International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy

 [bib_ref] Gestational diabetes in effective care, Hunter [/bib_ref] [bib_ref] Macrosomia: maternal characteristics and infant complications, Spellacy [/bib_ref] [bib_ref] Management of gestational diabetes: a self-fulfilling prophecy?, Coustan [/bib_ref] [bib_ref] Clinical impact of mild carbohydrate intolerance in pregnancy: a study of 2904..., Jensen [/bib_ref] [bib_ref] Women with impaired glucose tolerance during pregnancy have significantly poor pregnancy outcomes, Yang [/bib_ref] [bib_ref] Is mild gestational hyperglycaemia associated with maternal and neonatal complications? the Diagest..., Vambergue [/bib_ref] [bib_ref] The significance of one abnormal glucose tolerance test value on adverse outcome..., Langer [/bib_ref] [bib_ref] Do the current standards for glucose tolerance testing in pregnancy represent a..., Sacks [/bib_ref] [bib_ref] Pregnancy plasma glucose levels exceeding the American Diabetes Association thresholds, but below..., Ferrara [/bib_ref] [bib_ref] Gestational diabetes in effective care, Hunter [/bib_ref] [bib_ref] Screening for gestational diabetes: a systematic review and economic evaluation, Scott [/bib_ref] [bib_ref] Prevalence of overweight and obesity in the United States, Ogden [/bib_ref] [bib_ref] Effect of BMI on lifetime risk for diabetes in the U, Narayan [/bib_ref] [bib_ref] The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes,..., Dunstan [/bib_ref] [bib_ref] Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and..., Hapo Study Cooperative Research [/bib_ref] [bib_ref] Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and..., Hapo Study Cooperative Research [/bib_ref] [bib_ref] Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and..., Hapo Study Cooperative Research [/bib_ref] [bib_ref] Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and..., Hapo Study Cooperative Research [/bib_ref] [bib_ref] Gestational diabetes: infant and maternal complications of pregnancy in relation to third-trimester..., Pettitt [/bib_ref] [bib_ref] Adverse pregnancy outcome in women with mild glucose intolerance: is there a..., Jensen [/bib_ref] [bib_ref] Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without..., Sermer [/bib_ref] [bib_ref] Toward universal criteria for gestational diabetes: the 75-gram glucose tolerance test in..., Sacks [/bib_ref] [bib_ref] Pregnancy plasma glucose levels exceeding the American Diabetes Association thresholds, but below..., Ferrara [/bib_ref] [bib_ref] Summary and recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus, Metzger [/bib_ref] [bib_ref] Long-term effects of the intrauterine environment, birth weight, and breast-feeding in Pima..., Pettitt [/bib_ref] [bib_ref] Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia, Hillier [/bib_ref] 

## Translation of hapo study results for diagnosis of gdm
-Some studies cited above and others were presented at the IADPSG Pasadena meeting.
The results were consistent with HAPO findings indicating that associations between maternal glycemia and adverse outcomes are continuous across the range of glucose concentrations below levels diagnostic of diabetes [bib_ref] Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and..., Hapo Study Cooperative Research [/bib_ref]. As a result of the extensive efforts used to standardize procedures for participant enrollment [bib_ref] Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and..., Hapo Study Cooperative Research [/bib_ref] , laboratory analyses (34), data collection [bib_ref] Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and..., Hapo Study Cooperative Research [/bib_ref] , and analysis of results [bib_ref] Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and..., Hapo Study Cooperative Research [/bib_ref] , HAPO data were used as the basis for the new GDM diagnostic thresholds recommended in this report.
HAPO data show strong linear associations of risks for 90th percentiles of birth weight, cord C-peptide, and percent body fat with each of three measures of maternal glucose (FPG, 1-h, and 2-h post-75-g load). In determining the recommendations for diagnostic thresholds, associations with these outcomes were used to select glucose concentrations as potential diagnostic threshold values (supplemental . Published data support this decision. Fetal macrosomia (LGA) is a major indicator of the effects of hyperglycemia during pregnancy [bib_ref] Women with impaired glucose tolerance during pregnancy have significantly poor pregnancy outcomes, Yang [/bib_ref] [bib_ref] Increased macrosomia and perinatal morbidity independent of maternal obesity and advanced age..., Jang [/bib_ref] [bib_ref] Gestational diabetes: the consequences of not treating, Langer [/bib_ref]. Associations of LGA and excess adiposity with fetal hyperinsulinemia are strong and independent of confounders [bib_ref] Amniotic fluid insulin concentration as a predictor of obesity, Metzger [/bib_ref] [bib_ref] Can glucose tolerance test predict fetal hyperinsulinism, Weiss [/bib_ref]. This is supported by experiments in pregnant monkeys [bib_ref] Effects of hyperinsulinemia in the primate fetus, Susa [/bib_ref]. Risks of difficult delivery and maternal/ neonatal damage associated with fetal macrosomia [bib_ref] How big is too big? The perinatal consequences of fetal macrosomia, Zhang [/bib_ref] were confirmed in large populations [bib_ref] Macrosomic births in the United States: determinants, outcomes, and proposed grades of..., Boulet [/bib_ref] [bib_ref] The association between birthweight 4000 gm or greater and perinatal outcomes in..., Esakoff [/bib_ref]. Long-term risks associated with fetal macrosomia in infants of women with GDM (independent of confounders) include childhood overweight [bib_ref] Effects of maternal gestational diabetes on offspring adiposity at 4 -7 years..., Vohr [/bib_ref] [bib_ref] Birth weight and parental BMI predict overweight in children from mothers with..., Schaefer-Graf [/bib_ref] and metabolic factors that may increase risk of cardiovascular disease (CVD) [bib_ref] Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational..., Boney [/bib_ref].
In the HAPO study, frequencies of study outcomes were compared across the entire distribution of glucose concentrations, with the lowest glucose concentration ranges used as the reference for calculation of odds ratios (ORs) [bib_ref] Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and..., Hapo Study Cooperative Research [/bib_ref]. However, the IADPSG Consensus Panel decided that for selection of diagnostic thresholds, mean values for FPG, 1-h, and 2-h OGTT plasma glucose concentrations (4.5, 7.4, and 6.2 mmol/l, respectively) for the entire study cohort should be used as reference. Concentrations at which ORs for specific outcomes in adjusted models reached predefined values, with glucose modeled as a continuous variable, were then determined. After review of these data, the IADPSG Consensus Panel concluded that the predefined value for the OR at the threshold relative to the mean should be 1.75 (ORs 1.5 and 2.0 were also considered, see OTHER CONSIDER-ATIONS below). Finally, proportions of participants who would be identified by measurement of FPG only, FPG plus 1-h glucose concentration, and FPG plus both 1-h and 2-h plasma glucose concentrations were considered.

## Diagnostic recommendations
The stepwise consideration of the HAPO study data described above led to the recommendation of the values for FPG, 1-h, and 2-h plasma glucose concentration (S i and conventional) indicated in [fig_ref] Table 1 -: Threshold values for diagnosis of GDM or overt diabetes in pregnancyTo diagnose... [/fig_ref] as diagnostic thresholds. These thresholds are the average glucose values at which odds for birth weight 90th percentile, cord C-peptide 90th percentile, and percent body fat 90th percentile reached 1.75 times the estimated odds of these outcomes at mean glucose values, based on fully adjusted logistic regression models. At least one of these thresholds must be equaled or exceeded to make a diagnosis of GDM. Measuring FPG alone identified 8.3% of the cohort as having GDM. Adding measurement of the 1-h plasma glucose identified an additional 5.7%; adding the 2-h plasma glucose measurement identified another 2.1% of the cohort. Among the HAPO cohort, 11.1% had only one elevated result, 3.9% had two elevated results, and 1.1% had elevation of all three results. In addition, 1.7% of the cohort was unblinded due to an FPG or 2-h plasma glucose value on the enrollment OGTT above predefined values of 5.8 mmol/l (105 mg/dl) or 11.1 mmol/l (200 mg/dl), respectively [bib_ref] Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and..., Hapo Study Cooperative Research [/bib_ref]. Thus, by these new criteria, the total incidence of GDM was 17.8%; the FPG plus 1-h plasma glucose levels identified a large majority of these individuals.
Adjusted ORs and 95% CIs for associations between maternal glucose and HAPO study outcomes are in supplemental . ORs are for the difference in glucose between the mean glucose value and the recommended threshold. In addition to the outcomes used to determine the thresholds, there were strong associations between maternal glucose and preeclampsia (ORs 1.40 -1.57) and shoulder dystocia and/or birth injury (1.30 -1.43).
The frequencies of HAPO study outcomes when all three glucose measures were below threshold values and when any one or more values were greater than or equal to threshold concentration were compared (supplemental . The frequency of birth weight, C-peptide, or percent infant body fat 90th percentile was approximately twofold greater when any of the glucose values were greater than or equal to the threshold. The frequency of preeclampsia was twofold higher when one or more glucose values met or exceeded threshold, and frequencies of preterm delivery and primary cesarean section were 45% higher.

## Other considerations
Measurement of glucose. The frequencies and ORs for outcomes on which the recommended diagnostic thresholds are based increase substantially over relatively small changes in glucose concentration (supplemental and . Therefore, to achieve reliable diagnosis and classification of hyperglycemia in pregnancy, clinical laboratories must measure venous plasma or serum glucose using an enzymatic method with high accuracy and precision. This includes proper sample collection and processing to minimize pre-analytic glycolysis and proper laboratory analysis [bib_ref] Integration of local and central laboratory functions in a worldwide multicentre study:..., Hapo Study Cooperative Research [/bib_ref] [bib_ref] Can capillary whole blood glucose and venous plasma glucose measurements be used..., Stahl [/bib_ref]. Capillary and venous plasma glucose concentrations differ and are not interchangeable, and conversion factors do not accurately estimate equivalent values [bib_ref] Can capillary whole blood glucose and venous plasma glucose measurements be used..., Stahl [/bib_ref]. Alternative OR/threshold combinations. Consideration was given to glucose values and outcome frequencies for adjusted ORs of 1.5 and 2.0. The threshold OR of 1.5 identified 25% of the cohort with one or more glucose values that met or exceeded the threshold. The proportion of the cohort with FPG equal to or greater than threshold at ORs of 1.5, 1.75, or 2.0 (5.0, 5.1, and 5.3 mmol/l or 90, 92, or 95 mg/dl, respectively) differed substantially, representing 12, 8, and 4%, respectively. At ORs of 2.0, frequencies of birth weight, cord serum C-peptide, or percent infant body fat 90th percentile in those meeting threshold were modestly higher than those for OR 1.75 (supplemental , but the number of participants meeting threshold decreased from 16.1 to 8.8%, meaning that the higher thresholds would fail to identify many cases with nearly comparable risk of adverse outcomes.
Rounding threshold values to easy-toremember numbers. Values such as 5.0 and 9.0 mmol/l (90 and 155 mg/dl, respectively) for FPG and 2-h plasma glucose would be somewhat easier to remember than those indicated in [fig_ref] Table 1 -: Threshold values for diagnosis of GDM or overt diabetes in pregnancyTo diagnose... [/fig_ref]. However, this strategy is not feasible. First, as indicated above, arbitrarily choosing an FPG threshold of 5.0 mmol/l (90 mg/dl) would substantially affect the proportion of women meeting a diagnostic threshold. Second, both S i and standard units are widely used, and the numbers are not equally easy or difficult to remember for both units of measure. The values in [fig_ref] Table 1 -: Threshold values for diagnosis of GDM or overt diabetes in pregnancyTo diagnose... [/fig_ref] represent the best choice from a clinical perspective, and they meet the predefined strength of as-

## Diagnosis of hyperglycemia in pregnancy
sociation from an epidemiological perspective.

## Randomized treatment trials and choice of threshold values.
Two randomized controlled trials comparing active treatment versus standard obstetric care for mild GDM have been conducted during the years in which the HAPO study was carried out [bib_ref] Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of..., Crowther [/bib_ref]. In both randomized controlled trials, treatment, achieved primarily by diet/lifestyle modification, resulted in reduced birth weight and frequency of LGA births and preeclampsia. Recruitment processes and glycemic values of participants were not identical in the randomized controlled trials and the HAPO observational study. However, there was substantial overlap between glucose values used for inclusion in the randomized controlled trials and those recommended in this report as new threshold values. Furthermore, frequencies of outcomes such as LGA or birth weight 90th percentile and preeclampsia in usual care versus treatment arms of the randomized controlled trials are similar to those observed in the HAPO study among women with one or more glucose values that meet or exceed the threshold, compared with those with all values below threshold (supplemental . Although not directly comparable, it was concluded that results of the two randomized controlled trials [bib_ref] Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of..., Crowther [/bib_ref] and HAPO [bib_ref] Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and..., Hapo Study Cooperative Research [/bib_ref] are highly complementary.

## Detection and diagnosis of overt diabetes during pregnancy -the international
Workshop-Conferences on GDM have defined the condition as "any degree of glucose intolerance with onset or first recognition during pregnancy". The definition has applied whether or not insulin is used for treatment or hyperglycemia persists after pregnancy. The possibility that unrecognized glucose intolerance antedated the pregnancy is not excluded. This facilitates a uniform strategy for detection and classification of GDM but has limitations. As ongoing epidemics of obesity and diabetes result in more type 2 diabetes in young women, the number who are undiagnosed (before pregnancy) is increasing [bib_ref] Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among..., Lawrence [/bib_ref] [bib_ref] Trends in deliveries, prenatal care, and obstetrical complications in women with pregestational..., Feig [/bib_ref]. The need to identify these women and address perinatal risks that may be particular to their greater degree of hyperglycemia is becoming more important. The IADPSG Consensus Panel reviewed the current knowledge base during the June 2008 IADPSG meeting. The recommendations summarized below are the opinions of the IADPSG Consensus Panel.
The issue of classification of women with likely prepregnancy diabetes (overt diabetes) first noted during pregnancy was addressed via presentations by experienced clinicians/researchers (Yasue Omori, Lois Jovanovic, Elisabeth Mathiesen, and Siri Kjos), accompanied by interactive discussion. Several arguments were made for identifying as a distinct group women with overt diabetes:
- Increased risk of congenital anomalies in offspring (51). - Risk of diabetes complications (nephropathy and retinopathy) requiring treatment during pregnancy (52). - Need for rapid treatment and close follow-up during pregnancy to ensure prompt restoration of normal glycemia [bib_ref] Gestational diabetes mellitus diagnosed during early pregnancy, Bartha [/bib_ref] [bib_ref] Screening tests for gestational diabetes in Japan in the 1st and 2nd..., Maegawa [/bib_ref]. - Need to ensure confirmation and appropriate treatment of diabetes after pregnancy.

## Identification of overt diabetes
When and how to identify women with overt diabetes during pregnancy (not previously diagnosed) and how to define overt diabetes were considered during the IADPSG Pasadena meeting and subsequently. There was uniform agreement that this assessment should be made during the initial visit for prenatal care. There was debate about performing universal early testing or limiting testing to those women classified as high risk according to locally defined criteria. It was acknowledged that background population prevalence of diabetes in young women and extent of previous testing for metabolic disturbances vary greatly in different regions. Furthermore, it has not been determined whether universal testing early in pregnancy to detect overt diabetes is either of clinical value or cost-effective. IADPSG Consensus Panel members favored use of any available certified laboratory measure of glucose (FPG, random plasma glucose, or A1C) for initial detection of possible cases. An expert committee recently recommended that an A1C value 6.5% (measured in a laboratory standardized/aligned with the Diabetes Control and Complications Trial [DCCT]/UK Prospective Diabetes Study [UKPDS] assay) be used for diagnosis of diabetes outside pregnancy. Although many IADPSG Consensus Panel members favored using A1C for detection of overt diabetes in pregnancy, it was not feasible to recommend a single test to use exclusively. Cost and standardization of A1C testing are issues for consideration, and hemoglobin variants are prevalent in some populations. Attending the first prenatal visit in the fasting state is impractical in many settings. Consensus thresholds recommended for the individual glycemia measures are indicated in [fig_ref] Table 1 -: Threshold values for diagnosis of GDM or overt diabetes in pregnancyTo diagnose... [/fig_ref]. A tentative diagnosis of overt diabetes based on measurement of random plasma glucose must be confirmed with either an FPG or A1C value greater than or equal to the threshold using a DCCT/UKPDS standardized/aligned method.

## Other considerations
Timing of the initial test. It is desirable to detect overt diabetes in pregnancy as early as possible to provide an opportunity to optimize pregnancy outcome. However, there is variability in time of enrollment for prenatal care beyond the control of health care providers. Accordingly, no limit is placed on the timing of initial assessment for detection of overt diabetes in pregnancy. However, if enrollment is at 24 weeks' gestation or later and overt diabetes is not found, the initial test should be followed by a 75-g OGTT. Indeterminate results of initial testing. It was recognized that any assessment of glycemia in early pregnancy would also result in detection of milder degrees of hyperglycemia short of overt diabetes. Recently, it was reported that higher firsttrimester FPG levels (lower than those diagnostic of diabetes) are associated with increased risks of later diagnosis of GDM and adverse pregnancy outcomes [bib_ref] First-trimester fasting hyperglycemia and adverse pregnancy outcomes, Riskin-Mashiah [/bib_ref]. However, there have not been sufficient studies performed to know whether there is benefit of generalized testing to diagnose and treat GDM before the usual window of 24 -28 weeks' gestation. Therefore, the IADPSG Consensus Panel does not recommend routinely performing OGTTs before 24 -28 weeks' gestation. It is recommended that an FPG value in early pregnancy 5.1 mmol/l (92 mg/dl) also be classified as GDM.

## Summary of detection
STRATEGY -The overall strategy recommended by the IADPSG Consensus Panel for detection and diagnosis of hyperglycemic disorders in pregnancy is summarized in [fig_ref] Table 2 -: Strategy for the detection and diagnosis of hyperglycemic disorders in pregnancy*First prenatal... [/fig_ref]. Two discrete phases are included. The first is detection of women with overt diabetes not previ-ously diagnosed or treated outside of pregnancy. Universal early testing in populations with a high prevalence of type 2 diabetes is recommended, especially if metabolic testing in this age-group is not commonly performed outside of pregnancy. Well-designed studies should be conducted to determine whether it is beneficial and cost-effective to perform an OGTT in women who do not have overt diabetes at early testing but have indeterminate nondiagnostic results. The second phase is a 75-g OGTT at 24 -28 weeks' gestation in all women not previously found to have overt diabetes or GDM.

# Conclusions

## Immediate implications
These recommendations have widespread implications. The strategy outlined in [fig_ref] Table 2 -: Strategy for the detection and diagnosis of hyperglycemic disorders in pregnancy*First prenatal... [/fig_ref] will finally lead to using a 75-g glucose dose for an OGTT in all clinical settings in or outside of pregnancy. In some regions and/or countries, this represents a substantial change in longestablished practices. Glucose testing early in pregnancy to detect overt diabetes and again with a 75-g OGTT at 24 -28 weeks' of gestation in all pregnancies not already diagnosed with overt diabetes or GDM by early testing represents fundamental changes in strategies for detection and diagnosis of hyperglycemia in pregnancy. In most areas, using the outcome-linked diagnostic criteria in [fig_ref] Table 1 -: Threshold values for diagnosis of GDM or overt diabetes in pregnancyTo diagnose... [/fig_ref] and the detection strategy in [fig_ref] Table 2 -: Strategy for the detection and diagnosis of hyperglycemic disorders in pregnancy*First prenatal... [/fig_ref] will substantially increase the frequency of hyperglycemic disorders in pregnancy. However, this is consistent with the high prevalence of obesity and disorders of glucose metabolism in the general population of young adults [bib_ref] Prevalence of overweight and obesity in the United States, Ogden [/bib_ref] [bib_ref] Effect of BMI on lifetime risk for diabetes in the U, Narayan [/bib_ref] and with recent reports of a rising prevalence of GDM and preexisting overt diabetes in pregnant women [bib_ref] Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among..., Lawrence [/bib_ref].

## Future considerations
In future clinical practice, simpler and more cost-effective strategies that do not require performing an OGTT on most pregnant women may be developed. In the HAPO study, risks of some adverse outcomes were low when FPG was 4.4 mmol/l (80 mg/dl). However, it was thought that using FPG to potentially identify pregnancies at very low risk for GDM and for adverse outcomes requires further evaluation. Similarly, further evaluation of A1C results from the HAPO study, results from other populations, or new integrated tests of glycemia with a shorter timeframe than A1C might serve this purpose.
The HAPO study was a basic epidemiological investigation that for the first time conclusively identified strong continuous associations of maternal glucose levels below those diagnostic of diabetes with several perinatal outcomes. It was not a clinical trial, but two randomized controlled trials of treatment of mild GDM have been carried out successfully in participants with glucose values that overlap with the thresholds recommended in this report. However, it is likely that additional well-designed randomized controlled trials and other clinical studies will be needed to determine 1) cost-effective therapeutic strategies for treatment of GDM diagnosed by the IADPSG Consensus Panel-recommended criteria; 2) optimal glycemic treatment targets; 3) appropriate follow-up of mothers to determine risks for later development of diabetes, other metabolic disorders, or CVD risk factors; and 4) follow-up of children to assess potential associations of maternal glycemia with long-term risks of obesity, altered glucose metabolism, and CVD risk factors. If results indicate overt diabetes as per [fig_ref] Table 1 -: Threshold values for diagnosis of GDM or overt diabetes in pregnancyTo diagnose... [/fig_ref] Treatment and follow-up as for preexisting diabetes If results not diagnostic of overt diabetes and fasting plasma glucose 5.1 mmol/l (92 mg/dl) but 7.0 mmol/l (126 mg/dl), diagnose as GDM and fasting plasma glucose 5.1 mmol/l (92 mg/dl), test for GDM from 24 to 28 weeks' gestation with a 75-g OGTT  24-28 weeks' gestation: diagnosis of GDM 2-h 75-g OGTT: perform after overnight fast on all women not previously found to have overt diabetes or GDM during testing earlier in this pregnancy Overt diabetes if fasting plasma glucose 7.0 mmol/l (126 mg/dl) GDM if one or more values equals or exceeds thresholds indicated in [fig_ref] Table 1 -: Threshold values for diagnosis of GDM or overt diabetes in pregnancyTo diagnose... [/fig_ref] Normal if all values on OGTT less than thresholds indicated in [fig_ref] Table 1 -: Threshold values for diagnosis of GDM or overt diabetes in pregnancyTo diagnose... [/fig_ref] *To be applied to women without known diabetes antedating pregnancy. Postpartum glucose testing should be performed for all women diagnosed with overt diabetes during pregnancy or GDM. Decision to perform blood testing for evaluation of glycemia on all pregnant women or only on women with characteristics indicating a high risk for diabetes is to be made on the basis of the background frequency of abnormal glucose metabolism in the population and on local circumstances. 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.
[table] Table 1 -: Threshold values for diagnosis of GDM or overt diabetes in pregnancyTo diagnose GDM and cumulative proportion of HAPO cohort equaling or exceeding those thresholds [/table]
[table] Table 2 -: Strategy for the detection and diagnosis of hyperglycemic disorders in pregnancy*First prenatal visitMeasure FPG, A1C, or random plasma glucose on all or only high-risk women  [/table]