Gestational diabetes mellitus manifests in all trimesters of pregnancy

Gestational Diabetes Mellitus - A Perspective

“…They recognize and respond to maternal glycemia before 15 weeks of gestation, suggesting that metabolic perturbations are underway before diagnosis and that earlier screening and intervention may be warranted (Tisi et al, 2011). The study performed by the present authors group in the DIPAP project revealed that, 16.3% had glucose intolerance within 16 weeks, 22.4% between 17 -23 weeks and remaining 61.3% more than 24 weeks of gestation (Seshiah et., 2007). If a pregnant woman has an A1c level > 6%, she is more likely to be an overt diabetic .…”

“…If A1c level is more than 6% , the chances are that she may be a pre GDM or GDM, in whom the glucose intolerance was detected in the early weeks of pregnancy; all the more validating that the screening needs to be performed in the early weeks of gestation. The estimation of A1c may help in distinguishing a pre GDM from an early onset GDM, but not essential, as this differentiation is of no consequence in clinical practice, as the treatment approach is going to be the same (Seshiah et al, 2007). Further, A1c is not estimated in the community health centres, barring a few tertiary care hospitals due to the difficulty in standardization, inadequate technical support and the cost.…”

“…The cost will escalate further, if IADPSG diagnostic procedure is performed in each trimester in high risk population in whom GDM manifests in all trimesters of pregnancy (Seshiah et al, 2007). Among women with normal OGTT results in the first visit when tested in the subsequent visits, 28% of them were detected to have GDM (Seshiah et al, 2007). Hence, DIPSI procedure based on WHO criterion is feasible, sustainable, cost-effective and best buy to diagnose GDM in any country and particularly in less resource nations.…”

“…The cost involved in performing IADPSG recommended procedure is high, as this procedure requires three blood tests compared to one blood test of DIPSI. The cost will escalate further, if IADPSG diagnostic procedure is performed in each trimester in high risk population in whom GDM manifests in all trimesters of pregnancy (Seshiah et al, 2007). Among women with normal OGTT results in the first visit when tested in the subsequent visits, 28% of them were detected to have GDM (Seshiah et al, 2007).…”

To determine the eficacy of DIPSI as a method to screen GDM

“…The current guidelines by DIPSI 2014 recommended that testing by 75g 2hr oral glucose challenge test need not be done in fasting state and is done irrespective of the last meal. 7 This prospective study was undertaken to ascertain the validity of the DIPSI criterion in diagnosing GDM.…”