Periodic health examination, 1992 update: 1. Screening for gestational diabetes mellitus

Table 2: Summary of manoeuvres, effectiveness, level of evidence and recommendations for screening for gestational diabetes

Manoeuvre Effectiveness Level of evidence Recommendation

Search for risk factors* at the first visit and test for glycosuria at each visit. If result is positive do fasting and postprandial glucose tolerance tests (GCTs) Effectiveness not evaluated Expert opinion [35] and case series [36] (III) Poor evidence to include in periodic health examination of pregnant women (C)

50-g 1-hour GCT at 28 weeks' gestation Effectiveness of universal screening not evaluated. Screening may result in decreased incidence of macrosomia and birth trauma. Important questions persist about the significance of mild elevations in the blood glucose level and the benefit of treatment Cohort study [45] (II), case series [47-50] (III) and uncontrolled trial [52] (II) Poor evidence to include in periodic health examination of pregnant women (C)

Measurement of fasting and random blood glucose levels Sensitivity and specificity not properly evaluated. Women with an abnormal fasting glucose level are more likely than others to benefit from intervention Case series [2,3,43] (III) Poor evidence to include in periodic health examination of pregnant women (C)

*Risk factors for gestational diabetes are obesity, history of miscarriage or fetal death, age 40 years or more, family history of diabetes, polyhydramnios, history of premature infant or infant with macrosomia or congenital malformation, pre-eclampsia, excessive weight gain and glycosuria.

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Table 2: Summary of manoeuvres, effectiveness, level of evidence and recommendations for screening for gestational diabetes
Manoeuvre	Effectiveness	Level of evidence	Recommendation
Search for risk factors* at the first visit and test for glycosuria at each visit. If result is positive do fasting and postprandial glucose tolerance tests (GCTs)	Effectiveness not evaluated	Expert opinion [35] and case series [36] (III)	Poor evidence to include in periodic health examination of pregnant women (C)
50-g 1-hour GCT at 28 weeks' gestation	Effectiveness of universal screening not evaluated. Screening may result in decreased incidence of macrosomia and birth trauma. Important questions persist about the significance of mild elevations in the blood glucose level and the benefit of treatment	Cohort study [45] (II), case series [47-50] (III) and uncontrolled trial [52] (II)	Poor evidence to include in periodic health examination of pregnant women (C)
Measurement of fasting and random blood glucose levels	Sensitivity and specificity not properly evaluated. Women with an abnormal fasting glucose level are more likely than others to benefit from intervention	Case series [2,3,43] (III)	Poor evidence to include in periodic health examination of pregnant women (C)
*Risk factors for gestational diabetes are obesity, history of miscarriage or fetal death, age 40 years or more, family history of diabetes, polyhydramnios, history of premature infant or infant with macrosomia or congenital malformation, pre-eclampsia, excessive weight gain and glycosuria.