Recommendations for screening and diagnosis of gestational diabetes

1. Gastroepato
2. Diabetology
3. Screening and diagnosis if gestational diabetes
4. Type 1 or type 2 diabetes mellitus
5. Diabetes. What are we talking about?
6. The cardiometabolic risk in type 1 diabetes mellitus
7. The checks to be performed

notes by dr Claudio Italiano

• Diagnosis of diabetes in pregnancy
• Diagnosis of Gestational Diabetes at the 24th-28th week
• Risk of developing gestational diabetes

• Other recommendations for diagnosis  of diabetes in pregnancy

At the first pregnancy appointment, all women who do not report previous determinations should be given plasma glucose determination to identify women with pre-existing diabetes.
The importance of having a good metabolic control during pregnancy is due to the fact that if this control is not implemented, then there is the risk that a child with fetal and disordered macrosomia may be born.

  For this reason, screening in pregnant women is recommended to exclude gestational diabetes.

However, it may happen that a woman is already diabetic and in this case it is sufficient to find fasting glycemias greater than 126 mg% on 2 occasions, or an occasional 200 mg% glycemia, or a glycosylated hemoglobin greater than 6.5%.

Diagnosis of diabetes in pregnancy

- Women with a fasting plasma glucose values > 126 mg /dl  (7.0 mmol /L),
- Plasma glucose randomization > 200 mg /dl (11.1 mmol / L),
- HbA1c (standardized and performed within 12 weeks) > 6.5%.

Regardless of the mode used, it is necessary that results above the norm are confirmed in a second blood sample

- Screening for gestational diabetes is recommended in women with a physiological pregnancy but with definited risk factors.

At 16-18 weeks of gestational age, women with at least one of the following conditions:
- gestational diabetes in a previous pregnancy
- pregral mass body index (1MC) > 30
- confirmation, before or at the beginning of pregnancy, of plasma blood glucose levels between 100 and 125 mg / dl (5.6-6.9 mmol / l) must be offered a load curve with 100 g of glucose (OGTT 100 g) and an additional OGTT 100 g or 28 weeks gestational age, if the first determination was normal.

Women with one or more plasma glucose values ​​above the thresholds defined in the table are defined as having gestational diabetes.
A diagnosis is made of GDM when one or more values ​​are equal to or greater than the threshold values.

Diagnosis of Gestational Diabetes using OGTT to be performed at the 24th-28th week

Glycemia:
Glucose concentration threshold values
  FGP (fasting plasma glucose) 92 mg / dl if fasting blood sugar is this then the diagnosis of diabetes is negative and so to follow as specified below after oral glucose loading:
- at 1 hour after PG load 180 mg / dl
- at 2 hours PG 153 mg / dl

Risk of developing gestational diabetes

The risk of developing gestational diabetes in women is expected for a woman with at least one of the following conditions:
- age > 35 years
- pregravidic body mass index (IMC) > 25 kg / m2
- fetal macrosomia in a previous pregnancy (> 4.5 kg)
- gestational diabetes in a previous pregnancy (though with normal determination at 16 - 18 weeks)
- family history of diabetes (first degree relative with type 2 diabetes)
- family originating in areas with high prevalence of diabetes: South Asia (in particular India, Pakistan, Bangladesh), Caribbean (for the population of African origin), Middle East (in particular Saudi Arabia, United Arab Emirates, Iraq, Jordan, Syria , Oman, Qatar, Kuwait, Lebanon, Egypt)
An OGTT 100 g should be offered: women with one or more plasma glucose values ​​above the thresholds in the table are defined as having gestational diabetes.

Other recommendations for diagnosis  of diabetes in pregnancy

For the screening of gestational diabetes, fasting plasma glucose, random glycemia, glucose challenge test (GCT) or minicurva (in disuse), glycosuria, OGTT 100 g should not be used.
4 Professionals should inform pregnant women that:
- in most women, gestational diabetes is controlled by dietary changes and physical activity
- if diet and physical activity are not sufficient to control gestational diabetes, it is necessary to take insulin; this condition occurs in a percentage between 10% and 20% of women; Oral therapy can not be used
- if gestational diabetes is not controlled, there is a risk of an increased frequency of pregnancy and childbirth complications, such as pre-eclampsia and shoulder dystocia
- the diagnosis of gestational diabetes and associated with a potential increase in monitoring and assistance interventions during pregnancy and during delivery
- gestational diabetes sleeps have an increased risk, difficult to quantify, of developing type 2 diabetes, particularly in the first 5 years after childbirth.

A gestation must be given to OGTT 100 g not before six weeks after delivery.