Screening for Diabetes in Pregnancy


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Screening for Diabetes in Pregnancy

  1. 1. Screening for gestational diabetes mellitus<br />Screening should be performed to all pregnant women at 24-28 weeks of gestation.<br />First-trimester screening should be performed on patients with risk factors.<br />
  2. 2. Screen patients with any of the following risk factors for gestational diabetes mellitus at the first prenatal visit:<br /><ul><li>Family history of diabetes
  3. 3. Past history of GDM
  4. 4. Past obstetric history of IUFD, macrosomia or congenital anomalies.
  5. 5. Maternal age older than 35 years
  6. 6. Obesity
  7. 7. Certain ethnic groups</li></li></ul><li>Patients with risk factors who have negative test results in the first trimester should be retested at 24-28 weeks.<br />The condition may be missed during early testing on patients who will become glucose intolerant later, because the insulin resistance increases as the third trimester progresses. <br />
  8. 8. 50g Glucose challenge test (GCT): <br /><ul><li> 50gglucose is administered and plasma glucose is measured one hour after the glucose challenge.
  9. 9. The test can be performed at any time of day, regardless the time of the last meal.</li></li></ul><li>50g Glucose challenge test (GCT): <br />The sensitivity of gestational diabetes mellitus testing depends on the threshold value used for the glucose challenge. Current recommendations from the American Diabetes Association and the American College of Obstetricians and Gynecologists note that a threshold value of 140 mg/dL results in approximately 80% detection of gestational diabetes, while using a threshold of 130 mg/dL results in 90% detection.<br />
  10. 10. 100g Oral glucose tolerance test (OGTT):<br />Done for those with an abnormal screening result.<br />plasma glucose is measured during fasting state then 100g glucose is administered and plasma glucose is measured after 1, 2 and 3 hours. <br />
  11. 11. 100g Oral glucose tolerance test (OGTT):<br />Oral Glucose Tolerance Test For Gestational Diabetes can be summarized as follows:<br /><ul><li>Glucose challenge result greater than 130 mg/dL
  12. 12. Overnight fast of 8–14 hours
  13. 13. Following at least 3 days of unrestricted diet (>150 g carbohydrate) and physical activity
  14. 14. Patient should remain seated</li></li></ul><li>100g Oral glucose tolerance test (OGTT):<br />Two or more values must be met or exceeded for the diagnosis of gestational diabetes.<br />
  15. 15. 100g Oral glucose tolerance test (OGTT):<br /><ul><li>Patients with a single abnormal value on a 3 hour glucose tolerance test are likely to exhibit some degree of glucose intolerance.
  16. 16. When left untreated, they are at higher risk for macrosomia and neonatal morbidity.
  17. 17. Consequently, patients with a single abnormal value should receive dietary and physical activity counseling. </li></li></ul><li>Other tests:<br /><ul><li>Fasting plasma glucose</li></li></ul><li><ul><li>75g Oral glucose tolerance test</li></ul>75g glucose is administered and plasma glucose is measured after 2 hours.<br />The patient should be fasting for at least 8 hours.<br />
  18. 18. <ul><li>Random plasma glucose
  19. 19. Maternal HbA1C</li></ul>Diagnosis of diabetes in pregnancy should never be based on urine analysis for glucose since 18% of pregnant women have glucosuria.<br />
  20. 20. Screening for maternal complications:<br /><ul><li>Fundus Examination
  21. 21. Close monitoring of blood pressure
  22. 22. Uric acid
  23. 23. Urine analysis for protein
  24. 24. Renal function tests (urea and creatinine)
  25. 25. Urine culture
  26. 26. Maternal ECG and echocardiogram If diabetes is longstanding or associated with known microvascular disease</li></li></ul><li>Screening for fetal complications:<br />Ultrasound<br />used to:<br /><ul><li>Confirm gestational age
  27. 27. Detect congenital anomalies
  28. 28. Monitor fetal growth
  29. 29. Amniotic fluid volume.</li></li></ul><li>Screening for fetal complications:<br /><ul><li>Nuchal translucency if there is high risk for cardiac defects.
  30. 30. Fetal ECG to detect cardiac anomalies
  31. 31. Fetal movement assessment
  32. 32. Fetal umbilical Doppler studies
  33. 33. Amniocentesis for fetal lung profile if delivery is expected prior to 39 weeks’ gestation.</li>