Controversies in Screening and Diagnostic Criteria for Gestational Diabetes in Early and Late Pregnancy

Abstract

This review serves to evaluate the screening and diagnostic strategies for gestational diabetes and overt diabetes in pregnancy. We focus on the different early screening and diagnostic approaches in first trimester including fasting plasma glucose, random plasma glucose, oral glucose tolerance test, hemoglobin A1c, risk prediction models and biomarkers. Early screening for gestational diabetes is currently not recommended since the potential benefits and harms of early detection and subsequent treatment need to be further evaluated in randomized controlled trials.

Keywords: diagnostic criteria; early biomarkers; gestational diabetes (GDM); pregnancy; screening.

Figure 1

Overview of tested biomarkers. CRP, c-reactive protein; Free β-HCG, free β-human chorionic gonadotropin; GlyFn; glycosylated fibronectin; HbA1c, hemoglobin A1c; HDL, high density lipoprotein; hsCRP, high sensitive c-reactive protein; IGF, insulin like growth factor; IGFBP, insulin like growth factor binding protein; LDL, low density lipoprotein; MF, maternal factors; PAI-2, plasminogen activator inhibitor-2; PP13, placental protein 13; PAPP-A, pregnancy associated plasma protein-A; PlGF, Placental growth factor; microRNAs, micro ribonucleic acids; sFlt-1, soluble Fms-like tyrosine kinase-1; SHBG, sexual hormone binding globulin; sHLA-G, soluble human leucocyte antigen-G; TNF-α, tumor necrosis factor-α; TSH, thyroid-stimulating hormone; 1.5 AG, 1.5 Anhydroglucitol.