What are the Endocrine Society clinical practice guidelines on gestational diabetes mellitus (GDM)?

Updated: Apr 29, 2020
  • Author: Thomas R Moore, MD; Chief Editor: George T Griffing, MD  more...
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Answer

Answer

In November 2013, the Endocrine Society released a clinical practice guideline on diabetes and pregnancy. The group’s recommendations include the following [58, 59] :

  • All pregnant women who have not already been diagnosed with diabetes should be screened for the disease with a fasting plasma glucose (FPG), an HbA1c, or an untimed random plasma glucose test at their first prenatal visit

  • An FPG of 126 mg/dL or higher (≥7.0 mmol/L), an untimed random plasma glucose of 200 mg/dL or higher (≥11.1 mmol/L), or an HbA1c of 6.5% or higher indicates overt diabetes (type 1, type 2, or other), while an FPG of 92-125 mg/dL (5.1-6.9 mmol/L) indicates gestational diabetes

  • A diagnosis of overt diabetes must be confirmed with a second test (FPG, untimed random plasma glucose, HbA1c, or oral glucose tolerance test [OGTT]); these must be performed when hyperglycemic symptoms are absent and must be abnormal on another day

  • Women who by 24 weeks’ gestation have not yet been diagnosed with overt or gestational diabetes should, at between 24 and 28 weeks’ gestation, undergo a 2-hour, 75-g OGTT for gestational diabetes

  • At 24-28 weeks’ gestation, a result of 153-199 mg/dL (8.5-11 mmol/L) for a 2-hour, 75-g OGTT indicates gestational diabetes, while a test result of 200 mg/dL or higher (≥11.1 mmol/L) indicates overt diabetes

  • Initial treatment for gestational diabetes should consist of lifestyle changes with regard to diet and fitness

  • If lifestyle changes cannot sufficiently control blood glucose, pharmacologic treatment should be used

  • Women with gestational diabetes should undergo an OGTT 6-8 weeks postdelivery to rule out diabetes or prediabetes; they should also undergo regular testing for diabetes, especially prior to the next pregnancy

  • A detailed eye examination for diabetic retinopathy should be performed in women with type 1 or type 2 diabetes; if found, the retinopathy should be treated before conception


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