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Diabetes and Pregnancy

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4 Care During Pregnancy Testing for Overt Diabetes in Early Pregnancy Î 2.1. ES recommends universal testing for diabetes (see Table 1) with a fasting plasma glucose, an HbA1c, or an untimed random plasma glucose at the first prenatal visit (before 13 weeks gestation or as soon as possible thereafter) for those women not known to already have diabetes. (1|⊕⊕ ) Note: In the case of overt diabetes, but not gestational diabetes, a second test (either fasting plasma glucose, untimed random plasma glucose, HbA1c, or OGTT) must be performed in the absence of symptoms of hyperglycemia and found to be abnormal on another day to confirm the diagnosis. Testing for Gestational Diabetes at 24-28 Weeks Gestation Î 2.2. ES recommends pregnant women not previously identified (either during testing performed as per recommendation 2.1 or at some other time before 24 weeks gestation) as having overt diabetes or gestational diabetes be tested for gestational diabetes (see Table 2) by having a 2-hour, 75-g OGTT performed at 24-28 weeks gestation. (1|⊕⊕⊕ ) ES recommends that gestational diabetes be diagnosed with this test using the IADPSG criteria (majority opinion of this committee). (1|⊕⊕⊕ ) Note: The 75-g OGTT should be performed after an overnight fast of 8-14 hours and without having reduced usual carbohydrate intake for the preceding several days. The test should be performed with the patient seated, and the patient should not smoke during the test. One or more abnormal values establishes the diagnosis, with the exception that in the case of overt diabetes, but not gestational diabetes, a second test (either fasting plasma glucose, untimed random plasma glucose, HbA1c or OGTT), in the absence of symptoms of hyperglycemia, must be performed and found to be abnormal on another day to confirm the diagnosis of overt diabetes.

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