Diabetes in Pregnancy
Screening
Gestational Diabetes Mellitus
Screening Guidelines
Diabetes risk assessment
High risk
Average to
low risk
Screen at
confirmation
of pregnancy
Screen at 24
to 28 weeks
gestation
Lifelong
screening for
diabetes every
3 years3
Treat3
Normoglycemia
Positive for
GDM
Negative for
GDM
Positive for
GDM
Postpartum
Treat
Negative for
GDM
Screen for
diabetes at 6-12
weeks1,2
Prediabetes
Diabetes
1. AACE. Endocr Pract. 2011;17(2):1-53. 2. ADA. Diabetes Care. 2013;36(suppl 1):S11-S66.
Diabetes in Pregnancy:
Risk Factors
Criteria for Early Prenatal Diabetes Testing1,2,3
(screen patients at pregnancy confirmation)
•
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 lbs)
•
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 lbs 7 oz)
1. AACE. Endocr Pract. 2011;17(2):1-53. 2. ADA. Diabetes Care. 2013;36(suppl 1):S11-S66.
3. Innes et al. JAMA. 2002;287(19):2534-2541.
GDM Diagnosis
2 Approaches for Diagnosing Gestational Diabetes Mellitus (GDM)
AACE- and ADArecommended
1-step 75-g 2-hour oral glucose tolerance test (OGTT) 1,2
or
ACOGrecommended
2 steps: a 50-g 1-hour glucose challenge test (GCT), followed by
a 100-g 3-hour OGTT (if necessary)3
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)2
≥95 mg/dL (5.3 mmol/L)2
1-hour post-challenge
glucose
≥180 mg/dL (10.0 mmol/L)2
≥180 mg/dL (10.0 mmol/L)2
2-hour post-challenge
glucose
≥153 mg/dL (8.5 mmol/L2
≥155 mg/dL (8.6 mmol/L)2
3-hour post-challenge
glucose
†A
*A
≥140 mg/dL (7.8 mmol/L)2
positive diagnosis requires that test results satisfy any one of these criteria
positive diagnosis requires that ≥2 thresholds are met or exceeded
3.
1. AACE. Endocr Pract. 2011;17(2):1-53.
2. ADA. Diabetes Care. 2013;36(suppl 1):11-66.
Committee on Obstetric Practice. ACOG. 2011;504:1-3.
Diabetes in Pregnancy:
Established Diabetes
• All women of childbearing age diagnosed with T1DM or
T2DM should receive:
– Preconception diabetes counseling, including information on the risks
of uncontrolled diabetes during pregnancy1
– Preconception evaluation and treatment of diabetes-related
complications1
– Counseling on medications contraindicated during pregnancy1,2
• These include statins, angiotensin-converting-enzyme (ACE) inhibitors,
angiotensin II receptor blockers (ARBs), and most non-insulin antihyperglycemic
agents
– Counseling on effective contraception for all who wish to avoid
pregnancy1
(Slide 1 of 2)
2.
1. ADA. Diabetes Care. 2013;36(suppl 1):S11-S66.
Kitzmiller JL, et al. Diabetes Care. 2008;31(5):1060-79.
Diabetes in Pregnancy:
Established Diabetes
• All women of childbearing age diagnosed with T1DM or
T2DM should receive:
– Intensive pre- and post-conception A1C monitoring
• 50% risk reduction in adverse pregnancy outcomes for every 1% decrease in A1C prior to
conception1
• Weekly A1C testing after conception can greatly improve glycemic monitoring2
– ADA recommends preconception A1C <7.0%3
– AACE recommends preconception A1C <6.1%4
– Potential contraindications to pregnancy:
• Ischemic heart disease, untreated active proliferative retinopathy, renal insufficiency, and
severe gastroenteropathy5
(Slide 2 of 2)
1.
Mathiesen ER, et al. Endocrinol Metab Clin N Am. 2011;40:727-738.
2. Jovanovic L. Diabetes Care. 2011;34(1):53-54.
3. ADA. Diabetes Care. 2013;36(suppl 1):S11-S66.
4. AACE. Endocr Pract. 2011;17(2):1-53.
5. Jovanovic L, et al. Mt Sinai J Med. 2009;76(3):269-80.