In the absence of overt diabetes at the initial office visit, diabetes screening should occur between
the 24th and 28th weeks of gestation. Risk factors for gestational diabetes include age over 25
years, the patient who is overweight or obese at baseline, patients who have family histories of
type 2 diabetes, high risk racial or ethnic groups in the United States. This will include Hispanics
and Latino Americans, South or East Asians, and Pacific Islanders as well as native Americans.
The gestational diabetes is diagnosed when anyone of the following glucose values is exceeded,
an 8-hour fasting followed by 75 grams of glucose orally. If the result, fasting, is greater than
92 mg/dL, if the 1-hour glucose is greater than or equal to 118 mg/dL, or at 2 hours the glucose
level exceeds or is equal to 153 mg/dL. Complications related to gestational diabetes to be aware of
include miscarriage, fetal deformities, large for gestational age infants or macrosomia, and
pre-eclampsia. This is the occurrence of severe high blood pressure during pregnancy. Complications
during labor and delivery may also ensue and there may be increased perinatal complications and
mortality. Complication risk in gestational diabetes is proportional to the levels of hypoglycemia.
Screening patients for gestational diabetes particularly for women at higher risk should be screened
for diabetes at the 1st prenatal visit as early as possible. Once a diagnosis of gestational
diabetes is made, glucose monitoring should be performed at least 4 times daily. Fasting and 1-hour
and 2-hour postprandial values should be checked. Postprandial hypoglycemia in pregnancy may
predict worse fetal outcome and complications.