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
...tion Assessment...
...ssessment of Food/Nutrition-Related History...
...Assessment of Anthropometric Measurement of...
...sment of Biochemical Data, Medical Tests...
...of Nutrition-Focused Physical Findings...
Nutrition Intervention
...on Intervention...
...Medical Nutrition Therapy (MNT)The RDN should...
...M: Frequency and Duration of MNTThe R...
...escriptionFor women with GDM, the RDN s...
...onutrient RequirementsIn women with GDM, the RDN...
...Carbohydrate PrescriptionThe RDN should...
GDM: Carbohydrate and Post Prandial Br...
...tary Vitamin and Mineral IntakeThe RDN should e...
...M: Vitamin and Mineral SupplementationThe...
...and Snack DistributionIn women with GDM, the RDN...
...Use of High-Intensity SweetenersIn...
...l IntakeThe RDN should reinforce abst...
GDM: Physical ActivityUnless contraindicated, the...
Nutrition Monitoring and Evaluation
...utrition Monitoring and Evaluat...
...tion Monitoring and EvaluationFollowing the nutri...