San Gabriel Valley Perinatal Medical Group
  Specialists in High Risk Pregnancy
  Gestational Diabetic Screening and Management of an
  Abnormal 1 hour GTT

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Screen all high risk patients at first prenatal visit (screen with 1 hour 50 gm Glucola)

HIGH RISK PATIENTS:

  • >120% of IBW
  • Prior histroy of diabetes
  • Family history DM
  • Previous infant with macrosomia
  • History of prior stillbirth
  • History of  > 3 SABs
  • History of recurrent yeast vaginitis
  • History of recurrent UTIs
  • High risk ethnic group

Repeat screen on all patients (unless already diagnosed) between 24-28 weeks.

If screen > 140 proceed to 3 hour GTT

Diagnose GDM (gestional diabetes mellitus) if 2 or more values in 3 hour GTT are elevated:

  • Fasting blood sugar(FBS)  > 95
  • 1 hour > 180
  • 2 hour > 155
  • 3 hour > 140

If FBS < 95 on the 3 hour GTT there are 2 or 3 ther abnormal lab values manage as follows:

  • Refer to Sweet Success for education
  • Sweet Success diet
  • Exercise after meals
  • Ultrasound at 38 weeks to rule out macrosomia
  • Refer to perinatologist if the FBS > 95 or 1 hour postprandial blood sugars are persistently > 130 despite diet and exercise regimen.
  • Ultrasound at 38 weeks to evaluate for possible macrosomia.
  • Induction after 38 weeks if the cervix is favorable.
  • Begin twice weekly antenatal testing at 40 weeks (unless otherwise clinically indicated)
  • Deliver by 41 weeks

If FBS > 95 on the 3 hour GTT

  • Refer to perinatologist for ultrasound evaluation and consultation to determine need for insulin treatment.
  • Refer to Sweet Success for education
  • Sweet Success diet
  • Exercise after meals
  • Fetal echocardiogram if FBS > 120 or diagnosed during first trimester
  • Begin twice weekly antenatal testing at 34 weeks (unless otherwise clinically indicated)
  • Ultrasound at 38 weeks to evaluate for possible macrosomia.
  • Induction at 38 weeks  if the cervix is favorable.
  • Delivery by 40 weeks
Created: 3/18/2003 M Hellen Rodriguez, M.D
Updated: 3/18/2004 M Hellen Rodriguez, M.D

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