While there is controversy as to how best to screen for gestational diabetes mellitus (GDM) during pregnancy, all professional groups recommend screening during the postpartum period following GDM for prediabetes or diabetes at 4 to 12 weeks postpartum. Historically, two options, fasting plasma glucose (FPG) and the 2 hour oral glucose tolerance test (OGTT) have been used. However, ACOG, citing the Fifth International Workshop on Gestational Diabetes recommends the 2 hour OGTT, which should include FPG as well, to improve sensitivity:
Up to 1/3 of women who had GDM during their pregnancy will have impaired glucose metabolism or diabetes at postpartum screening and up to 70% may develop diabetes later in life. Even if screening is negative at the postpartum visit, the ADA and ACOG recommended assessing glycemic status every 1 to 3 years and counseling patients regarding diet and/or exercise as needed. Follow up screening is particularly advantageous for those women considering future pregnancies as it gives an opportunity for preconception counseling and management prior to the next pregnancy.
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