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

Reviews/Commentaries/ADA Statements

International Association of Diabetes and Pregnancy Study Groups Consensus Panel*

Diabetes Care 2010 Mar; 33(3): 676-682. https://doi.org/10.2337/dc09-1848

Article Figures & 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 (%)
Glucose measure	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.