임신성당뇨병 검사

2019 당뇨병 진료지침

모든 임신부는 첫 산전방문 시 공복혈장포도당, 무작위 혈장 포도당, 또는 당화혈색소를 측정해 당뇨병 여부를 검사한다.

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미국당뇨병학회 (ADA)

첫 산전방문 시 당뇨병 위험인자들에 대한 평가를 하고 위험인자가 있는 경우에는 당뇨병 여부를 검사합니다. 그 위험인자 기준은 다음과 같습ㄴ다.

 

BMI ≥25 kg/m2 (≥23 kg/m2 in Asian Americans) plus one or more of the following:

■ Gestational diabetes mellitus in a previous pregnancy

■ A1C ≥5.7% (39 mmol/mol), impaired glucose tolerance, or impaired fasting glucose on previous testing

■ First-degree relative with diabetes

■ High-risk race/ethnicity (eg, African American, Latino, Native American, Asian American, Pacific Islander)

■ History of cardiovascular disease

■ Hypertension (≥140/90 mmHg) or on therapy for hypertension

■ High-density lipoprotein cholesterol level <35 mg/dL and/or a triglyceride level >250 mg/dL

■ Polycystic ovary syndrome

■ Physical inactivity

■ Other clinical condition associated with insulin resistance (eg, severe obesity, acanthosis nigricans)

■ Previous birth of an infant weighing ≥4000 grams

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Screening for diabetes in pregnant and postpartum patients

GTT: glucose tolerance test; ADA: American Diabetes Association; ACOG: American College of Obstetricians and Gynecologists; BMI: body mass index; A1C: glycated hemoglobin; GCT: glucose challenge test; USPSTF: United States Preventive Services Task Force.

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* ADA and ACOG define women at increased risk of overt diabetes based on:

BMI ≥25 kg/m2 (≥23 kg/m2 in Asian Americans) plus one or more of the following:

■ Gestational diabetes mellitus in a previous pregnancy

■ A1C ≥5.7% (39 mmol/mol), impaired glucose tolerance, or impaired fasting glucose on previous testing

■ First-degree relative with diabetes

■ High-risk race/ethnicity (eg, African American, Latino, Native American, Asian American, Pacific Islander)

■ History of cardiovascular disease

■ Hypertension (≥140/90 mmHg) or on therapy for hypertension

■ High-density lipoprotein cholesterol level <35 mg/dL and/or a triglyceride level >250 mg/dL ​

■ Polycystic ovary syndrome

■ Physical inactivity

■ Other clinical condition associated with insulin resistance (eg, severe obesity, acanthosis nigricans)

■ Previous birth of an infant weighing ≥4000 grams

UpToDate includes older age as a risk factor for early testing and uses age 40 years as the threshold.

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¶ There is no consensus on the type of test to administer. Options include any of the following:

One step test (eg, 2-hour, 75 gram oral GTT)

Two step test (one-hour, 50 gram GCT without regard to time of day/previous meals; screen-positive patients go on to have a 3-hour 100 gram oral GTT)

 

Δ Both ADA and ACOG suggest early pregnancy testing for undiagnosed type 2 diabetes in women with risk factors. By contrast, a USPSTF guideline concluded available evidence was insufficient to assess the balance of benefits and harms of screening asymptomatic pregnant women for glucose intolerance before 24 weeks of gestation.

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◊ Either a one step or two step diabetes screening test can be used.

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§ Postpartum, a fasting plasma glucose test is a reasonable alternative to the GTT but does not allow for diagnosis of impaired glucose tolerance; A1C can also be substituted in patients in whom obtaining a fasting specimen is especially inconvenient, but it performs less well in postpartum women because of increased peripartum red cell turnover. For subsequent testing, refer to the UpToDate topic on screening and diagnosis of diabetes mellitus in pregnancy.

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