2014糖尿病指南: 妊娠糖尿病Diabetes in Pregnancy (Gestational Diabetes)

2014糖尿病指南: 妊娠糖尿病Diabetes in Pregnancy (Gestational Diabetes)

Preconception Care

Maintain A1C levels as close to <7.0% as possible before attempting conception

All women of childbearing potential
  - Provide preconception counseling starting at puberty

Evaluate and treat (if necessary) in women contemplating pregnancy
    • Retinopathy
    • Nephropathy
    • Neuropathy
    • CVD

Evaluate, consider risk/benefit profile of medications being used for diabetes and associated conditions prior to conception
   Contraindicated/not recommended in pregnancy
     • Statins
     • ACEIs
     • ARBs
     • Most noninsulin therapies

Gestational Diabetes

Pregnant women with risk factors
   - First prenatal visit: screen for undiagnosed type 2 diabetes using standard criteria

Pregnant women without known prior diabetes
   - Screen at 24-28 wks

Women with GDM
   - Screen for persistent diabetes 6-12 wks postpartum using OGTT and nonpregnancy diagnostic criteria

Women with GDM history and prediabetes
  - Lifestyle interventions or metformin for diabetes prevention

Glycemic targets
   • Preprandial: ≤95 mg/dL (5.3 mmol/L) and either
   • 1-h postmeal: ≤140 mg/dL (7.8 mmol/L) or
   • 2-h postmeal: ≤120 mg/dL (6.7 mmol/L)

Gestational Diabetes Screening and Diagnosis

No uniform approach for GDM diagnosis, Two options for women not previously diagnosed with overt diabetes:

“One-Step” (IADPSG)
  • 75-g OGTT with PG measurement fasting and at 1 h and 2 h, at 24-28 wks
  • Perform OGTT in am after overnight fast (≥8 h)
  • GDM diagnosis made if PG values in excess of
     o Fasting: ≥92 mg/dL (5.1 mmol/L)
     o 1 h: ≥180 mg/dL (10.0 mmol/L)
     o 2 h: ≥153 mg/dL (8.5 mmol/L)

“Two-Step” (NIH)
  • 50-g GLT (nonfasting) with PG measurement at 1 h (Step 1), at 24-28 wks
  • If PG at 1 h after load is ≥140 mg/dL*
(10.0 mmol/L), proceed to 100-g OGTT (Step 2), performed while patient is fasting
  • GDM diagnosis made when PG measured 3 h post-test is ≥140 mg/dL (7.8 mmol/L)

*Threshold of 135 mg/dL in high-risk ethnic minorities with higher prevalence of GDM recommended by ACOG

ACEI=angiotensin-converting enzyme inhibitor; ACOG=American College of Obstetricians and Gynecologists; ARB=angiotensin receptor blocker; CVD=cardiovascular disease; GDM=gestational diabetes mellitus; GLT=glucose load test; IADPSG=International Association of Diabetes and
Pregnancy Study Groups; NIH=National Institutes of Health; OGTT=oral glucose tolerance test; PG=plasma glucose