Screening

Screening for GDM also identifies the woman at risk of having a macrosomic baby, the result of excessive glucose crossing the placenta. Non-low-risk pregnant women are routinely screened, usually before the mid-second trimester, with a 50-g glucose challenge test given under random conditions—not necessarily fasting. The "low-risk group" is defined as nonminority women younger than 25 years old with no suggestion of insulin resistance, that is, no prior history of glucose intolerance, obesity, hypertension, or family history of DM. A glucose value of 140 mg/dL after ingestion is positive and leads to a formal glucose tolerance test (GTT).

To prepare for GTT, the patient is asked to increase carbohydrate intake to about 300 g for 3 days. Although this is a diabetogenic stimulus, restricting carbohydrates can also downregulate the beta-cell response and result in a false-positive study. The fasting patient drinks 100 g of a glucose solution. Glucose values are determined fasting and at 1, 2, and 3 hours. Normal values are less than 95, 180, 155, and 140 mg/dL, respectively; two higher values make the diagnosis of GDM. However, GTT does not consider the woman's preconception weight. Small women, whose total daily carbohydrate intake may never exceed 250 g, may demonstrate positive results despite their fasting and postprandial glucose values during pregnancy (or later on their regular diet) remaining within normal range. The standard GTT using 75 g has now been standardized for pregnancy but is subject to the same criticism as the 100-g test.

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