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International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy

  1. International Association of Diabetes and Pregnancy Study Groups Consensus Panel*
  1. Corresponding author: Boyd E. Metzger, bem{at}northwestern.edu.
Diabetes Care 2010 Mar; 33(3): 676-682. https://doi.org/10.2337/dc09-1848
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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 measureGlucose concentration threshold*Above threshold (%)
    mmol/lmg/dlCumulative
    FPG5.1928.3
    1-h plasma glucose10.018014.0
    2-h plasma glucose8.515316.1†
    To diagnose overt diabetes in pregnancy
    Measure of glycemiaConsensus 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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Diabetes Care: 33 (3)

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March 2010, 33(3)
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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*
Diabetes Care Mar 2010, 33 (3) 676-682; DOI: 10.2337/dc09-1848

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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*
Diabetes Care Mar 2010, 33 (3) 676-682; DOI: 10.2337/dc09-1848
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  • Article
    • THE HAPO STUDY
    • OTHER STUDIES REVIEWED
    • TRANSLATION OF HAPO STUDY RESULTS FOR DIAGNOSIS OF GDM
    • DETECTION AND DIAGNOSIS OF OVERT DIABETES DURING PREGNANCY
    • SUMMARY OF DETECTION STRATEGY
    • CONCLUSIONS
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