All pregnant women should be screened for GDM, whether by hx,<sup>4</sup> clinical risk factor assessment, or labs. [B] Screen @ 24-28 wks, including pts who tested (-) on early screen. 2-step testing is common:

By rray, 28 November, 2014
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<sup>4</sup> Traditional hx factors (FHx/personal hx of DM, previous adverse preg outcome, glycosuria, obesity) will miss ~ 1/2 of GDM cases.<br><br><sup>5</sup> Select consistent cut-offs for practice, considering factors like community GDM prevalence, resource availability, etc. No RCTs support benefit for specific 1-h cut-off. For 3-h cut-off, no clear comparative trial results available; select either Carpenter/Coustan (140 mg/dL, plasma/serum) or NDDG (145 mg/dL plasma).<br><br>
<sup>6</sup> Insufficient evidence exists about optimal BG monitoring freq. No study has demonstrated superiority of 1- vs 2-h postprandial BG. ADA and ACOG recommend 140 mg/dL @ 1 h post prandial, or 120 mg/dL @ 2 h, to ↓ macrosomia risk.<br><br>
<sup>7</sup> Antepartum fetal testing is recommended if established pre-preg DM. There is no consensus regarding antepartum testing in well-controlled GDM; choose per local practice.
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Step 1: 50-g PO glucose followed by 1-h venous glucose level. Select (+) test threshold:<sup>5</sup> 135 or 140 mg/dL. [C]
Step 2: If 50-g 1-h meets/exceeds threshold, then order 100-g 3-h diagnostic OGTT. Select (+) test threshold:<sup>5</sup> 140 or 145 mg/dL. [C]
If (+): Monitor BG<sup>6</sup> while on nutrition tx [C], starting 4x/day (fasting and 1 or 2 h post-meals); then modify freq. once controlled. Antepartum fetal surveillance may be beneficial if GDM glycemic control is poor.<sup>7</sup>