A primigravida comes to antenatal clinic for a routine antenatal visit. When should she be screened for diabetes in pregnancy?
Early in pregnancy and/or repeat at 24 to 28 weeks of pregnancy
Screen early in pregnancy at the first antenatal contact and, if negative, repeat at 24 to 28 weeks. Indian national policy (MoHFW / DIPSI) mandates universal screening at the first visit because Indian women have an 11-fold higher risk of gestational diabetes than Caucasian women, and because early testing detects pre-existing overt diabetes during organogenesis. The DIPSI test is a single-step, non-fasting 75 g oral glucose load with plasma glucose at 2 hours; 140 mg/dL or more diagnoses GDM. The repeat at 24 to 28 weeks targets the window when placental lactogen, progesterone, cortisol and growth hormone drive insulin resistance to its peak.
Why the others are wrong: 24 to 28 weeks with a repeat at 30 to 32 weeks omits early screening and misses overt diabetes during organogenesis. Early plus 30 to 32 weeks starts right but delays the second test past the peak insulin-resistance window. 9 to 11 weeks with a repeat at 30 to 32 weeks is arbitrary and again misses 24 to 28 weeks.
Key point: GDM screening in India is universal, not risk-based: first visit, then 24 to 28 weeks, by the non-fasting 75 g DIPSI test, cut-off 140 mg/dL at 2 hours.
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