Intermediate hyperglycemia in early pregnancy: A South Asian perspective

Table 2 Recommendations of various organizations for “intermediate hyperglycemia” screening before 24 gestational weeks

Organization	Timing	Target population	Test	Threshold PG values in mmol/L	Position of the association in 2022
International Association of the Diabetes and Pregnancy Study Group (IADPSG): 2010	First antenatal visit	Universal or only high-risk women	Fasting plasma glucose	5.1-6.9; if < 5.1, OGTT after 24 GW	2016: Withdrew the recommendation for FPG testing before 24 GW
World Health Organization: 2013	Any time before 24 GW	Not defined	75 g OGTT	FPG 5.1-6.9; 1-h PG ≥ 10; 2-h PG 8.5-11.0	No change from 2013 recommendation
American Diabetes Association (ADA): 2010	During first antenatal visit, suggest risk stratification	Those women with marked obesity, personal history of GDM, glycosuria, or a strong family history of diabetes, testing as soon as possible	One step test: 75 g 2-h OGTT, or two step test: 50 g OCT + 100 g 3-h OGTT	One step: FPG ≥ 5.2, 1-h ≥ 10, 2-h ≥ 8.6 (one abnormal value); two step: FPG ≥ 5.2, 1-h ≥ 10.0, 2-h ≥ 8.6, 3-h 7.8 (require two abnormal values)	2015: Test for undiagnosed diabetes at the first prenatal visit for those with risk factors, using standard diagnostic criteria; 2021: Test for undiagnosed pre-diabetes and diabetes at the first prenatal visit in those with risk factors using standard diagnostic criteria; 2022: Before 15 GW, test women with risk factors or consider testing all women for undiagnosed DM
2011-2014: Accepted IADPSG criteria for GDM diagnosis at 24-28 GW	No guideline for screening before 24 GW	Not specified	Nil		Screen women at risk for adverse events by FPG (6.1 mmol/L), HbA1c (4.1 mmol/mol)
American College of Obstetricians and Gynaecologists (ACOG): 2018	First antenatal visit, selective for women at risk for undiagnosed diabetes and GDM	Selective for women at risk for undiagnosed type 2 diabetes or GDM	Two step: 50 g OCT + 100 g 3-h OGTT1 or one step: 75 g OGTT in select situations	FPG > 5.3, > 5.8; 1-h PG ≥ 10, ≥ 10.6; 2-h PG ≥ 8.6, ≥ 9.2; 3-PG ≥ 7.8, ≥ 8.0 (NDDG or C&C criteria); one step same as IADPSG recommendations for DM, no specific recommendation for intermediate hyperglycemia	No Changes in criteria after 2018
Diabetes In Pregnancy Study group of India (DIPSI)	Yes	Universal	Non fasting 75 g OGTT	2 h PG ≥ 7.8	No further modifications
National Institute for Health and Care Excellence (NICE): 2015 and 2021	Yes	Selective for women with history of previous GDM at first antenatal visit; other risk factors, no testing before 24 GW	Blood self-monitoring of glucose or 75 g OGTT	FPG ≥ 5.6; 2 h PG ≥ 7.8	No further modification

¹American College of Obstetricians and Gynecologists approves both Carpenter and Coustan criteria and National Diabetes Data Group and PG threshold values of both criteria are shown.

3-PG: 3 h post glucose load plasma glucose values; GW: Gestational week; OGTT: Oral glucose tolerance test; PG: Plasma glucose; FPG: Fasting plasma glucose; DM: Type 2 diabetes; GDM: Gestational diabetes; OCT: Oral glucose challenge.