Who Should be Screened

Prior to the Fourth International Workshop on Gestational Diabetes, universal screening for GDM was recommended (32). The recommendations of the 5th International Workshop on Gestational Diabetes will be soon forthcoming. However, the Workshop and subsequent ADA recommendations advise screening only those women at high risk for GDM (33). The risk factors associated with GDM include:

■ Elevated pre-pregnancy weight (greater than 110% IBW)

■ Family history of diabetes, especially in a first degree relative

■ History of macrosomia in prior pregnancy

■ History of abnormal glucose tolerance

■ History of poor obstetric outcome, or

■ Member of minority populations at increased risk for type 2 diabetes

The ADA position statement suggests that it is not cost-effective to screen women at low risk, and recommends screening only be done in the presence of one or more risk factors (34,35). This change in recommendation has been challenged, however, as universal screening appears to improve detection of as many as 10% of all cases of GDM (36).

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