Current trends in the diagnosis and management of gestational diabetes mellitus in the United States.
OBJECTIVE
To assess current practice patterns among members of the Society for Maternal-Fetal Medicine (SMFM) with respect to the diagnosis and management of gestational diabetes mellitus (GDM).


METHODS
A 38 question survey on GDM diagnosis and management was distributed to SMFM members.


RESULTS
2330 SMFM members were surveyed with a 40% response rate. Overall, 90.6% of respondents recommend a 2-step (versus a 1-step) diagnostic test. Cutoff values for the 1-h-50 g glucose challenge test vary from 130-140 mg/dL, but the majority (83%) adopts Carpenter Coustan criteria for the 3-h-100 g oral glucose tolerance test. The majority recommend glucose testing four times a day, with 55% preferring post-prandial testing at 2 h. Glyburide is used by 57% as a first-line agent, while 4% use metformin. Long-acting insulin analogs (glargine and/or detemir) are used by 46% and 33.6% of respondents, respectively. Antenatal testing is recommended by 38.7% for diet-controlled GDM compared to 98.7% for pharmacologically controlled GDM, with 56% starting by 34 weeks gestation. Most respondents recommend delivery of diet-controlled GDM at 40 weeks and pharmacologically controlled GDM at 39 weeks. Most (69%) offer elective cesarean section for an estimated fetal weight of >4500 g.


CONCLUSIONS
There is significant variation in the diagnosis and management of GDM among SMFM members.
a Department of Obstetrics and Gynecology , Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine , New York , NY , USA.
Brianne E
BE
Bimson
a Department of Obstetrics and Gynecology , Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine , New York , NY , USA.
Barak M
BM
Rosenn
a Department of Obstetrics and Gynecology , Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine , New York , NY , USA.
Sara A
SA
Morris
a Department of Obstetrics and Gynecology , Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine , New York , NY , USA.
Elizabeth B
EB
Sasso
a Department of Obstetrics and Gynecology , Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine , New York , NY , USA.
Rachelle A
RA
Schwartz
a Department of Obstetrics and Gynecology , Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine , New York , NY , USA.
Lois E
LE
Brustman
D000328:Adult; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000706:statistics & numerical data / Q000639:trends*; D011247:Pregnancy; D014481:United States
D007004:Hypoglycemic Agents
Gestational diabetes mellitus; management; survey