Screening and Diagnosis of Gestational Diabetes Mellitus

Two approaches are used to screen and diagnose for GDM, the two-step and the one-step method [3]. The two-step method is used primarily in the United States. The first step is the oral glucose challenge test (OGCT). A solution containing 50 g glucose is consumed, and the plasma glucose level is checked 1 h later. If the test is >140 mg/dl, the second step, the oral glucose tolerance test (OGTT) is administered after 3 days of unrestricted carbohydrates (at least 150 g/day) and unlimited physical activity. The woman fasts for at least 8 h the night before the test. Blood is drawn for a fasting glucose level, followed by 100 g of glucose solution given orally and redrawn at 1, 2, and 3 h. The oral glucose tolerance test is discontinued if the fasting glucose is >126 mg/dl or a random glucose is > 200 mg/dl. GDM is diagnosed if at least two of the values exceed the Carpenter and Coustan criteria (see Table 10.5).

The second method eliminates the 50 g OGCT. The one-step approach uses a 75-g glucose solution as the OGTT and the blood is drawn at fasting, 1 h, and 2 h. The criteria for the diagnosis of GDM are the same as the 3-h oral glucose tolerance test (Table 10.5). This method is used by the World Health Organization, but may also be more cost-effective in populations at high risk for GDM. One abnormal value on the oral glucose tolerance test is not a diagnosis for GDM; however, it may indicate adverse perinatal outcome compared to women with normal results [59].

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