Diagnosis of Gestational Diabetes
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Traditionally in the United States, pregnant women have been tested for gestational diabetes using the oral glucose tolerance test (OGTT). Currently, all women are tested at about 24 to 26 weeks of pregnancy, earlier if more risk factors are present. They drink a solution of 50g glucose followed one hour later by a blood test to measure glucose metabolization. If after one hour the blood sugar is >140, a second 3-hour 100 g OGTT is done. If the 1-hour test is >185, the doctor may skip the second test and proceed to treating GDM.
The American Diabetes Association (ADA) and the World Health Organization (WHO) provide differing recommendations for the screening of GDM. WHO in particular recommends a 75 g oral load with fasting and 2 hour plasma glucose test for pregnant women as well as non-pregnant adults when screening for glucose intolerance. The fasting plasma glucose has seen an increase in use in recent years. The test offers simplicity, low cost, reproducibility and worldwide availability making it the best test overall for diagnosing diabetes. When applied to pregnancy and the detection of GDM, fasting plasma glucose can serve as a screening and diagnostic tool as it can screen for sub-categories of GDM. A fasting plasma glucose value of <85 would be considered normal although at-risk women should be retested again later in the pregnancy. Fasting plasma glucose values between 85 mg/dl and 126 mg/dl should be followed up with a glucose tolerance test. Values > or = to 125 mg/dl would receive the diagnosis of gestational diabetes. To assure proper diagnosis, all tests should be given after complete 8 hour fasting.
Diagnosis and treatment of Gestational Diabestes has gone through many changes over the last decade all in efforts to provide greater detection and treatment to women and their children. Interesting, outcomes over that time have not changed significantly. Infant weight, Apgars, and C-section rates all remained similar whether women were subject to WHO and NDDG criteria or CDA’s, and differing diet recommendations and glucose testing. However, research continues on new testing and treatment options particularly as studies continue to indicate long-term effects on infants as a result of GDM.