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.
Clinical evidence of diabetic complications, such as neuropathy, retinopathy, and albuminuria, would indicate longer-standing hyperglycemia that predated pregnancy.
INVESTIGATIONS
Anti-beta cell serologies (e.g., glutamic acid decarboxylase-65 [GAD-65] and anti-insulin antibodies) and postpartum glycemia testing can be performed.[23]
The finding of a markedly elevated HbA1c level or fasting plasma glucose in the first trimester suggests that diabetes existed before pregnancy.
Type 2 diabetes
SIGNS / SYMPTOMS
There may be no difference in signs and symptoms in women with GDM who had unrecognized type 2 diabetes before pregnancy.
Compared with women with autoimmune (type 1) diabetes, women with type 2 diabetes are more likely to have overweight or obesity, have a family history of type 2 diabetes, and exhibit evidence of insulin resistance, such as dyslipidemia, acanthosis nigricans, or history of polycystic ovary syndrome.
Clinical evidence of diabetic complications, such as neuropathy, retinopathy, and albuminuria, would indicate longer-standing hyperglycemia that predated pregnancy.
INVESTIGATIONS
The finding of an elevated HbA1c level or fasting plasma glucose in the first trimester suggests that diabetes existed before pregnancy.[23]
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