• >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