Gestacional Diabetes Screening, Diagnosis and Reclassification Screening Bibliography: Introduction: Conclusions: The screening, diagnosis and reclassification tests of GD are validated and easy to interpret when performed correctly and in the correct timing of pregnancy. The systematization of procedures is essential for a correct approach. Gestational Diabetes (GD) is defined as any degree of impaired glucose tolerance first detected during pregnancy. In Portugal, Diabetes Mellitus (DM) complicates 4% of pregnancies. Of these, 90% are GD. A correct diagnosis and treatment can prevent many maternal and fetal complications. Diagnosis 1) Blayo A, Mandelbrot L. Screening and diagnosis of gestational diabetes. Diabetes Metab Dec;30(6): ) Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest Mar;115(3): ) Diagnosis and Classification of Diabetes Mellitus. American Diabetes Association. Diabetes Care. Volume 31, Supplement 1, January ) Forsbach-Sánchez G, Tamez-Peréz HE, Vazquez-Lara J. Diabetes and pregnancy. Arch Med Res May- Jun;36(3): ) Maresh M. Screening for gestational diabetes mellitus. Semin Fetal Neonatal Med Aug;10(4): ) Phillips PJ, Jeffries B. Gestational diabetes-worth finding and actively treating. Aust Fam Physician Sep;35(9): ) Recomendações 2006 do Grupo de estudo da Diabetes da APMCG na diabetes tipo 2 para a Prática Clínica Diária em Cuidados de Saúde Primários. 7) Diabetes e Gravidez. Circular Normativa DGS nº8, 4/11/98 Reclassification Reclassification Test Two blood samples: After 8 to 14 h fasting 2 h after ingestion of 75 grams of glucose in 300 cc of water GD Reclassification Test NormalIFGIGTDM Fasting< 100 mg/dL100 – 125 mg/dL< 126 mg/dL≥ 126 mg/dL After 2 hours< 140 mg/dL 140 – 199 mg/dL≥ 200 mg/dL OGTT TimingGlycaemia Fasting≥ 95 mg/dl 1 hour≥ 180 mg/dl 2 hours≥ 155 mg/dl 3 hours≥ 140 mg/dl Low risk ● Age < 25 years ● BMI< 25 kg/m 2 ●N o history of DM in fist degree relatives ● No personal history of DM, IFG or IGT ● No repeated UTI or glycosuria ● No prior poor obstetric outcomes (All criteria) OGTT Four blood samples: After 8 to 14 h fasting 1, 2 and 3 hours after ingestion of 100 grams of glucose in 400 cc of water Previous 3 days without food or physical exercise restriction Remain seated until last blood sample O’ Sullivan Test One blood sample 1 hour after ingestion of 50 grams of glucose in 200 cc of water Fasting is not required Screening Test positivity Fasting glycaemia≥ 126 mg/dl O’Sullivan Test≥ 140 mg/dl GD Diagnosis Fasting venous glycaemia ≥ 126 mg/dL, in 2 occasions Ocasional venous glycaemia ≥ 200 mg/dl, in 2 occasions Positive OGTT High risk ● Age ≥ 35 years ● BMI ≥ 30 kg/m 2 ●H istory of DM in first degree relatives ●P ersonal history of DM, IFG or IGT ● Repeated UTI ● Glycosuria ●Prior macrossomic infant ●Congenital malformations ●Multiparity ≥ 4 ● Spontaneous abortions ≥ 2 ● Unexplained stillbirth (One or more criteria) Risk assessment in first consultation Average risk Without high or low risk criteria Abbreviation Index: IFG – Impaired fasting glucose IGT – Impaired glucose tolerance GD – Gestacional Diabetes DM – Diabetes Mellitus BMI – Body Mass Index UTI – Urinay tract infection OGTT – Oral Glucose Tolerance Test Objectives: Describe laboratory tests indicated in the screening, diagnosis and reclassification of GD; Create flowcharts that allow for proper consultation. O’Sullivan Test at 1st consultation, and e 32 weeks Positive if ≥ 2 altered values Guide to DM consultation Pre-diabetic states Intensify surveillance and preventive measures Encourage healthy lifestyles Test indicated in all women with GD, 6-8 weeks after delivery OGTT Immediate OGTT Positive Negative Referenciation Repeat OGTT in next steps Fasting glucose at 1st consultation and O’Sullivan Test at and 32 weeks Pedro Bairrada 1, Anabela Andrade 1, Esther Rodriguez 1, Rita Gomes 1, Rui Macedo 1, Rui Pinheiro 1 1 Centro de Saúde de São Martinho do Bispo Contact – Fasting glucose at 1st consultation and 32 weeks; O’Sullivan Test at weeks Methodology: Search articles published between in Pubmed / Medline, with the term “Gestational Diabetes”. Search guidelines of national and foreign organizations.