GESTATIONAL DIABETES MELLITUS

New Guidelines for Screening
GDM = any degree of glucose intolerance during pregnancy GDM complicates ~5% of all pregnancies
All patients with GDM MUST be referred to high-risk OB*

Screen everyone for diabetes ASAP

Screen all patients with 1-hr test ASAP (dx of pregnancy or initial visit) – this initial screen is for PREEXISTING DIABETES. If positive, do 3-hr screen. If the 3-hour test is positive refer to high-risk. Patients with a negative early screen should be rescreened at 24-28 wks.

Screen everyone for GDM between 24-28 wks

Patients with GDM in prior pregnancy are screened with a 3-hr test. 

Screen everyone else with a 1-hr test. 1-hr glucose = blood sugar one hour after 50 gram glucose load. The test does not have to be done fasting.

>/=130</=200 = positive (do 3-hr test) >200 have GDM

3-hr test = fasting plus 3 hourly blood sugars drawn after a 100 gram glucose load. 

There are many criteria for diagnosing GDM. 

 

Time Carpenter/Coustan FBS 95 mg/dl 1 hour 180 2 hour 155 3 hour 140

Two high values = GDM One high value still increased risk for macrosomia. Consider repeat 3hr test in 1 month. Check fetal size (send for ultrasound). Referrals to HROB for GDM MMG2 patients go to CFCC for the Diabetes Program Fax copy of POPRAS and consult form with HMO authorization if required Provide a prescription for a Freestyle glucometer and supplies - Instruct the patient to test 4 times a day - Fasting & 2hrs after breakfast, lunch and dinner - Bring record to appt Importance of testing and treating Fasting hyperglycemia is associated with intrauterine death in the last 4-8wks of pregnancy. GDM of any severity increases macrosomia and risk for neonatal hypoglycemia, jaundice, polycythemia and hypocalcemia. Postpartum testing Women with GDM are more likely to develop DM. Test woman for diabetes at postpartum exam. Consider additional testing at next well-woman exam.