Release Date: 2023-09-14

The Screening, Diagnosis, and Classification of Diabetes Mellitus in Pregnancy

Release Date: 2023-09-14

The screening, diagnosis, and classification of diabetes mellitus in pregnancy are critical to ensure optimal maternal and fetal health outcomes. Pregnant women are routinely screened for gestational diabetes mellitus (GDM) between 24-28 weeks of gestation using glucose challenge tests followed by diagnostic oral glucose tolerance tests (OGTT) if initial screening is positive. Pre-existing diabetes, including [...]

Media Type
  • PDF

Buy from

Price may vary by retailers

Work TypeBook Chapter
Published inCurrent Perspective on Diabetes Mellitus in Clinical Sciences
First Page249
Last Page257
DOIhttps://doi.org/10.69860/nobel.9786053359111.23
ISBN978-605-335-911-1 (PDF)
LanguageENG
Page Count9
Copyright HolderNobel Tıp Kitabevleri
Licensehttps://nobelpub.com/publish-with-us/copyright-and-licensing
The screening, diagnosis, and classification of diabetes mellitus in pregnancy are critical to ensure optimal maternal and fetal health outcomes. Pregnant women are routinely screened for gestational diabetes mellitus (GDM) between 24-28 weeks of gestation using glucose challenge tests followed by diagnostic oral glucose tolerance tests (OGTT) if initial screening is positive. Pre-existing diabetes, including type 1 or type 2 diabetes diagnosed before pregnancy, requires early identification and management to minimize risks such as congenital anomalies and macrosomia. Proper classification based on glucose levels helps guide appropriate management strategies, including diet modification, glucose monitoring, insulin therapy, and close prenatal care coordination between obstetricians, endocrinologists, and other healthcare providers. Regular monitoring throughout pregnancy and postpartum is crucial to mitigate complications and ensure the best possible outcomes for both mother and baby.
  • Amylidi S, Mosimann B, Stettler C, Fiedler GM, Surbek D, Raio L. First-trimester glycosylated hemoglobin in women at high risk for gestational diabetes. Acta Obstet Gynecol Scand 2016;95:93–7.

  • Sacks DA, Metzger BE. Classifi cation of diabetes in pregnancy: time to reassess the alphabet. Obstet Gynecol. 2013 Feb;121(2 Pt 1):345-8.

  • Classifi cation and diagnosis of diabetes. American Diabetes Association. Diabetes Care 2017;40:S11–24.

  • Albrecht SS, Kuklina EV, Bansil P, Jamieson DJ, Whiteman MK, Kourtis AP, Posner SF, Callaghan WM. Diabetes trends among delivery hospitalizations in the U.S., 1994-2004. Diabetes Care. 2010;33(4):768. Epub 2010 Jan 12.

  • Deputy NP, Kim SY, Conrey EJ, Bullard KM. Prevalence and Changes in Preexisting Diabetes and Gestational Diabetes Among Women Who Had a Live Birth - United States, 2012-2016. MMWR Morb Mortal Wkly Rep. 2018;67(43):1201. Epub 2018 Nov 2

  • Wahabi HA, Fayed A, Esmaeil S, et al. Systematic review and meta-analysis of the effectiveness of prepregnancy care for women with diabetes for improving maternal and perinatal outcomes. PLoS One 2020;15:e0237571

  • Feig DS, Hwee J, Shah BR, Booth GL, Bierman AS, Lipscombe LL. Trends in incidence of diabetes in pregnancy and serious perinatal outcomes: a large, population-based study in Ontario, Canada, 1996-2010. Diabetes Care 2014;37:1590–1596

  • Peng TY, Ehrlich SF, Crites Y, et al. Trends and racial and ethnic disparities in the prevalence of pregestational type 1 and type 2 diabetes in Northern California: 1996-2014. Am J Obstet Gynecol 2017;216:177. e1–177.e8

  • Jovanovi_c L, Liang Y,Weng W, Hamilton M, Chen L, Wintfeld N. Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy. Diabetes Metab Res Rev 2015;31:707–716

  • International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classifi cation of Hyperglycemia in Pregnancy. Diabetes Care 2010; DOI: 10.2337/dc09-1848

  • Kitzmiller JL, Wallerstein R, Correa A, Kwan S. Preconception care for women with diabetes and prevention of major congenital malformations. Birth Defects Res A Clin Mol Teratol 2010; 88:791.

  • Evers IM, de Valk HW, Visser GH. Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ 2004; 328:915.

  • Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: A large, population-based study. Diabetes Care 2009; 32:2005.

  • Wahabi HA, Fayed A, Esmaeil S, et al. Systematic review and meta-analysis of the effectiveness of prepregnancy care for women with diabetes for improving maternal and perinatal outcomes. PLoS One 2020; 15:e0237571.

  • American Diabetes Association. Diagnosis and classifi cation of diabetes mellitus (Position Statement). Diabetes Care 2009;32(Suppl. 1):S62–S67

  • Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus: the organizing committee. Diabetes Care 1998;21(Suppl. 2):B161– B167

  • Bouthoorn SH, Silva LM, Murray SE, Steegers EA, Jaddoe VW, Moll H, et al. Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study. Acta Diabetol 2015;52:445–52.

  • Jarrett RJ. Refl ections on gestational diabetes. Lancet 1981;28:1220–1221

  • Hunter DJS, Keirse MJNC. Gestational diabetes in effective care. In Pregnancy and Childbirth. Chalmers I, Enkin M, Kierse M, Eds. New York, Oxford University Press, 1989, p. 403–410

  • Spellacy WN, Miller S, Winegar A, Peterson PQ. Macrosomia: maternal characteristics and infant complications. Obstet Gynecol 1985;66:158–161

  • Jensen DM, Damm P, Sørensen B, Mølsted-Pedersen L, Westergaard JG, Klebe J, Beck-Nielsen H. Clinical impact of mild carbohydrate intolerance in pregnancy: a study of 2904 nondiabetic Danish women with risk factors for gestational diabetes. Am J Obstet Gynecol 2001;185:413– 419

  • Yang X, Hsu-Hage B, Zhang H, Zhang C, Zhang Y, Zhang C. Women with impaired glucose tolerance during pregnancy have signifi cantly poor pregnancy outcomes. Diabetes Care 2002;25:1619–1624

  • Vambergue A, Nuttens MC, Verier-Mine O, Dognin C, Cappoen JP, Fontaine P. Is mild gestational hyperglycaemia associated with maternal and neonatal complications? the Diagest Study. Diabet Med 2000;17:203–208

  • Coustan DR, Dyer AR, Metzger BE. Onestep or 2-step testing for gestational diabetes: which is better? Am J Obstet Gynecol 2021; 225:634–644

  • HAPO Study Cooperative Research Group. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Intl J Gynaecol Obstet 2002;78:69–77

  • HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA, Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991–2002

  • O’Sullivan JB, Mahan CM, Charles D, Dandrow RV. Screening criteria for high-risk gestational diabetic patients. Am J Obstet Gynecol 1973;116:895–900.

  • Moyer VA. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. U.S. Preventive Services Task Force.

  • Management of diabetes in pregnancy. American Diabetes Association. Diabetes Care 2017;40:S114–9.

  • Chamberlain JJ, Rhinehart AS, Shaefer CF Jr, Neuman A. Diagnosis and management of diabetes:synopsis of the 2016 American Diabetes Association Standards of Medical Care in Diabetes. Ann Intern Med 2016;164:542–52.

  • Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefi ts and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Offi ce of Medical Applications of Research. Ann Intern Med. 2013;159(2):123.

  • Sacks DA, Hadden DR, Maresh M, et al.; HAPO Study Cooperative Research Group. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care 2012;35:526–528

  • Brown FM, Wyckoff J. Application of onestep IADPSG versus two-step diagnostic criteria for gestational diabetes in the real world: impact on health services, clinical care, and outcomes. Curr Diab Rep 2017;17:85

  • Hillier TA, Pedula KL, Ogasawara KK, et al. A pragmatic, randomized clinical trial of gestational diabetes screening. N Engl J Med 2021;384:895–904

  • Cowie CC, Casagrande SS, Menke A, et al., Eds. Diabetes in America. 3rd ed. National Institute of Diabetes and Digestive and Kidney Diseases, 2018. Accessed 3 March 2022. Available from https://www.niddk. nih.gov/about-niddk/strategicplans- reports/diabetes-in-america-3rd-edition

  • Landon MB, Spong CY, Thom E, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl JMed 2009;361:1339–1348

  • Crowther CA, Hiller JE,Moss JR,McPhee AJ, Jeffries WS; Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352:2477–2486

  • Josefson JL, Scholtens DM, Kuang A, et al.;HAPO Follow-up Study Cooperative Research Group. Newborn adiposity and cord blood C-peptide as mediators of the maternal metabolic environment and childhood adiposity. Diabetes Care 2021;44:1194–1202

  • Tam WH, Ma RCW, Ozaki R, et al. In utero exposure to maternal hyperglycemia increases childhood cardiometabolic risk in offspring. Diabetes Care 2017;40:679–686

  • Landon MB, Rice MM, Varner MW, et al.;Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network. Mild gestational diabetes mellitus and long-termchild health. Diabetes Care 2015;38:445–452

  • Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classifi cation of hyperglycemia in pregnancy. International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Diabetes Care 2010;33:676–82.

  • Farrar D, Duley L, Medley N, Lawlor DA. Different strategies for diagnosing gestational diabetes to improve maternal and infant health. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD007122.

  • McIntyre HD. Discovery, Knowledge, and Action-Diabetes in Pregnancy Across the Translational Spectrum: The 2016 Norbert Freinkel Award Lecture. Diabetes Care 2018; 41:227.

  • Schaefer UM, Songster G, Xiang A, et al. Congenital malformations in offspring of women with hyperglycemia fi rst detected during pregnancy. Am J Obstet Gynecol 1997; 177:1165.

  • Omori Y, Jovanovic L. Proposal for the reconsideration of the defi nition of gestational diabetes. Diabetes Care 2005; 28:2592.

  • Sheffi eld JS, Butler-Koster EL, Casey BM, et al. Maternal diabetes mellitus and infant malformations. Obstet Gynecol 2002; 100:925.

  • McLaren RA Jr, Ruymann KR, Ramos GA, et al. Early screening for gestational diabetes mellitus: a metaanalysis of randomized controlled trials. Am J Obstet Gynecol MFM 2022; 4:100737.

  • Radder JK, van Roosmalen J. HbA1c in healthy, pregnant women. Neth J Med 2005; 63:256

  • Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009;373:1773–9. (Meta-analysis)

  • Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus [published erratum appears in Diabetes Care 2007;30:3154]. Diabetes Care 2007;30 Suppl 2:S251–60.

Share This Chapter!