diabetes mellitus in pregnancy_ screening and diagnosis
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7/24/2019 Diabetes Mellitus in Pregnancy_ Screening and Diagnosis
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Offi cial reprint from UpToDatewww.uptodate.com ©2016 UpToDate
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Range of diagnostic criteria for gestational diabetes
Approach Criteria* Fasting
mg/dL
One-hour
mg/dL
Two-hour
mg/dL
Three-
hour
mg/dL
Two step (100-
gram load)
Carpenter
and Coustan
95 (5.3
mmol/L)
180 (10.0
mmol/L)
155 (8.6
mmol/L)
140 (7.8
mmol/L)
NDDG 105 (5.8
mmol/L)
190 (10.6
mmol/L)
165 (9.2
mmol/L)
145 (8.0
mmol/L)
Two step (75-
gram load)
CDA 95 (5.3
mmol/L)
191 (10.6
mmol/L)
160 (8.9
mmol/L)
One step (75-
gram load)
WHO 92 to 125
(5.1 to 6.9
mmol/L)
180 (10.0
mmol/L)
153 to 199
(8.5 to 11
mmol/L)
IADPSG 92 to 125(5.1 mmol/L)
180 (10.0mmol/L)
153 (8.5mmol/L)
These thresholds are for diagnosis of gestational diabetes. Diagnosis of overt diabetes and
diabetes in pregnancy are based on different criteria (eg, IADPSG: fasting blood glucose ≥126
mg/dL [7.0 mmol/L] is consistent with overt diabetes; WHO: two-hour glucose ≥200 mg/dL
[11.1 mmol/L] following a 75-gram oral glucose load is consistent with diabetes in
pregnancy).
NDDG: National Diabetes Data Group; CDA: Canadian Diabetes Association; WHO: World Health
Organization; IADPSG: International Association of Diabetes and Pregnancy Study Groups.
Data from: Vandorsten JP, Dodson WC, Espeland MA, et al. National Institutes of Health consensus
development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statements
2013; 29:1.
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Diagnostic criteria for the 100-gram three-hour GTT to diagnose
gestational diabetes mellitus
Plasma or serum glucose
level
Carpenter/Coustan
Plasma level
National Diabetes Data
Group
mg/dL mmol/L mg/dL mmol/L
Fasting 95 5.3 105 5.8
One hour 180 10.0 190 10.6
Two hours 155 8.6 165 9.2
Three hours 140 7.8 145 8.0
100-gram oral glucose load is given in the morning to a patient who has fasted overnight for
at least 8 hours. Glucose concentration greater than or equal to these values at TWO or more
time points is a positive test.
Two different classification schemes of GDM based upon results of the three-hour GTT results
have been proposed. The Fourth International Workshop-Conference on Gestational Diabetes
GTT values cited above are based upon the Carpenter and Coustan modification of earlier
values. They are lower than those proposed by the Expert Committee on the Diagnosis and
Classification of Diabetes Mellitus and the National Diabetes Data Group (NDDG), which used
cutoff values of 105, 190, 165, and 145 mg/dL (5.8, 10.6, 9.2, and 8.0 mmol/L), respectively.
The values are lower because the thresholds derived from the older Somogyi-Nelson method
of glucose analysis were corrected to account for the enzymatic assays currently in use.
GTT: glucose tolerance test.
Data from: VanDorsten JP, Dodson WC, Espeland MA, et al. National Institutes of Health Consensus
Development Conference Statement: Diagnosing Gestational Diabetes Mellitus. NIH Consens State Sci
Statements 2013; 29:1.
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IADPSG and ADA criteria for a positive two-hour 75-gram oral
glucose tolerance test for the diagnosis of gestational diabetes
Two hour 75-gram oral glucose tolerance test
Fasting ≥92 mg/dL (5.1 mmol/L)
OR
One-hour ≥180 mg/dL (10.0 mmol/L)
OR
Two-hour ≥153 mg/dL (8.5 mmol/L)
The diagnosis of gestational diabetes is made at 24 to 28 weeks of gestation when one or
more plasma glucose values meets or exceeds the above values.
ADA: American Diabetes Association; IADPSG: International Association of the Diabetes and Pregnancy
Study Groups.
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ADA criteria for the diagnosis of diabetes
1. A1C ≥6.5 percent. The test should be performed in a laboratory using a method that is NGSP
certified and standardized to the DCCT assay.*
OR
2. FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least eight hours.*
OR
3. Two-hour plasma glucose ≥200 mg/dL (11.1 mmol/L) during an OGTT. The test should be
performed as described by the World Health Organization, using a glucose load containing the
equivalent of 75-gram anhydrous glucose dissolved in water.*
OR
4. In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma
glucose ≥200 mg/dL (11.1 mmol/L).
A1C: glycated hemoglobin; DCCT: diabetes control and complications trial; FPG: fasting plasma glucose;
NGSP: national glycohemoglobin standardization program; OGTT: oral glucose tolerance test.* In the absence of unequivocal hyperglycemia, criteria 1 to 3 should be confirmed by repeat testing.
Reprinted with permission from: American Diabetes Association. Standards of Medical Care in Diabetes
2011. Diabetes Care 2011; 34:S11. Copyright © 2011 American Diabetes Association.
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ACOG two step approach for screening and diagnosis of gestational
diabetes
Step one
1. Give 50-gram oral glucose load without regard to time of day
2. Measure plasma or serum glucose
3. Glucose ≥135 mg/dL (7.5 mmol/L) or ≥140 mg/dL (7.8 mmol/L) is elevated and requires
administration of a 100-gram oral glucose tolerance test*. The lower threshold provides greater
sensitivity, but would result in more false positives and would require administering the full
glucose tolerance test to more patients than the 140 mg/dL threshold. The lower threshold
should be considered in populations with higher prevalence of gestational diabetes.
Step two
1. Measure fasting serum or plasma glucose concentration
2. Give 100-gram oral glucose load
3. Measure plasma or serum glucose at one, two, and three hours after glucose load
4. A positive test is defined by elevated glucose concentrations at two or more time points
(either Carpenter and Coustan thresholds or National Diabetes Data Group thresholds can be
used)
*Some experts use a threshold of 130 mg/dL (7.2 mmol/L)
Data from: American College of Obstetricians and Gynecologists. Practice Bulletin number 137:
Gestational diabetes. Obstet Gynecol 2013; 122:406.
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World Health Organization (WHO) thresholds for positive two-hour
75-gram oral GTT (2013). A diagnosis of "gestational diabetes
mellitus" is made when one or more of the following
glucose thresholds is met any time during pregnancy.
Fasting 9 2 to 125 mg/dL (5 .1 to 6 .9 mmol/L )
OR
On e-h our ≥1 80 mg/dL (10.0 mmol/L)
OR
Two-hour 153 to 199 mg/dL (8.5 to 11.0 mmol/L)
By comparison, a diagnosis of "diabetes mellitus in pregnancy" is made if one or more of the
following criteria are met: fasting plasma glucose ≥126 mg/dL (7.0 mmol/L), two hour plasma
glucose ≥200 mg/dL (11.1 mmol/L) following a 75 gram oral glucose load, random blood
glucose ≥200 mg/dL (11.1 mmol/L) in the presence of diabetes symptoms. There are no
established criteria for the diagnosis of "diabetes mellitus in pregnancy" based on the 1-hour
post-load value.
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