1. Gestational Diabetes Testing Paradigms in a Rural Office November 7, 2014

2. Learning Objectives • Understand normal glucose levels in pregnancy. • Define Gestational Diabetes Mellitus • Understand testing for Gestational Diabetes Mellitus

3. What's normal? Patterns of Glycemia in Normal Pregnancy: Should the current therapeutic targets be challenged? Teri Hernandez PhD RN et al ; Diabetes Care July 2011 34:7 p. 1660-1668. • Pooled Analysis of approximately 45 years of data concerning pregnant women with normal BMI and normal glucose tolerance. • FBS = 71 mg/dl • 1 Hour postprandial = 109 mg/dl • 2 Hour postprandial = 99 mg/dl

5. When did we start testing and how? • Non challenge testing (Risk factors only) • Challenge Testing • 1973 O'Sullivan and Mahan proposed the one hour glucose tolerance test. • 2010 International Association of Diabetes and Pregnancy Study Group recommended a single 2 hour diagnostic glucose challenge test. • Alternative Testing • Jelly Beans, Candy Bars, Proscribed Meals

6. A Word About Statistics Sensitivity Specificity Negative in Health How many people without the diagnosis are identified as negative. • Positive in disease • How many people who have the diagnosis are identified as positive.

7. DataOne year prior and one year following start of 2 hour GTT One hour GTT: 259 Two hour GTT: 286 Positive tests: 29 (10.1%) Time to teaching: 6.5d (0-15d) • Positive screens: 68 • Positive 3 hour gtt: 11 (4.2%) • Time to teaching: 16.4d (7-35d) Cost….

8. Are making a difference? Why do we care?

9. Outcomes Australian Carbohydrate Intolerance Study in Pregnant Women, 2005 • 1,000 women NICHD Maternal Fetal Medicine Network, 2009 • 958 women Hyperglycemia and Adverse Pregnancy Outcome Study • 15 Centers; 9 Countries; 23,316 women • 1 Hour GTT

10. Summary How do we test for Gestational Diabetes. ACOG continues to recommend the 2-step diagnostic approach to screening. What are normal values in pregnancy. Importance of diagnosis and management. Are we teaching for the future?