The Australasian Diabetes in Pregnancy Society Gestational diabetes mellitus — management guidelines Linda Hoffman, Chris Nolan, J Dennis Wilson, Jeremy JN Oats and David … Published in MJA 1998; 169: 93-97 Updated by ADIPS in December 2002 Updated guidelines endorsed by RANZ COG Council, February 2003 Synopsis• GDM is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy.• Universal screening is recommended. If selective screening is considered more appropriate …

Diagnosis The guidelines for diagnosing GDM in Australia are essentially unchanged from those recommended for use in Australasia in 1991.22 Although there are no uniform international criteria for the diagnosis of GDM, commonly used criteria are those of O’Sullivan and Mahan23 and the World Health Organization (WHO).24 One problem with the development of absolute diagnostic criteria is the lack of evidence that perinatal mortality is increased in pregnancies associated with mild degrees of hyperglycaemia. The commonly used diagnostic criteria were not formulated to assess the risk of adverse perinatal outcomes, although this was a factor taken into account in the diagnostic criteria at the Mercy Hospital for Women, Melbourne.4 The existence of different methods of performing glucose tolerance tests has also hindered the development of uniform diagnostic criteria for GDM. After consensus, ADIPS has endorsed the diagnostic criteria developed by the working party chaired by Dr F I R Martin in 1991, which are modified WHO criteria.22 In New Zealand, the 2 hour oral glucose tolerance test (OGTT) cut-off value for a positive diagnosis is a venous plasma glucose level of 9.0 mmol/L. This figure was chosen by a majority decision of specialists at the 1992 meeting of the New Zealand Society for the Study of Diabetes. They chose the higher figure to reduce the worry and inconvenience for women of being given a false positive diagnosis and to reduce the strain on stretched specialist resources in many centres. ADIPS recognises the importance of working towards an Australasian consensus on this issue. If the clinical suspicion of GDM is high, a diagnostic OGTT is indicated, irrespective of the stage of pregnancy. In such circumstances, if an OGTT gives normal results early in pregnancy the test should be repeated between 26 and 30 weeks’ gestation. A 75 g OGTT should use 75 g of anhydrous glucose or the equivalent, and preferably should also be performed after a high carbohydrate diet of at least 150 g of carbohydrate for three days. Management of GDM A team approach is ideal for managing women with GDM and, if available, should be used. The team would usually comprise an obstetrician, diabetes physician, a diabetes educator (diabetes midwifery educator), dietitian, midwife and paediatrician. In practice, however, the team Diagnosis The guidelines for diagnosing GDM in Australia are essentially unchanged from those recommended for use in Australasia in 1991.22 Although there are no uniform international criteria for the diagnosis of GDM, commonly used criteria are those of O’Sullivan and Mahan23 and the World Health Organization (WHO).24 One problem with the development of absolute diagnostic criteria is the lack of evidence that perinatal mortality is increased in pregnancies associated with mild degrees of hyperglycaemia. The commonly used diagnostic criteria were not formulated to assess the risk of adverse perinatal outcomes, although this was a factor taken into account in the diagnostic criteria at the Mercy Hospital for Women, Melbourne.4 The existence of different methods of performing glucose tolerance tests has also hindered the development of uniform diagnostic criteria for GDM. After consensus, ADIPS has endorsed the diagnostic criteria developed by the working party chaired by Dr F I R Martin in 1991, which are modified WHO criteria.22 In New Zealand, the 2 hour oral glucose tolerance test (OGTT) cut-off value for a positive diagnosis is a venous plasma glucose level of 9.0 mmol/L. This figure was chosen by a majority decision of specialists at the 1992 meeting of the New Zealand Society for the Study of Diabetes. They chose the higher figure to reduce the worry and inconvenience for women of being given a false positive diagnosis and to reduce the strain on stretched specialist resources in many centres. ADIPS recognises the importance of working towards an Australasian consensus on this issue. If the clinical suspicion of GDM is high, a diagnostic OGTT is indicated, irrespective of the stage of pregnancy. In such circumstances, if an OGTT gives normal results early in pregnancy the test should be repeated between 26 and 30 weeks’ gestation. A 75 g OGTT should use 75 g of anhydrous glucose or the equivalent, and preferably should also be performed after a high carbohydrate diet of at least 150 g of carbohydrate for three days. Management of GDM A team approach is ideal for managing women with GDM and, if available, should be used. The team would usually comprise an obstetrician, diabetes physician, a diabetes educator (diabetes midwifery educator), dietitian, midwife and paediatrician. In practice, however, the team…

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