4 NEWS
4 NEWS
18 JULY 2025 ausdoc. com. au
GDM update raises thresholds
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Mohana Basu THE first update to gestational diabetes guidelines in a decade has raised the glucose thresholds for diagnosis, aiming to reduce over-medicalisation for women with low-risk pregnancies.
The previous guidelines recommended basing diagnosis of gestational diabetes on 75g two-hour pregnancy oral glucose tolerance test( POGTT) thresholds derived from a 2008 study.
New guidelines from the
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Australasian Diabetes in Pregnancy Society, published in the Medical Journal of Australia last month, have raised these thresholds.
They recommend diagnosing overt diabetes in pregnancy based on any of the following at any time in pregnancy:
• Fasting plasma glucose ≥7.0mmol / L
• Two-hour POGTT ≥11.1mmol / L
• HbA1c ≥6.5 %( 48mmol / mol).
They recommend a diagnosis of gestational diabetes mellitus based on any of the following criteria
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during a 75g POGTT:
• Fasting plasma glucose between 5.3mmol / L and 6.9mmol / L
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Previous thresholds were derived from a 2008 study.
• One-hour glucose ≥10.6mmol / L
• Two-hour glucose between 9.0mmol / L and 11.0mmol / L. The guidelines recommend
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universal testing with a 75g two-hour POGTT at 24-28 weeks’ gestation but that women with risk factors have their HbA1c measured during the first antenatal visit.
Possible risk factors include obesity, PCOS, a family history of diabetes, previous adverse pregnancy outcomes, or being 30 or older, they say.
“ Services in areas with a high background population prevalence of type 2 diabetes may opt for universal HbA1c screening after consideration
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of logistic and cost implications,” the guideline authors said.
An HbA1c of 6.5 % or more indicated overt diabetes in pregnancy, they added.
They said women with an HbA1c of 6.0-6.4 % and a history of gestational diabetes should undergo a 75g POGTT before 20 weeks’ gestation, preferably between 10 and 14 weeks.
A POGTT before 10 weeks was discouraged based on limited evidence and poor tolerance. Med J Aust 2025; 23 Jun.
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A spokesperson for the Tasmanian Department of Health said the program had been designed to involve fixed-term contracts of 6-12 months for individual GPs over two years.
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They denied that the program ended prematurely, saying it had been extended beyond its two years to allow more time for evaluation.
AMA Tasmania said it supported the program and was disappointed it had stopped.
“ When you have specialist GPs working in a hospital outpatient clinic, you bring together such a wonderful mix of skills and connect clinicians who otherwise don’ t work together,” its Southern Division Representative Dr Meg Creely said.
References: 1. CELEBREX RELIEF ® Product Information. 2. Ekman EF et al. Am J Orthop 2002; 31( 8): 445-451. 3. Petri M et al. J Rheumatol 2004; 31( 8): 1614-1620. 4. Ralha LV et al. Revista Brasileira de Medicina 2008; 65( 11): 378-387. 5. Bertin P et al. J Int Med Res 2003; 31( 2): 102-112. 6. Cheung R et al. Clin Ther 2007; 29:2498 – 2510. 7. CELEBREX ® Product Information 12 / 10 / 2021. 8. Chan FKL et al. Lancet 2010; 376:173-179. 9. Tai FWD, McAlindon ME. Clin Med( Lond) 2021; 21( 2): 131-134. 10. Australian and New Zealand College of Anaesthetists & the Faculty of Pain Medicine. PS41( G). Position statement on acute pain management 2023. Available at: https:// www. anzca. edu. au / safety-advocacy / standards-of-practice / policies,-statements,-and-guidelines; Accessed October 2024. 11. Bhala N et al. Lancet 2013; 382:769-79( incl. Suppl Appendix).
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