Detecting glucose intolerance after pregnancy
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OGTT is most likely to diagnose all individuals with abnormal glycaemic states in the postnatal period, but resource issues and patient acceptability may limit the utility of this as a diagnostic test and so should not be routinely offered.
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Fasting plasma glucose and HbA1c should not be used to determine glucose status before six weeks after delivery as levels may not be representative.
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Explain to women who were diagnosed with gestational diabetes about the risks of gestational diabetes in future pregnancies and offer them testing for diabetes when planning future pregnancies.
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For women who were diagnosed with gestational diabetes and whose blood glucose levels returned to normal after the birth:
- Offer lifestyle advice (including weight management, diet and exercise).
- Offer a fasting plasma glucose test 6–13 weeks after the birth to exclude diabetes (for practical reasons this might take place at the 6-week postnatal check or timed to co-ordinate with their baby vaccination schedule).
- If a fasting plasma glucose test has not been performed by 13 weeks, offer a fasting plasma glucose test, or an HbA1c test if a fasting plasma glucose test is not possible, after 13 weeks.
- Do not routinely offer a 75 g two-hour OGTT.
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For women having a fasting plasma glucose test as the postnatal test:
- Advise women with a fasting plasma glucose level below 6.0 mmol/L that:
- they have a low probability of having diabetes at present
- they should continue to follow the lifestyle advice (including weight management, diet and exercise) given after the birth
- they will need an annual test to check that their blood glucose levels are normal
- they have a moderate risk of developing type 2 diabetes, and offer them advice and guidance in line with SIGN 172: Prevention, early recognition and treatment, and remission of type 2 diabetes.
- Advise women with a fasting plasma glucose level between 6.0 and 6.9 mmol/L that they are at high risk of developing type 2 diabetes, and offer them advice, guidance and interventions in line with SIGN 172: Prevention, early recognition and treatment, and remission of type 2 diabetes.
- Advise women with a fasting plasma glucose level of 7.0 mmol/L or above that they are likely to have type 2 diabetes, and offer them a diagnostic test to confirm diabetes.
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For women having an HbA1c test as the postnatal test:
- Advise women with an HbA1c level below 39 mmol/mol (5.7%) that:
- they have a low probability of having diabetes at present
- they should continue to follow the lifestyle advice (including weight management, diet and exercise) given after the birth
- they will need an annual test to check that their blood glucose levels are normal
- they have a moderate risk of developing type 2 diabetes, and offer them advice and guidance in line with SIGN 172: Prevention, early recognition and treatment, and remission of type 2 diabetes.
- Advise women with an HbA1c level between 39 and 47 mmol/mol (5.7% and 6.4%) that they are at high risk of developing type 2 diabetes, and offer them advice, guidance and interventions in line with SIGN 172: Prevention, early recognition and treatment, and remission of type 2 diabetes.
- Advise women with an HbA1c level of 48 mmol/mol (6.5%) or above that they have type 2 diabetes and refer them for further care.
In most centres in Scotland women with GDM have HbA1c measured 3 months after delivery and are offered entry to the A Healthier Future: type 2 diabetes prevention, early detection and intervention framework
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Rates of uptake of screening should be monitored and the effects of strategies, such as education of women and healthcare professionals, and introduction of screening co-ordinators, should be tested to evaluate improvement in uptake.
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Strategies to improve uptake of screening are vital to allow early interventions and improve metabolic outcomes, for example trying to co-ordinate with other postpartum milestones such as vaccinations.