Screening for diabetes during pregnancy

Screening is important for the early detection of the diabetes thereby quality of life can be improved. Following should be considered in the screening;
1. Who Should Be Screened
2. Routing screening tests
3. How to diagnose
Who should be screened?

Screen patients with any of the following risk factors for GDM at the first prenatal visit.

1. Maternal age older than 35 years
2. Women who are obese (>90 kg)
3. Women with a Strong immediate family history of type 2 diabetes mellitus or GDM

4. Women of ethnic/racial high risk groups
5. Women who have had a >9 # baby
6. Previous infant weighing more than 4000 g
7. Previous unexplained fetal demise
8. Previous pregnancy with GDM
9. Fasting glucose value greater than 140 mg/dl (7.8mmol/L) or random glucose value greater than 200 mg/dl (11.1mmol/L)

Routing screening test
1. Oral Glucose Tolerance Test;
A) A 50-g, 1-hour screening test is administered to all pregnant women at 26-28 weeks', followed by a 100-g, 3-hour OGTT for those with an abnormal screening result or,
B) A 1-step, 75-g, 2-hour test can be administered.
OGTT prerequisites for gestational diabetes are as follows:
a. One-hour, 50-g glucose challenge result greater than 135 mg/dL
b. Overnight fast of 8-14 hours
c. Carbohydrate loading for 3 days (>150 g carbohydrates)
d. Seated and not smoking during the test
e. Two or more values met or exceeded
f. Either a 2-hour (75 g of glucose) or 3-hour (100 g of glucose) test
How to diagnose
Plasma glucose criteria for gestational diabetes are as follows:
1. Fasting test
I. With glucose load of 100 g, result of 95 mg/dL (5.3 mmol/L)
II. With glucose load of 75 g, result of 95 mg/dL (5.3 mmol/L)

2. one-hour test
I. With glucose load of 100 g, result of 180 mg/dL (10 mmol/L)
II. With glucose load of 75 g, result of 180 mg/dL (10 mmol/L)

3. two-hour test
I. With glucose load of 100 g, result of 155 mg/dL (8.6 mmol/L)
II. With glucose load of 75 g, result of 155 mg/dL (8.6 mmol/L)

4. Three-hour test –
I. With glucose load of 100 g, result of 140 mg/dL (7.8 mmol/L)