Gestational Diabetes Mellitus
Screening and Referral
Screening and Referral
All pregnant women are generally tested for GDM between 24–28 weeks of gestation, [American College of Obstetricians and Gynecologists (ACOG), 2013] if they have not previously been diagnosed with overt diabetes.
Screening and diagnosis of GDM may be made by one of two strategies at 24–28 weeks of gestation:
ONE-STEP STRATEGY:
Perform a 75g oral glucose tolerance test (OGTT), with plasma glucose measurement when patient is fasting and at 1 and 2 hours. The OGTT should be performed in the morning after an overnight fast of at least 8 hours. A GDM diagnosis is made when any of the following plasma glucose values are met or exceeded:
| Time | Criteria |
|---|---|
| Fasting | 92 mg/dL (5.1 mmol/L) |
| 1 h | 180 mg/dL (10.0 mmol/L) |
| 2 h | 153 mg/dL (8.5 mmol/L) |
Step 1: Perform a 50g glucose load test (GLT) (nonfasting), with plasma glucose measurement at 1 hour. If the plasma glucose level measured 1 hour after the load is ≥140 mg/dL (7.8 mmol/L), proceed to a 100g OGTT.
[Note: The ACOG recommends 135mg/dL (7.5mmol/L) in high-risk ethnic populations with higher prevalence of GDM. Some experts also recommend 130mg/dL (7.2 mmol/L).]
Step 2: The 100g OGTT should be performed when the patient is fasting.
A GDM diagnosis is made if at least two of the following four plasma glucose levels (measured fasting and 1 h, 2 h, 3 h after the OGTT) are met or exceeded:
| Time | Carpenter/Coustan | National Diabetes Data Group | |
|---|---|---|---|
| Fasting | 95 mg/dL (5.3 mmol/L) | OR | 105 mg/dL (5.8 mmol/L) |
| 1 h | 180 mg/dL (10.0 mmol/L) | OR | <190 mg/dL (10.6 mmol/L) |
| 2 h | 155 mg/dL (8.6 mmol/L) | OR | 165 mg/dL (9.2 mmol/L) |
| 3 h | 140 mg/dL (7.8 mmol/L) | OR | 145 mg/dL (8.0 mmol/L) |
GDM: Referral to an RDN
Nutrition Assessment
...ion Assessment...
...Assessment of Food/Nutrition-Related...
...of Anthropometric Measurement of Women wit...
...t of Biochemical Data, Medical Tests, and Proced...
...ent of Nutrition-Focused Physical Findings and C...
Nutrition Intervention
...ition Intervention
...Medical Nutrition Therapy (MNT)The RDN sho...
...: Frequency and Duration of MNTThe RDN sh...
...: Calorie PrescriptionFor women with...
...nutrient RequirementsIn women with GDM, t...
...arbohydrate PrescriptionThe RDN should individ...
...ydrate and Post Prandial Breakfast GlycemiaThe...
...ry Vitamin and Mineral IntakeThe RDN shou...
...nd Mineral SupplementationThe RDN should...
...Meal and Snack DistributionIn women with GDM, t...
GDM: Use of High-Intensity SweetenersIn pregnan...
...akeThe RDN should reinforce abstinence from...
...al ActivityUnless contraindicated, the RDN should...
Nutrition Monitoring and Evaluation
...tion Monitoring and Evaluatio...
...n Monitoring and EvaluationFollowing the nutritio...