Gestational Diabetes Mellitus
DEFINITION, DETECTION, AND DIAGNOSIS Definition Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy (1). The definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy. It does not exclude the possibility that unrecognized glucose intolerance may have antedated or begun concomitantly with the pregnancy. Approximately 7% of all pregnancies are complicated by GDM, resulting in more than 200,000 cases annually. The prevalence may range from 1 to 14% of all pregnancies, depending on the population studied and the diagnostic tests employed. Detection and diagnosis Risk assessment for GDM should be undertaken at the first prenatal visit. Women with clinical characteristics consistent with a high risk of GDM (marked obesity, personal history of GDM, glycosuria, or a strong family history of diabetes) should undergo glucose testing (see below) as soon as feasible. If they are found not to have GDM at that initial screening, they should be retested between 24 and 28 weeks of gestation. Women of average risk should have testing undertaken at 24–28 weeks of gestation. Low-risk status requires no glucose testing, but this category is limited to those women meeting all of the following characteristics: Weight normal before pregnancy Member of an ethnic group with a low prevalence of GDM No known diabetes in first-degree relatives No history of abnormal glucose tolerance No history of poor obstetric outcome A fasting plasma glucose level >126 mg/dl (7.0 mmol/l) or a casual plasma glucose >200 mg/dl (11.1 mmol/l) meets the threshold for the diagnosis of diabetes, if confirmed on a subsequent day, and precludes the need for Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Timing of Delivery in Gestational Diabetes Mellitus: Need for Person-Centered, Shared Decision-Making
- Quality of Life in Women with Gestational Diabetes Mellitus: A Systematic Review
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 >>
Gestational Diabetes Mellitus: Why Screen And How To Diagnose
Go to: What are the existing diagnostic criteria? O' Sullivan and Mahan in 1964 proposed the first diagnostic criteria for GDM, assaying whole blood glucose with the Somogyi-Nelson method, during a three-hour oral glucose tolerance test (OGTT)7. Glucose levels of 90, 165, 145 and 125 mg/dl (for fasting, one-hour, two-hour and three-hour postglucose load respectively) were proposed as diagnostic thresholds for GDM. More than a decade later, in 1979, the National Diabetes Data Group (NDDG) suggested measuring plasma instead of whole blood glucose and set new threshold values (105, 190, 165 and 145 mg/dl)8. In 1982, Carpenter and Coustan proposed changing the values to 95, 180, 155 and 140 mg/dl9. According to the NDDG and Carpenter and Coustan criteria, the diagnosis of GDM is established if two or more glucose values are higher than the defined cutoffs during a three-hour OGTT. In 1989, Sacks et al proposed the more inclusive criteria of 96, 172, 152 and 131 mg/dl, after calculating glucose concentrations in paired whole blood and plasma specimens of 995 consecutive pregnant women10. All the aforementioned diagnostic thresholds were based on data from women who were diagnosed with diabetes after gestation and not on any short-term adverse pregnancy outcomes. In 2010, the International Association of Diabetes and Pregnancy Groups (IADPSG) proposed a new set of criteria, based on the incidence of adverse perinatal outcomes, as assessed in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study11,12. According to these criteria, the diagnosis of GDM is made if at least one value of plasma glucose concentration is equal to or exceeds the thresholds of 92, 180 and 153 mg/dl (for fasting, one-hour and 2-hour postglucose load glucose values respectively), after performing Continue reading >>
An Evaluation Of Two Different Screening Criteria In Gestational Diabetes Mellitus
Background: The objective of this study was to identify the gestational diabetes mellitus (GDM) prevalence difference according to American Diabetes Association (ADA) criteria and International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for 75 g oral glucose tolerance test (OGTT). Methods: This study was conducted at Erciyes University Department of Obstetrics and Gynecology. A total of 320 pregnant who met the criteria were included in the study and 75 g OGTT was applied. Irrespective of the first results, the test was applied to most participants 2 weeks later. Results: The GDM prevalence was found to be 9.1% according to the ADA criteria and 19.4% according to the IADPSG criteria. According to the ADA criteria, GDM prevalence was found to be statistically significantly high (p < .05) in patients with risk factors. According to the IADPSG criteria no relationship was found between GDM prevalence and any of the risk factors (p > .05). The patients diagnosed with GDM were observed not to reach the threshold levels for HbA1c. Conclusion: According to the IADPSG criteria, GDM prevalence doubles and leads to an increase in healthcare costs and workloads. HbA1c has no role in the diagnosis of GDM. Continue reading >>
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 Mellitus In Pregnancy: Screening And Diagnosis
INTRODUCTION Pregnancy is accompanied by insulin resistance, mediated primarily by placental secretion of diabetogenic hormones including growth hormone, corticotropin-releasing hormone, placental lactogen, and progesterone. These and other metabolic changes ensure that the fetus has an ample supply of nutrients. (See "Maternal adaptations to pregnancy: Endocrine and metabolic changes".) Gestational diabetes develops during pregnancy in women whose pancreatic function is insufficient to overcome the insulin resistance associated with the pregnant state. Among the main consequences are increased risks of preeclampsia, macrosomia, and cesarean delivery, and their associated morbidities. The approach to screening for and diagnosis of diabetes in pregnant women will be reviewed here. Management and prognosis are discussed separately: Continue reading >>
- Diagnosis and treatment of diabetes mellitus in chronic pancreatitis
- Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
Comparing The Diagnostic Criteria For Gestational Diabetes Mellitus Of World Health Organization 2013 With 1999 In Chinese Population
Go to: Study population The World Diabetes Foundation (WDF) Denmark funded a project in 2010 to help establish GDM centers in China (10–517). As part of the project data of 17, 186 pregnant women were systematically collected in 13 hospitals, including Peking University First Hospital (PUFH) where 75 g OGTT between 24 and 28 weeks was carried out on all pregnant women. At the PUFH these records pertained to women registered at the prenatal clinic between January 1, 2010 and December 31, 2012, while at the other 12 participating hospitals records pertained to women registered between July 1, 2011 and February 29, 2012. After an overnight fast venous blood samples were recorded at 0 hour; 1 hour and 2 hours after a 75 g glucose load. Previously known DM patients and DM patients diagnosed by fasting plasma glucose ≥7.00 mmol/L at the first prenatal visit were excluded from the study. Diagnostic criteria for gestational diabetes mellitus As described a diagnostic 2-h 75 g OGTT at 24–28th week of gestation was carried out. Two different cut-off values of plasma glucose were used to analyze the data: GDM was diagnosed by WHO 2013 criteria when one of the following plasma glucose value was met or exceeded: 0 hour, 5.10 mmol/L; 1 hour, 10.00 mmol/L; 2 hours, 8.50 mmol/L; GDM was diagnosed by WHO 1999 criteria when 0 hour ≥7.00 mmol/L or 2 hours ≥7.80 mmol/L. Data analysis was performed using the Predictive Analytics Software Statistics (PASW), formerly called SPSS Statistics, which was acquainted by IBM in 2009. The eligible population of pregnant women included in the study was classified into four groups: (1) Normal by both WHO 1999 and 2013 criteria; (2) GDM by both 1999 and 2013 criteria; (3) GDM by WHO 2013 criteria only; (4) GDM by WHO 1999 criteria only. Freque Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
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Screening And Diagnosis Of Gestational Diabetes Mellitus
Screening and Diagnosis of Gestational Diabetes Mellitus Diabetes and pregnancy: an Endocrine Society clinical practice guideline. U.S. Preventive Services Task Force (USPSTF) Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Internet citation: National Guideline Clearinghouse (NGC). Guideline synthesis: Screening and diagnosis of gestational diabetes. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2014 May (revised 2017 July). [cited YYYY Mon DD]. Available: A direct comparison of recommendations presented in the above guidelines for the detection and diagnosis of GDM in pregnant women not previously diagnosed with type 1 or 2 diabetes mellitus is provided below. Treatment of GDM is beyond the scope of this synthesis. TES and the USPSTF agree that pregnant women should be screened for GDM at 2428 weeks gestation. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for GDM in asymptomatic pregnant women before 24 weeks of gestation. When deciding whether to screen for GDM before 24 weeks of gestation, the USPSTF addresses factors that should be considered by primary care providers. Historically, GDM has been diagnosed in the United States using a two-step approach: administration of a 50-gram oral glucose solution followed by a 1-hour venous glucose determination. Individuals meeting or exceeding the screening threshold then undergo a 100-g, 3-hour diagnostic OGTT, given while the patient is fasting. In a divergence from established U.S. practice, TES recommends a one-step approach to screening using a 2-hour, 75-g OGTT. TES further recommends that the IADPSG criteria be u Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Diagnosis and treatment of diabetes mellitus in chronic pancreatitis
- Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management
New Thresholds For Diagnosis Of Diabetes In Pregnancy
Share Midwives should diagnose women with gestational diabetes if they either have a fasting plasma glucose level of 5.6 mmol/litre or above, or a 2-hour plasma glucose level of 7.8 mmol/litre or above, according to NICE. Midwives should diagnose women with gestational diabetes if they either have a fasting plasma glucose level of 5.6 mmol/litre or above, or a 2-hour plasma glucose level of 7.8 mmol/litre or above, according to NICE. Updated guidelines on diabetes in pregnancy lower the fasting plasma glucose thresholds for diagnosis, and include new recommendations on self-management for women with type 1 diabetes. Around 35,000 women have either pre-existing or gestational diabetes each year in England and Wales. Nearly 90 per cent of the women who have diabetes during pregnancy, have gestational diabetes, which may or may not resolve after pregnancy. Rates have increased in recent years to due rising obesity rates among the general population, and increasing number of pregnancies among older women. Of the women with diabetes in pregnancy who do not have gestational diabetes, 7.5 per cent of women have type 1 diabetes, and the remainder have type 2 diabetes, both of which have also increased recently. Following a number of developments, such as new technologies and research on diagnosis and treatment of gestational diabetes, NICE has updated its guidelines on diabetes in pregnancy. Diagnosis Among the new recommendations are that a woman should be diagnosed with gestational diabetes if she has either a fasting plasma glucose level of 5.6 mmol/litre or above, or a 2-hour plasma glucose level of 7.8 mmol/litre or above. NICE says this could help tackle current variation in the number in the glucose levels used for diagnosing gestational diabetes, and may lead to an incr Continue reading >>
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 >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management
- Role of Medical Nutrition Therapy in the Management of Gestational Diabetes Mellitus
Different Strategies For Diagnosing Gestational Diabetes Mellitus (gdm) To Improve Maternal And Infant Health
What is the issue? We aimed to evaluate and compare different ways of diagnosing gestational diabetes mellitus (GDM). We searched for all relevant studies in January 2017. Why is this important? Between seven and 24 pregnant women in every 100 develop GDM. GDM is when there is an inability to process carbohydrates properly, which leads to high blood sugar (hyperglycaemia). GDM can result in increased risks of problems around the time of birth for the mother and her baby. Treatment can reduce these risks, and therefore diagnosing the condition accurately means that treatment can be given to improve the health of mothers and their babies. Different testing strategies aim to diagnose GDM. We wanted to compare the different strategies, to see how they affected the health of women and their infants, and to assess the cost of the strategies to the healthcare service. What evidence did we find? We found seven trials. A total of 1420 women were included, in settings in Turkey, Mexico, Nigeria, New Zealand, Canada and the USA. Across the trials, different testing approaches and criteria were evaluated as were different diagnostic tests including different oral glucose tolerance test loads; a glucose drink; a candy bar and food high in glucose. Women were given these items to eat/drink, and this was then followed by a blood test to measure blood sugar levels and questionnaires. In some tests, women were required to fast from the night before. The main outcomes we looked for were frequency of diagnosis, incidence of caesarean section, assisted birth and vaginal birth, and incidence of macrosomia in babies (larger than normal weight at birth). Other outcomes spanned a range, including any side effects of the tests, the mothers' preferences, and the health of the babies. There were Continue reading >>
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 >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Timing of Delivery in Gestational Diabetes Mellitus: Need for Person-Centered, Shared Decision-Making
- Quality of Life in Women with Gestational Diabetes Mellitus: A Systematic Review
Trends In The Diagnosis Of Gestational Diabetes Mellitus
Copyright © 2016 Surabhi Mishra et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable degree with onset or recognition during pregnancy. As prevalence of diabetes is linked to impaired glucose tolerance during antenatal period, routine antenatal screening of GDM is required. However, screening tests for GDM remain controversial. Objective. To review different diagnostic criteria for GDM. Materials and Methods. Freely accessible, full-text articles from 1964 to 2015, available in PubMed in English language, pertaining to screening of GDM were reviewed. Results. First diagnostic criteria for GDM in 1964 by O’Sullivan and Mahan, modified by the National Diabetes Data Group (NDDG) in 1979 and Carpenter in 1982. The cut-off value as per WHO definition of GDM was 140 mg/dL, 2 hours after 75 g glucose intake. Diabetes in Pregnancy Study Group India (DIPSI), in 2006, endorsed WHO criteria but irrespective of the last meal timings. Being cost-effective, it formed the basis of national guidelines for Indians in 2014. Conclusions. As typical clinical scenarios are usually varied, practical guidelines that meet the constraints of low-resource settings like India are required. 1. Introduction Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable degree with onset or recognition during pregnancy. As per the International Diabetes Federation (IDF), Diabetes Atlas 2015, one in seven births are affected by GDM [1]. India, being the second leading dweller of diabetic subjects (69.2 millio Continue reading >>
Updated Guidelines On Screening For Gestational Diabetes
1Department of Medicine, Government Medical College and Hospital, Chandigarh, India; 2Bharti Hospital, Karnal, Haryana, India; 3Excel Center, Guwahati, Assam, India; 4Saket City Hospital, New Delhi, India Abstract: Gestational diabetes mellitus (GDM) is associated with an increased risk of complications for both mother and baby during pregnancy as well as in the postpartum period. Screening and identifying these high-risk women is important to improve short- and long-term maternal and fetal outcomes. However, there is a lack of international uniformity in the approach to the screening and diagnosis of GDM. The main purpose of this review is to provide an update on screening for GDM and overt diabetes during pregnancy, and discuss the controversies in this field. We take on debatable issues such as adoption of the new International association of diabetes and pregnancy study groups criteria instead of the Carpenter and Coustan criteria, one-step versus two-step screening, universal screening versus high-risk screening before 24 weeks of gestation for overt diabetes, and, finally, the role of HbA1c as a screening test of GDM. This discussion is followed by a review of recommendations by professional bodies. Certain clinical situations, in which a pragmatic approach is needed, are highlighted to provide a comprehensive overview of the subject. Keywords: pregnancy, guidelines, IADPSG, GDM, Carpenter and Coustan criteria Gestational diabetes mellitus (GDM) has classically been defined as any glucose intolerance first identified during pregnancy.1 Recently, the American Diabetes Association (ADA) defined it as “Diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes”.2 However, as per IADPSG (International association of diabete Continue reading >>
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 >>
