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GDM
#1
Definition
For many years, GDM was defined as any degree of glucose intolerance that was first recognized during pregnancy, regardless of whether the condition may have predated the pregnancy or persisted after the pregnancy. This definition facilitated a uniform strategy for detection and classification of GDM, but it was limited by imprecision. The ongoing epidemic of obesity and diabetes has led to more type 2 diabetes in women of childbearing age, with an increase in the number of pregnant women with undiagnosed type 2 diabetes, Because of the number of pregnant women with undiagnosed type 2 diabetes, it is reasonable to test women with risk factors for type 2 diabetes at their initial prenatal visit, using standard diagnostic criteria Women with diabetes in the first trimester would be classified as having type 2 diabetes. GDM is diabetes diagnosed in the second or third trimester of pregnancy that is not clearly either type 1 or type 2 diabetes “Management of Diabetes in Pregnancy”).
 
 
Diagnosis
 
GDM carries risks for the mother and neonate. Not all adverse outcomes are of equal clinical importance. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study (38), a large-scale (25,000 pregnant women) multinational cohort study, demonstrated that risk of adverse maternal, fetal, and neonatal outcomes
Continuously increased as a function of maternal glycaemia at 24–28 weeks, even within ranges previously considered normal for pregnancy. For most complications, there was no threshold for risk. These results have led to careful reconsideration of the diagnostic criteria for GDM. GDM diagnosis (Table 2.5) can be accomplished with either of two strategies:
 
1. “One-step” 75-g OGTT or
2. “Two-step” approach with a 50-g (no fasting) screen followed by a 100-g Different diagnostic criteria will identify different degrees of maternal hyperglycemia and maternal/fetal risk, leading some experts to debate, and disagree on, optimal strategies for the diagnosis of GDM.
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#2
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