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...
...ment of Food/Nutrition-Related History of W...
...Assessment of Anthropometric Measurem...
...M: Assessment of Biochemical Data, Medica...
...M: Assessment of Nutrition-Focused Physic...
Nutrition Intervention
...ition Intervention...
...Medical Nutrition Therapy (MNT)The RDN should p...
...and Duration of MNTThe RDN should provide r...
...Calorie PrescriptionFor women with GDM,...
...Macronutrient RequirementsIn women...
...rate PrescriptionThe RDN should individualize...
...bohydrate and Post Prandial Breakfa...
...y Vitamin and Mineral IntakeThe RD...
...DM: Vitamin and Mineral SupplementationTh...
GDM: Meal and Snack DistributionIn women wi...
...h-Intensity SweetenersIn pregnant women with GDM...
...lcohol IntakeThe RDN should reinforce a...
...ActivityUnless contraindicated, the RDN sho...
Nutrition Monitoring and Evaluation
...n Monitoring and Evaluation...
...ition Monitoring and EvaluationFollowing the n...