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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Diabetes In Pregnancy Series
Sponsored by The Indian Health Service Clinical Support Center
PART 2: Management, delivery, and postpartum
15. A.C.O.G. Resources
What is the latest A.C.O.G. statement on this?
Gestational Diabetes. ACOG Practice Bulletin No. 30. American College of Obstetricians and Gynecologists. Obstet Gynecol 2001;98:525–538
Summary of Recommendations*
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- The laboratory screening test should consist of a 50-g, 1-hour oral glucose challenge at 24–28 weeks of gestation, which may be administered without regard to the time of the last meal.
- A screening test threshold of 140 mg/dL has 10% less sensitivity than a threshold of 130 mg/dL but fewer false-positive results; either threshold is acceptable.
- The screening test generally should be performed on venous plasma or serum samples using well-calibrated and well-maintained laboratory instruments.
- Available evidence does not support a recommendation for or against moderate caloric restriction in obese women with GDM. However, if caloric restriction is used, the diet should be restricted by no more than 33% of calories.
- For women with GDM and an estimated fetal weight of 4,500 g or more, cesarean delivery may be considered because it may reduce the likelihood of permanent brachial plexus injury in the infant.
When medical nutritional therapy has not resulted in fasting glucose levels less than 95 mg/dL or 1-hour postprandial values less than 130–140 mg/dL or 2-hour postprandial values less than 120 mg/dL, insulin should be considered. The following recommendations are based primarily on consensus and expert opinion (Level C):
Although universal glucose challenge screening for GDM is the most sensitive approach, there may be pregnant women at low risk who are less likely to benefit from testing. Such low-risk women should have all of the following characteristics:
- Age younger than 25 years
- Not a member of a racial or ethnic group with high prevalence of diabetes (eg, Hispanic, African, Native American, South or East Asian, or Pacific Islands ancestry)
- Body mass index of 25 or less
- No history of abnormal glucose tolerance
- No previous history of adverse pregnancy outcomes usually associated with GDM
- No known diabetes in first degree relative
There is insufficient evidence to determine the optimal antepartum testing regimen for women with GDM with relatively normal glucose levels on diet therapy and no other risk factors.
Either the plasma or serum glucose level established by Carpenter and Coustan or the plasma level designated by the National Diabetes Data Group conversions are appropriate to use in the diagnosis of GDM.
If you ARE an A.C.O.G. member, read the full text on-line.
- ACOG
Practice Bulletin No. 30, September 2001 – Gestational Diabetes
- Pregestational diabetes mellitus. ACOG Practice Bulletin No. 60
- ACOG
Practice Bulletin No. 40, November 2002 – Shoulder Dystocia
- ACOG
Practice Bulletin No. 10, November 1999 – Induction of labor
- ACOG
Practice Bulletin No. 17, June 2000 – Operative vaginal delivery
- ACOG
Practice Bulletin No. 22, November 2000 – Fetal macrosomia
* ACOG Evidence grading system
The MEDLINE database, the Cochrane Library, and ACOG's own internal resources and documents were used to conduct a literature search to locate relevant articles published between January 1985 and October 2000. The search was restricted to articles published in the English language. Priority was given to articles reporting results of original research, although review articles and commentaries also were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document.
Guidelines published by organizations or institutions such as the National Institutes of Health and the American College of Obstetricians and Gynecologists were reviewed, and additional studies were located by reviewing bibliographies of identified articles. When reliable research was not available, expert opinions from obstetrician–gynecologists were used. Studies were reviewed and evaluated for quality according to the method outlined by the U.S. Preventive Services Task Force:
- I Evidence: obtained from at least one properly designed randomized controlled trial.
- II -1 Evidence obtained from well-designed controlled trials without randomization.
- II -2 Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
- II -3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
- III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Based on the highest level of evidence found in the data, recommendations are provided and graded according to the following categories:
- Level A—Recommendations are based on good and consistent scientific evidence.
- Level B—Recommendations are based on limited or inconsistent scientific evidence.
- Level C—Recommendations are based primarily on consensus and expert opinion.
