International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy
- International Association of Diabetes and Pregnancy Study Groups Consensus Panel*
- Corresponding author: Boyd E. Metzger, bem{at}northwestern.edu.
Article Figures & Tables
Tables
- Table 1
Threshold values for diagnosis of GDM or overt diabetes in pregnancy
To diagnose GDM and cumulative proportion of HAPO cohort equaling or exceeding those thresholds Glucose measure Glucose concentration threshold* Above threshold (%) mmol/l mg/dl Cumulative FPG 5.1 92 8.3 1-h plasma glucose 10.0 180 14.0 2-h plasma glucose 8.5 153 16.1† To diagnose overt diabetes in pregnancy Measure of glycemia Consensus threshold FPG‡ ≥7.0 mmol/l (126 mg/dl) A1C‡ ≥6.5% (DCCT/UKPDS standardized) Random plasma glucose ≥11.1 mmol/l (200 mg/dl) + confirmation§ ↵*One or more of these values from a 75-g OGTT must be equaled or exceeded for the diagnosis of GDM.
↵†In addition, 1.7% of participants in the initial cohort were unblinded because of FPG >5.8 mmol/l (105 mg/dl) or 2-h OGTT values >11.1 mmol/l (200 mg/dl), bringing the total to 17.8%.
↵‡One of these must be met to identify the patient as having overt diabetes in pregnancy.
↵§If a random plasma glucose is the initial measure, the tentative diagnosis of overt diabetes in pregnancy should be confirmed by FPG or A1C using a DCCT/UKPDS-standardized assay.
- Table 2
Strategy for the detection and diagnosis of hyperglycemic disorders in pregnancy*
First prenatal visit Measure FPG, A1C, or random plasma glucose on all or only high-risk women† If results indicate overt diabetes as per Table 1 Treatment and follow-up as for preexisting diabetes If results not diagnostic of overt diabetes and fasting plasma glucose ≥5.1 mmol/l (92 mg/dl) but <7.0 mmol/l (126 mg/dl), diagnose as GDM and fasting plasma glucose <5.1 mmol/l (92 mg/dl), test for GDM from 24 to 28 weeks' gestation with a 75-g OGTT‡ 24–28 weeks' gestation: diagnosis of GDM 2-h 75-g OGTT: perform after overnight fast on all women not previously found to have overt diabetes or GDM during testing earlier in this pregnancy Overt diabetes if fasting plasma glucose ≥7.0 mmol/l (126 mg/dl) GDM if one or more values equals or exceeds thresholds indicated in Table 1 Normal if all values on OGTT less than thresholds indicated in Table 1 ↵*To be applied to women without known diabetes antedating pregnancy. Postpartum glucose testing should be performed for all women diagnosed with overt diabetes during pregnancy or GDM.
↵†Decision to perform blood testing for evaluation of glycemia on all pregnant women or only on women with characteristics indicating a high risk for diabetes is to be made on the basis of the background frequency of abnormal glucose metabolism in the population and on local circumstances.
↵‡The panel concluded that there have been insufficient studies performed to know whether there is a benefit of generalized testing to diagnose and treat GDM before the usual window of 24–28 weeks' gestation.
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