Diabetes mellitus in Pregancy: The history speaks & dilemma which tets to folow?

Part 1: hstory:p--How should we diagnose  Diabetes in Pregnancy: History : family history of GDM , premature cardiac events leading to sudden deaths. / premature  renal failure(cod)
Diagnosis of diabetes in pregnancy starts with identifying high risk factors in the history (such as family h/o diabetes, previous pregnancy 1) diagnosed GDM, 2) birth of large baby,3)  IUFD of a large baby with no other cause ,4)  shoulder Dystocia,5)  previous anomalous baby, 6) recurrent UTI 7 ) and in the examination findings (such as obesity, acanthosis nigricans, acrocordons, abnormal waist -hip ratio and so on). Taken all points together one can roughly estimate the possibility of developing GDM .

History elicited in prepreg counselling  period or at first visit but then what ??  Why history is so important?? This alerts us!!! Does not matter whether relatives get annoyed with repeated blood tests!!  In women who exhibit some of the high risk factors cited have high risk factors in history and examination.  In India at least, we should be more vigilant & frequently monitor her for the possible onset of deterioration of glucose control at many phases of pregnancy. We the care givers should be alert to diagnose GDM earliest with FBS/Post meal B S / better still OGTT/DIPSI tests till 36 weeks of gestation- when HPL levels eventually plateau (HPL is one important factor that makes pregnancy diabetogenic).

  part II :Lab tests:-Dilemma start about which method to adopt in  Lab diagnosis of GDM FBS/50Gm/75 Gm ? Empty stomach/ unrelated to food ?? :-Cut off value varies. No uniformity across the states .Some still stress on FBS(vide infra),  whereas others relies more on PPBS:-GCT (after glucose load) . No uniformity on the lab diag modalities!! Everyone is claiming superiority about early detection of any deterioration of carbohydrate metabolism!!! One of the 6 methods that are in vague for screening is as follows: --method is described below but admittedly this method is not superb or best one than the existing other 5 methods!! As mentioned time and again screening tets and timing varies from center to center!!! No nationwide uniformity!!!

.Part III(Which Lab tests)  What is done at booking visits? One method is as follows  ? -  Membes may differ but I know of centers where it is a common practice of “Routine screening is done for all women with fasting BSL” right  at their first antenatal visit (mind you my dear members--any report higher than 85 mg% is taken seriously) . However  if she comes after food to ANC OPD then one may perform 1 hr 50 Gm post glucose test(anhydrous glucose). B) Second  visits : screening to all women :- irrespective of risk stratification :: at 16-24 weeks.:-- 50 g OGCT between 16-24 weeks even in n otherwise low-risk women with normal fasting BSL at first antenatal visit, taking 130 mg% (PPBS) as the cut off. As mentioned earlier that
the fasting BSL at their first antenatal visit which is not often done and many consider it is irrelevant but some center pay great reliance on FBS(people know that in first time booking women had to turn to ANC OPD in a fasting state) Any report higher than 85 mg% is taken seriously)

   Suppose in the booking visit her FBS If higher than 92 mg% -with H/O some previous Obstet mishaps then doctors become serious and they initially considerate as a case of GDM or DM until proved otherwise   till Final diag is made (after such screening  method of FBS > 92 mg)  such group of doctors  .  Consider her temporarily t as diabetes:  and insist on confirmation  within few days with either a) 75 gm (anhydrous)  OGTT or as b) by DIPSI method i.e. 2 hr PPBS  75 Gm after she ingests  82.5 gm commercial glucose (not anhydrous in truest  sense ) suggests. C) Many a Obstetrician perform screening by single value 2-hour after 75 g glucose orally irrespective of last food  and any value >140 mg% being positive for GDM, may not be for frank DM. This opinion was upheld by most members yesterday.