POSITION STATEMENT ABCD position statement on screening for gestational diabetes mellitus S Robinson*, A Dornhorst, on behalf of the Association of British Clinical Diabetologists (ABCD) Introduction Gestational diabetes mellitus (GDM) ABSTRACT
Gestational diabetes mellitus is an increasingly common medical problem seen inpregnancy. A randomised clinical trial, published in 2005, showed improved perinatal
morbidity and mortality in pregnancies of women with actively managed gestational
diabetes. Prior to 2003 the evidence base for screening and treating all women with
gestational diabetes was not strong enough for the National Institute for Clinical
Excellence (NICE), in its 2003 antenatal guidelines, to recommend universal screening for
gestational diabetes. As we await the review of these original 2003 NICE guidelines we
offer a pragmatic approach for the detection of glucose intolerance in pregnancy.
Copyright 2007 John Wiley & Sons. Practical Diabetes Int 2007; 24(4): 192–195
are strictly classified as GDM,although clinically are best consid-
KEY WORDS gestational diabetes; screening; macrosomia; guidelines
therefore it should not be offered’.
fetal insulin secretion extending undiagnosed pre-gestational dia-
Screening for diabetes in pregnancy Stephen Robinson, MD, FRCP, Consultant
Medicine at St Mary’s Hospital, Paddington,
Received: 15 January 2007 Anne Dornhorst, DM, FRCP, FRCPath, *Correspondence to: Stephen Robinson, Accepted: 16 January 2007 Pract Diab Int May 2007 Vol. 24 No. 4Copyright 2007 John Wiley & SonsPOSITION STATEMENT ABCD position statement on screening for gestational diabetes mellitus Table 1. Identifying glucose intolerance within the antenatal clinic:
is at high risk of diabetes in preg-nancy could be based on a GDM
Assess background prevalence of GDM and type 2 diabetes:
prevalence of >2% when universallyscreened. (Table 1.)
within this age group. Ideally, T2DMshould be identified prior to preg-
Consider screening using known risk factors**
started and glycaemic targetsreached before any pregnancy.
* If random booking glucose is >7mmol/L test for GDM at time of booking and, if
** Known risk factors: age >30 yrs, BMI >30kg/m2, family history of diabetes or
previous GDM, non-white ethnic group, poor obstetric history.
prevalence of T2DM. Again, a prag-matic approach to deciding if an
or fed state. A positive test result is a
Screening for GDM Diagnosis of GDM
a diagnostic test if positive (i.e. a two-
effective and easier to provide, giventhe screening test is performed non-
Table 2. Identifying glucose intolerance within the antenatal clinic:
a pragmatic approach. Part 2: screening/diagnostic tests
natal populations (i.e. when >20% ofscreening tests are positive) going
Deciding on either a two-stage (screening and diagnostic) test for GDM or a one-stage diagnostic test for GDM at 28 weeks:
easier to administer than organisingmultiple recalls for a second test.
Followed by 75g OGTT on all positive results
Consider diagnostic 75g OGTT at 28 weeks
measurement of plasma or serumglucose one hour following a 50g
* A positive GCT when 1-hr glucose is >7.8mmol/L.
** A positive 75g OGTT when fasting glucose is >6.0mmol/L or 2-hr glucose is >7.8mmol/L. Pract Diab Int May 2007 Vol. 24 No. 4Copyright 2007 John Wiley & SonsPOSITION STATEMENT ABCD position statement on screening for gestational diabetes mellitus
for women with pre-gestational formin with insulin in women with
glucose persistently >8mmol/L Australia and the results of this trialsuggest insulin should be consid-
Management of GDM
required, or routine antenatal care.
The rate of serious perinatal mortal-ity and morbidity defined as death,
shoulder dystocia, bone fracture, andnerve palsy was reduced in the inter-
• Both gestational diabetes mellitus and pre-existing type 1 or type 2
diabetes mellitus (T1DM/T2DM) are common and a cause of morbidity and
• There is a now an evidence base for treatment of diabetes in pregnancy,
• There is less consensual evidence for the screening and diagnostic tests for
GDM; a pragmatic approach is therefore suggested
• The prevalence for T2DM and risk factors for GDM, including ethnicity,
should be taken into consideration when deciding which screening system
for GDM is best suited for any individual antenatal unit
Pract Diab Int May 2007 Vol. 24 No. 4Copyright 2007 John Wiley & SonsPOSITION STATEMENT ABCD position statement on screening for gestational diabetes mellitus References
comes. N Engl J Med 2005; 352:
Surveillance. Definition, diagnosis andclassification of diabetes mellitus and its
Group. The Hyperglycaemia andAdverse Pregnancy Outcome
complications. Report of a WHO consul-tation. Part 1: diagnosis and classifica-
(HAPO) Study. Int J Gynaecol Obstettion of diabetes mellitus. Geneva: World
2002; 78: 69–77. et al. The effects of carbohydrate
1982; 248(8): 949–952.
trolled gestational diabetes. ObstetConclusion Gynecol 1998; 91: 600–604.
JS, et al. High prevalence of gesta-
MA, et al. Postprandial versus
minority groups. Diabetic Med 1992;
preprandial blood glucose monitor-ing in women with gestational dia-
an increased perinatal mortality rate. 9(9): 820–825.
apy. N Engl J Med 1995; 333:
diabetic mothers. Acta Endocrinologica
1954; 15: 33–52.
14. Masson EA, Patmore JE, Brash PD, et
5. Maresh M, Beard RW, Bray CS, et al. al. Pregnancy outcome in type I dia-
of gestational diabetes. Obstet Gynecol
1989; 74(3 Pt 1): 342–346.
2003; 20: 46–50.
6. NICE recommendations. Antenatal
15. Langer O, Conway DL, Berkus MD, etcare for the healthy pregnant woman. al. A comparison of glyburide andinsulin in women with gestational
diabetes mellitus. N Engl J Med 2000;
7. Marquette GP, Klein VR, Niebyl JR. 343: 1134–1138.
diabetes. Am J Perinatology 1985; 2:
2006; 23: 144(7): 768–773.
Fowler SE, et al; Diabetes Prevention
tus. Diabetes Care 2004; 27(Suppl 1): Conflict of interest statement
10. Crowther CA, Hilier J, Moss J, et al.
formin. N Engl J Med 2002; 346: Pract Diab Int May 2007 Vol. 24 No. 4Copyright 2007 John Wiley & Sons
After reading this article, you should be able to:define the terms prematurity, extreme prematurity andlist the well-known complications of premature infantsexplain the basic principles of anaesthetizing aRDS may be complicated by air leak (pneumothorax, pneu-Mean survival rates for babies born at 24 weeks and 27 weeks aremomediastinum, pulmonary interstitial emphysema) and lead tocurrently
MATERIAL SAFETY DATA SHEET ISOPROPANOL (ISOPROPYL ALCOHOL) 60 - 100 % 1. CHEMICAL PRODUCT AND COMPANY IDENTIFICATION EMERGENCY TELEPHONE NUMBERS (FOR EMERGENCIES INVOLVING CHEMICAL SPILLS OR RELEASE)Toronto, ON (416) 226-6117 Montreal, QC (514) 861-1211 Winnipeg, MB (204) 943-8827Edmonton, AB (780) 424-1754 Calgary, AB (403) 263-8660 Vancouver, BC (604) 685-5036Isopropanol (Isop