The ADA guidelines place considerable emphasis on diabetes screening for individuals who are planning to become pregnant or are in the early stages of pregnancy. Individuals in the preconception stage should be screened for diabetes if they have risk factors. Providers should also consider screening all individuals planning to become pregnant for undiagnosed diabetes before conception. Moreover, pregnant patients with risk factors should be screened prior to 15 weeks. In addition, all patients with undiagnosed diabetes should be screened at the first prenatal visit.
Special recommendations for gestational diabetes mellitus (GDM) include the following:
- Before 15 weeks of gestation, screen for abnormal glucose metabolism to identify patients who are at higher risk of adverse pregnancy and neonatal outcomes, are more likely to need insulin, and are at high risk of a later gestational diabetes mellitus diagnosis. Treatment may provide some benefit.
- Screen for early abnormal glucose metabolism using fasting glucose of 110–125 mg/dL (6.1 mmol/L) or A1C 5.9–6.4% (41–47 mmol/mol).
- Screen for gestational diabetes mellitus (GDM) at 24–28 weeks of gestation in pregnant patients not previously found to have diabetes or high-risk abnormal glucose metabolism detected earlier in the current pregnancy.
- Screen patients with GDM for prediabetes or diabetes at 4–12 weeks postpartum using the 75-g oral glucose tolerance test and clinically appropriate nonpregnancy diagnostic criteria.
- Patients with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years, and if found to have prediabetes, should receive intensive lifestyle interventions and/or metformin to prevent diabetes.
