Differentials
Type 1 diabetes
SIGNS / SYMPTOMS
There may be no difference in signs and symptoms, although glucose level deterioration and tendency for ketosis is greater in type 1 diabetes. Women with type 1 diabetes are more likely to be white and lean.
Clinical evidence of diabetic complications, such as neuropathy, retinopathy, and albuminuria, would indicate longer-standing hyperglycaemia that antedated pregnancy.
INVESTIGATIONS
Anti-beta cell serologies (e.g., glutamic acid decarboxylase-65 [GAD-65] and anti-insulin antibodies) and postnatal glycaemia testing can be performed.[21]
The finding of a markedly elevated HbA1c level or fasting plasma glucose (FPG) in the first trimester suggests that diabetes existed before pregnancy.
The World Health Organization recommends that diabetes in pregnancy (rather than gestational diabetes) should be diagnosed if one or more of the following criteria are met: FPG ≥7.0 mmol/L (126 mg/dL); 2-hour plasma glucose ≥11.1 mmol/L (200 mg/dL) following a 75-g oral glucose load; random plasma glucose ≥11.1 mmol/L (200 mg/dL) in the presence of diabetes symptoms.[2]
Type 2 diabetes
SIGNS / SYMPTOMS
There may be no difference in signs and symptoms in women with GDM who had unrecognised type 2 diabetes before pregnancy.
Compared with women with autoimmune (type 1) diabetes, women with type 2 diabetes are more likely to have obesity, have a family history of type 2 diabetes, and exhibit evidence of insulin resistance, such as dyslipidaemia, acanthosis nigricans, or history of polycystic ovarian syndrome.
Clinical evidence of diabetic complications, such as neuropathy, retinopathy, and albuminuria, would indicate longer-standing hyperglycaemia that antedated pregnancy.
INVESTIGATIONS
The finding of an elevated HbA1c level or fasting plasma glucose (FPG) in the first trimester suggests that diabetes existed before pregnancy.[21]
The World Health Organization recommends that diabetes in pregnancy (rather than gestational diabetes) should be diagnosed if one or more of the following criteria are met: FPG ≥7.0 mmol/L (126 mg/dL); 2-hour plasma glucose ≥11.1 mmol/L (200 mg/dL) following a 75-g oral glucose load; random plasma glucose ≥11.1 mmol/L (200 mg/dL) in the presence of diabetes symptoms.[2]
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