Diagnosis and Classification of
Hyperglycemia in Pregnancy
Home > Reference > ADA Diagnosis of Hyperglycemia in Pregnancy
American Diabetes Association (ADA) Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy 
The International Association of Diabetes and Pregnancy Study Groups (IADPSG) new recommendations include a two phase strategy for diagnosis and classification of hyperglycemia in pregnancy that consists of early screening for overt diabetes, and implementation of a 75 -gram glucose oral glucose tolerance test OGTT for the diagnosis of gestational diabetes (GDM).
The first phase of the strategy was arrived at by consensus opinion and is intended to identify women with overt diabetes at their first prenatal visit by early testing in populations with a high prevalence of type 2 diabetes. It was not deemed feasible to recommend a single test to use exclusively. Although, many members of the consensus panel favored using A1C for the detection of overt diabetes in pregnancy, the prevalence of hemoglobin variants in some populations as well as cost and standardization issues were apparently concerns with A1C testing.
The second phase of the strategy involves performance of a 2-h 75-g OGTT at 24 to 28 weeks' on all women not previously found to have overt diabetes or GDM during testing earlier in their current pregnancy. The threshold values on the 2-h 75-g OGTT for the diagnosis of GDM were arrived at after review and consideration of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study data. These threshold values are glucose values at which there is an increased odds for birth weight, cord C-peptide, and percent body fat to be greater than 90th percentile. The panel concluded that there have been insufficient studies performed to know whether there is a benefit of generalized testing to diagnose and treat GDM before the usual window of 24–28 weeks’ gestation.
Two Phase Strategy:
I. First Prenatal Visit*
The Sweet Success Program of California recommends that individuals with an A1C of 5.7-6.4% (prediabetes-glucose intolerance) should be informed of their increased risk for diabetes , and should receive early diet education and exercise modifications similar to patients with GDM .
II. At 24 to 28 weeks'
Postpartum glucose testing should be performed for all women diagnosed with overt diabetes during pregnancy or GDM
1. Condensed from: International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010 Mar;33(3):676-82. PMID: 20190296
Guidelines for Diagnosis of Hyperglycemia in Pregnancy – 2011
Reprinted with permission of The American Diabetes Association.