Ps robinson 10.07.qxp

POSITION STATEMENT
ABCD position statement on screening for
gestational diabetes mellitus
S Robinson*, A Dornhorst, on behalf of the Association of British Clinical Diabetologists (ABCD)
Introduction
Gestational diabetes mellitus (GDM)
ABSTRACT
Gestational diabetes mellitus is an increasingly common medical problem seen inpregnancy. A randomised clinical trial, published in 2005, showed improved perinatal morbidity and mortality in pregnancies of women with actively managed gestational diabetes. Prior to 2003 the evidence base for screening and treating all women with gestational diabetes was not strong enough for the National Institute for Clinical Excellence (NICE), in its 2003 antenatal guidelines, to recommend universal screening for gestational diabetes. As we await the review of these original 2003 NICE guidelines we offer a pragmatic approach for the detection of glucose intolerance in pregnancy.
Copyright 2007 John Wiley & Sons.
Practical Diabetes Int 2007; 24(4): 192–195 are strictly classified as GDM,although clinically are best consid- KEY WORDS
gestational diabetes; screening; macrosomia; guidelines
therefore it should not be offered’.
fetal insulin secretion extending undiagnosed pre-gestational dia- Screening for diabetes
in pregnancy
Stephen Robinson, MD, FRCP, Consultant
Medicine at St Mary’s Hospital, Paddington, Received: 15 January 2007
Anne Dornhorst, DM, FRCP, FRCPath,
*Correspondence to: Stephen Robinson,
Accepted: 16 January 2007
Pract Diab Int May 2007 Vol. 24 No. 4 Copyright 2007 John Wiley & Sons POSITION STATEMENT
ABCD position statement on screening for gestational diabetes mellitus
Table 1. Identifying glucose intolerance within the antenatal clinic:
is at high risk of diabetes in preg-nancy could be based on a GDM Assess background prevalence of GDM and type 2 diabetes:
prevalence of >2% when universallyscreened. (Table 1.) within this age group. Ideally, T2DMshould be identified prior to preg- Consider screening using known risk factors** started and glycaemic targetsreached before any pregnancy. * If random booking glucose is >7mmol/L test for GDM at time of booking and, if ** Known risk factors: age >30 yrs, BMI >30kg/m2, family history of diabetes or previous GDM, non-white ethnic group, poor obstetric history.
prevalence of T2DM. Again, a prag-matic approach to deciding if an or fed state. A positive test result is a Screening for GDM
Diagnosis of GDM
a diagnostic test if positive (i.e. a two- effective and easier to provide, giventhe screening test is performed non- Table 2. Identifying glucose intolerance within the antenatal clinic:
a pragmatic approach. Part 2: screening/diagnostic tests natal populations (i.e. when >20% ofscreening tests are positive) going Deciding on either a two-stage (screening and diagnostic)
test for GDM or a one-stage diagnostic test for GDM at
28 weeks:
easier to administer than organisingmultiple recalls for a second test.
Followed by 75g OGTT on all positive results Consider diagnostic 75g OGTT at 28 weeks measurement of plasma or serumglucose one hour following a 50g * A positive GCT when 1-hr glucose is >7.8mmol/L. ** A positive 75g OGTT when fasting glucose is >6.0mmol/L or 2-hr glucose is >7.8mmol/L.
Pract Diab Int May 2007 Vol. 24 No. 4 Copyright 2007 John Wiley & Sons POSITION STATEMENT
ABCD position statement on screening for gestational diabetes mellitus
for women with pre-gestational formin with insulin in women with glucose persistently >8mmol/L Australia and the results of this trialsuggest insulin should be consid- Management of GDM
required, or routine antenatal care.
The rate of serious perinatal mortal-ity and morbidity defined as death, Key points
shoulder dystocia, bone fracture, andnerve palsy was reduced in the inter- • Both gestational diabetes mellitus and pre-existing type 1 or type 2 diabetes mellitus (T1DM/T2DM) are common and a cause of morbidity and • There is a now an evidence base for treatment of diabetes in pregnancy, • There is less consensual evidence for the screening and diagnostic tests for GDM; a pragmatic approach is therefore suggested • The prevalence for T2DM and risk factors for GDM, including ethnicity, should be taken into consideration when deciding which screening system for GDM is best suited for any individual antenatal unit Pract Diab Int May 2007 Vol. 24 No. 4 Copyright 2007 John Wiley & Sons POSITION STATEMENT
ABCD position statement on screening for gestational diabetes mellitus
References
comes. N Engl J Med 2005; 352:
Surveillance. Definition, diagnosis and classification of diabetes mellitus and its Group. The Hyperglycaemia andAdverse Pregnancy Outcome complications. Report of a WHO consul-tation. Part 1: diagnosis and classifica- (HAPO) Study. Int J Gynaecol Obstet tion of diabetes mellitus. Geneva: World 2002; 78: 69–77.
et al. The effects of carbohydrate 1982; 248(8): 949–952.
trolled gestational diabetes. Obstet Conclusion
Gynecol 1998; 91: 600–604.
JS, et al. High prevalence of gesta- MA, et al. Postprandial versus minority groups. Diabetic Med 1992; preprandial blood glucose monitor-ing in women with gestational dia- an increased perinatal mortality rate.
9(9): 820–825.
apy. N Engl J Med 1995; 333:
diabetic mothers. Acta Endocrinologica 1954; 15: 33–52.
14. Masson EA, Patmore JE, Brash PD, et 5. Maresh M, Beard RW, Bray CS, et al.
al. Pregnancy outcome in type I dia- of gestational diabetes. Obstet Gynecol 1989; 74(3 Pt 1): 342–346.
2003; 20: 46–50.
6. NICE recommendations. Antenatal 15. Langer O, Conway DL, Berkus MD, et care for the healthy pregnant woman.
al. A comparison of glyburide andinsulin in women with gestational http://www.rcog.org.uk/resources/Public/Antenatal_Care.pdf diabetes mellitus. N Engl J Med 2000; 7. Marquette GP, Klein VR, Niebyl JR.
343: 1134–1138.
diabetes. Am J Perinatology 1985; 2:
2006; 23:
144(7): 768–773.
Fowler SE, et al; Diabetes Prevention tus. Diabetes Care 2004; 27(Suppl 1):
Conflict of interest statement
10. Crowther CA, Hilier J, Moss J, et al.
formin. N Engl J Med 2002; 346:
Pract Diab Int May 2007 Vol. 24 No. 4 Copyright 2007 John Wiley & Sons

Source: http://diabetologists-abcd.org.uk/Shared_Documents/position_papers/Position_Paper_on_GDM.pdf