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{{Gestational diabetes}}
{{Gestational diabetes}}
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For more information regarding GDM laboratory findings please click [[Gestational diabetes diagnostic criteria|here]]
==Overview==
==Overview==
Generally a test for gestational diabetes is carried out between the 24th and 28th week of pregnancy. If patient is at risk for gestational diabetes (see Risk Factors) he or she could prescribe a glucose test earlier in the pregnancy.
Generally, a test for gestational diabetes is carried out between the 24th and 28th week of pregnancy.  
 
If a patient is at risk for gestational diabetes (see [[Gestational diabetes risk factors|risk factors]]), screening should be done earlier in the pregnancy.


Often, gestational diabetes can be managed through a combination of diet and exercise. If that is not possible, it is treated with insulin(usually 15% need Insulin), in a similar manner to [[diabetes mellitus]].
==Laboratory Findings==
==Laboratory Findings==
A health care team will check the affected person's blood glucose level. Depending on the mother's risk and her test results, she may have one or more of the following tests.
Depending on the woman's risk and her previous test results, she may have one or more of the following tests.<ref name="pmid26696673">{{cite journal |vauthors= |title=Professional Practice Committee for the Standards of Medical Care in Diabetes-2016 |journal=Diabetes Care |volume=39 Suppl 1 |issue= |pages=S107–8 |year=2016 |pmid=26696673 |doi=10.2337/dc16-S018 |url=}}</ref>


* Fasting blood glucose or random blood glucose test
* Screening glucose test
* Screening glucose challenge test
* Oral glucose tolerance test (OGTT)
* Oral glucose tolerance test (OGTT)


===Screening glucose challenge test===
===Screening glucose test===
There are several tests intended to identify gestational diabetes in pregnant women. The first, called the Screening glucose challenge test, is a preliminary screening test performed between 26-28 weeks. If a woman tests positive during this screening test, the second test, called the Glucose Tolerance Test, may be performed. This test will diagnose whether diabetes exists or not by indicating whether or not the body is using glucose (a type of sugar) effectively. The Glucose Challenge Screening is now considered to be a standard test performed during the second trimester of pregnancy.
There are several tests intended to identify gestational diabetes in pregnant women. <ref name="pmid7148898">{{cite journal |vauthors=Carpenter MW, Coustan DR |title=Criteria for screening tests for gestational diabetes |journal=Am. J. Obstet. Gynecol. |volume=144 |issue=7 |pages=768–73 |year=1982 |pmid=7148898 |doi= |url=}}</ref><ref name="pmid510803">{{cite journal |vauthors= |title=Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group |journal=Diabetes |volume=28 |issue=12 |pages=1039–57 |year=1979 |pmid=510803 |doi= |url=}}</ref>
 
* The first, called the screening glucose challenge test, is a preliminary screening test performed between 24-28 weeks. If a woman tests positive during this screening test, a second test called the Glucose Tolerance Test, may be performed.  
The glucose values used to detect gestational diabetes were first determined by O'Sullivan and Mahan (1964) in a retrospective study designed to detect risk of developing type II diabetes in the future. The values were set using whole blood and required two values reaching or exceeding the value to be positive. <ref name=AMN>{{cite web | Carla Janzen, MD, Jeffrey S. Greenspoon, MD | title =Gestational Diabetes | publisher=Armenian Medical Network | work =Diabetes Mellitus & Pregnancy - Gestational Diabetes | url=http://www.health.am/pregnancy/gestational-diabetes/ | year = 2006 | accessdate=2006-11-27}}</ref>  Subsequent information has led to alteration in O'Sullivan's criteria. For example: when methods for blood glucose determination changed from the use of whole blood to venous plasma samples, the criteria for GDM were also changed once whole blood glucose values are lower than plasma levels due to glucose uptake by hemoglobin (NDDG,1979).
* The second test confirms the diagnoses.  
The screening glucose challenge test is now considered as the standard test performed during the second trimester of pregnancy.


The diagnostic criteria from the National Diabetes Data Group (NDDG) have been used most often, but some centers rely on the Carpenter and Coustan criteria, which set the cutoff for normal at lower values. Compared with the NDDG criteria, the Carpenter and Coustan criteria lead to a diagnosis of gestational diabetes in 54 percent more pregnant women, with an increased cost and no compelling evidence of improved perinatal outcomes. <ref name=NCBI2>{{cite journal | author = Carpenter MW, Coustan DR. | title = [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&dopt=Citation&list_uids=83071919 Criteria for screening tests for gestational diabetes.],  | journal =  Am J Obstet Gynecol.  | volume = | issue =1;144(7):768-73 | pages = | year = 1982 Dec}}</ref>


===Oral glucose tolerance test===
===Oral glucose tolerance test===
Women who are considered at risk for gestational diabetes are given a screening test called a 50 gram glucose challenge between the 24th and 28th weeks of pregnancy (those with two or more risk factors may be tested earlier). The glucose challenge is performed by giving 50 grams of a glucose drink and then drawing a blood sample one hour later and measuring the level of blood glucose present. Women with a blood sugar level greater than 140 mg/dl may have gestational diabetes, and require a follow up test called a 3-hour oral glucose tolerance test (OGTT). <ref name=niddk>{{cite web | Boyd E. Metzger, M.D., Susan A. Biastre, R.D., L.D.N., C.D.E., Beverly Gardner, R.D., L.D.N., C.D.E. | title =What I need to know about Gestational Diabetes | publisher=National Diabetes Information Clearinghouse | work =National Diabetes Information Clearinghouse | url=http://diabetes.niddk.nih.gov/dm/pubs/gestational/ | year = 2006 | accessdate=2006-11-27}}</ref>
Women who are considered at risk for gestational diabetes are given a screening test called a 50 gram glucose challenge between the 24th and 28th weeks of pregnancy (those with two or more risk factors may be tested earlier). The glucose challenge is performed by giving 50 grams of a glucose drink and then drawing a blood sample one hour later to measure the level of blood glucose present. Women with a blood sugar level greater than 140 mg/dl may have gestational diabetes, and require a follow-up test called a 3-hour oral glucose tolerance test (OGTT). <ref name=niddk>{{cite web | Boyd E. Metzger, M.D., Susan A. Biastre, R.D., L.D.N., C.D.E., Beverly Gardner, R.D., L.D.N., C.D.E. | title =What I need to know about Gestational Diabetes | publisher=National Diabetes Information Clearinghouse | work =National Diabetes Information Clearinghouse | url=http://diabetes.niddk.nih.gov/dm/pubs/gestational/ | year = 2006 | accessdate=2006-11-27}}</ref><ref name="pmid7148898">{{cite journal |vauthors=Carpenter MW, Coustan DR |title=Criteria for screening tests for gestational diabetes |journal=Am. J. Obstet. Gynecol. |volume=144 |issue=7 |pages=768–73 |year=1982 |pmid=7148898 |doi= |url=}}</ref><ref name="pmid510803">{{cite journal |vauthors= |title=Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group |journal=Diabetes |volume=28 |issue=12 |pages=1039–57 |year=1979 |pmid=510803 |doi= |url=}}</ref>


The test should be done in the morning after an overnight fast of between 8 and 14 h and after at least 3 days of unrestricted diet (>=150 g carbohydrate per day) and unlimited physical activity. The subject should remain seated and should not smoke throughout the test.
==References==
The [[American Diabetes Association]] sets the following guidelines for results from the OGTT (oral glucose tolerance test)


[[Image:Gestational_Diabetes.png]]
{{Reflist|2}}


===Fasting blood glucose or random blood glucose test===
A fasting plasma glucose level >126 mg/dl (7.0 mmol/l) or a casual plasma glucose >200 mg/dl (11.1 mmol/l) meets the threshold for the diagnosis of diabetes, if confirmed on a subsequent day, and precludes the need for any glucose challenge. In the absence of this degree of hyperglycemia, evaluation for GDM in women with average or high-risk characteristics should follow one of two approaches: <ref name=NCBI1>{{cite journal | author =  American Diabetes Association | title = [http://care.diabetesjournals.org/cgi/content/full/25/suppl_1/s94 Gestational Diabetes Mellitus],  | journal =  Diabetes Care  | volume = | issue =25:S94-S96 | pages = | year = 2002}}</ref>
* One-step approach
* Two-step approach
The following are the values which the American Diabetes Association considers to be abnormal during the Glucose Tolerance Test:
* Fasting Blood Glucose Level≥95 mg/dl (5.33 mmol/L)
* 1 Hour Blood Glucose Level≥180 mg/dl (10 mmol/L)
* 2 Hour Blood Glucose Level≥155 mg/dl (8.6 mmol/L)
* 3 Hour Blood Glucose Level≥140 mg/dl (7.8 mmol/L)
==References==
{{reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Disease]]
[[Category:Obstetrics]]
[[Category:Endocrinology]]


==References==
{{reflist|2}}
{{WH}}
{{WS}}
[[Category:Disease]]
[[Category:Obstetrics]]
[[Category:Obstetrics]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Emergency medicine]]

Latest revision as of 21:51, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

For more information regarding GDM laboratory findings please click here

Overview

Generally, a test for gestational diabetes is carried out between the 24th and 28th week of pregnancy.

If a patient is at risk for gestational diabetes (see risk factors), screening should be done earlier in the pregnancy.

Laboratory Findings

Depending on the woman's risk and her previous test results, she may have one or more of the following tests.[1]

  • Screening glucose test
  • Oral glucose tolerance test (OGTT)

Screening glucose test

There are several tests intended to identify gestational diabetes in pregnant women. [2][3]

  • The first, called the screening glucose challenge test, is a preliminary screening test performed between 24-28 weeks. If a woman tests positive during this screening test, a second test called the Glucose Tolerance Test, may be performed.
  • The second test confirms the diagnoses.

The screening glucose challenge test is now considered as the standard test performed during the second trimester of pregnancy.


Oral glucose tolerance test

Women who are considered at risk for gestational diabetes are given a screening test called a 50 gram glucose challenge between the 24th and 28th weeks of pregnancy (those with two or more risk factors may be tested earlier). The glucose challenge is performed by giving 50 grams of a glucose drink and then drawing a blood sample one hour later to measure the level of blood glucose present. Women with a blood sugar level greater than 140 mg/dl may have gestational diabetes, and require a follow-up test called a 3-hour oral glucose tolerance test (OGTT). [4][2][3]

References

  1. "Professional Practice Committee for the Standards of Medical Care in Diabetes-2016". Diabetes Care. 39 Suppl 1: S107–8. 2016. doi:10.2337/dc16-S018. PMID 26696673.
  2. 2.0 2.1 Carpenter MW, Coustan DR (1982). "Criteria for screening tests for gestational diabetes". Am. J. Obstet. Gynecol. 144 (7): 768–73. PMID 7148898.
  3. 3.0 3.1 "Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group". Diabetes. 28 (12): 1039–57. 1979. PMID 510803.
  4. "What I need to know about Gestational Diabetes". National Diabetes Information Clearinghouse. National Diabetes Information Clearinghouse. 2006. Retrieved 2006-11-27. Text " Boyd E. Metzger, M.D., Susan A. Biastre, R.D., L.D.N., C.D.E., Beverly Gardner, R.D., L.D.N., C.D.E. " ignored (help)

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