Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Screening and diagnosis of gestational diabetes mellitus

INTRODUCTION

Pregnancy is characterized, in part, by insulin resistance and hyperinsulinemia, thus it may predispose some women to develop diabetes during gestation. The resistance stems from placental secretion of diabetogenic hormones including growth hormone, cortisol, placental lactogen, and progesterone, as well as increased maternal adipose deposition, decreased exercise, and increased caloric intake. These and other endocrinologic and metabolic changes ensure that the fetus has an ample supply of fuel and nutrients at all times. Gestational diabetes (GDM) occurs when pancreatic function is not sufficient to overcome the insulin resistance created by changes in diabetogenic hormones during pregnancy. (See "Maternal endocrine and metabolic adaptation to pregnancy".)

TERMINOLOGY

Gestational diabetes is defined as any degree of impaired glucose tolerance of with onset or first recognition during pregnancy [1].

Most women with GDM have impaired glucose tolerance that begins in pregnancy, but some may have type 2 diabetes that was unrecognized prior to pregnancy. About 10 percent of women with GDM have circulating islet-cell antibodies; they may have a "latent" form of type 1 diabetes, although their risk of developing type 1 diabetes is not known [2]. Specific HLA alleles (DR3 or DR4) appear to predispose to the development of type 1 diabetes after delivery, as does the presence of islet-cell antibodies [3].

SIGNIFICANCE

Several adverse outcomes are associated with increasing levels of glucose impairment [4-6]:

  • Preeclampsia
  • Polyhydramnios
  • Fetal macrosomia
  • Birth trauma
  • Operative delivery
  • Perinatal mortality
  • Neonatal metabolic complications (hypoglycemia, hyperbilirubinemia, hypocalcemia, erythremia) (see "Infant of a diabetic mother")
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2009 UpToDate, Inc.
References Top
  1. Proceedings of the 4th International Workshop-Conference on Gestational Diabetes Mellitus. Chicago, Illinois, USA. 14-16 March 1997. Diabetes Care 1998; 21 Suppl 2:B1.
  2. Mauricio, D, Balsells, M, Morales, J, et al. Islet cell autoimmunity in women with gestational diabetes and risk of progression to insulin-dependent diabetes mellitus. Diabetes Metab Rev 1996; 12:275.
  3. Ferber, KM, Keller, E, Albert, ED, Ziegler, AG. Predictive value of human leukocyte antigen class II typing for the development of islet autoantibodies and insulin-dependent diabetes postpartum in women with gestational diabetes. J Clin Endocrinol Metab 1999; 84:2342.
  4. Crowther, CA, Hiller, JE, Moss, JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352:2477.
  5. Dodd, JM, Crowther, CA, Antoniou, G, et al. Screening for gestational diabetes: The effect of varying blood glucose definitions in the prediction of adverse maternal and infant health outcomes. Aust N Z J Obstet Gynaecol 2007; 47:307.
  6. Metzger, BE, Lowe, LP, Dyer, AR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358:1991.
  7. Ornoy, A. Growth and neurodevelopmental outcome of children born to mothers with pregestational and gestational diabetes. Pediatr Endocrinol Rev 2005; 3:104.
  8. Dabelea, D. The predisposition to obesity and diabetes in offspring of diabetic mothers. Diabetes Care 2007; 30 Suppl 2:S169.
  9. Kaaja, RJ, Greer, IA. Manifestations of chronic disease during pregnancy. JAMA 2005; 294:2751.
  10. Centers for Disease Control. Prenatal care and pregnancies complicated by diabetes. US reporting areas, 1989. MMWR CDC Surveill Summ 1993; 42:119.
  11. O'Sullivan, JB, Mahan, CB. Criteria for oral glucose tolerance test in pregnancy. Diabetes 1964; 13:278.
  12. Mestman, JH. Outcome of diabetes screening in pregnancy and perinatal morbidity in infants of mothers with mild impairment in glucose tolerance. Diabetes Care 1980; 3:447.
  13. Amankwah, KS, Prentice, RL, Fleury, RJ. The incidence of gestational diabetes. Obstet Gynecol 1977; 49:497.
  14. Carpenter, MW, Coustan, DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982; 144:768.
  15. Hadden, DR. Geographic, ethnic, and racial variations in the incidence of gestational diabetes mellitus. Diabetes 1985; 34 Suppl 2:8.
  16. Dabelea, D, Snell-Bergeon, JK, Hartsfield, CL, et al. Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program. Diabetes Care 2005; 28:579.
  17. Getahun, D, Nath, C, Ananth, CV, et al. Gestational diabetes in the United States: temporal trends 1989 through 2004. Am J Obstet Gynecol 2008; 198:525.
  18. Solomon, CG, Willett, WC, Carey, VJ, et al. A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA 1997; 278:1078.
  19. Hedderson, MM, Williams, MA, Holt, VL, et al. Body mass index and weight gain prior to pregnancy and risk of gestational diabetes mellitus. Am J Obstet Gynecol 2008; 198:409.
  20. Toulis, KA, Goulis, DG, Kolibianakis, EM, et al. Risk of gestational diabetes mellitus in women with polycystic ovary syndrome: a systematic review and a meta-analysis. Fertil Steril 2009; 92:667.
  21. Glueck, CJ, Wang, P, Kobayashi, S, et al. Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome. Fertil Steril 2002; 77:520.
  22. Begum, MR, Khanam, NN, Quadir, E, et al. Prevention of gestational diabetes mellitus by continuing metformin therapy throughout pregnancy in women with polycystic ovary syndrome. J Obstet Gynaecol Res 2009; 35:282.
  23. Herring, SJ, Oken, E, Rifas-Shiman, SL, et al. Weight gain in pregnancy and risk of maternal hyperglycemia. Am J Obstet Gynecol 2009; 201:61.
  24. Saldana, TM, Siega-Riz, AM, Adair, LS, Suchindran, C. The relationship between pregnancy weight gain and glucose tolerance status among black and white women in central North Carolina. Am J Obstet Gynecol 2006; 195:1629.
  25. Tovar, A, Must, A, Bermudez, OI, et al. The impact of gestational weight gain and diet on abnormal glucose tolerance during pregnancy in Hispanic women. Matern Child Health J 2009; 13:520.
  26. Dempsey, JC, Sorensen, TK, Williams, MA, et al. Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy. Am J Epidemiol 2004; 159:663.
  27. Zhang, C, Solomon, CG, Manson, JE, Hu, FB. A prospective study of pregravid physical activity and sedentary behaviors in relation to the risk for gestational diabetes mellitus. Arch Intern Med 2006; 166:543.
  28. Oken, E, Ning, Y, Rifas-Shiman, SL, et al. Associations of physical activity and inactivity before and during pregnancy with glucose tolerance. Obstet Gynecol 2006; 108:1200.
  29. Langer, O, Yogev, Y, Most, O, Xenakis, EM. Gestational diabetes: the consequences of not treating. Am J Obstet Gynecol 2005; 192:989.
  30. Bonomo, M, Corica, D, Mion, E, et al. Evaluating the therapeutic approach in pregnancies complicated by borderline glucose intolerance: a randomized clinical trial. Diabet Med 2005; 22:1536.
  31. O'Sullivan, JB, Gellis, SS, Dandrow, RV, Tenney, BO. The potential diabetic and her treatment in pregnancy. Obstet Gynecol 1966; 27:683.
  32. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008; 148:759.
  33. Ecker, JL, Greene, MF. Gestational diabetes--setting limits, exploring treatments. N Engl J Med 2008; 358:2061.
  34. Hillier, TA, Vesco, KK, Pedula, KL, et al. Screening for gestational diabetes mellitus: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2008; 148:766.
  35. Gestational diabetes mellitus. Diabetes Care 2004; 27 Suppl 1:S88.
  36. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational diabetes. Obstet Gynecol 2001; 98:525.
  37. Periodic health examination, 1992 update: 1. Screening for gestational diabetes mellitus. Canadian Task Force on the Periodic Health Examination. CMAJ 1992; 147:435.
  38. Naylor, CD, Sermer, M, Chen, E, Farine, D. Selective screening for gestational diabetes mellitus. N Engl J Med 1997; 337:1591.
  39. Danilenko-Dixon, DR, Van Winter, JT, Nelson, RL, Ogburn, PL Jr. Universal versus selective gestational diabetes screening: application of 1997 American Diabetes Association recommendations. Am J Obstet Gynecol 1999; 181:798.
  40. Jensen, DM, Molsted-Pedersen, L, Beck-Nielsen, H, et al. Screening for gestational diabetes mellitus by a model based on risk indicators: A prospective study. Am J Obstet Gynecol 2003; 189:1383.
  41. Moses, RG, Moses, J, Davis, WS. Gestational diabetes: do lean young Caucasian women need to be tested? Diabetes Care 1998; 21:1803.
  42. Moses, RG, Moses, M, Russell, KG, Schier, GM. The 75-g glucose tolerance test in pregnancy: a reference range determined on a low-risk population and related to selected pregnancy outcomes. Diabetes Care 1998; 21:1807.
  43. Jovanovic, L, Peterson, CM. Screening for gestational diabetes. Optimum timing and criteria for retesting. Diabetes 1985; 34 Suppl 2:21.
  44. Riskin-Mashiah, S, Younes, G, Damti, A, Auslender, R. First-trimester fasting hyperglycemia and adverse pregnancy outcomes. Diabetes Care 2009; 32:1639.
  45. Coustan, DR, Widness, JA, Carpenter, MW, et al. Should the fifty-gram, one-hour plasma glucose screening test for gestational diabetes be administered in the fasting or fed state? Am J Obstet Gynecol 1986; 154:1031.
  46. Brody, SC, Harris, R, Lohr, K. Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force. Obstet Gynecol 2003; 101:380.
  47. Carpenter, MW. Rationale and performance of tests for gestational diabetes. Clin Obstet Gynecol 1991; 34:544.
  48. Lamar, ME, Kuehl, TJ, Cooney, AT, et al. Jelly beans as an alternative to a fifty-gram glucose beverage for gestational diabetes screening. Am J Obstet Gynecol 1999; 181:1154.
  49. Murphy, NJ, Meyer, BA, O'Kell, RT, Hogard, ME. Carbohydrate sources for gestational diabetes mellitus screening. A comparison. J Reprod Med 1994; 39:977.
  50. Court, DJ, Mann, SL, Stone, PR, et al. Comparison of glucose polymer and glucose for screening and tolerance tests in pregnancy. Obstet Gynecol 1985; 66:491.
  51. Bergus, GR, Murphy, NJ. Screening for gestational diabetes mellitus: comparison of a glucose polymer and a glucose monomer test beverage. J Am Board Fam Pract 1992; 5:241.
  52. Reece, EA, Holford, T, Tuck, S, et al. Screening for gestational diabetes: one-hour carbohydrate tolerance test performed by a virtually tasteless polymer of glucose. Am J Obstet Gynecol 1987; 156:132.
  53. Guelinckx, I, Devlieger, R, Vansant, G. Reproductive outcome after bariatric surgery: a critical review. Hum Reprod Update 2009; 15:189.
  54. Bevier, WC, Fischer, R, Jovanovic, L. Treatment of women with an abnormal glucose challenge test (but a normal oral glucose tolerance test) decreases the prevalence of macrosomia. Am J Perinatol 1999; 16:269.
  55. Radder, JK, van Roosmalen, J. HbA1c in healthy, pregnant women. Neth J Med 2005; 63:256.
  56. Shivvers, SA, Lucas, MJ. Gestational diabetes. Is a 50-g screening result > or = 200 mg/dL diagnostic?. J Reprod Med 1999; 44:685.
  57. Ramos, GA, Jacobson, GF, Kirby, RS, et al. Comparison of glyburide and insulin for the management of gestational diabetics with markedly elevated oral glucose challenge test and fasting hyperglycemia. J Perinatol 2007; 27:262.
  58. Fourth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 1998 Aug 21 Suppl 2.
  59. Conn, JW. Interpretation of the glucose tolerance test: necessity of standard preparatory diet. Am J Med Sci 1940; 199:555.
  60. Crowe, SM, Mastrobattista, JM, Monga, M. Oral glucose tolerance test and the preparatory diet. Am J Obstet Gynecol 2000; 182:1052.
  61. Entrekin, K, Work, B, Owen, J. Does a high carbohydrate preparatory diet affect the 3-hour oral glucose tolerance test in pregnancy? J Matern Fetal Med 1998; 7:68.
  62. Harlass, FE, McClure, GB, Read, JA, Brady, K. Use of a standard preparatory diet for the oral glucose tolerance test. Is it necessary? J Reprod Med 1991; 36:147.
  63. Riccardi, G, Vaccaro, O, Rivellese, A, et al. Reproducibility of the new diagnostic criteria for impaired glucose tolerance. Am J Epidemiol 1985; 121:422.
  64. Harlass, FE, Brady, K, Read, JA. Reproducibility of the oral glucose tolerance test in pregnancy. Am J Obstet Gynecol 1991; 164:564.
  65. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2000; 23 Suppl 1:S4.
  66. Schwartz, ML, Ray, WN, Lubarsky, SL. The diagnosis and classification of gestational diabetes mellitus: is it time to change our tune?. Am J Obstet Gynecol 1999; 180:1560.
  67. Ricart, W, Lopez, J, Mozas, J, et al. Potential impact of American Diabetes Association (2000) criteria for diagnosis of gestational diabetes mellitus in Spain. Diabetologia 2005; 48:1135.
  68. Gokcel, A, Bagis, T, Killicadag, EB, et al. Comparison of the criteria forgestational diabetes mellitus by NDDG and Carpenter and Coustan, and the outcomes of pregnancy. J Endocrinol Invest 2002; 25:357.
  69. Cheng, YW, Block-Kurbisch, I, Caughey, AB. Carpenter-coustan criteria compared with the national diabetes data group thresholds for gestational diabetes mellitus. Obstet Gynecol 2009; 114:326.
  70. Di Cianni, G, Seghieri, G, Lencioni, C, et al. Normal glucose tolerance and gestational diabetes mellitus: what is in between?. Diabetes Care 2007; 30:1783.
  71. Ergin, T, Lembet, A, Duran, H, et al. Does insulin secretion in patients with one abnormal glucose tolerance test value mimic gestational diabetes mellitus?. Am J Obstet Gynecol 2002; 186:204.
  72. Langer, O, Brustman, L, Anyaegbunam, A, Mazze, R. The significance of one abnormal glucose tolerance test value on adverse outcome in pregnancy. Am J Obstet Gynecol 1987; 157:758.
  73. Lindsay, MK, Graves, W, Klein, L. The relationship of one abnormal glucose tolerance test value and pregnancy complications. Obstet Gynecol 1989; 73:103.
  74. Corrado, F, D'Anna, R, Cannata, ML, et al. Positive association between a single abnormal glucose tolerance test value in pregnancy and subsequent abnormal glucose tolerance. Am J Obstet Gynecol 2007; 196:339.
  75. Gabbe, SG, Graves, CR. Management of diabetes mellitus complicating pregnancy. Obstet Gynecol 2003; 102:857.
  76. Jovanovic-Peterson, L, Bevier, W, Peterson, CM. The Santa Barbara County Health Care Services program: birth weight change concomitant with screening for and treatment of glucose-intolerance of pregnancy: a potential cost-effective intervention?. Am J Perinatol 1997; 14:221.
  77. Langer, O, Anyaegbunam, A, Brustman, L, Divon, M. Management of women with one abnormal oral glucose tolerance test value reduces adverse outcome in pregnancy. Am J Obstet Gynecol 1989; 161:593.
  78. Weissman, A, Solt, I, Zloczower, M, Jakobi, P. Hypoglycemia during the 100-g oral glucose tolerance test: incidence and perinatal significance. Obstet Gynecol 2005; 105:1424.
  79. Abell, DA, Beischer, NA. Evaluation of the three-hour oral glucose tolerance test in detection of significant hyperglycemia and hypoglycemia in pregnancy. Diabetes 1975; 24:874.
  80. WHO Consultation: Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications: Report of a WHO Consultation. Part I: Diagnosis and Classification of Diabetes Mellitus. WHO/NCD/NCS/99.2, World Health Organization, Geneva 1999.
  81. Schmidt, MI, Duncan, BB, Reichelt, AJ, et al. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care 2001; 24:1151.
  82. Schrader HM, Jovanovic-Peterson, L, Bevier, W, Peterson, CM. Fasting plasma glucose and glycosylated protein at 24 to 28 weeks of gestation predict macrosomia in the general obstetric population. Am J Perinatol 1995; 12:247.
  83. Perucchini, D, Fischer, U, Spinas, GA, et al. Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study. BMJ 1999; 319:812.
  84. Omori, Y, Jovanovic, L. Proposal for the reconsideration of the definition of gestational diabetes. Diabetes Care 2005; 28:2592.
  85. Sheffield, JS, Butler-Koster, EL, Casey, BM, et al. Maternal diabetes mellitus and infant malformations. Obstet Gynecol 2002; 100:925.
  86. Fuchtenbusch, M, Ferber, K, Standl, E, Ziegler, AG. Prediction of type 1 diabetes postpartum in patients with gestational diabetes mellitus by combined islet cell autoantibody screening. Diabetes 1997; 46:1459.
white circle LOG IN
white circle DEMO