This is a clinical summary of U.S. Preventive Services Task Force Recommendations for screening for diabetes in pregnancy. For all pregnant women after 24 weeks of gestation without any specific diabetes symptoms
Risk Assessment
Risk factors that increase a woman's risk for developing GDM include:
- obesity,
- increased maternal age,
- history of GDM,
- family history of diabetes, and
- belonging to an ethnic group with increased risk for type 2 diabetes mellitus (Hispanic, Native American, South or East Asian, African American, or Pacific Islands descent).
Screening Tests
The most commonly used screening test in the United States is the 50-g oral glucose challenge test, administered between 24 and 28 weeks of gestation in a nonfasting state. If the screening threshold is met or exceeded (130 mg/dL,135 mg/dL, or 140 mg/dL), patients receive the oral glucose tolerance test. A diagnosis of GDM is made when 1 or more glucose values fall at or above the specified glucose thresholds.
Other methods of screening include fasting plasma glucose and screening based on risk factors. However, there is limited evidence about these alternative screening approaches.
Treatment
Initial treatment includes moderate physical activity, dietary changes, support from diabetes educators and nutritionists, and glucose monitoring. If the patient's glucose is not controlled after these initial interventions, she may be prescribed medication (either insulin or oral hypoglycemic agents), have increased surveillance in prenatal care, and have changes in delivery management.