A 26-year-old female in her 24th week of pregnancy presented for an antenatal checkup. She had no significant medical history but her mother had type 2 diabetes. Laboratory tests found her fasting blood glucose was 93 mg/dL, 1-hour postprandial was 196 mg/dL, and 2-hour was 153 mg/dL on an oral glucose tolerance test. Her Hba1c was 7%. She was screened for gestational diabetes due to her family history of diabetes.

1. Case 3 History: 26 yr female, in her first pregnancy, came for antenatal check up in her 24 th week of pregnancy Past History: No past significant Obstetric history Family History: Mother is Type 2 DM

2. Personal History: Not significant, O/E: Weight : 54 kg Height: 155 cm Pulse: 80/min Regular BP : 130/80 mm of hg. CVS/RS/AS/CNS : Normal Peri Pulse: Normal felt Feet / Nails / Sensation : clinically Normal Uterine size: Normal for gestational age

3. Laboratory Ix: 1. OGTT: with 75 gm glucose showed FBG : 93 mg/dL, Ur Sugar: nil PP1BG : 196 mg/dL, Ur Sugar: trace PP2BG : 153 mg/dL, Ur Sugar : nil 2. Hba1c : 7 %

4. Q: 1. Screening for GDM is indicated in women at first visit with: 1. Obesity 2. P/H/O GDM 3. Presence of Glycosuria 4. All of above.

5. Which patients need screening? 1. Age < 25 yrs 2. BMI < 25 kg/m2, before pregnancy 3. No P/H/O abnormal glucose tolerance 4. No P/H/O poor obstetrical outcomes 5. No F/H/O Type 2 DM in first degree relatives 6. Ethnic group with low prevalence of GDM Ethnic group prone for GDM are: 1. SEA, south or east Asian 2. Pacific Islander 3. Hispanic American 4. Native American 5. African American 1. Age > 30 yrs 2. Obesity : BMI >30 kg/m2 3. P/H/O GDM, IGT, IFG 4. Presence of Urine Sugar / Glycosuria 5. P/H/O delivery of Large for gestational age infant. Baby weight : > 4.5 kg or > 9 pounds 6. P/H/O poor obstetrical outcomes Still birth Polyhydroamnios Anomalies Shoulder Dystocia 6. F/H/O Type 2 DM in first degree relative 7. H/O PCOS (Polycystic Ovarian Syndrome) LOW RISK OF GDM Do Not require Screening for GDM But close monitoring is required VERY HIGH RISK OF GDM requires Screening for GDM

6. When to diagnose GDM? Conversion: 1. m mol/ L = mg/dL X 18 < 120 – 127 mg/dL .. (120) > 153 mg/dL > 200 mg/dL PPBG 2 Hr < 140 mg/dL > 180 mg/dL PPBG 1 Hr (75 gm oral glucose) < 90 – 99 mg/dL ..(95) > 92 mg/dL > 126 mg/dL FBG ( 8 – 10 Hr of zero calorie orally) Targets for GDM GDM DM Venous sample ADA criteria for diagnosis of GDM

7. Q. 2. Which is the best time to screen for GDM ? 1. 16 – 20 weeks of pregnancy 2. 20 – 24 weeks of pregnancy 3. 24 – 28 weeks of pregnancy 4. 28 – 38 weeks of pregnancy - Ideally at first visit, all expected mother should be screened if they are high risk - All high risk for GDM should be best screened at 24 – 28 weeks of pregnancy for GDM

8. Q. 3. Which test should be used for screening for GDM and ? 1. FBG 2. PPBG 3. RBG 4. OGTT 5. Hba1c