Diagnosis and Management of Gestational Diabetes Mellitus: An Overview of National and International Guidelines

Abstract

Importance: Gestational diabetes mellitus (GDM) represents one of the most frequent complications of pregnancy and is associated with increased maternal and neonatal morbidity. Its incidence is rising, mostly due to an increase in maternal age and maternal obesity rate.Objective: The aim of this study was to review and compare the recommendations of the most recently published guidelines on the diagnosis and management of this condition.Evidence Acquisition: A descriptive review of guidelines from the National Institute for Health and Care Excellence (NICE), the International Federation of Gynecology and Obstetrics, the Australasian Diabetes in Pregnancy Society (ADIPS), the Society of Obstetricians and Gynecologists of Canada (SOGC), the American College of Obstetricians and Gynecologists (ACOG), the American Diabetes Association, and the Endocrine Society on gestational diabetes mellitus was carried out.Results: The NICE guideline recommends targeted screening only for women with risk factors, whereas the International Federation of Gynecology and Obstetrics, ADIPS, SOGC, and the ACOG recommend screening for all pregnant women at 24 to 28 weeks of gestation in order to diagnose and effectively manage GDM; they also state that women with additional risk factors should be screened earlier (ie, in the first trimester) and retested at 24 to 28 weeks, if the initial test is negative. These guidelines describe similar risk factors for GDM and suggest the same thresholds for the diagnosis of GDM when using a 75-g 2-hour oral glucose tolerance test. Of note, the NICE only assesses the fasting and the 2-hour postprandial glucose levels for the diagnosis of GDM. Moreover, the SOGC and the ACOG do not recommend this test as the optimal screening method. The Endocrine Society alone, on the other hand, recommends the universal testing of all pregnant women for diabetes before 13 weeks of gestation or as soon as they attend the antenatal service and retesting at 24 to 28 weeks if the initial results are normal. In addition, there is a general consensus on the appropriate ultrasound surveillance of pregnancies complicated with GDM, and all the medical societies, except the ADIPS, recommend self-monitoring of capillary glucose to assess the glycemic control and set the same targets for fasting and postprandial glucose levels. There is also agreement that lifestyle modifications should be the first-line treatment; however, the reviewed guidelines disagree on the medical management of GDM. In addition, there are controversies regarding the timing of delivery, the utility of hemoglobin A 1c measurement, and the postpartum and lifelong screening for persistent hyperglycemia and type 2 diabetes. However, all the guidelines state that all women in pregnancies complicated by GDM should

Impact of the Gestational Diabetes Diagnostic Criteria during the Pandemic: An Observational Study

“…The diagnosis of gestational diabetes is a source of controversy due to differences in the recommendations of scientific societies; general consensus about the best diagnosis strategy for gestational diabetes mellitus (GDM) has never been reached. The most controversial aspects are: (a) the need for universal versus selective screening (i.e., only those women with risk factors); (b) the two-step approach using a screening test followed by a diagnostic test versus the one-step approach using only a diagnostic OGTT; (c) the most appropriate test for diagnosis (100 versus 75 g OGTT); and even (d) the proposed cut-off points [ 1 , 2 ]. In the middle of this unsolved controversy, the COVID-19 pandemic has intruded.…”

Analysis of specific lipid metabolites in cord blood of patients with gestational diabetes mellitus

“…Before the test, the patient was fasted for eight hours, and taken 75 g of glucose within 5 min, and then test the blood glucose at 1 h and 2 h, respectively. Any patient with blood glucose level that meets or exceeds the following criteria was diagnosed as GDM: Fasting: 5.1 mmol/L; 1 h after meal: 10.0 mmol/L; 2 h after meal: 8.5 mmol/L (Tsakiridis et al, 2021).…”

A Review of the Associations Between Obstructive Sleep Apnea and Gestational Diabetes Mellitus and Possible Mechanisms of Disease

“…As a state of abnormal glucose tolerance, gestational diabetes mellitus (GDM) is a common gestational complication defined as any degree of glucose intolerance with onset or first recognition during pregnancy [7]. GDM is usually diagnosed at 24-28 weeks of pregnancy and is associated with adverse maternal and fetal outcomes [8][9][10][11][12].…”