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
...ion Assessment...
...nt of Food/Nutrition-Related History o...
...Assessment of Anthropometric Measurement of Women...
...t of Biochemical Data, Medical Tests, and P...
...of Nutrition-Focused Physical Findings and Cl...
Nutrition Intervention
Nutrition Interv...
...Medical Nutrition Therapy (MNT)The RD...
...equency and Duration of MNTThe RDN sh...
...PrescriptionFor women with GDM, the RDN...
...ient RequirementsIn women with GDM, the RDN shoul...
GDM: Carbohydrate PrescriptionThe RDN...
...M: Carbohydrate and Post Prandial Breakfast Glyc...
...y Vitamin and Mineral IntakeThe RDN should e...
...and Mineral SupplementationThe RDN should co...
...M: Meal and Snack DistributionIn wom...
...M: Use of High-Intensity SweetenersIn...
...ol IntakeThe RDN should reinforce abstin...
...ysical ActivityUnless contraindicated, the RDN sh...
Nutrition Monitoring and Evaluation
Nutrition Monitoring and Evaluation
...utrition Monitoring and EvaluationFollowing t...