All -

Check out March 2010 Diabetes Care, page 676 for the International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. These are the synthesis and review of the results from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study and many others as well as a consensus among many experts from around the world who met together in 2008.

Notice these recommendations for making the diagnosis (these aren't treatment guidelines) include both Gestation Diabetes as well as a relatively new category of prepregnancy (also called overt) diabetes. This is the woman who enters pregnancy with preexisting diabetes but the diabetes is not detected/diagnosed until she is pregnant. The paper notes, " As ongoing epidemics of obesity and diabetes result in more type 2 diabetes in young women, the number who are undiagnosed (before pregnancy) is increasing. The need to identify these women and address perinatal risks that may be particular to their greater degree of hyperglycemia is becoming more important.

Recommendations for diagnostic thresholds:
Fasting plasma glucose recommendation is: 92 or above

1 hour is 180 or above

2 hour is 153 or above

I encourage you to review this interesting paper in Diabetes Care, March 2010.

Thanks,

Hope Warshaw, MMSc, RD, CDE

Nutrition Section editor, www.PRESENTdiabetes.com

I often wonder how many of our GDM's have overt t2. We don't see the OB's requesting A1C's when the GDM is diagnosed. Do other's get these labs? If not, do you routinely request them?

Jennifer -

You raise a good point about measuring A1C to detect the pre-existing/overt type 2 in GDMs. This is particularly relevant now as the American Diabetes Association has in their 2010 Clinical Practice Recommendations (Diabetes Care, Jan 2010) approved the use of A1C as the diagnostic test for diabetes vs. fasting or casual blood glucose measure and describe it as better for a variety of reasons from more convenient, reflects less day to day variation.

The cutpoints (using a method certified by the National Glycohemoglobin Standardization Program) :

< 5.7% - normal

5.7 - 6.4 % - at risk/pre-diabetes

>6.5% - diabetes

Another resource health care providers who work with women with gestational diabetes might want to know about is the Nutrition Practice Guidelines for Gestation Diabetes Mellitus developed by several dietitian experts and published/sold by the American Dietetic Association (www.eatright.org) and search on nutrition practice guidelines.

Thanks,

Hope Warshaw, MMSc, RD, CDE

Nutrition Section Editor, www.PRESENTdiabetes.com