Update zu: Ersttrimester Diagnostik und Therapie @ 11–13⁺⁶ Schwangerschaftswochen

1. Introduction: First-trimester screening for abnormal glucose metabolism

A summary of the guideline (LL) was published in 2 parts in “Ultraschall in der Medizin” [1] [2]. The full version has been published at https://register.awmf.org/de/leitlinien/detail/085-002. Amendment 1.3 to Chapter 11 of the full version, published on 20 June 2025, replaces the previous version of Chapter 11 of the guideline.

Amendment 1.3 had become necessary because a Trilogy in “Lancet” [3] [4] [5] had published evidence requesting a change in paradigm of screening and prevention for GDM from 24–28 weeks of gestation to the 11–13^+ 6 weeks of gestation.

The rationale for an amendment for chapter 11 is new evidence that early screening at 11–13^+ 6 weeks and early intervention in high risk groups halves macrosomia and respiratory distress in neonates. There are additional non-significant positive effects.

The guideline groups AWMF 085–002 S2e LL “First trimester diagnosis and therapy at the 11–13^+ 6 weeks of pregnancy” and AWMF 057–008 S3 LL “Gestational diabetes mellitus (GDM): diagnosis, therapy and follow-up” have independently adopted recommendations on GDM screening in the first trimester, subsequently harmonizing them for both guidelines. The 2 groups also refer to each otherʼs guidelines.

The following information is based on the short version of Amendment 1.3.

For the full version both in English and German, please go to the link above on the AWMF website.

Publication History

Article published online:
09 September 2025

• References

• 1 von Kaisenberg C, Kozlowski P, Kagan KO. et al. Ersttrimester Diagnostik und Therapie @ 11–13+6 Schwangerschaftswochen – Teil 1. Ultraschall in Med 2025; 46: 36-48
• 2 von Kaisenberg C, Kozlowski P, Kagan KO. et al. Ersttrimester Diagnostik und Therapie @ 11–13+6 Schwangerschaftswochen – Teil 2. Ultraschall in Med 2025; 46: 145-161
• 3 Hivert MF, Backman H, Benhalima K. et al. Pathophysiology from preconception, during pregnancy, and beyond. Lancet 2024; 404: 158-174
• 4 Sweeting A, Hannah W, Backman H. et al. Epidemiology and management of gestational diabetes. Lancet 2024; 404: 175-192
• 5 Simmons D, Gupta Y, Hernandez TL. et al. Call to action for a life course approach. Lancet 2024; 404: 193-214
• 6 Yeral MI, Ozgu-Erdinc AS, Uygur D. et al. Prediction of gestational diabetes mellitus in the first trimester, comparison of fasting plasma glucose, two-step and one-step methods: a prospective randomized controlled trial. Endocrine 2014; 46: 512-518
• 7 Association AD. Standards of Medical Care in Diabetes 2013. Diabetes Care 2013; 36 (Suppl. 01) S11-S66
• 8 Metzger BE, Gabbe SG, Persson B. et al. International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care 2010; 33: 676-682
• 9 Simmons D, Hague WM, Teede HJ. et al. Hyperglycaemia in early pregnancy: the Treatment of Booking Gestational diabetes Mellitus (TOBOGM) study. A randomised controlled trial. Med J Aust 2018; 209: 405-406
• 10 Colagiuri S, Falavigna M, Agarwal MM. et al. Strategies for implementing the WHO diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Diabetes Res Clin Pr 2014; 103: 364-372
• 11 Benhalima K, Geerts I, Calewaert P. et al. The 2024 Flemish consensus on screening for gestational diabetes mellitus early and later in pregnancy. Acta Clin Belg 2024; 79 (03) 217-224
• 12 Simmons D, Nema J, Parton C. et al. The treatment of booking gestational diabetes mellitus (TOBOGM) pilot randomised controlled trial. BMC Pregnancy Childbirth 2018; 18 (01) 151
• 13 Simmons D, Immanuel J, Hague WM. et al. Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy. N Engl J Med 2023; 388 (23) 2132-2144
• 14 Bhattacharya S, Nagendra L, Dutta D. et al. Treatment Versus Observation in Early Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Clin Endocrinol Metab 2024;
• 15 Simmons D, Immanuel J, Hague WM. et al. Effect of treatment for early gestational diabetes mellitus on neonatal respiratory distress: A secondary analysis of the TOBOGM study. BJOG: Int J Obstet Gynaecol 2024;
• 16 Kattini R, Hummelen R, Kelly L. Early Gestational Diabetes Mellitus Screening With Glycated Hemoglobin: A Systematic Review. J Obstet Gynaecol Can 2020; 42 (11) 1379-1384