Table 2.
Recommended risk factors by organization
| Agency | Nature of screening strategy |
|---|---|
| NICE16 (UK) | Offer OGTT only to women with at least one of the following: |
| • BMI ≥30 kg/m2 | |
| • Previous macrosomic baby (>4.5 kg) | |
| • Previous GDM | |
| • Family history of diabetes | |
| • Family minority ethnic origin with a high prevalence of diabetes | |
| ADA15 | Testing at first antenatal visit should be undertaken to identify undiagnosed type 2 diabetes (universal OGTT testing is recommended at 24–28 weeks) in all pregnant women who are overweight (BMI ≥25 kg/m2) and have additional risk factors: |
| • Physical inactivity | |
| • First-degree relative with diabetes | |
| • High-risk race/ethnicity (eg, African-American, Latino, Native American, Asian-American, and Pacific Islander) | |
| • Women who delivered a baby weighing >4 kg or were diagnosed with GDM | |
| • Hypertension (≥140/90 mmHg or on therapy for hypertension) | |
| • HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L) | |
| • Women with polycystic ovarian syndrome | |
| • A1C ≥5.7%, IGT, or IFG on previous testing | |
| • Other clinical conditions associated with insulin resistance (eg, severe obesity and acanthosis nigricans) | |
| • History of CVD | |
| ADIPS (Nankervis et al12) | Women who are from a high-risk ethnic background or have a BMI of 25–35 kg/m2 as their only risk factor should be considered “moderate risk” and should initially be screened with either a random or a fasting glucose test in early pregnancy, followed by an OGTT if clinically indicated. ADIPS suggests that the thresholds for further action are not clear currently and clinical judgment should be exercised. |
| Women at “high risk” of GDM (one high-risk factor or two moderate-risk factors) should be offered a 75 g OGTT, with venous plasma samples taken: fasting, 1 hour and 2 hours at the first opportunity after conception. Women at moderate or high risk with normal glucose should be offered an OGTT at 24–28 weeks: | |
| • Moderate-risk factors for GDM | |
| • Ethnicity: Asian, Indian subcontinent, Aboriginal, Torres Strait Islander, Pacific Islander, Maori, Middle Eastern, and non-white African | |
| • BMI: 25–35 kg/m2 | |
| • High-risk factors for GDM | |
| • Previous GDM | |
| • Previously elevated blood glucose level | |
| • Maternal age ≥40 years | |
| • Family history of DM (first-degree relative with diabetes or a sister with GDM) | |
| • BMI >35 kg/m2 | |
| • Previous macrosomia (BW >4,500 g or >90th percentile) | |
| • Polycystic ovarian syndrome | |
| • Medications: corticosteroids, antipsychotics |
Abbreviations: ADA, American Diabetes Association; ADIPS, Australasian Diabetes in Pregnancy Society; AIC, glycated hemoglobin; BMI, body mass index; BW, birth weight; CVD, cardiovascular disease; DM, diabetes mellitus; GDM, gestational diabetes mellitus; HDL, high-density lipoprotein; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; OGTT, oral glucose tolerance test; WHO, World Health Organization.