Gestational diabetes
Also known as: GDM
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ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus
American College of Obstetricians and Gynecologists (ACOG) · 2018 · Practice Bulletin No. 190
ACOG's practice bulletin on gestational diabetes mellitus, summarising the condition, reviewing management approaches supported by clinical research, and identifying areas where evidence remains unsettled. It notes that debate continues over both diagnostic thresholds and treatment. Metadata record only.
Diabetes in pregnancy: management from preconception to the postnatal period
National Institute for Health and Care Excellence (NICE) · 2015 · NICE guideline NG3 (last updated December 2020)
The UK national guideline covering diabetes in women who are planning a pregnancy or already pregnant, including gestational diabetes. It spans preconception planning, diagnosis, antenatal, intrapartum, neonatal and postnatal care, with an emphasis on supporting self-management of blood glucose. Metadata record only.
- Published 25 February 2015 and last updated 16 December 2020. source
- Covers six care phases: preconception, gestational diabetes diagnosis and management, antenatal, intrapartum, neonatal and postnatal care. source
- Was under NICE surveillance review in 2025 with planned updates relating to closed-loop glucose management technology. source
US vs EU key differences
- Screening architecture differs fundamentally: ACOG screens all pregnant patients at 24-28 weeks with a two-step 50-g glucose challenge followed by a 100-g 3-hour OGTT, while NICE offers a single-step 75-g 2-hour OGTT only to women with defined risk factors such as BMI 30 or above, prior GDM, or a previous baby of 4.5 kg or more. source
- Diagnostic thresholds differ: NICE diagnoses gestational diabetes on a single abnormal value (fasting 5.6 mmol/L or above, or 2-hour 7.8 mmol/L or above), whereas the US Carpenter-Coustan approach requires two or more abnormal values on the 3-hour 100-g test (fasting 95, 1-hour 180, 2-hour 155, 3-hour 140 mg/dL). source
- First-line drug ordering is reversed: ACOG names insulin as the preferred pharmacological therapy with metformin only as an alternative, while NICE starts with metformin and adds or substitutes insulin only if metformin is contraindicated or targets are unmet. source
- Glycaemic targets are near-identical apart from the 2-hour postprandial value: both use a fasting target of 95 mg/dL (5.3 mmol/L) and a 1-hour target of 140 mg/dL (7.8 mmol/L), but ACOG accepts under 120 mg/dL at 2 hours versus NICE's tighter 6.4 mmol/L (about 115 mg/dL). source
- Version currency differs: the US bulletin dates to 2018 and the NICE guideline to 2015, so neither is recent relative to the field. source
What changed recently
- EUNICE guideline NG3 (February 2015) → NICE guideline NG3 (last updated December 2020)2020-12-16
The December 2020 update added new recommendations on continuous glucose monitoring and flash glucose monitoring in pregnancy for women with type 1 diabetes, dropped glibenclamide because the drug had been discontinued, and added referral advice to the NHS Diabetes Prevention Programme after gestational diabetes.
- USPractice Bulletin No. 137 (August 2013) → Practice Bulletin No. 1902018-02-01
Bulletin 190 replaced the 2013 gestational diabetes bulletin No. 137 and hardened ACOG's stance on drug therapy: insulin is named the preferred first-line agent when nutrition therapy fails, and glyburide is no longer endorsed as a first-choice alternative, a reversal of the earlier position that glyburide and insulin were broadly equivalent.
source ↗curation confidence 90%
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