Comprehensive Guide to Diabetes Screening in Pregnancy

This comprehensive guide covers the screening, diagnosis, and management of diabetes in pregnancy, including gestational diabetes mellitus (GDM). It includes information on criteria for early prenatal diabetes testing, approaches for diagnosing GDM, and diagnostic criteria for oral glucose tolerance testing. Key factors such as lifestyle, family history, race/ethnicity, and clinical conditions are discussed to aid in identifying high-risk individuals. Regular screening and timely intervention are emphasized to optimize maternal and fetal health outcomes.

• Pregnancy
• Diabetes Screening
• Gestational Diabetes
• Prenatal Testing
• GDM

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1. Screening for Diabetes in Pregnancy 1

2. Gestational Diabetes Mellitus Screening Diabetes risk assessment Lifelong screening for diabetes every 3 years High risk Average to low risk Normoglycemia Treat Screen at confirmation of pregnancy Screen at 24 to 28 weeks gestation Prediabetes Positive for GDM Negative for GDM Positive for GDM Negative for GDM Screen for diabetes at 6-12 weeks Treat Postpartum Diabetes GDM, gestational diabetes mellitus. Handelsman YH, et al. Endocr Pract. 2015;21(suppl 1):1-87. ADA. Diabetes Care. 2018;41(suppl 1):S13-S27. 2

3. Criteria for Early Prenatal Diabetes Testing Inactive/sedentary lifestyle First-degree relative (parent or sibling) with diabetes High-risk race/ethnicity (eg, African American, Latino, Native American, Asian American, Pacific Islander) History of gestational diabetes mellitus or previous delivery of a large baby (>9 lb) Hypertension (blood pressure 140/90 mmHg) HDL cholesterol level <35 mg/dL and/or triglyceride levels >250 mg/dL History of polycystic ovary syndrome (PCOS) A1C 5.7%, impaired fasting glucose (IFG), or impaired glucose tolerance (IGT) on a previous diabetes screening test Other clinical conditions associated with insulin resistance (eg, severe obesity, acanthosis nigricans) History of cardiovascular disease Low maternal birth weight (<4 lb 7 oz) Screen at-risk patients for undiagnosed diabetes at pregnancy confirmation Handelsman YH, et al. Endocr Pract. 2015;21(suppl 1):1-87. ADA. Diabetes Care. 2018;41(suppl 1):S13-S27. Innes et al. JAMA. 2002;287(19):2534-2541. 3

4. GDM Diagnosis 2 Approaches for Diagnosing GDM AACE- and ADA- recommended 1-step 75-g 2-hour OGTT ACOG- recommended 2 steps: a 50-g 1-hour GCT, followed by a 100-g 3-hour OGTT (if necessary) GDM Diagnostic Criteria for OGTT Testing 75-g 2-hour* 100-g 3-hour Fasting plasma glucose (FPG) 92 mg/dL (5.1 mmol/L) 95 mg/dL (5.3 mmol/L) 1-hour post-challenge glucose 180 mg/dL (10.0 mmol/L) 180 mg/dL (10.0 mmol/L) 2-hour post-challenge glucose 153 mg/dL (8.5 mmol/L 155 mg/dL (8.6 mmol/L) 3-hour post-challenge glucose 140 mg/dL (7.8 mmol/L) *A positive diagnosis requires that test results satisfy any one of these criteria. A positive diagnosis requires that 2 thresholds are met or exceeded. AACE, American Association of Clinical Endocrinologists; ACOG, American College of Obstetrics and Gynecology; ADA, American Diabetes Association; GCT, glucose challenge test; GDM, gestational diabetes mellitus; OGTT, oral glucose tolerance test. Handelsman YH, et al. Endocr Pract. 2015;21(suppl 1):1-87. ADA. Diabetes Care. 2018;41(suppl 1):S13-S27. Committee on Obstetric Practice. ACOG. 2011;504:1-3. 4