bcd900ce_Prevention__NOTES
[TOPIC] G Gestational Diabetes [REC] I [NOTES] 
Fair to good evidence that screening combined with diet and insulin therapy can reduce the rate of fetal macrosomia in women with gestational diabetes mellitus (GDM). The USPSTF found insufficient evidence, however, that screening for GDM substantially reduces important adverse health outcomes for mothers or their infants (for example, cesarean delivery, birth injury, or neonatal morbidity or mortality). Risk factors for GDM include maternal obesity (usually defined as a body mass index [BMI] of 25 or more), older age (usually defined as older than 25 years), family or personal history of diabetes, or a history of GDM in a prior pregnancy. Expert groups have also identified certain ethnic groups as being at increased risk for GDM (such as Hispanic, African American, American Indian, and South or East Asian). Using all the above criteria, however, would identify 90 percent of all pregnant women as being at increased risk for GDM. The optimal approach to screening and diagnosis is uncertain. Expert panels in the United States recommend a 50-g 1-hour glucose challenge test (GCT) at 24 to 28 weeks' gestation, followed by a 100-g 3-hour oral glucose tolerance test (OGTT) for women who screen positive on the GCT.
Prevention
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