Gestational Diabetes Mellitus Screening and Diagnosis
An ideal screening test for gestational diabetes should be capable of identifying not only women with the disease but also the women with a high risk of developing gestational diabetes mellitus (GDM). Screening and diagnosis are the main steps leading to
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Gestational Diabetes Mellitus Screening and Diagnosis U. Yasemin Sert
and A. Seval Ozgu-Erdinc
diagnosis methods of GDM accepted by different study groups will be discussed which will be followed by the evaluation of different glycemic thresholds. Then the advantages and disadvantages of used methods will be explained and the chapter will finish with an evaluation of the current international guidelines.
Abstract
An ideal screening test for gestational diabetes should be capable of identifying not only women with the disease but also the women with a high risk of developing gestational diabetes mellitus (GDM). Screening and diagnosis are the main steps leading to the way of management. There is a lack of consensus among healthcare professionals regarding the screening methods worldwide. Different study groups advocate a variety of screening methods with the support of evidence-based comprehensive data. Some of the organizations suggest screening for high risk or all pregnant women, while others prefer to offer definitive testing without screening. Glycemic thresholds are also not standardized to decide GDM among different guidelines. Prevalence rates of GDM vary between populations and with the choice of glucose thresholds for both screening and definitive tests. One-step or two-step methods have been used for GDM diagnosis. However, screening includes selecting patients with historical risk factors, 50 g 1-h glucose challenge test, fasting plasma glucose, random plasma glucose, and hemoglobin A1c with different cutoffs. In this chapter, screening and U. Y. Sert and A. S. Ozgu-Erdinc (*) Ministry of Health-Ankara City Hospital, Universiteler Mahallesi Bilkent Cad, Ankara, Turkey
Keywords
100-g Oral glucose tolerance test · 50-g glucose challenge test · 75-g Oral glucose tolerance test · Diagnosis · Fasting plasma glucose · Gestational diabetes mellitus · Hemoglobin A1c · Postprandial glucose · Random plasma glucose · Screening
1
Introduction
Diabetes mellitus is defined as a metabolic disease presented with the defect of the function of glucose metabolism (American Diabetes A 2013). Pregnancy is naturally associated with pancreatic β-cell hyperplasia, which results in higher fasting and postprandial insulin levels (Butte 2000). While during the first-trimester blood glucose levels decrease with increasing insulin, hormones such as cortisol and estrogen lead to insulin resistance, especially in the second and third trimesters (Carr and Gabbe 1998). In addition to the hormonal changes, placental
U. Y. Sert and A. S. Ozgu-Erdinc
tumor necrosis factor (TNF)-α, human placental lactogen (HPL), and growth hormone (GH) impair glucose metabolism due to pregnancy-associated insulin resistance (IR) (Barbour et al. 2007; Catalano et al. 1991). The problem can be characterized by the failure of insulin secretion, activity, or both, which results in a diabetogenic state in pregnancy (Mumtaz 2000). Ge
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