Gestational Diabetes Mellitus

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Poorly controlled gestational diabetes is associated with an increase in the incidence of preeclampsia, polyhydramnios, fetal macrosomia, birth trauma, operative delivery, and neonatal hypoglycemia. There is an increased incidence of hyperbilirubinemia, hypocalcemia, and erythremia. Later development of diabetes mellitus in the mother is also more frequent. The prevalence of gestational diabetes is higher in black, Hispanic, Native American, and Asian women than white women. The prevalence of gestational diabetes is 1.4 to 14 percent.

Risk Factors for Gestational Diabetes

• A family history of diabetes, especially in first degree relatives

• Prepregnancy weight of 110 percent of ideal body weight (pregravid weight more than 90 kg) or more or weight gain in early adulthood.

• Age greater than 25 years

• A previous large baby (greater than 9 pounds [4.1 kg])

• History of abnormal glucose tolerance

• Hispanic, African, Native American, South or East Asian, and Pacific Island ancestry

• A previous unexplained perinatal loss or birth of a malformed child

• The mother was large at birth (greater than 9 pounds [4.1

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I. Screening and diagnostic criteria

A. Screening for gestational diabetes should be performed at 24 to 28 weeks of gestation. However, it can be done as early as the first prenatal visit if there is a high degree of suspicion that the pregnant woman has undiagnosed type 2 diabetes (eg, obesity, previous gestational diabetes or fetal macrosomia, age >25 years, family history of diabetes).

B. 50-g oral glucose challenge is given for screening and glucose is measured one hour later; a value >140 mg/dL (7.8 mmol/L) is considered abnormal. Women with an abnormal value are then given a 100-g, three-hour oral glucose tolerance test (GTT).

Criteria for Gestational Diabetes with Three Hour Oral Glucose Tolerance Test

Fasting

>95 mg/dL

1 hour

>180 mg/dL

2 hour

>155 mg/dL

3 hour

>140 mg/dL

Any two or more abnormal results are diagnostic of gestational diabetes.

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