Table 2.

Strategy for the detection and diagnosis of hyperglycemic disorders in pregnancy^*

First prenatal visit
Measure FPG, A1C, or random plasma glucose on all or only high-risk women†
If results indicate overt diabetes as per Table 1
Treatment and follow-up as for preexisting diabetes
If results not diagnostic of overt diabetes
and fasting plasma glucose ≥5.1 mmol/l (92 mg/dl) but <7.0 mmol/l (126 mg/dl), diagnose as GDM
and fasting plasma glucose <5.1 mmol/l (92 mg/dl), test for GDM from 24 to 28 weeks' gestation with a 75-g OGTT‡

24–28 weeks' gestation: diagnosis of GDM
2-h 75-g OGTT: perform after overnight fast on all women not previously found to have overt diabetes or GDM during testing earlier in this pregnancy
Overt diabetes if fasting plasma glucose ≥7.0 mmol/l (126 mg/dl)
GDM if one or more values equals or exceeds thresholds indicated in Table 1
Normal if all values on OGTT less than thresholds indicated in Table 1

*To be applied to women without known diabetes antedating pregnancy. Postpartum glucose testing should be performed for all women diagnosed with overt diabetes during pregnancy or GDM.

†Decision to perform blood testing for evaluation of glycemia on all pregnant women or only on women with characteristics indicating a high risk for diabetes is to be made on the basis of the background frequency of abnormal glucose metabolism in the population and on local circumstances.

‡The panel concluded that there have been insufficient studies performed to know whether there is a benefit of generalized testing to diagnose and treat GDM before the usual window of 24–28 weeks' gestation.