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Gestational Diabetes Mellitus: Merican Iabetes Ssociation
Gestational Diabetes Mellitus: Merican Iabetes Ssociation
DEFINITION, DETECTION, ● Member of an ethnic group with a low Mahan, modified by Carpenter and Cous-
AND DIAGNOSIS prevalence of GDM tan, and are shown in Table 1. Alterna-
● No known diabetes in first-degree relatives tively, the diagnosis can be made using a
Definition ● No history of abnormal glucose tolerance 75-g glucose load and the glucose thresh-
Gestational diabetes mellitus (GDM) is ● No history of poor obstetric outcome old values listed for fasting, 1 h, and 2 h
defined as any degree of glucose intoler- (Table 2); however, this test is not as well
ance with onset or first recognition during A fasting plasma glucose level ⬎126 validated for detection of at-risk infants or
Table 1—Diagnosis of GDM with a 100-g Table 2—Diagnosis of GDM with a 75-g ommended when MNT fails to main-
oral glucose load oral glucose load tain self-monitored glucose at the
following levels:
mg/dl mmol/l mg/dl mmol/l Fasting whole blood glucose
Fasting 95 5.3 Fasting 95 5.3 ⱕ95 mg/dl (5.3 mmol/l)
1-h 180 10.0 1-h 180 10.0 Fasting plasma glucose
2-h 155 8.6 2-h 155 8.6 ⱕ105 mg/dl (5.8 mmol/l)
3-h 140 7.8 Two or more of the venous plasma concentrations
or
Two or more of the venous plasma concentrations must be met or exceeded for a positive diagnosis. 1-h postprandial whole blood glucose
must be met or exceeded for a positive diagnosis. The test should be done in the morning after an ⱕ140 mg/dl (7.8 mmol/l)
The test should be done in the morning after an overnight fast of between 8 and 14 h and after at least 1-h postprandial plasma glucose
overnight fast of between 8 and 14 h and after at least 3 days of unrestricted diet (ⱖ 150 g carbohydrate ⱕ155 mg/dl (8.6 mmol/l)
3 days of unrestricted diet (ⱖ150 g carbohydrate per per day) and unlimited physical activity. The subject
should remain seated and should not smoke or
day) and unlimited physical activity. The subject
should remain seated and should not smoke throughout the test. 2-h postprandial whole blood glucose
ⱕ120 mg/dl (6.7 mmol/l)
not FDA approved for the treatment of and according to the guidelines of the Offspring of women with GDM
gestational diabetes and further studies “Report of the Expert Committee on the should be followed closely for the devel-
are needed in a larger patient popula- Diagnosis and Classification of Diabetes opment of obesity and/or abnormalities of
tion to establish its safety. Mellitus” (5). See Table 3 for diagnostic glucose tolerance.
● Programs of moderate physical exercise criteria. If glucose levels are normal post-
have been shown to lower maternal partum, reassessment of glycemia should
glucose concentrations in women with be undertaken at a minimum of 3-year
GDM. Although the impact of exercise intervals. Women with IFG or IGT in the References
on neonatal complications awaits rigor- postpartum period should be tested for 1. Metzger BE, Coustan DR (Eds.): Proceed-
ous clinical trials, the beneficial glucose diabetes annually; these patients should ings of the Fourth International Work-
lowering effects warrant a recommen- receive intensive MNT and should be shop-Conference on Gestational Diabetes
Mellitus. Diabetes Care 21 (Suppl. 2):B1–
dation that women without medical or placed on an individualized exercise pro-
B167, 1998
obstetrical contraindications be en- gram because of their very high risk for 2. Franz MJ, Horton ES, Bantle JP, Beebe CA,
couraged to start or continue a program development of diabetes. All patients with Brunzell JD, Coulston AM, Henry RR,
of moderate exercise as a part of treat- prior GDM should be educated regarding Hoogwerf BJ, Stacpoole PW: Nutrition