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Gestational Diabetes Testing Protocol Periprocedural Care

  • Author: Sonal J Patel, MD; Chief Editor: George T Griffing, MD  more...
 
Updated: Nov 03, 2014
 

Patient Education & Consent

Patients should be informed of the reasons for screening and process of the OGTT test. A thorough discussion of the ramifications of an abnormal test should ensue as well. Patients should be aware that in the event of an abnormal test, treatment needs to begin immediately, whether that entails dietary modifications, oral hypoglycemic agents, or insulin.

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Patient Preparation

Patients should be fasting at least 8 hours prior to testing. No preparatory diet is needed.

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Monitoring and Follow up

In the event of an abnormal 75-g OGTT, patients should be counseled on gestational diabetes mellitus and receive nutritional counseling. If postprandial blood sugars still remain elevated and glycemic control is less than ideal, medication should be initiated.

Following delivery, patients should be screened for persistent diabetes 6-12 weeks postpartum, as an increased risk of developing type 2 diabetes, type 1 diabetes, and cardiovascular disease exists.[5, 9] Following that, these patients should have lifelong screening for prediabetes or diabetes development every 3 years.[9, 13, 14]

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Contributor Information and Disclosures
Author

Sonal J Patel, MD Fellow, Department of Endocrinology, Scott and White Hospital, Texas A&M Health Science Center College of Medicine

Sonal J Patel, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American Medical Association, American Thyroid Association, Endocrine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Deepika Reddy, MD Assistant Professor of Medicine, Texas A&M Health Science Center College of Medicine; Attending Physician, Department of Endocrinology and Metabolism, Scott and White Clinic

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

References
  1. National Diabetes Information. Clearinghouse (NDIC). http://diabetes.niddk.nih.gov/DM/PUBS/statistics/#Gestational. 2011.

  2. Metzger BE, Coustan DR. Proceedings of the Fourth International Work-shop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 1998. 21 (Suppl. 2):B1–B167.

  3. Setji TL, Brown AJ, Feinglos MN. Gestational Diabetes Mellitus. Clinical Diabetes. 2005. 23:17-24.

  4. Jovanovic L, Pettitt DJ. Gestational diabetes mellitus. JAMA. 2001 Nov 28. 286(20):2516-8. [Medline].

  5. Metzger BE, Buchanan TA. Summary and Recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2005. 30 (Suppl. 2):S251-260.

  6. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005 Jun 16. 352(24):2477-86. [Medline].

  7. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009 Oct 1. 361(14):1339-48. [Medline].

  8. Lowe LP, Metzger BE, Dyer AR, Lowe J, McCance DR, Lappin TR, et al. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations of maternal A1C and glucose with pregnancy outcomes. Diabetes Care. 2012 Mar. 35(3):574-80. [Medline]. [Full Text].

  9. American Diabetes Association. Standards of Medical Care in Diabetes-2011. Diabetes Care. 2011. 34 (Suppl. 1):S11-61.

  10. McIntyre HD, Metzger BE, Coustan DR, Dyer AR, Hadden DR, Hod M, et al. Counterpoint: establishing consensus in the diagnosis of GDM following the HAPO study. Curr Diab Rep. 2014 Jun. 14(6):497. [Medline]. [Full Text].

  11. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010 Mar. 33(3):676-82. [Medline].

  12. American College of Obstetricians and Gynecologists. Screening and diagnosis of gestational diabetes mellitus. Committee Opinion No. 504. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2011. 118:751-3.

  13. Tieu J, McPhee AJ, Crowther CA, Middleton P. Screening and subsequent management for gestational diabetes for improving maternal and infant health. Cochrane Database Syst Rev. 2014 Feb 11. 2:CD007222. [Medline].

  14. Carson MP, Morgan B, Gussman D, Brown M, Rothenberg K, Wisner TA. SUGAR: Spotting Undiagnosed Glucose Abnormal Results-A New Protocol To Increase Postpartum Testing Among Women With Gestational Diabetes Mellitus. Am J Perinatol. 2014 Aug 5. [Medline].

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