal surveillance of blood pressure and urine protein.

Management:

1.  Nutrition counseling by RD with adequate kcal for appropriate weight gain and to meet maternal blood glucose goals.

2.  Participate in moderate physical activity

3.  Obese women (BMI>30)

     30-33% kcal restriction (~25 kcal/kg actual weight)

     35-40% carbohydrates

4.  Insulin therapy if MNT goals are not met: 

     FBG <95 mg/dl or FPG<105 mg/dl

     1-hr postprandial blood glucose: <140 mg/dl or plasma glucose: <155 mg/dl

     2-hr postprandial blood glucose: <120 mg/dl or plasma glucose: <130 mg/dl

Long-term therapeutic considerations:

6 wk postpartum women should be reevaluated for diabetes mellitus and education on lifestyle modifications to decrease risk for developing type 2 diabetes mellitus or treated if diagnosed postpartum.

None stated - position statement conveyed all recommendations.

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Consensus document from the American Diabetes Association. Specific reommendations given for diagnosis, interventions and follow up. None of the original research was discussed in the document.