Thank you Mustafa. Very elaborate.

What I needed most is,how do you screen/ which criteria,for screening GDM, U use 75g 2 hour test, 75 g 3 hour test, A1c, 100 g 3 hour test or just go for bad obstetric history?

What timings you in practice select to screen?

Regards

Interesting. Following

Eagerly following.

Interesting question and answers.

this link is useful

www.uobabylon.edu.iq/publications/medicine.../medicine28_14.doc

regards

Dear Mostafa Madmoli

Some very nice additions to the discussions. I think you have a very clear idea on the subject.

Few questions:

1- Why to wait till 24-28 weeks once most of the fetal growth has already occurred to cause macrosmia?

2- Most of sub-contental and african ladies are anemic, and HbA1c will give higher results for HbA1c in that category, range wise diagnosing them to have GDM?

3- Isn't the 50 gram test obsolete or still being used in certain set ups?

4- Ladies vary in weight and a lady subjected to standard 75 gram glucose with a BMI of over 35 or 40 may be falsely termed as negative (False Negative) as this load of glucose will be too minimal for that lady.

I hope this is what i daily feel when doing these tests in my lab. So confused about these very criteria.

Regards

Following

I think Screening strategies for GDM or these kind of practices are very less in developing countries.

Routine screening for gestational diabetes

• Initial glucose challenge test. You'll drink a syrupy glucose solution. One hour later, you'll have a blood test to measure your blood sugar level. A blood sugar level below 130 to 140 milligrams per deciliter (mg/dL), or 7.2 to 7.8 millimoles per liter (mmol/L), is usually considered normal on a glucose challenge test, although this may vary by clinic or lab. If your blood sugar level is higher than normal, it only means you have a higher risk of gestational diabetes. You'll need a glucose tolerance test to determine if you have the condition.
• Follow-up glucose tolerance testing. You'll fast overnight, then have your blood sugar level measured. Then you'll drink another sweet solution — this one containing a higher concentration of glucose — and your blood sugar level will be checked every hour for three hours. If at least two of the blood sugar readings are higher than normal, you'll be diagnosed with gestational diabetes.

In Germany all pregnant women get a routine check for gestational diabetes according to pregnancy guidelines. They drink a 50 gr glucose solution and the venous blood sugar level is measured 1 hour later. This takes place between 24-28 weeks of pregnancy. If the measured blood glucose level is above 135 mg/dl there is more diagnostic to follow.

The discussion continues if this is really the best way for a general screening, not everyone agrees.

In Belgium , we have recommendations from KCE concerning low risk pregnancies

What are the recommended clinical assessment and screening tests during pregnancy?

KCE Reports 248 (2015)

You can read it on https://kce.fgov.be/en/what-are-the-recommended-clinical-assessment-and-screening-tests-during-pregnancy

We also have the GGOLFB protocol (2017) https://www.ggolfb.be/sites/default/files/article/file/04%20%20Diabe%CC%80te%20-%20protocole%20GGOLFB%20-%202017.pdf

which recommands a fasting blood glucose at the first prenatal consultation

with a level = 92 mg/dl

-> If blood glucose between 92 mg/l et 125 mg/dL :consider as gestational diabetes • If blood glucose ≥ 126 mg / dL : consider as pregestational diabetes • If blood glucose gestational diabetes if one value is abnormal

Dear @Françoise Mijcke

Thanks for such a comprehensive reply. IADPSG criteria is what we follow in routine.

1- But do you really really adjust glucose as patient's body weight?

2- Why we wait till20 weeks when most of the fetal growth patterns are already established?

Regards

Gestational diabetes, with no apparent risk factors can simply be diagnosed through blood sugar fasting, blood HbA1C, or blood sugar random, if deranged can give reason to further investigation to finally label as GDM. As you have rightly mentioned, that why wait till 20th weeks of gestation, we can make routine blood and urine tests for glucose screeing , the early antenatal visits plan; before it affects fetus and mother adversly. Guidelines are there for diagnosing GDM, but according to our context and the areas where antenal facilities are less robust, simple urine and blood HbA1C can be helpful.

In Ghana, all pregnant women go through routine laboatory investigation during their booking visit which in most cases may not include blood glucose. We do not do a routine check for GDM for all pregnant women. This implies that most women may be dignosed after they have presented with some signs and symptoms

Diagnosis is made through blood glucose test when clients present with signs and symptoms

Diagnosis is made through blood glucose test when clients present with signs and symptoms

What we usually do in Nigeria is that;after considering signs and symptoms such as family history of diabetes, obesity, history of giving birth to macrosomic baby impaired fasting glucose value,and other visible symptoms.We then asked the pregnant women to fast overnight -then blood sample is drawn along with urine.Those who have impaired fasting blood glucose, must undergo Oral Glucose Tolerance Test (OGTT). A glucose load of 50g is given to them to drink,and blood samples are taken within two hours period. Every thirty minutes,blood is collected. Also,urine sample is collected every one hour. A graph is then plotted -concentration against time. The pattern of the graph gives the clearer picture of the results,what to deduce and expect. Normally, blood glucose returns to fasting level after two-hour period. However, in abnormal situations, a different pattern is seen,suggestive of gestational diabetes or other glucose-related ailments. I hope this helps.

What we usually do in Nigeria is that;after considering signs and symptoms such as family history of diabetes, obesity, history of giving birth to macrosomic baby impaired fasting glucose value,and other visible symptoms.We then asked the pregnant women to fast overnight -then blood sample is drawn along with urine.Those who have impaired fasting blood glucose, must undergo Oral Glucose Tolerance Test (OGTT). A glucose load of 50g is given to them to drink,and blood samples are taken within two hours period. Every thirty minutes,blood is collected. Also,urine sample is collected every one hour. A graph is then plotted -concentration against time. The pattern of the graph gives the clearer picture of the results,what to deduce and expect. Normally, blood glucose returns to fasting level after two-hour period. However, in abnormal situations, a different pattern is seen,suggestive of gestational diabetes or other glucose-related ailments. I hope this helps.

We are following a single step 75 gm 2 hr PP sample as per dipsi guidelines .@

I agree with Nura Audu.

Dear Renuka

How do you feel about your results in comparison IADPSG criteria? I guess it is the one most recommended

regards

Please see SA guidelines for DM

Dear@Faz

Thanks for the guidelines

regards

Routine screening for gestational diabetes

As follow

1. Initial glucose challenge test. drink a syrupy glucose solution (usually 75 gm glucose). One hour later; the blood sugar level. would be measured, if it is below 130 to 140 mg/dL, this usually considered normal on a glucose challenge test, If blood sugar level is higher than normal, it only means a higher risk of gestational diabetes. There would be a need for a glucose tolerance test to confirm the condition.

2. Follow-up glucose tolerance testing.

Gestational diabetes - Diagnosis and treatment - Mayo Clinic

https://www.mayoclinic.org/diseases.../gestational-diabetes/diagnosis.../drc-20355345

The ADA recommends screening for congenital anomalies in women withgestational diabetes who present with evidence of preexisting hyperglycemia, such as an A1C level greater than 7 percent, a fasting glucose level greater than 120 mg per dL, or adiagnosis of gestational diabetes in the first trimester.

Very true M. A. A. Al- Fatlawi

Grateful for your contribution

This is what i got a summary from various criteria

@ Dr. Sikandar Hayat Khan

Please take a look at the following useful links.

Article Gestational diabetes mellitus 2018 guidelines: An update

http://www.apiindia.org/medicine_update_2013/chap44.pdf

Thanks!

Thank you Arvind Singh

Hello see link below and attached info.

Good luck.

https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/antenatal-care/who-recommendation-diagnosis-gestational-diabetes-pregnancy-0

The normal blood sugar levels in pregnant women who have not had diabetes during or before pregnancy are the following: The average fasting fasting blood glucose (GST) is 69-75 mg / dL. Average blood sugar ranges after one hour of eating a meal between 105-108 mg / dL

Gestational diabetes mellitus develops during pregnancy in women whose pancreatic function is insufficient to overcome the insulin resistance associated with the pregnant state. Among the main consequences are increased risks of preeclampsia, macrosomia, and cesarean delivery, and their associated morbidities.

Please take a look at the following links.

https://www.uptodate.com/contents/diabetes-mellitus-in-pregnancy-screening-and-diagnosis

Thank you all for your contribution

We use IADPSG criteria, where we collect samples in fasting, 1 hour and then 2 hours.

I sometimes feel we can skip the 1 hour reading, any comments???

regards