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Gestational Diabetes Ogtt

Glucose Tolerance Test

Glucose Tolerance Test

What is a glucose tolerance test? A glucose tolerance test measures how well your body’s cells are able to absorb glucose, or sugar, after you ingest a given amount of sugar. Doctors use fasting blood sugar levels and hemoglobin A1c values to diagnose type 1 and type 2 diabetes, and prediabetes. A glucose tolerance test can also be used. Doctors primarily use a glucose tolerance test to diagnose gestational diabetes. Doctors often diagnose type 1 diabetes quickly because it usually develops quickly and involves high blood sugar levels. Type 2 diabetes, on the other hand, often develops over years. Type 2 diabetes is the most common form of diabetes, and it usually develops during adulthood. Gestational diabetes occurs when a pregnant woman who doesn’t have diabetes before pregnancy has high blood sugar levels as a result of the pregnancy. The American Diabetes Association estimates that gestational diabetes occurs in 9.2 percent of pregnancies. Doctors should screen all women for gestational diabetes. Gestational diabetes can cause pregnancy complications, so early detection and prompt treatment are important. If you’re pregnant, your doctor will usually recommend this test between the 24th and 28th week of your pregnancy. Your doctor may also recommend that you have this test earlier if you’re having the symptoms of prediabetes or diabetes. Preparing for the glucose tolerance test involves the following: Continue to eat a normal diet in the days leading up to the test. Consult with your doctor about any medications you’re currently taking. Some medications, such as corticosteroids, beta-blockers, diuretics, and antidepressants, can interfere with the results. Abstain from food for at least eight hours before the scheduled test. You may drink water, but avoid Continue reading >>

Maternal 75-g Ogtt Glucose Levels As Predictive Factors For Large-for-gestational Age Newborns In Women With Gestational Diabetes Mellitus

Maternal 75-g Ogtt Glucose Levels As Predictive Factors For Large-for-gestational Age Newborns In Women With Gestational Diabetes Mellitus

PrintversionISSN 2359-3997On-lineversionISSN 2359-4292 Arch. Endocrinol. Metab.vol.60no.1So PauloFeb.2016 Maternal 75-g OGTT glucose levels as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus 1Endocrinology Diabetes and Metabolic Disorders Clinic, Medical Faculty, Skopje, R. Macedonia 2Faculty of Medical Science, Goce Delcev University, Stip, R. Macedonia 3Gynecology and Obstetric Clinic, Medical Faculty, Skopje, R. Macedonia Our goal was to investigate which glucose measurement from the 75-g oral glucose tolerance test (OGTT) has more capability of predicting large for-gestational-age (LGA) newborns of mothers with gestational diabetes mellitus (GDM). The study group consisted of 118 consecutively pregnant women with singleton pregnancy, patients of Outpatients Department of the Endocrinology, Diabetes, and Metabolic Disorders Clinic. All were prospectively screened for GDM between 24th and 28th week of pregnancy and followed to delivery. Outcome measures included: patients ages, pre-pregnancy BMI, BMI before delivery, FPG, 1 and 2 hour OGTT glucose values, haemoglobin A1c at third trimester, gestational week of delivery, mode of delivery and baby birth weight. From 118 pregnancies, 78 (66.1%) women were with GDM, and 40 (33.9%) without GDM. There were statistically significant differences (30.7 versus 5.0%, p < 0.01) between LGA newborns from GDM and control group, respectively. Gestation week of delivery and fasting glucose levels were independent predictors for LGA (Beta = 0.58 and Beta = 0.37 respectively, p < 0.01). Areas under the receiver operator characteristic curve (AUC) were compared for the prediction of LGA (0.782 (0.685-0.861) for fasting, 0.719 (0.607-0.815) for 1-hour and 0.51 (0.392-0.626) for 2-hou Continue reading >>

13.3 Gestational Diabetes Mellitus

13.3 Gestational Diabetes Mellitus

Clinical context Gestational diabetes, or GDM, is defined as glucose intolerance that begins or is first diagnosed during pregnancy. It may appear earlier, particularly in women with a high level of risk for GDM. GDM generally develops and is diagnosed in the late second or early third trimester of the pregnancy. GDM affects about 9.6–13.6% of pregnancies in Australia.245,246 The reported prevalence of GDM varies for a number of reasons. One reason is the use of different screening and diagnostic criteria. The prevalence is also affected by maternal factors such as history of previous gestational diabetes, ethnicity, advanced maternal age, family history of diabetes, pre-pregnancy weight and high gestational weight gain. Mothers of different ethnicity born in areas with high diabetes prevalence such as Polynesia, Asia and the Middle East, are three times as likely to have GDM as mothers born in Australia. Among Aboriginal and Torres Strait Islander mothers, GDM is twice as common, and pre-gestational diabetes affecting pregnancy is three to four times as common as in non-Indigenous mothers.245 In pregnancy, there is a natural increase in levels of hormones including cortisol, growth hormone, human placental lactogen, and progesterone and prolactin levels, causing two to three fold increases in insulin resistance. The action of these hormones is usually compensated by increased insulin release. In pregnant women with abnormal glucose tolerance or impaired β-cell reserve, the pancreas is unable to sufficiently increase insulin secretion in order to control BGLs. Potential maternal complications during pregnancy and delivery include pre-eclampsia and higher rates of caesarean delivery, maternal birth injury, postpartum haemorrhage. For the neonate, complications can inc Continue reading >>

Glucose Screening Tests During Pregnancy

Glucose Screening Tests During Pregnancy

TWO-STEP TESTING During the first step, you will have a glucose screening test: You DO NOT need to prepare or change your diet in any way. You will be asked to drink a liquid that contains glucose. Your blood will be drawn 1 hour after you drink the glucose solution to check your blood glucose level. If your blood glucose from the first step is too high, you will need to come back for a 3-hour glucose tolerance test. For this test: DO NOT eat or drink anything (other than sips of water) for 8 to 14 hours before your test. (You also cannot eat during the test.) You will be asked to drink a liquid that contains glucose, 100 grams (g) . You will have blood drawn before you drink the liquid, and again 3 more times every 60 minutes after you drink it. Each time, your blood glucose level will be checked. Allow at least 3 hours for this test. ONE-STEP TESTING You need to go to the lab one time for a 2-hour glucose tolerance test. For this test: DO NOT eat or drink anything (other than sips of water) for 8 to 14 hours before your test. (You also cannot eat during the test.) You will be asked to drink a liquid that contains glucose (75 g). You will have blood drawn before you drink the liquid, and again 2 more times every 60 minutes after you drink it. Each time, your blood glucose level will be checked. Allow at least 2 hours for this test. Continue reading >>

Do I Need An Oral Glucose Tolerance Test?

Do I Need An Oral Glucose Tolerance Test?

Your blood sugar level can give your doctor important clues about your health, and an oral glucose tolerance test (OGTT) shows how well your body handles sugar from foods. It can tell whether you are at risk for diabetes or if you already have it. A shorter version of an OGTT checks for diabetes during pregnancy. Normally when you eat, your blood sugar rises. Your pancreas, a long gland deep in the belly, releases a hormone called insulin. It helps move sugar from your blood into your cells for energy and storage. Then your blood sugar goes back down to normal. If you have type 2 diabetes, your body uses insulin poorly. Glucose builds up in your blood. This excess sugar can damage blood vessels around your body. Diabetes can lead to heart disease, nerve damage, eye disease, and kidney damage. You might need an oral glucose tolerance test if you: Have a close family member with diabetes Have high triglycerides (a type of fat in your blood) Have polycystic ovarian syndrome (which causes menstrual problems) Delivered a baby who weighed more than 9 pounds A shorter version of this test is done between the 24th and 28th week of pregnancy to see whether you have gestational diabetes. It's called the oral glucose challenge test. To get an accurate result on the OGTT, eat about 150 grams of carbohydrates each day for 3 days before the test. Don't eat or drink anything except water after about 10 o’clock the night before. You don't need to do any special prep before the pregnancy glucose challenge test. You can eat in the morning. Just avoid foods with a lot of sugar, such as doughnuts or orange juice. You'll get the OGTT at your doctor's office, a clinic, hospital, or lab. Here’s what happens: A nurse or doctor will take a blood sample from a vein in your arm to test your s Continue reading >>

Gestational Diabetes

Gestational Diabetes

Gestational diabetes is high blood sugar that develops during pregnancy and usually disappears after giving birth. It can occur at any stage of pregnancy, but is more common in the second half. It occurs if your body cannot produce enough insulin – a hormone that helps control blood sugar levels – to meet the extra needs in pregnancy. Gestational diabetes can cause problems for you and your baby during and after birth. But the risk of these problems happening can be reduced if it's detected and well managed. Who's at risk of gestational diabetes Any woman can develop gestational diabetes during pregnancy, but you're at an increased risk if: your body mass index (BMI) is above 30 – use the healthy weight calculator to work out your BMI you previously had a baby who weighed 4.5kg (10lbs) or more at birth you had gestational diabetes in a previous pregnancy one of your parents or siblings has diabetes your family origins are south Asian, Chinese, African-Caribbean or Middle Eastern If any of these apply to you, you should be offered screening for gestational diabetes during your pregnancy. Symptoms of gestational diabetes Gestational diabetes doesn't usually cause any symptoms. Most cases are only picked up when your blood sugar level is tested during screening for gestational diabetes. Some women may develop symptoms if their blood sugar level gets too high (hyperglycaemia), such as: But some of these symptoms are common during pregnancy anyway and aren't necessarily a sign of a problem. Speak to your midwife or doctor if you're worried about any symptoms you're experiencing. How gestational diabetes can affect your pregnancy Most women with gestational diabetes have otherwise normal pregnancies with healthy babies. However, gestational diabetes can cause problems s Continue reading >>

Gestational Diabetes Mellitus: Test And Diagnosis - Healthxchange

Gestational Diabetes Mellitus: Test And Diagnosis - Healthxchange

Gestational Diabetes Mellitus: Test and Diagnosis Gestational Diabetes Mellitus: Test and Diagnosis It is important to test for gestational diabetes mellitus (GDM) if you are pregnant. Doctors from the Division of Obstetrics & Gynaecology at KK Women's and Children's Hospital, a member of the SingHealth group, explain why. Detect gestational diabetes mellitus early to help reduce the risks to the pregnancy. Who should test for gestational diabetes mellitus? Although the risk of gestational diabetes mellitus (GDM) is higher in certain groups of women, it can happen to any woman in her pregnancy. In Singapore, all pregnant women will be offered screening for GDM with an oral glucose tolerance test between 24 and 28 weeks of pregnancy. If you have had GDM before, have glucose in the urine, or symptoms suggestive of diabetes, the oral glucose tolerance test will be performed earlier in pregnancy and repeated again at 24 and 28 weeks if the first test was normal. Detection of GDM is important so that appropriate treatment can be given to reduce the risks to the pregnancy, say doctors from the Division of Obstetrics& Gynaecology at KK Women's and Children's Hospital (KKH), a member of the SingHealth group. How is gestational diabetes mellitus diagnosed? An oral glucose tolerance test (OGTT) to diagnose GDM requires: Fasting overnight (not eating or drinking anything apart from water) Blood test in the morning, followed by a 75 g glucose drink Repeat blood glucose tests at 1 hour and 2 hours after the glucose drink Are there any risks or side effects from the OGTT? The standard glucose drink is sweet and may cause some to feel nauseated. In rare cases, it may trigger vomiting. If this happens, we will need to reschedule the test to be done on another day if you are agreeable. Continue reading >>

Gestational Diabetes

Gestational Diabetes

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 2 Diabetes article more useful, or one of our other health articles. This article deals only with gestational diabetes. There is a separate Diabetes in Pregnancy article, which provides information about pregnancy in women with pre-existing diabetes. Gestational diabetes mellitus (GDM) is any degree of glucose intolerance with its onset (or first diagnosis) during pregnancy and usually resolving shortly after delivery[1]. Pregnancy hormones decrease fasting glucose levels, increase fat deposition, delay gastric emptying and increase appetite. However, over the course of pregnancy, postprandial glucose concentrations increase as insulin resistance increases. This is normally countered by an increased production of insulin but in women with GDM there is an insufficient compensatory rise[2]. There is no clear agreement on diagnostic criteria[3]. Pregnancy hyperglycaemia without meeting GDM diagnostic criteria affects a significant proportion of pregnant women each year and is associated with a range of adverse pregnancy outcomes[4]. The National Institute for Health and Care Excellence (NICE) recommends that GDM should be diagnosed if the pregnant woman has either[5]: Fasting plasma glucose level of 5.6 mmol/L or above; or Two-hour plasma glucose level of 7.8 mmol/L or above. Although the World Health Organization (WHO) now recommends that HbA1c can be used as a diagnostic test for diabetes, it is currently not recommended for diagnosis during pregnancy[6]. Many of the problems associated with GDM are common to established diabetes in pregnancy - hype Continue reading >>

Screening And Diagnosis Of Gestational Diabetes Mellitus, Where Do We Stand

Screening And Diagnosis Of Gestational Diabetes Mellitus, Where Do We Stand

Go to: Any degree of glucose intolerance with the onset or first recognition during pregnancy is defined as Gestational Diabetes Mellitus (GDM) [1]. Women with history of GDM are at an increased risk of adverse maternal and perinatal outcome and also at increased risk of future diabetes predominantly Type II including their children and therefore there are two generations at risk [2]. Any degree of glucose intolerance during pregnancy is associated with adverse maternal and fetal outcome. The adverse maternal complications include hypertension, preeclampsia, urinary tract infection, hydramnios, increased operative intervention and future DM. In the fetus and neonates it is associated with macrosomia, congenital anomalies, metabolic abnormalities, RDS, etc. and subsequent childhood and adolescent obesity [3]. Therefore, it is important to diagnose early and treat promptly to prevent complications. GDM is a topic of considerable controversy when it comes to its screening, diagnosis and its cost-effectiveness. Precise level of glucose intolerance characterizing GDM has been controversial over three decades. High prevalence of DM and genetic predisposition to metabolic syndrome among Asians, particularly in Indian women, predisposes women to develop GDM and its complications. So, there is a need for cost-effective universal screening and diagnostic method. Unfortunately there is no international consensus on the screening and diagnostic criteria for GDM. The rationale of this review is to provide recent updates and to discuss the controversies of screening and diagnosis of GDM. It affects 7% of all pregnancies worldwide and in India it ranges from 6 to 9% in rural and 12 to 21% in urban area [4]. The high rate implies that Indian population has a higher incidence of DM and Continue reading >>

Diabetes Management Guidelines

Diabetes Management Guidelines

Source: American Diabetes Association. Standards of medical care in diabetes—2016. Diabetes Care. 2016;39(suppl 1):S1-S106. Available here. Refer to source document for full recommendations, including class of recommendation and level of evidence. Jump to a topic or click back/next at the bottom of each page Diabetes in Pregnancy (Gestational Diabetes) Glycemic Targets in Pregnancy Pregestational diabetes Gestational diabetes mellitus (GDM) Fasting ≤90 mg/dL (5.0 mmol/L) ≤95 mg/dL (5.3 mmol/L) 1-hr postprandial ≤130-140 mg/dL (7.2-7.8 mmol/L) ≤140 mg/dL (7.8 mmol/L) 2-hr postprandial ≤120 mg/dL (6.7 mmol/L) ≤120 mg/dL (6.7 mmol/L) A1C 6.0-6.5% (42-48 mmol/L) recommended <6.0% may be optimal as pregnancy progresses Achieve without hypoglycemia Recommendations for Pregestational Diabetes Pregestational type 1 and type 2 diabetes confer greater maternal and fetal risk than GDM Spontaneous abortion Fetal anomalies Preeclampsia Intrauterine fetal demise Macrosomia Neonatal hypoglycemia Neonatal hyperbilirubinemia Diabetes in pregnancy may increase the risk of obesity and type 2 diabetes in offspring later in life Maintain A1C levels as close to normal as is safely possible Ideally, A1C <6.5% (48 mmol/L) without hypoglycemia Discuss family planning Prescribe effective contraception until woman is prepared to become pregnant Women with preexisting type 1 or type 2 diabetes Counsel on the risk of development and/or progression of diabetic retinopathy Perform eye exams before pregnancy or in first trimester; monitor every trimester and for 1 year postpartum Management of Pregestational Diabetes Insulin is the preferred medication for pregestational type 1 and type 2 diabetes not adequately controlled with diet, exercise, and metformin Insulin* management during pre Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

Key Messages Pregestational Diabetes All women with pre-existing type 1 or type 2 diabetes should receive preconception care to optimize glycemic control, assess complications, review medications and begin folate supplementation. Care by an interdisciplinary diabetes healthcare team composed of diabetes nurse educators, dietitians, obstetricians and diabetologists, both prior to conception and during pregnancy, has been shown to minimize maternal and fetal risks in women with pre-existing type 1 or type 2 diabetes. Gestational Diabetes Mellitus The diagnostic criteria for gestational diabetes mellitus (GDM) remain controversial; however, the committee has chosen a preferred approach and an alternate approach. The preferred approach is to begin with a 50 g glucose challenge test and, if appropriate, proceed with a 75 g oral glucose tolerance test, making the diagnosis of GDM if ≥1 value is abnormal (fasting ≥5.3 mmol/L, 1 hour ≥10.6 mmol/L, 2 hours ≥9.0 mmol/L). The alternate approach is a 1-step approach of a 75 g oral glucose tolerance test, making the diagnosis of GDM if ≥1 value is abnormal (fasting ≥5.1 mmol/L, 1 hour ≥10.0 mmol/L, 2 hours ≥8.5 mmol/L). Untreated GDM leads to increased maternal and perinatal morbidity, while treatment is associated with outcomes similar to control populations. Highlights of Revisions All recommendations have been updated and reorganized to clarify management considerations for women with pregestational or gestational diabetes in the prepregnancy period, during pregnancy, and in the intrapartum and postpartum periods. New criteria have been added for the screening and diagnosis of GDM (Figures 1 and 2). Figure 1 Preferred approach for the screening and diagnosis of gestational diabetes. Figure 2 Alternative approach f Continue reading >>

Diagnosis And Management Of Gestational Diabetes Mellitus

Diagnosis And Management Of Gestational Diabetes Mellitus

Gestational diabetes occurs in 5 to 9 percent of pregnancies in the United States and is growing in prevalence. It is a controversial entity, with conflicting guidelines and treatment protocols. Recent studies show that diagnosis and management of this disorder have beneficial effects on maternal and neonatal outcomes, including reduced rates of shoulder dystocia, fractures, nerve palsies, and neonatal hypoglycemia. Diagnosis is made using a sequential model of universal screening with a 50-g one-hour glucose challenge test, followed by a diagnostic 100-g three-hour oral glucose tolerance test for women with a positive screening test. Treatment consists of glucose monitoring, dietary modification, exercise, and, when necessary, pharmacotherapy to maintain euglycemia. Insulin therapy is the mainstay of treatment, although glyburide and metformin may become more widely used. In women receiving pharmacotherapy, antenatal testing with nonstress tests and amniotic fluid indices beginning in the third trimester is generally used to monitor fetal well-being. The method and timing of delivery are controversial. Women with gestational diabetes are at high risk of subsequent development of type 2 diabetes. Lifestyle modification should therefore be encouraged, along with regular screening for diabetes. Evidence for screening, diagnosing, and managing gestational diabetes mellitus has continued to accrue over the past several years. In 2003, the U.S. Preventive Services Task Force1 (USPSTF) and the Cochrane Collaboration2 found insufficient evidence to recommend for or against screening for or treating gestational diabetes. However, a subsequent randomized controlled trial (RCT) found that screening and intervention for gestational diabetes were beneficial.3 Nonetheless, in 2008, Continue reading >>

Diabetes Mellitus And Pregnancy

Diabetes Mellitus And Pregnancy

Initiate testing early enough to avoid significant stillbirth but not so early that a high rate of false-positive test results is encountered. In patients with poor glycemic control, intrauterine growth restriction, or significant hypertension, begin formal biophysical testing as early as 28 weeks. In patients who are at lower risk, most centers begin formal fetal testing by 34 weeks. Fetal movement counting is performed in all pregnancies from 28 weeks onward. There is no consensus regarding antenatal testing in patients with gestational diabetes that is well controlled with diet. Monitoring fetal growth continues to be a challenging and imprecise process. Although currently available tools (serial plotting of fetal growth parameters based on ultrasonographic measurement) are superior to those used previously for clinical estimations, accuracy is still only within 15%. [ 95 ] In the obese fetus, the inaccuracies are further magnified. In 1992, Bernstein and Catalano reported that significant correlation exists between the degree of error in the ultrasonogram-based estimation of fetal weight and the percentage of body fat on the fetus. [ 96 ] Perhaps this is the reason no single formula has proven to be adequate in identifying a macrosomic fetus with certainty. Despite problems with accuracy, ultrasonogram-based estimations of fetal size have become the standard of care. Estimate fetal size once or twice at least 3 weeks apart in order to establish a trend. Time the last examination to be at 36-37 weeks' gestation or as close to the planned delivery date as possible. Select the timing of delivery to minimize morbidity for the mother and fetus. Delaying delivery to as near as possible to the expected date of confinement helps maximize cervical maturity and improves the Continue reading >>

Gestational Diabetes Uk

Gestational Diabetes Uk

Gestational Diabetes UK is dedicated to offering support and evidence based research to women diagnosed with gestational diabetes in the UK and Republic of Ireland. If you have been diagnosed, or are going to be tested for gestational diabetes and want a support network and community for help, advice and to discuss all things related to gestational diabetes, then please join our Facebook support group, Gestational Diabetes UK. What is gestational diabetes? Diabetes is caused by too much glucose (sugar) in the blood. The amount of glucose in the blood is controlled by a hormone called 'insulin'. During pregnancy, the body produces a number of hormones, such as oestrogen, progesterone and human placental lactogen (HPL). These hormones make the body insulin resistant, which means the cells respond less well to insulin and the level of glucose in the blood remains high. To cope with the increased amount of glucose in the blood, the body should produce more insulin. However, some women either cannot produce enough insulin in pregnancy to transport the glucose into the cells, or their body cells are more resistant to insulin. This is known as 'gestational diabetes mellitus'. Gestational diabetes can be defined as carbohydrate intolerance. Gestational diabetes is usually diagnosed by having a OGTT/GTT (oral glucose tolerance test) between 24 - 28 weeks, however women showing symptoms or those that have higher risks of developing gestational diabetes may be tested earlier. Gestational diabetes affects around 5% of UK pregnancies Are some women at a higher risk of getting gestational diabetes than others? You have an increased risk of gestational diabetes if: your body mass index (BMI) is 30 or more you have previously had a baby who weighed 4.5kg (10lbs) or more at birth you ha Continue reading >>

Gestational Diabetes

Gestational Diabetes

Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy.[2] Gestational diabetes generally results in few symptoms;[2] however, it does increase the risk of pre-eclampsia, depression, and requiring a Caesarean section.[2] Babies born to mothers with poorly treated gestational diabetes are at increased risk of being too large, having low blood sugar after birth, and jaundice.[2] If untreated, it can also result in a stillbirth.[2] Long term, children are at higher risk of being overweight and developing type 2 diabetes.[2] Gestational diabetes is caused by not enough insulin in the setting of insulin resistance.[2] Risk factors include being overweight, previously having gestational diabetes, a family history of type 2 diabetes, and having polycystic ovarian syndrome.[2] Diagnosis is by blood tests.[2] For those at normal risk screening is recommended between 24 and 28 weeks gestation.[2][3] For those at high risk testing may occur at the first prenatal visit.[2] Prevention is by maintaining a healthy weight and exercising before pregnancy.[2] Gestational diabetes is a treated with a diabetic diet, exercise, and possibly insulin injections.[2] Most women are able to manage their blood sugar with a diet and exercise.[3] Blood sugar testing among those who are affected is often recommended four times a day.[3] Breastfeeding is recommended as soon as possible after birth.[2] Gestational diabetes affects 3–9% of pregnancies, depending on the population studied.[3] It is especially common during the last three months of pregnancy.[2] It affects 1% of those under the age of 20 and 13% of those over the age of 44.[3] A number of ethnic groups including Asians, American Indians, Indigenous Australians, and Pacific Continue reading >>

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