Gestational diabetes testing guidelines updated
New criteria may double the number of women who receive a diagnosis of gestational diabetes
In an effort to increase the identification of women with gestational diabetes and reduce health risks to mother and fetus, the American Diabetes Association (ADA) has adopted new guidelines for testing pregnant women for gestational diabetes; these guidelines have been published in a special supplement to the January 2011 issue of Diabetes Care.
The International Association of Diabetes and Pregnancy Study Groups, which includes the ADA, developed the new recommendations based on data from the Hyperglycemia and Adverse Pregnancy Outcomes study, which showed that the risk of adverse maternal, fetal, and neonatal outcomes increases directly with a mother’s glucose levels. The research also revealed that these risks are present at glucose levels previously considered to be normal.
The guidelines recommend that all pregnant women not previously known to have diabetes be tested for gestational diabetes using the 75-g oral glucose tolerance test between 24 and 28 weeks of gestation and using diagnostic cut points of greater than 92 mg/dL for the fasting glucose test, higher than 180 mg/dL one hour after drinking the 75-g glucose solution, and above 153 mg/dL two hours after drinking the solution. In addition, the guidelines say all pregnant women with risk factors for type 2 diabetes should be tested for diabetes upon their first neonatal visit, with a diagnosis at this stage considered type 2 diabetes and not gestational diabetes. The percentage of pregnant women diagnosed with gestational diabetes is expected to double under the new criteria.
“We support a worldwide, uniform definition of gestational diabetes, and this is the best way to get there,” Carol Wysham, MD, chair of the ADA’s Professional Practice Committee, said in a statement. “However, we also recognize that health systems need time to convert to the new strategy and in the interim, they can continue to use prior methods for diagnosis until they can make the switch. It’s important that they do ultimately convert, though, as the new definition will enable us to ward off preventable complications in both mother and child.”
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