Summary and Recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus
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).
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↵* Glucose measured by capillary glucose meter with values adjusted to reflect plasma concentration (3).
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↵† Values obtained by continuous monitoring of interstitial fluid (2).
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↵‡ The time of the “peak” postprandial glucose concentration = 70 min (44–96).
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- 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 - 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:
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Member of an ethnic group with a low prevalence of GDM
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No known diabetes in first-degree relatives
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Age <25 years
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Weight normal before pregnancy
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Weight normal at birth
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No history of abnormal glucose metabolism
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No history of poor obstetric outcome
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Average risk: Perform blood glucose testing at 24–28 weeks using either:
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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.
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One-step procedure: Diagnostic oral glucose tolerance test performed on all subjects.
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High-risk: Perform blood glucose testing as soon as feasible, using the procedures described above if one or more of these are present:
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Severe obesity
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Strong family history of type 2 diabetes
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Previous history of: GDM, impaired glucose metabolism, or glucosuria
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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.
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- 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).
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↵* 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.
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↵† Two or more of the venous plasma glucose concentrations indicated below must be met or exceeded for a positive diagnosis.
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↵‡ 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.
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