Guidelines Issued to Properly Diagnose, Manage Diabetes in Pregnancy

The Endocrine Society recently released a new clinical practice guideline addressing up-to-date issues regarding the management of women with type 1 or type 2 diabetes mellitus preconceptionally, during pregnancy, and after pregnancy. Chief among the new recommendations is the call for universal diabetes testing for pregnant women at their first prenatal visit.

The guideline entitled “Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline” appeared in the November 2013 issue of the Journal of Clinical Endocrinology and Metabolism.

According to lead author Ian Blumer, MD, of the Charles H. Best Diabetes Centre, Whitby, Ontario, and chair of the task force that authored the guideline, many traditional screening methods are failing to diagnosis diabetes in pregnant women.

The new guidelines issued a recommendation that all women without a previous diabetes diagnosis be tested for the condition at their first prenatal visit or by 13 weeks’ gestation. Overt diabetes should be diagnosed if the fasting plasma glucose level is 126 mg/dL or greater, an untimed plasma glucose level is 200 mg/dL or greater, or a glycosylated hemoglobin concentration is 6.5% or greater.

A test for gestational diabetes should be conducted at 24 to 28 weeks’ gestation. The new guideline recommended that a lower blood glucose level be used to diagnose gestational diabetes. To diagnose gestational diabetes, the guideline recommended using a fasting plasma glucose level range of 92 mg/dL to 125 mg/dL.

“Using these lower levels will allow for the detection of gestational diabetes in many women when it would otherwise go undetected using the older diagnostic thresholds,” Blumer said in a press release. “Once the diagnosis is made, treatment can be given to help the fetus grow normally.”

Experts recommended lifestyle changes, such as medical nutrition therapy and daily moderate exercise lasting 30 minutes, for the initial treatment of gestational diabetes. If these changes do not control the condition, blood glucose–lowering medication should be prescribed.

Women in whom gestational diabetes is diagnosed should also undergo a glucose tolerance test at 6 to 12 weeks’ post-delivery to rule out prediabetes or diabetes. In addition, these women should be tested regularly for diabetes, especially before any future pregnancies.

Pertinent Points:
- Traditional screening is not sufficient at diagnosing diabetes in pregnant women.
- Pregnant women should be tested for diabetes by 13 weeks’ gestation and tested again for gestational diabetes between 24 and 28 weeks’ gestation. 

References:

Reference
Blumer I, Hadar E, Hadden DR, et al. Diabetes and pregnancy: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2013;98:4227-4249.