14 Thus, the lower screening level of 130 mg per dL identifies more patients with gestational diabetes at the cost of more false-positive results. Using a value of 130 mg per dL or higher will increase the sensitivity of the test from 80 to 90 percent and decrease its specificity, compared with using a value of 140 mg per dL or higher. To be considered normal, serum or plasma glucose values should be less than 130 mg per dL (7.2 mmol per L) or less than 140 mg per dL (7.8 mmol per L). Patients do not have to fast for this test. Initial screening for gestational diabetes is accomplished by performing a 50-g, one-hour glucose challenge test at 24 to 28 weeks of gestation. In patients who require insulin or have other comorbid conditions, it is appropriate to begin antenatal screening with nonstress tests and an amniotic fluid index at 32 weeks of gestation. In patients with well-controlled diabetes, there is no need to pursue delivery before 40 weeks of gestation. Patients not meeting these goals with dietary changes alone should begin insulin therapy. The postprandial treatment goal should be a capillary blood glucose level of less than 140 mg per dL (7.8 mmol per L) at one hour and less than 120 mg per dL (6.7 mmol per L) at two hours. The commonly accepted treatment goal is to maintain a fasting capillary blood glucose level of less than 95 to 105 mg per dL (5.3 to 5.8 mmol per L) the ambiguity (i.e., the range) is due to imperfect data. ![]() Patients diagnosed with gestational diabetes should monitor their blood glucose levels, exercise, and undergo nutrition counseling for the purpose of maintaining normoglycemia. In some prospective studies, treatment of gestational diabetes has resulted in a decrease in shoulder dystocia (a frequently discussed perinatal outcome), but cesarean delivery has not been shown to reduce perinatal morbidity. Data on perinatal mortality, however, are inconsistent. While no large randomized controlled trials show that screening for and treating gestational diabetes affect perinatal outcomes, multiple studies have documented an increase in adverse pregnancy outcomes in patients with the disorder. ![]() Gestational diabetes mellitus is a common but controversial disorder.
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