
ACOG Releases Updated Guidance on Gestational Diabetes
SUMMARY:
ACOG has released updated guidance on gestational diabetes (GDM), which has become increasingly prevalent worldwide. Highlights and changes from the previous practice bulletin include the following:
Fetal Monitoring
Screening for GDM – One or Two Step?
ACOG (based on NIH consensus panel findings) still supports the ‘2 step’ approach (24 – 28 week 1 hour venous glucose measurement following 50g oral glucose solution), followed by a 3 hour oral glucose tolerance test (OGTT) if positive
Note: While the diagnosis of GDM is based on 2 abnormal values on the 3 hour OGTT, ACOG states, due to known adverse events, one abnormal value may be sufficient to make the diagnosis
1 step approach (75 g OGTT) on all women will increase the diagnosis of GDM but sufficient prospective studies demonstrating improved outcomes still lacking
ACOG does acknowledge that some centers may opt for ‘1 step’ if warranted based on their population
Who Should be Screened Early?
ACOG has adopted the NIDDK / ADA guidance on screening for diabetes and prediabetes which takes in to account not only previous pregnancy history but also risk factors associated with type 2 diabetes. Screen early in pregnancy if:
Patient is overweight with BMI of 25 (23 in Asian Americans), and one of the following:
Physical inactivity
Known impaired glucose metabolism
Previous pregnancy history of:
GDM
Macrosomia (≥ 4000 g)
Stillbirth
Hypertension (140/90 mm Hg or being treated for hypertension)
HDL cholesterol ≤ 35 mg/dl (0.90 mmol/L)
Fasting triglyceride ≥ 250 mg/dL (2.82 mmol/L)
PCOS, acanthosis nigri
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