Current trends in the diagnosis and management of gestational diabetes mellitus in the United States

Brianne E. Bimson, Barak M. Rosenn, Sara A. Morris, Elizabeth B. Sasso, Rachelle A. Schwartzy, Lois E. Brustman

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Objective: To assess current practice patterns among members of the Society for Maternal-Fetal Medicine (SMFM) with respect to the diagnosis and management of gestational diabetes mellitus (GDM). Methods: A 38 question survey on GDM diagnosis and management was distributed to SMFM members. Results: 2330 SMFM members were surveyed with a 40% response rate. Overall, 90.6% of respondents recommend a 2-step (versus a 1-step) diagnostic test. Cutoff values for the 1-h-50 g glucose challenge test vary from 130-140 mg/dL, but the majority (83%) adopts Carpenter Coustan criteria for the 3-h-100 g oral glucose tolerance test. The majority recommend glucose testing four times a day, with 55% preferring post-prandial testing at 2 h. Glyburide is used by 57% as a first-line agent, while 4% use metformin. Long-acting insulin analogs (glargine and/or detemir) are used by 46% and 33.6% of respondents, respectively. Antenatal testing is recommended by 38.7% for diet-controlled GDM compared to 98.7% for pharmacologically controlled GDM, with 56% starting by 34 weeks gestation. Most respondents recommend delivery of diet-controlled GDM at 40 weeks and pharmacologically controlled GDM at 39 weeks. Most (69%) offer elective cesarean section for an estimated fetal weight of 44500 g. Conclusions: There is significant variation in the diagnosis and management of GDM among SMFM members.

Original languageEnglish
Pages (from-to)2607-2612
Number of pages6
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume30
Issue number21
DOIs
StatePublished - 2017
Externally publishedYes

Keywords

  • Gestational diabetes mellitus
  • Management
  • Survey

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