Strategy for the detection and diagnosis of hyperglycemic disorders in pregnancy*
| First prenatal visit |
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| 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 |
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| 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.