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Re: GDM screeningFrom: Braun, R. Daniel (rbraun@iupui.edu)Tue Mar 23 03:53:04 1999
R. Daniel Braun, MD FACOG Clinical Professor Department of Obstetrics and Gynecology Indiana U. School of Medicine Indianapolis, IN -----Original Message----- From: Hugo D. Ribot Jr. [SMTP:hribot@mindspring.com] Sent: Monday, March 22, 1999 1:31 PM To: Multiple recipients of list Subject: GDM screening Dear gang: Like Dr. Shen, I would like to conduct a group poll re: GDM screening. 1) Do you "pre-load" with extra carbos/sugars for 3 days prior to a 3 hr GTT? YES, It is part of the test to preload and the test will give a significant number of false positives if you do not 2) Do you do weekly NSTs on patients with abnormal - 3 hr GTTs but diet controlled? NO, I do induce at 40 weeks though. - 1 hr screens but normal 3 hr GTTs? NO, I thought these were abnormal patients, but then I studied over 800 of them and compared them with normal controls. No diference in macrosomia, shoulder dystocia or cord gases or pH. (Unpublished data) - 3 hr GTTs requiring insulin (no pregestational diabetes)? YES, starting at 37 weeks and induction at 40 weeks. 3) If you have a pt with abnormal 1 hr test but normal 3 hr GTT, do you still check their fasting or postprandial glucose? NO, baseed on above data. Oded Langer in San Antonio disagrees with that and he does treat these people as being abnormal. Had a big argument - er, I mean, discussion - with our new (finished residency 7/98) associate about not torturing/unnecessarily worrying pts with fingersticks/etc if 3 hr GTT is WNL. Appreciate all the feedback. Hugo Hugo D. Ribot Jr., M.D., FACOG 9 yrs private practice Cartersville, GA
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