Module 5 Unit A Flashcards
What patients are eligible for selective GDM screening?
Women who are considered to be at low risk for GDM.
> 25
Not Hispanic, African American, Native American, South
or East Asian, or Pacific Islander
BMI 25 or less
No hx of abnormal glucose tolerance
No hx of adverse OB outcomes
No first degree relative with DM
What is the rationale for universal GDM screening?
90% of the population have risk factors and trying to identify 10% of women without screening is unnecessarily complex
Will identify women w/ previously undetected diabetes
When is the 50 g 1‐hour test screening test used?
It is used in early pregnancy with high risk patients.
If the results are negative, then it is repeated between 24 -28 weeks.
The test is used to test all pregnant women between 24 -28 weeks.
When is the 100 g GDM screening used?
The 3‐hour, 100 g OGTT is the common diagnostic test used in the United States when a 1‐hour screen is positive. The test is administered in the morning after an overnight fast.
When is the 75 g GDM screening used?
The one‐step method combines screening and diagnosis in one test. A 75 g oral glucose load is administered and plasma glucose levels are evaluated after 1 and 2 hours. Only one abnormal value is required for a diagnosis of GDM.
What is the GDM2 step testing approach?
The two‐step method, commonly known as the 1‐hour oral glucose tolerance test (OGTT), starts with a 50 g oral glucose load administered with plasma glucose levels evaluated after 1 hour. A positive screening result is then followed up with a 3‐hour oral glucose tolerance test for diagnosis. Screening and diagnosis occur in two separate steps. The 1‐hour OGGT is considered positive at levels exceeding 130–140 mg/dL
What is the GTM 1 step testing approach?
The one‐step method combines screening and diagnosis in one test. A 75 g oral glucose load is administered and plasma glucose levels are evaluated after 1 and 2 hours. Only one abnormal value is required for a diagnosis of GDM.
What is the threshold value for the one hour, 50 g gdm screening?
The 1‐hour OGGT is considered positive at levels exceeding 130–140 mg/dL.
What are the threshold values for a 3 hour, 100 g gdm screening?
Blood Sample National Diabetes Carpenter &
Data Group Coustan
Fasting 105 mg/dL 95 mg/dL
(5.8 mmol/L) (5.3 mmol/L)
1 hour 190 mg/dL 180 mg/dL
(10.5 mmol/L) (10.0 mmol/L)
2 hour 165 mg/dL 155 mg/dL
(9.2 mmol/L) (8.6 mmol/L)
3 hour 145 mg/dL 140 mg/dL
(8.0 mmol/L) (7.8 mmol/L)
What is the NDDG scale?
100gm glucose load
Fasting >/= 105
Postprandial 1hr >/= 190
Pp 2 hr >/= 165
Pp 3 hr >/= 145
Dx >/= 2 abnormal values
Diagnoses 3.3 %
What is the Carpenter/Coustan scale?
100gm glucose load
Fasting >/= 95
Postprandial 1hr >/= 180
Pp 2 hr >/= 155
Pp 3 hr >/= 140
Dx >/= 2 abnormal values
Diagnoses 5.1%
Why does ACOG support a 2 step testing versus one step testing?
It would increase (around 3x) the number diagnosed w/GDM w/o proven improvement in outcomes
How is GDM diagnosed in the pregnant patient?
A positive diagnosis of GDM traditionally has required that two or more threshold glucose levels on the 3‐hour test be met or exceeded. However, ACOG (2017) now states that one elevated value may be used to establish the diagnosis of GDM, noting that research evidence has demonstrated an increased risk for adverse perinatal outcomes with even one abnormal value.
What is the 1st line management of GDM?
Diet and exercise
When are diet and exercise indicated in GDM management?
If there are no OB contraindications to exercise.
