Table 2 Comparative guidelines for GDM management, National Health Mission in India, WHO and FIGO

Guideline prescribed by the National Health Mission in India

Demand generation – Community awareness, Sensitization for GDM, and client mobilization. Diagnosis – The first GDM testing OGTT at first ANC contact and if < 140 mg/ dL, then second testing OGTT at 24–28 weeks of pregnancy.

Management – If the OGTT result is ≥140 mg/dL then start MNT and exercise on the same day. Start medical management if PPBS result ≥120 mg/dL in a subsequent follow-up visit.

Follow-up – PPBS monthly till delivery. Ultrasonography at 18–20, 28–30 & 34–36 weeks of pregnancy.

Referral – As per the reasons cited in the guideline [24]

WHO guidelines

Diabetes mellitus in pregnancy should be diagnosed by the 2006 WHO criteria for diabetes if one or more of the following criteria are met:

• fasting plasma glucose ≥7.0 mmol/l (126 mg/ dl)

• 2-plasma glucose ≥11.1 mmol/l (200 mg/dl) following a 75 g oral glucose load

• random plasma glucose ≥11.1 mmol/l (200 mg/ dl) in the presence of diabetes symptoms.

The diagnosis of gestational diabetes mellitus at any time during pregnancy should be based on any one of the following values:

• Fasting plasma glucose = 5.1–6.9 mmol/l (92–125 mg/dl)

• 1-h post 75 g oral glucose load > = 10.0 mmol/l (180 mg/dl)*

• 2-h post 75 g oral glucose load 8.5–11.0 mmol/l (153–199 mg/dl)

Medical Nutrition Therapy and Insulin Therapy/Metformin as required [25]

FIGO guidelines

All women at booking/first trimester-Measure FPG, RBG, or HBA1c to detect diabetes in pregnancy

In 24–28 weeks, if it turns to be negative, perform 75-g 2-h OGTT

-If lifestyle modification fails, metformin, glyburide, or insulin should be considered as safe and effective treatment options for GDM

-Self-monitoring of blood glucose is recommended for all pregnant women with diabetes, 3–4 times a day:

Fasting: Once daily, following at least 8 h of overnight fasting.

Postprandial: 2–3 times daily, 1 or 2 h after the onset of meals, rotating meals on different days of the week

Self-monitoring of the blood glucose is recommended for all pregnant women with diabetes at least once daily, with documented relation to the timing of the meal.

Recommendations for insulin treatment in women with gestational diabetes mellitus:

-The following insulin may be considered safe and effective treatment during pregnancy: Regular insulin, NPH, lispro, aspart, and detemir [26]