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Gestational Diabetes Mellitus

	DEFINITION, DETECTION, AND DIAGNOSIS

 
Definition
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy (1). The definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy. It does not exclude the possibility that unrecognized glucose intolerance may have antedated or begun concomitantly with the pregnancy.

Approximately 7% of all pregnancies are complicated by GDM, resulting in more than 200,000 cases annually. The prevalence may range from 1 to 14% of all pregnancies, depending on the population studied and the diagnostic tests employed.

Detection and diagnosis
Risk assessment for GDM should be undertaken at the first prenatal visit. Women with clinical characteristics consistent with a high risk of GDM (marked obesity, personal history of GDM, glycosuria, or a strong family history of diabetes) should undergo glucose testing (see below) as soon as feasible. If they are found not to have GDM at that initial screening, they should be retested between 24 and 28 weeks of gestation. Women of average risk should have testing undertaken at 24–28 weeks of gestation. Low-risk status requires no glucose testing, but this category is limited to those women meeting all of the following characteristics:

• Age <25 years
  
• Weight normal before pregnancy
  
• Member of an ethnic group with a low prevalence of GDM
  
• No known diabetes in first-degree relatives
  
• No history of abnormal glucose tolerance
  
• No history of poor obstetric outcome
  

A fasting plasma glucose level >126 mg/dl (7.0 mmol/l) or a casual plasma glucose >200 mg/dl (11.1 mmol/l) meets the threshold for the diagnosis of diabetes, if confirmed on a subsequent day, and precludes the need for any glucose challenge. In the absence of this degree of hyperglycemia, evaluation for GDM in women with average or high-risk characteristics should follow one . . . [Full Text of this Article]

One-step approach:
Two-step approach:

	OBSTETRIC AND PERINATAL CONSIDERATIONS

 
Long-term considerations

	THERAPEUTIC STRATEGIES DURING PREGNANCY

 
Monitoring
Management

	LONG-TERM THERAPEUTIC CONSIDERATIONS

 

	Footnotes

 

	References

 

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				C. Ouzilleau, M.-A. Roy, L. Leblanc, A. Carpentier, and P. Maheux An observational study comparing 2-hour 75-g oral glucose tolerance with fasting plasma glucose in pregnant women: both poorly predictive of birth weight Can. Med. Assoc. J., February 18, 2003; 168(4): 403 - 409. [Abstract] [Full Text] [PDF]