International Journal of Gynecology and Obstetrics 115 Suppl. 1 (2011) S26–S29 Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo ARTICLE Matching diagnosis and management of diabetes in pregnancy to local priorities and resources: An international approach H. David McIntyre a, *, Jeremy J.N. Oats b , Willibald Zeck c,d,e , V. Seshiah f , Moshe Hod g a University of Queensland, Mater Health Services and Mater Medical Research Institute, South Brisbane, Australia b Department of Obstetrics and Gynecology, University of Melbourne, Victoria, Australia c United Nations Children’s Fund (UNICEF), Regional Office, Kathmandu, Nepal d Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria e Duke Global Health Institute, Duke University, Durham NC, USA f Dr V. Seshiah Diabetes Research Institute and Dr Balaji Diabetes Care Centre, Chennai, India g Division of Maternal Fetal Medicine, Helen Schneider Hospital for Women, Rabin Medical Center, Petah-Tiqva, Israel article info Keywords: Diagnosis Gestational diabetes Hyperglycemia IADPSG Low-income countries Pregnancy abstract The International Association of the Diabetes and Pregnancy Study Groups’ (IADPSG) criteria for the diagnosis and classification of hyperglycemia in pregnancy are described and application of these in differing healthcare contexts on a worldwide basis is reported. Existing local protocols and known epidemiologic and clinical data regarding the detection and management of overt diabetes and gestational diabetes in the context of human pregnancy are considered. Although the IADPSG criteria are uniform, their introduction poses a variety of practical and technical challenges in differing healthcare contexts, both between and within countries. Knowledge of local factors will be vital in the implementation of the new guidelines and will require extensive liaison with local clinical and health policy groups. Resource availability will be critical in determining the type of treatment available in this context. The IADPSG criteria offer an important opportunity for a uniform approach to diabetes in pregnancy. Scaled implementation of these criteria adapted to a variety of local healthcare contexts should improve both research endeavors and patient care. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. 1. Introduction The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) has recently published a suggested diagnostic pathway and criteria for diabetes in pregnancy [1], based on the epidemiologic findings of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study [2] and other available data. These recommendations allow for pragmatic local variations in implementation of revised diagnostic protocols, in particular in relation to early pregnancy screening designed to detect undiagnosed type 2 diabetes. Whilst wishing to emphasize the importance of diabetes in pregnancy across a variety of healthcare contexts, the IADPSG recognizes that pregnancy healthcare priorities may vary according to local factors, including available resources for both diagnosis and management and the relative frequency and importance of hyperglycemia compared with other health risks in different countries or areas. This article aims to consider the issues involved in detection and management of diabetes in pregnancy across a range of *Corresponding author. David McIntyre. University of Queensland, Mater Health Services and Mater Medical Research Institute, South Brisbane, QLD 4101, Australia. Tel +61 7 3163 6358; Fax + 61 7 3163 2510. E-mail address: david.mcintyre@mater.org.au (D. McIntyre). contexts, broadly divided into high-/middle-/low-income countries as defined by the World Bank [3]. It is acknowledged that differing healthcare contexts may also exist within countries, but such local variations are beyond the scope of this paper. 2. IADPSG recommendations The published IADPSG recommendations for diagnosis and classification of hyperglycemia in pregnancy [1] propose the following diagnostic pathway: 1. Early pregnancy Test with any of: random plasma glucose (RPG), fasting plasma glucose (FPG), or HbA 1c (for all or only for high-risk women depending on local circumstances) to detect overt diabetes. FPG ≥7.0 mmol/L or HbA 1c ≥6.5% are considered as overt diabetes requiring immediate therapy. RPG ≥11.1mmol/L indicates likely overt diabetes and requires FPG or HbA 1c for confirmation. FPG 5.1–6.9mmol/L is accepted as gestational diabetes mellitus (GDM). 2. 24–28 weeks of gestation Diagnostic 75 g oral glucose tolerance test (OGTT) including fasting, 1- and 2-h samples for all women not previously found to have abnormal results. Glucose thresholds for diagnosis of GDM: fasting ≥5.1 mmol/L (92 mg/dL); 1 h ≥10.0 mmol/L (180 mg/dL); 2 h ≥8.5 mmol/L (153 mg/dL). 0020-7292/$ – see front matter © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.