Gestacional Diabetes

Screening, Diagnosis and Reclassification

Screening

Bibliography:

Introduction:

Conclusions:

The screening, diagnosis and reclassification tests of GD are validated and easy to interpret when performed correctly

and in the correct timing of pregnancy. The systematization of procedures is essential for a correct approach.

Gestational Diabetes (GD) is defined as any degree of impaired glucose tolerance first detected during pregnancy. In Portugal, Diabetes Mellitus (DM) complicates

4% of pregnancies. Of these, 90% are GD. A correct diagnosis and treatment can prevent many maternal and fetal complications.

Diagnosis

1) Blayo A, Mandelbrot L. Screening and diagnosis of gestational diabetes. Diabetes Metab. 2004 Dec;30(6):575-80. 2) Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest. 2005 Mar;115(3):485-91. 3) Diagnosis and Classification of Diabetes Mellitus. American Diabetes Association. Diabetes Care. Volume 31, Supplement 1, January 2008. 4) Forsbach-Sánchez G, Tamez-Peréz HE, Vazquez-Lara J. Diabetes and pregnancy. Arch Med Res. 2005 May-Jun;36(3):291-9. 5) Maresh M. Screening for gestational diabetes mellitus. Semin Fetal Neonatal Med. 2005 Aug;10(4):317-23. 6) Phillips PJ, Jeffries B. Gestational diabetes-worth finding and actively treating. Aust Fam Physician. 2006 Sep;35(9):701-3. 7) Recomendações 2006 do Grupo de estudo da Diabetes da APMCG na diabetes tipo 2 para a Prática Clínica Diária em Cuidados de Saúde Primários. 7) Diabetes e Gravidez. Circular Normativa DGS nº8, 4/11/98

Reclassification

Reclassification Test

• Two blood samples:

•After 8 to 14 h fasting

•2 h after ingestion of 75 grams of

glucose in 300 cc of water

GD Reclassification Test

Normal IFG IGT DM

Fasting < 100 mg/dL 100 – 125 mg/dL < 126 mg/dL ≥ 126 mg/dL

After 2 hours < 140 mg/dL < 140 mg/dL 140 – 199 mg/dL ≥ 200 mg/dL

OGTT

Timing Glycaemia

Fasting ≥ 95 mg/dl

1 hour ≥ 180 mg/dl

2 hours ≥ 155 mg/dl

3 hours ≥ 140 mg/dl

Low risk

●Age < 25 years

●BMI< 25 kg/m2

●No history of DM in fist degree relatives

●No personal history of DM, IFG or IGT

●No repeated UTI or glycosuria

●No prior poor obstetric outcomes

(All criteria)

OGTT

• Four blood samples:

•After 8 to 14 h fasting

•1, 2 and 3 hours after ingestion of 100

grams of glucose in 400 cc of water

• Previous 3 days without food or physical

exercise restriction

• Remain seated until last blood sample

O’ Sullivan Test

•One blood sample 1 hour after ingestion

of 50 grams of glucose in 200 cc of water

• Fasting is not required

Screening Test positivity

Fasting glycaemia ≥ 126 mg/dl

O’Sullivan Test ≥ 140 mg/dl

GD Diagnosis

Fasting venous glycaemia ≥ 126 mg/dL, in 2 occasions

Ocasional venous glycaemia ≥ 200 mg/dl, in 2 occasions

Positive OGTT

High risk

●Age ≥ 35 years ●BMI ≥ 30 kg/m2

●History of DM in first degree relatives

●Personal history of DM, IFG or IGT

●Repeated UTI ●Glycosuria

●Prior macrossomic infant

●Congenital malformations ●Multiparity ≥ 4

●Spontaneous abortions ≥ 2

●Unexplained stillbirth

(One or more criteria)

Risk assessment in first consultation

Average risk

Without high or low

risk criteria

Abbreviation Index:IFG – Impaired fasting glucoseIGT – Impaired glucose toleranceGD – Gestacional Diabetes DM – Diabetes MellitusBMI – Body Mass IndexUTI – Urinay tract infectionOGTT – Oral Glucose Tolerance Test

Objectives: Describe laboratory tests indicated in the screening, diagnosis and reclassification of GD; Create flowcharts that allow for proper consultation.

O’Sullivan Test at 1st consultation,

24-28 and e 32 weeks

Positive if ≥ 2 altered values

Guide to DM

consultation

Pre-diabetic states

Intensify surveillance and

preventive measures

Encourage healthy

lifestyles

Test indicated in all women with GD,

6-8 weeks after delivery

OGTT

Immediate OGTT

Positive Negative

ReferenciationRepeat OGTT in

next steps

Fasting glucose at 1st consultation and

O’Sullivan Test at 24-28 and 32 weeks

Pedro Bairrada1, Anabela Andrade1, Esther Rodriguez1, Rita Gomes1, Rui Macedo1, Rui Pinheiro1 1Centro de Saúde de São Martinho do Bispo

Contact – pedroabairrada@gmail.com

Fasting glucose at 1st consultation and 32

weeks; O’Sullivan Test at 24-28 weeks

Methodology: Search articles published between 2003-2007 in Pubmed / Medline, with the term “Gestational Diabetes”. Search guidelines of national and foreign organizations.