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.
