1. UNITE FOR DIABETES CPG
Screening and
Diagnosis of
Diabetes in
Pregnant Women
Iris Thiele Isip Tan MD, FPCP, FPSEM
Clinical Associate Professor
UP College of Medicine
Section of Endocrinology, Diabetes & Metabolism
Department of Medicine, Philippine General Hospital

2. 6.1 Should universal screening for diabetes
be done among pregnant women?
Recommendation:
All pregnant women should be screened for
gestational diabetes (Level 2, Grade B).

3. 6.1 Should universal screening for diabetes
be done among pregnant women?
National GDM
Technical Working
Party of N. Zealand
DIPSI Universal
Universal screening
screening
high GDM
ADA prevalence NICE
Very low risk* in India Women with
women need any risk factor
not be should be
screened screened

4. 6.1 All pregnant women should be screened
for gestational diabetes (Level 2, Grade B).
Filipino women are at
increased risk for
diabetes in pregnancy.
ASGODIP Data n/N
Low risk 35/853
High risk 136/350
171/1203
Overall
14.2%
Litonjua AD et al. AFES Study Group on Diabetes in Pregnancy:
Preliminary Data on Prevalence. PJIM 1996:34:67-68.

5. 6.1 All pregnant women should be screened
for gestational diabetes (Level 2, Grade B).
RR for developing
gestational diabetes by
ethnicity (adjusted for age, BMI and
parity; white as reference)
UK Data (1992) RR (95%CI)
Black 3.1 (1.8 to 5.5)
South East Asian 7.6 (4.1 to 14.1)
Indian 11.3 (6.8 to 18.8)
Dornhorst A, Paterson CM, Nicholls JSD, et al. High prevalence of gestational
diabetes in women from ethnic minority groups. Diabetic Medicine 1992; 9:820–5.

6. 6.1 All pregnant women should be screened
for gestational diabetes (Level 2, Grade B).
Macrosomia Shoulder Dystocia
Increased
risk of
perinatal
morbidity
Birth injuries Hypoglycemia
http://www.flickr.com/photos/mikewade/3267336862/ http://www.flickr.com/photos/jessicafm/280232106/
http://www.flickr.com/photos/clairity/1385780317/ http://www.flickr.com/photos/tessawatson/379265818/

7. 6.1 All pregnant women should be screened
for gestational diabetes (Level 2, Grade B).
Treatment
reduces
perinatal
ACHOIS morbidity
Landon et al
Crowther et al.
NEJM 2009;
NEJM 2005;
361:1339-48.
352:2477-86.

8. ACHOIS
Crowther et al.
NEJM 2005; M
352:2477-86.
O Randomized
controlled
I Serious trial
perinatal
P Intervention complications
(n=490)
death
diet CBG insulin shoulder dystocia
vs bone fracture
nerve palsy
routine care
(n=510)
GDM
24-28 wks AOG
Crowther CA et al. Effect of Treatment of Gestational Diabetes
Mellitus on Pregnancy Outcomes. NEJM 2005; 352:2477-86.

9. Any serious perinatal complication
ACHOIS Adj RR 0.33 (95% CI 0.14-0.75), p=0.01
Crowther et al.
NEJM 2005; M
352:2477-86.
O Randomized
controlled
I Serious trial
perinatal
P Intervention complications
(n=490)
death
diet CBG insulin shoulder dystocia
vs bone fracture
nerve palsy
routine care
(n=510)
GDM
24-28 wks AOG
Crowther CA et al. Effect of Treatment of Gestational Diabetes
Mellitus on Pregnancy Outcomes. NEJM 2005; 352:2477-86.

10. Landon et al
NEJM 2009; M
361:1339-48.
O Randomized
Composite of controlled
I stillbirth/ trial
perinatal
P Intervention death and
(n=485)
neonatal
diet CBG insulin
complications
vs hyperbilirubinemia
routine care hypoglycemia
(n=473) hyperinsulinemia
birth trauma
“mild” GDM
24-31 wks AOG
Landon MB et al. A multicenter, randomized trial of treatment
for mild gestational diabetes. NEJM 2009; 361:1339-48.

11. Composite endpoint
RR 0.87 (95% CI 0.72-1.07), p=0.14
Landon et al
NEJM 2009; M
361:1339-48.
O Randomized
Composite of controlled
I stillbirth/ trial
perinatal
P Intervention death and
(n=485)
neonatal
diet CBG insulin
complications
vs hyperbilirubinemia
routine care hypoglycemia
(n=473) hyperinsulinemia
birth trauma
“mild” GDM
24-31 wks AOG
Landon MB et al. A multicenter, randomized trial of treatment
for mild gestational diabetes. NEJM 2009; 361:1339-48.

12. Composite endpoint
RR 0.87 (95% CI 0.72-1.07), p=0.14
Landon et al
NEJM 2009; M
361:1339-48.
O Randomized
controlled
I trial
P Intervention
(n=485)
diet CBG insulin
vs
routine care
(n=473)
“mild” GDM
24-31 wks AOG
Landon MB et al. A multicenter, randomized trial of treatment
for mild gestational diabetes. NEJM 2009; 361:1339-48.

13. Composite endpoint
RR 0.87 (95% CI 0.72-1.07), p=0.14
Landon et al
NEJM 2009; M
361:1339-48.
O Randomized
LGA infants controlled
I RR 0.49 trial
P Intervention (95%CI 0.32-0.76)
p<0.001
(n=485)
diet CBG insulin BW >4000 g
vs RR 0.41
routine care (95%CI 0.26-0.66)
(n=473) p<0.001
“mild” GDM
24-31 wks AOG
Landon MB et al. A multicenter, randomized trial of treatment
for mild gestational diabetes. NEJM 2009; 361:1339-48.

14. 6.1 All pregnant women should be screened
for gestational diabetes (Level 2, Grade B).
Cesearean Section Preeclampsia
Increased
risk of
maternal
morbidity
Pregnancy-induced hypertension Type 2 diabetes mellitus
http://www.flickr.com/photos/j2dread/4501366303/ http://www.flickr.com/photos/ulybug/512369383/
http://www.flickr.com/photos/78428166@N00/4921825364/

15. 6.1 All pregnant women should be screened
for gestational diabetes (Level 2, Grade B).
Treatment
reduces
maternal
morbidity
Landon et al Ratner et al
NEJM 2009; JCEM 2008;
361:1339-48 93:4774-9

16. Landon et al
NEJM 2009; M
361:1339-48.
O Randomized
Composite of controlled
I stillbirth/ trial
perinatal
P Intervention death and
(n=485)
neonatal
diet CBG insulin
complications
vs hyperbilirubinemia
routine care hypoglycemia
(n=473) hyperinsulinemia
birth trauma
“mild” GDM
24-31 wks AOG
Landon MB et al. A multicenter, randomized trial of treatment
for mild gestational diabetes. NEJM 2009; 361:1339-48.

17. Landon et al
NEJM 2009;
361:1339-48.
Preeclampsia
Cesarean Preeclampsia or gestational
delivery RR 0.46 hypertension
RR 0.79 (0.22-0.97) RR 0.63
(0.64-0.99) p=0.02 (0.42-0.96)
p=0.02 p=0.01
Landon MB et al. A multicenter, randomized trial of treatment
for mild gestational diabetes. NEJM 2009; 361:1339-48.

18. Ratner et al
JCEM 2008; M
93:4774-9
O Randomized
controlled
I Time to trial
development
P DPP arms of diabetes
placebo
metformin
semiannual FPG
intensive lifestyle
annual OGTT
Women in DPP
350 with previous GDM
1416 without Ratner RE et al. Prevention of diabetes in women with a history of gestational
diabetes: effects of metformin and lifestyle interventions. JCEM 2008;93: 4774-9

19. 4778 Ratner et al. Diabetes in Women with a History of GDM J Clin Endocrinol Metab, December 2008, 93(12):4774 – 4779
Cumulative incidence of diabetes in DPP (%)
A 45
40 Without a history of GDM
35
Cumulative incidence (%)
30
Placebo
25
Placebo
(n=487)
20
15 Metformin
Metformin
ILS
(n=464)
10
ILS
5
(n=465)
0
0 0.5 1 1.5 2 2.5 3
Years from randomization
B 45
40 With a history of GDM
Placebo
}
Placebo
~50%
35
(n=122)
30
Cumulative incidence (%)
25
reduction
20 Metformin
(n=111)
Metformin
15
10
ILS
(n=117)
ILS
5
0
0 0.5 1 1.5 2 2.5 3
Years from randomization
FIG. 4. Cumulative incidence of diabetes in DPP by randomized treatment group. Panel A, Women without a history of GDM; Panel B, women with a history of GDM.
Ratner RE et al. Prevention of diabetes in women with a history of gestational
diabetes: effects of metformin 54% Caucasian. In interventions. JCEM 2008;93: 4774-9
We estimate that metformin therapy, on the other hand, whereas DPP was ethnically mixed with and lifestyle
may be as much as 3 times more effective in reducing the the DPP, the GDM population was older (43 vs. 34 yr) and
incidence of diabetes in those with a history of GDM com- considerably more distant from their index pregnancies (12

20. 6.2 For pregnant women, when should
screening be done?
Recommendations:
1. All pregnant women should be evaluated at the
first prenatal visit for risk factors for diabetes
(Level 4, Grade C).

21. All pregnant women should be evaluated at
6.2 the first prenatal visit for risk factors for
diabetes (Level 4, Grade C).
National GDM
Technical Working
Party of N. Zealand
Screen high risk
USPSTF women at
No RCTs on booking
screening
before 24 NICE
ADA
weeks AOG Determine risk
Screen high
risk women at factors for GDM
at booking
first prenatal
appointment
visit
http://www.flickr.com/photos/fdecomite/406635986/

22. Bartha et al.
Am J Obstet
Gynecol 2000; M
182:346-50.
O Cross-
Early- (n=65) vs sectional
I late-onset comparative
P 50-g GCT (n=170) GDM
1st visit then pregnancy
24-28 weeks complications,
if initial result obstetric and
normal perinatal
(n=3986) outcomes
Pregnant at first
prenatal visit
Bartha JL et al. Gestational Diabetes Mellitus Diagnosed During
Early Pregnancy. Am J Obstet Gynecol 2000; 182:346-50.

23. Women with an early diagnosis of
Bartha et al. GDM represent a high-risk subgroup
Am J Obstet
Gynecol 2000; M
182:346-50.
O Cross-
Early- (n=65) vs sectional
I late-onset comparative
P 50-g GCT (n=170) GDM
1st visit then pregnancy
24-28 weeks complications,
if initial result obstetric and
normal perinatal
(n=3986) outcomes
Pregnant at first
prenatal visit
Bartha JL et al. Gestational Diabetes Mellitus Diagnosed During
Early Pregnancy. Am J Obstet Gynecol 2000; 182:346-50.

24. Women with an early diagnosis of
Bartha et al. GDM represent a high-risk subgroup
Am J Obstet
Gynecol 2000; M
182:346-50.
O Cross-
sectional
Early- vs late- comparative
I onset GDM
P 50-g GCT
1st visit then
24-28 weeks
if initial result
normal
(n=3986)
Pregnant at first
prenatal visit
Bartha JL et al. Gestational Diabetes Mellitus Diagnosed During
Early Pregnancy. Am J Obstet Gynecol 2000; 182:346-50.

25. Women with an early diagnosis of
Bartha et al. GDM represent a high-risk subgroup
Am J Obstet
Gynecol 2000; M
182:346-50.
O Cross-
sectional
Early- vs late- comparative
I onset GDM
P 50-g GCT
1st visit then Likely Higher need
24-28 weeks hypertensive for insulin
(18.46% vs (33.85% vs
if initial result
5.88%, 7.06%,
normal p=0.006) p=0.0000)
(n=3986)
Pregnant at first
prenatal visit
Bartha JL et al. Gestational Diabetes Mellitus Diagnosed During
Early Pregnancy. Am J Obstet Gynecol 2000; 182:346-50.

26. Risk Factors for
Gestational Diabetes
Prior history of GDM (OR 23.6 [95%CI 11.6, 48.0])3
Glucosuria (OR 9.04 [95%CI 2.6, 63.7]2; PPV 50% 4)
Family history of diabetes (OR 7.1 [95%CI 5.6, 8.9]1; OR 2.74
[95%CI 1.47, 5.11]3)
First-degree relative with type 2 diabetes (PPV 6.7%)4
First-degree relative with type 1 diabetes (PPV 15%)4
Prior macrosomic baby (OR 5.59 [95%CI 2.68, 11.7])3
Age >25 years old (OR 1.9 [95%CI 1.3, 2.7]1; OR 3.37 [95%CI
1.45, 7.85]3)
1 Davey RX, Hamblin PS. Selective versus universal screening for gestational diabetes mellitus:
an evaluation of predictive risk factors. Medical Journal of Australia 2001;174(3):118–21.
2 Schytte T, Jorgensen LG, Brandslund I, et al. The clinical impact of screening for gestational
diabetes. Clinical Chemistry and Laboratory Medicine 2004;42(9):1036–42.
3 Ostlund I, Hanson U. Occurrence of gestational diabetes mellitus and the value of different screening indicators
for the oral glucose tolerance test. Acta Obstetricia et Gynecologica Scandinavica 2003;82(2):103–8.
4 Griffin ME, Coffey M, Johnson H, et al. Universal vs. risk factor-based screening for gestational diabetes
mellitus: detection rates, gestation at diagnosis and outcome. Diabetic Medicine 2000;17(1):26–32.

27. Risk Factors for
Gestational Diabetes
Diagnosis of polycystic ovary syndrome
(OR 2.89 [95%CI 1.68, 4.98])5
Overweight or obese before pregnancy
(BMI >27 kg/m2 OR 2.3 [95%CI 1.6, 3.3]1; BMI>30 kg/m2
OR 2.65 [95%CI 1.36, 5.14]3
Macrosomia in current pregnancy (PPV 40% 4)
Polyhydramnios in current pregancy (PPV 40% 4)
Intake of drugs affecting carbohydrate metabolism
1 Davey RX, Hamblin PS. Selective versus universal screening for gestational diabetes mellitus:
an evaluation of predictive risk factors. Medical Journal of Australia 2001;174(3):118–21.
3 Ostlund I, Hanson U. Occurrence of gestational diabetes mellitus and the value of different screening indicators
for the oral glucose tolerance test. Acta Obstetricia et Gynecologica Scandinavica 2003;82(2):103–8.
4 Griffin ME, Coffey M, Johnson H, et al. Universal vs. risk factor-based screening for gestational diabetes
mellitus: detection rates, gestation at diagnosis and outcome. Diabetic Medicine 2000;17(1):26–32.
5 Toulis KA, Goulis DG, Kolibiankis EM, Venetis CA, et al. Risk of gestational diabetes mellitus in women with
polycystic ovary syndrome: a systematic review and a meta-analysis. Fertil Steril 2009;92(2):667–77.

28. 6.2 For pregnant women, when should
screening be done?
Recommendations:
2. High-risk women should be tested at the
soonest possible time (Level 3, Grade B).

29. High-risk women should be tested at the
6.2 soonest possible time (Level 3, Grade B).
ADA
Screen very
high risk women
DIPSI at first prenatal
Screen early visit
“... fetal beta cell
recognizes and
NICE responds... as early
Offer SMBG or as 16th week of
OGTT at 16-18 gestation.”
wks AOG to
women with
previous GDM

30. 6.2 For pregnant women, when should
screening be done?
Recommendations:
3. Routine testing for gestational diabetes is
recommended at 24-28 weeks age of gestation
for women with no risk factors (Level 3, Grade B).

31. Routine testing for gestational diabetes is
6.2 recommended at 24-28 weeks age of gestation
(Level 3, Grade B).
ADA
Test “greater than
low risk women”
for GDM at 24-28
ACHOIS wks AOG
Treatment of
GDM after 24 wks
USPSTF AOG reduces
complications NICE
No evidence
that screening after
Offer OGTT at 24
the 24th week to 28 wks AOG to
leads to reduction women with other
in morbidity & risk factors
mortality

32. 6.2 For pregnant women, when should
screening be done?
Recommendations:
4. Testing for gestational diabetes should still be
carried out in women at risk, even beyond 24 to
28 weeks age of gestation (Level 3, Grade C).

33. Testing for gestational diabetes should still be
6.2 carried out in women at risk, even beyond 24 to
28 weeks age of gestation (Level 3, Grade C).
Positive OGTT <26 weeks AOG >26 weeks AOG
15/295 20/558
Low risk
5.1% 3.6%
43/120 93/230
High risk
35.8% 40.4%
Litonjua AD et al. AFES Study Group on Diabetes in Pregnancy:
Preliminary Data on Prevalence. PJIM 1996:34:67-68.

34. Testing for gestational diabetes should still be
6.2 carried out in women at risk, even beyond 24 to
28 weeks age of gestation (Level 3, Grade C).
3 macrosomic
ASGODIP Higher babies
Cardinal Santos morbidity
Medical Center
rate (33%) 1 infant with
>75%
in those multiple
diagnosed congenital
evaluated
GDM from anomalies
after 26th
26 to 38 and Down’s
wk AOG
wks AOG syndrome
Sy RAG et al. Viewpoints on Gestational Diabetes: Report from ASGODIP Participating
Hospital: Cardinal Santos Medical Center. PJIM 1996;34:45-48

35. Testing for gestational diabetes should still be
6.2 carried out in women at risk, even beyond 24 to
28 weeks age of gestation (Level 3, Grade C).
ASGODIP (Veterans Memorial Medical Center)
AOG tested
% <20 weeks 21-30 weeks 31-40 weeks
n=19 n = 74 n = 60
Negative
95 92 85
for GDM
Positive
5 8 15
for GDM
Bihasa MTG et al. Screening for gestational diabetes: Report from ASGODIP
participating hospital: Veterans Memorial Medical Center. PJIM 1996:34:57-61.

36. 6.3 Which tests should be used to screen pregnant
women for gestational diabetes?
Recommendation:
An oral glucose tolerance test (OGTT), preferably
the 75-g OGTT, should be used to screen for
gestational diabetes (Level 3, Grade B).

37. An oral glucose tolerance test (OGTT), preferably
6.3 the 75-g OGTT, should be used to screen for
gestational diabetes (Level 3, Grade B).
IASDPG
Initial visit DIPSI
FPG, A1c or RPG
75-g OGTT at
75-g OGTT
ADA
24-28 wks One-step
OGTT or
ASGODIP two-step
50-g GCT with GCT NICE
if low-risk
75-g OGTT
75-g OGTT
if high-risk

38. Should we still do the 50-g glucose
challenge test (GCT)?
fair
Positive likelihood ratio:
The increase in the odds of having the
disease after a positive test result
Qualitative
LR (+) LR (-) LR(+) 4.34
Strength 95%CI(1.53,12.26)
Excellent 10 0.1
Very Good 6 0.2 NICE LR(-) 0.42
95%CI(0.33,0.55)
Fair 2 0.5 does not
Useless 1 1 recommend
50-g GCT
4 studies
n=2437
National Institute for Health and Clinical Excellence. Diabetes in pregnancy: management of diabetes
& its complications from pre-conception to the postnatal period. March 2008 (reissued July 2008)

39. Should we still do the 50-g glucose
challenge test (GCT)?
Positive Predictive value
The probability that a patient with a
fair
positive test result will have the disease
(+) OGTT (-) OGTT Total
(+) GCT 91 113 204
(-) GCT Not done 477 Positive
Total 681 Predictive
Value (PPV)
44.6%
Carlos-Raboca J et al. JAFES 2002;20:19-24

40. Should we still do the 50-g glucose
challenge test (GCT)?
Significantly
affected by the
time of the last
More likely to meal
be positive if
conducted in
the afternoon
Only
moderately
reproducible
http://www.flickr.com/photos/neeta_lind/3572379176/

41. Should we still do the 50-g glucose
challenge test (GCT)?
ASGODIP
Veterans Memorial
17.8%1
FEU-NRMFH
48%2
PGH (unpublished) after (+) GCT
36%
10 to 23% of after (+) GCT
women fail to
return for OGTT
1 De Asis TP et al. Incidence of gestational diabetes mellitus at
after an initial Veterans Memorial Medical Center PJIM 1996; 34:63-66
GCT 2 Chua-Ho C et al. Screening for gestational diabetes mellitus: Report from
ASGODIP Participating Hospital FEU-NRMFH PJIM 1996; 34:43-44
http://www.flickr.com/photos/daquellamanera/4552683663/

42. 75-g or 100-g OGTT?
100-g OGTT
high glucose
load often
unpalatable
100-g OGTT
duration
75-g OGTT
100-g more 3 hours
international
cumbersome; standard in
4 blood non-pregnant
samples

43. 75-g or 100-g OGTT?
Head-to-
head
studies
Pettitt et al Deerochanawong
Diabetes Care et al Diabetologia
1994; 17(11): 1996;39:1070-3
1264-8

44. Pettitt et al
Diabetes Care
1994; 17(11):
M
1264-8 O Cross-
sectional
I Macrosomia comparative
P WHO 75-g Cesarean
OGTT section
vs
NDDG
100-g OGTT
Pregnant Pima Indian
women (n=127)
Pettitt DJ et al. Comparison of WHO and NDDG procedures to detect abnormalities
of glucose tolerance during pregnancy. Diabetes Care 1994;17(11): 1264-8

45. Pettitt et al
Diabetes Care
1994; 17(11):
M
Cross-
1264-8 O sectional
comparative
I
P WHO 75-g
OGTT
vs
NDDG
100-g OGTT
Pregnant Pima Indian
women (n=127)
Pettitt DJ et al. Comparison of WHO and NDDG procedures to detect abnormalities
of glucose tolerance during pregnancy. Diabetes Care 1994;17(11): 1264-8

46. Pettitt et al
Diabetes Care
1994; 17(11):
M
Cross-
1264-8 O sectional
Macrosomia comparative
I
6/16 (38%) Cesarean
P WHO 75-g had (+) 75g section
OGTT OGTT
4/7 (57%)
vs 1/16 (6%) had (+) 75g
had (+) 100 g OGTT
NDDG OGTT No one had (+)
100-g OGTT 100g OGTT
Pregnant Pima Indian
women (n=127)
Pettitt DJ et al. Comparison of WHO and NDDG procedures to detect abnormalities
of glucose tolerance during pregnancy. Diabetes Care 1994;17(11): 1264-8

47. Deerochanawong
et al Diabetologia M
1996;39:1070-3
O Cross-
sectional
I Diagnosed comparative
P WHO 75-g GDM
OGTT Macrosomia
vs
NDDG
100-g OGTT
Pregnant 24-28 wks
AOG (n=709)
Deerochanawong et al. Comparison of NDDG and WHO criteria for detecting
gestational diabetes. Diabetologia 1996;39: 1070-3

48. Deerochanawong
et al Diabetologia M
1996;39:1070-3
O Cross-
sectional
Diagnosed comparative
I GDM
P WHO 75-g 75-g OGTT
OGTT 15.7%
(111/709)
vs
100-g OGTT
NDDG 1.4%
100-g OGTT (10/709)
Pregnant 24-28 wks
AOG (n=709)
Deerochanawong et al. Comparison of NDDG and WHO criteria for detecting
gestational diabetes. Diabetologia 1996;39: 1070-3

49. Deerochanawong
et al Diabetologia M
1996;39:1070-3
O Cross-
sectional
Diagnosed comparative
I GDM
P WHO 75-g 75-g OGTT
Macrosomia
OGTT 15.7%
(111/709) 6/14 (43%)
vs (+)75g OGTT
100-g OGTT
NDDG 1.4% 3/14 (21%)
100-g OGTT (10/709) (+)100 g OGTT
Pregnant 24-28 wks
AOG (n=709)
Deerochanawong et al. Comparison of NDDG and WHO criteria for detecting
gestational diabetes. Diabetologia 1996;39: 1070-3

50. 6.4 What criteria will be used to interpret
the 75-g OGTT?
Recommendation:
The criteria put forth by the International
Association of Diabetes & Pregnancy Study Groups
(IADPSG) will be used to interpret the 75-g OGTT
(Level 3, Grade B).
International Association of Diabetes and Pregnancy Study Groups Consensus Panel. IADPSG Recommendations on
the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care 2010; 33(3):676-82.

51. Interpreting the 75-g OGTT
Threshold(s) for diagnosing gestational
diabetes (mg/dL)
75-g OGTT ASGODIP
IADPSG* ADA** & DIPSI
FBS 92 95 -
1-hour 180 180 -
2-hour 153 155 140
*Any one value meeting threshold is considered gestational diabetes.
** Two values must meet thresholds to be considered gestational diabetes

52. 6.5 What other tests can be used to screen
pregnant women for diabetes?
Recommendation:
The following tests should not be used for the
diagnosis of diabetes in pregnancy (Level 5,
Grade D):
Capillary blood glucose FBS*
RBS* HbA1c
Fructosamine Urine glucose
Do an OGTT for those with glucosuria, elevated
CBG or HbA1c.
* If available at consultation, use same diagnostic
threshold for diabetes as in non-pregnant

53. CBG should not be used for the diagnosis
6.5
of diabetes in pregnancy (Level 5,Grade D).
Postprandial
CBG higher
than venous
Validity of blood
CBG vs
OGTT
Different Sensitivity
unproven
glucometers 47-87%
used in Specificity
studies 51-100%

54. FBS should not be used for the diagnosis
6.5
of diabetes in pregnancy (Level 5,Grade D).
Paucity of
data regarding
reproducibility
FBS varies
with
advancing
gestation
Agardh C- D . Åberg A , Nordén N . Glucose levels and insulin secretion during a 75 g
glucose challenge test in normal pregnancy. J Intern Med 1996 ; 240 : 303–9.
Lind T , Billewicz WZ , Brown G . A serial study of changes occurring in the oral glucose
tolerance test in pregnancy J Obstet Gynaecol Br Com 1973 ; 80 : 1033–9 .
Kühl C . Glucose metabolism during and after pregnancy in normal and
gestational diabetic women . Acta Endocrinol 1975 ; 79 : 709–19.

55. RBS should not be used for the diagnosis
6.5
of diabetes in pregnancy (Level 5,Grade D).
RBS 6.5 mmol/L
(117 mg/dL)
Sensitivity 75%
No optimal Specificity 78%
threshold for
RBS indicating
an OGTT
Only 2 studies:
RBS vs
OGTT Jowett NI , Samanta AK , Burden AC . Screening for diabetes in pregnancy: Is a random blood
glucose enough? Diabet Med 1987;4:160–3
Östlund I , Hanson U . Repeated random blood glucose measurements as universal screening
test for gestational diabetes mellitus . Acta Obstet Gynecol Scand 2004;83:46–51

56. A1c should not be used for the diagnosis
6.5
of diabetes in pregnancy (Level 5,Grade D).
HbA1c values
did not differ
between normal
women and
HbA1c in those with
normal women GDM
varies with
ethnicity and
gestation
Loke DFM . Glycosylated haemoglobins in women with low risk for diabetes in pregnancy .
Singapore Med J 1998;36:501–4
Agarwal M , Dhatt GS , Punnose J , Koster G . Gestational diabetes:
a reappraisal of HBA1c as a screening test . Acta Obstet Gynecol Scand 2005;84:1159–63

57. 6.5 Fructosamine should not be used for the
diagnosis of diabetes in pregnancy (Level 5,Grade D).
Fructosamine
did not differ
between normal
women and
Fructosamine those with
varies with GDM
ethnicity and
albumin levels
Bor MV , Bor P , Cevik C . Serum fructosamine and fructosamine - albumen ratio as screening tests
for gestational diabetes mellitus . Gynecol Obstet 1999; 262:105–11
Huter O , Heinz D , Brezinka C , Soelder E , Koelle D , Patsch JR . Low sensitivity of serum fructosamine
as a screening parameter for gestational diabetes mellitus . Gynecol Obstet Invest 1992;34:20–3
Cefalu WT , Prather KL , Chester DL , Wheeler CJ , Biswas M , Pernoll MI . Total serum glycated proteins in
detection and monitoring of gestational diabetes . Diabetes Care 1990;13:872–5

58. Urine glucose should not be used for the
6.5 diagnosis of diabetes in pregnancy (Level 5,Grade D).
High ascorbic
acid intake can
cause
Glucosuria glucosuria
trace glucose
75 to >250 mg/dL
Sensitivity False-positive
7-36% glucosuria
Specificity with high levels of
urinary ketones
83-98% (starvation
ketosis)

59. Comments/suggestions welcome
unitefordiabetes2010@gmail.com
Thank You
http://www.endocrine-witch.info