Putting Prevention into Practice

An Evidence-Based Approach

Screening for Gestational Diabetes

 

Am Fam Physician. 2021 Dec ;104(6):641-642.

Author disclosure: No relevant financial affiliations.

Case Study

A 28-year-old South Asian patient at 30 weeks' gestation, S.F., presents to transfer prenatal care to your clinic. The patient has recently moved, and prenatal records indicate that S.F.'s most recent prenatal visit was at 22 weeks' gestation. This is the patient's first pregnancy. S.F. states that they have not been screened for gestational diabetes mellitus. The patient's prepregnancy body mass index was 23 kg per m2, with a gain of 20 lb (9.1 kg) in this pregnancy. S.F.'s history reveals no medical comorbidities or family history of diabetes.

Case Study Questions

1. Based on the U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for gestational diabetes, which one of the following approaches is most appropriate for this patient?

  • A. Screen for gestational diabetes at this visit.

  • B. Do not screen for gestational diabetes because the patient presents after 28 weeks' gestation.

  • C. Do not screen for gestational diabetes because the patient does not have risk factors for it.

  • D. Do not screen for gestational diabetes because the potential harms associated with screening outweigh the benefits.

  • E. Refer the patient to a diabetes educator to start home glucose monitoring.

2. After discussing screening for gestational diabetes, the patient would like to know more about the benefits of treatment if the diagnosis is made at 24 weeks or later. Based on the available evidence reviewed by the USPSTF, treatment decreases the risk of which of the following?

  • A. Primary cesarean delivery.

  • B. Shoulder dystocia.

  • C. Preeclampsia.

  • D. Macrosomia.

3. The patient is available for screening today but is not currently fasting. Which screening modality is the most appropriate for this patient?

  • A. Offer the two-step screening approach, starting with the one-hour glucose challenge test.

  • B. Offer screening using a nonfasting plasma glucose test.

  • C. Offer screening using a risk-based questionnaire.

  • D. Offer screening using A1C concentration.

  • E. Offer the two-step screening

Author disclosure: No relevant financial affiliations.

References

1. Davidson KW, Barry MJ, Mangione CM, et al. Screening for gestational diabetes: US Preventive Services Task Force recommendation statement [published correction appears in JAMA. 2021;326(13):1331]. JAMA. 2021;326(6):531–538.

2. Pillay J, Donovan L, Guitard S, et al. Screening for gestational diabetes: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021;326(6):539–562.

This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/gestational-diabetes-screening.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Putting Prevention into Practice published in AFP is available at https://www.aafp.org/afp/ppip.

 

 

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