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
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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