Summary and Recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus

Boyd E. Metzger; Thomas A. Buchanan; Donald R. Coustan; Alberto de Leiva; David B. Dunger; David R. Hadden; Moshe Hod; John L. Kitzmiller; Siri L. Kjos; Jeremy N. Oats; David J. Pettitt; David A. Sacks; Christos Zoupas

doi:10.2337/dc07-s225

Original Articles

Summary and Recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus

Boyd E. Metzger, MD1,
Thomas A. Buchanan, MD2,
Donald R. Coustan, MD3,
Alberto de Leiva, MD, PHD4,
David B. Dunger, MBBS, MD, FRCP5,
David R. Hadden, MD, FRCP6,
Moshe Hod, MD7,
John L. Kitzmiller, MD8,
Siri L. Kjos, MD9,
Jeremy N. Oats, DM10,
David J. Pettitt, MD11,
David A. Sacks, MD12 and
Christos Zoupas, MD13

¹Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
²Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
³Brown Medical School, Women and Infant's Hospital of Rhode Island, Providence, Rhode Island
⁴Department of Endocrinology, Hospital de la Santa Creui Sant Pau, Universitat Autònoma, Barcelona, Spain
⁵Department of Pediatrics, University of Cambridge, Addenbrooke's Hospital, Cambridge, U.K.
⁶Regional Endocrinology and Diabetes Centre, Royal Victoria Hospital, Belfast, U.K.
⁷Perinatal Division, Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
⁸Division of Maternal-Fetal Medicine, Santa Clara County Health System, San Jose, California
⁹Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, California
¹⁰Division of Maternity Services, The Royal Women's Hospital, Carlton, Victoria, Australia
¹¹Sansum Diabetes Research Institute, Santa Barbara, California
¹²Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, Bellflower, California
¹³Diabetes Center, Hygeia General Hospital, Athens, Greece

Address correspondence and reprint requests to Boyd E. Metzger, MD, Northwestern University Feinberg School of Medicine, Tarry Building 15-735, 303 East Chicago Ave., Chicago, IL 60611. E-mail: bem{at}northwestern.edu

Diabetes Care 2007 Jul; 30(Supplement 2): S251-S260. https://doi.org/10.2337/dc07-s225

Article Figures & Tables

Tables

Table 1—

Ambulatory glucose values in pregnant women with normal glucose tolerance

Study	Subjects (n)	Fasting	Postprandial (60 min)	Postprandial (peak)
Paretti et al. (3)*	51	69 (57–81)	108 (96–120)
		3.8 (3.2–4.5)	6.0 (5.3–6.7)
Yogev et al. (2)†	57	75 (51–99)	105 (79–131)	110 (68–142)‡
		4.2 (2.8–5.5)	5.8 (4.4–7.3)	6.1 (3.8–7.9)

Data are conventional and SI units (95% CI).
*
↵* Glucose measured by capillary glucose meter with values adjusted to reflect plasma concentration (3).
†
↵† Values obtained by continuous monitoring of interstitial fluid (2).
‡
↵‡ The time of the “peak” postprandial glucose concentration = 70 min (44–96).

Table 2—

Metabolic assessments recommended after GDM

Time	Test	Purpose
Post-delivery (1–3 days)	Fasting or random plasma glucose	Detect persistent, overt diabetes
Early postpartum (around the time of postpartum visit)	75-g 2-h OGTT	Postpartum classification of glucose metabolism*
1 year postpartum	75-g 2-h OGTT	Assess glucose metabolism
Annually	Fasting plasma glucose	Assess glucose metabolism
Tri-annually	75-g 2-h OGTT	Assess glucose metabolism
Prepregnancy	75-g 2-h OGTT	Classify glucose metabolism

*
↵* Classification of glucose metabolism by criteria recommended by the American Diabetes Association (8). OGTT, oral glucose tolerance test.

Table 1—

Screening strategy for detecting GDM

GDM risk assessment: Should be ascertained at the first prenatal visit

Low risk: Blood glucose testing not routinely required if all of the following characteristics are present:
- Member of an ethnic group with a low prevalence of GDM
- No known diabetes in first-degree relatives
- Age <25 years
- Weight normal before pregnancy
- Weight normal at birth
- No history of abnormal glucose metabolism
- No history of poor obstetric outcome
Average risk: Perform blood glucose testing at 24–28 weeks using either:
- Two-step procedure: 50 g glucose challenge test (GCT) followed by a diagnostic oral glucose tolerance test in those meeting the threshold value in the GCT.
- One-step procedure: Diagnostic oral glucose tolerance test performed on all subjects.
High-risk: Perform blood glucose testing as soon as feasible, using the procedures described above if one or more of these are present:
- Severe obesity
- Strong family history of type 2 diabetes
- Previous history of: GDM, impaired glucose metabolism, or glucosuria

If GDM is not diagnosed, blood glucose testing should be repeated at 24–28 weeks or at any time a patient has symptoms or signs that are suggestive of hyperglycemia.

Reproduced with minor modifications from Metzger et al. (9). “Weight normal at birth” is an additional low-risk criterion that must now be met.

Table 2—

Diagnosis of GDM by an oral glucose tolerance test

	Oral glucose load*
		100-g glucose†			75-g glucose†
Fasting‡	95 mg/dl	5.3 mmol/l	95 mg/dl	5.3 mmol/l
1-h‡	180 mg/dl	10.0 mmol/l	180 mg/dl	10.0 mmol/l
2-h‡	155 mg/dl	8.6 mmol/l	155 mg/dl	8.6 mmol/l
3-h‡	140 mg/dl	7.8 mmol/l	—	—

Data are from Metzger et al. (9).
*
↵* The test should be performed in the morning after an overnight fast of at least 8 h but not more than 14 h and after at least 3 days of unrestricted diet (≥150 g carbohydrate/day) and physical activity. The subject should remain seated and should not smoke throughout the test.
†
↵† Two or more of the venous plasma glucose concentrations indicated below must be met or exceeded for a positive diagnosis.
‡
↵‡ The cutoff values are those proposed by Carpenter and Coustan (10) for extrapolation of the whole blood glucose values found by O'Sullivan and Mahan (11) to plasma glucose concentrations.