Gestational diabetes screening: Difference between revisions
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==Overview== | ==Overview== | ||
The most useful method for GDM screening is to perform 50 gram | The most useful method for GDM screening is to perform the 50 gram glucose test in 24-28 weeks of pregnancy in low risk women. [[Gestational diabetes risk factors|High risk]] pregnancies should be screened earlier, at the first prenatal visit if possible. | ||
==Screening== | ==Screening== | ||
Screening can be performed during the first prenatal visit especially | Screening can be performed during the first prenatal visit, especially in women with [[Gestational diabetes risk factors|risk factors]] for GDM. If the result is negative or the test was not done during the first prenatal visit, screening at 24-28 weeks of gestation is ideal.<ref name="pmid26696675">{{cite journal |vauthors= |title=2. Classification and Diagnosis of Diabetes |journal=Diabetes Care |volume=39 Suppl 1 |issue= |pages=S13–22 |year=2016 |pmid=26696675 |doi=10.2337/dc16-S005 |url=}}</ref><ref name="pmid24424622">{{cite journal |vauthors=Moyer VA |title=Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement |journal=Ann. Intern. Med. |volume=160 |issue=6 |pages=414–20 |year=2014 |pmid=24424622 |doi=10.7326/M13-2905 |url=}}</ref> | ||
===50 gram Glucose Test=== | ===50 gram Glucose Test=== | ||
*Regardless of the fasting status of the woman, a 50 gram glucose load is given. 1 hour later, plasma glucose level should be measured. A measurement greater than 130 mg/dl is suggestive of GDM (130 mg/dl threshold has 88% to 99% sensitivity, and 66% to 77% specificity).<ref name="pmid23712349">{{cite journal |vauthors=Donovan L, Hartling L, Muise M, Guthrie A, Vandermeer B, Dryden DM |title=Screening tests for gestational diabetes: a systematic review for the U.S. Preventive Services Task Force |journal=Ann. Intern. Med. |volume=159 |issue=2 |pages=115–22 |year=2013 |pmid=23712349 |doi=10.7326/0003-4819-159-2-201307160-00657 |url=}}</ref> | |||
*The next step is to confirm the diagnosis by performing a 100 gram 3 hour Glucose Test. | |||
== | ==2020 American Diabetes Association Standards of Medical Care in Diabetes (DO NOT EDIT)<ref>{{cite journal|title=14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2020|journal=Diabetes Care|volume=43|issue=Supplement 1|year=2019|pages=S183–S192|issn=0149-5992|doi=10.2337/dc20-S014}}</ref>== | ||
{|class="wikitable" | ===Screening for Gestational Diabetes (GDM)<ref name="pmid26696680">{{cite journal |vauthors= |title=Standards of Medical Care in Diabetes-2016: Summary of Revisions |journal=Diabetes Care |volume=39 Suppl 1 |issue= |pages=S4–5 |year=2016 |pmid=26696680 |doi=10.2337/dc16-S003 |url=}}</ref>=== | ||
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| bgcolor="seashell" |<nowiki>"</nowiki>'''1.''' Test for undiagnosed type 2 diabetes at the first prenatal visit in those with risk factors, using standard diagnostic criteria. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|- | |- | ||
| bgcolor=" | | bgcolor="seashell" |<nowiki>"</nowiki>'''2.''' Test for gestational diabetes mellitus at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor=" | | bgcolor="seashell" |<nowiki>"</nowiki>'''3.''' Screen women with gestational diabetes mellitus for persistent diabetes at 6–12 weeks postpartum, using the oral glucose tolerance test and clinically appropriate nonpregnancy diagnostic criteria ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor=" | | bgcolor="seashell" |<nowiki>"</nowiki>'''4.''' Women with a history of gestational diabetes mellitus should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor=" | | bgcolor="seashell" |<nowiki>"</nowiki>'''5.''' Women with a history of gestational diabetes mellitus found to have prediabetes should receive lifestyle interventions or metformin to prevent diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Obstetrics]] | [[Category:Obstetrics]] | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 18:40, 10 February 2021
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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]
Overview
The most useful method for GDM screening is to perform the 50 gram glucose test in 24-28 weeks of pregnancy in low risk women. High risk pregnancies should be screened earlier, at the first prenatal visit if possible.
Screening
Screening can be performed during the first prenatal visit, especially in women with risk factors for GDM. If the result is negative or the test was not done during the first prenatal visit, screening at 24-28 weeks of gestation is ideal.[1][2]
50 gram Glucose Test
- Regardless of the fasting status of the woman, a 50 gram glucose load is given. 1 hour later, plasma glucose level should be measured. A measurement greater than 130 mg/dl is suggestive of GDM (130 mg/dl threshold has 88% to 99% sensitivity, and 66% to 77% specificity).[3]
- The next step is to confirm the diagnosis by performing a 100 gram 3 hour Glucose Test.
2020 American Diabetes Association Standards of Medical Care in Diabetes (DO NOT EDIT)[4]
Screening for Gestational Diabetes (GDM)[5]
| "1. Test for undiagnosed type 2 diabetes at the first prenatal visit in those with risk factors, using standard diagnostic criteria. (Level of Evidence: B)" |
| "2. Test for gestational diabetes mellitus at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. (Level of Evidence: A)" |
| "3. Screen women with gestational diabetes mellitus for persistent diabetes at 6–12 weeks postpartum, using the oral glucose tolerance test and clinically appropriate nonpregnancy diagnostic criteria (Level of Evidence: E)" |
| "4. Women with a history of gestational diabetes mellitus should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. (Level of Evidence: B)" |
| "5. Women with a history of gestational diabetes mellitus found to have prediabetes should receive lifestyle interventions or metformin to prevent diabetes. (Level of Evidence: A)" |
References
- ↑ "2. Classification and Diagnosis of Diabetes". Diabetes Care. 39 Suppl 1: S13–22. 2016. doi:10.2337/dc16-S005. PMID 26696675.
- ↑ Moyer VA (2014). "Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement". Ann. Intern. Med. 160 (6): 414–20. doi:10.7326/M13-2905. PMID 24424622.
- ↑ Donovan L, Hartling L, Muise M, Guthrie A, Vandermeer B, Dryden DM (2013). "Screening tests for gestational diabetes: a systematic review for the U.S. Preventive Services Task Force". Ann. Intern. Med. 159 (2): 115–22. doi:10.7326/0003-4819-159-2-201307160-00657. PMID 23712349.
- ↑ "14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2020". Diabetes Care. 43 (Supplement 1): S183–S192. 2019. doi:10.2337/dc20-S014. ISSN 0149-5992.
- ↑ "Standards of Medical Care in Diabetes-2016: Summary of Revisions". Diabetes Care. 39 Suppl 1: S4–5. 2016. doi:10.2337/dc16-S003. PMID 26696680.