Gestational Screening

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Gestational diabetes — diabetes that sometimes develops in the second or third trimester of pregnancy, and that usually resolves on its own after delivery of the baby — occurs in about 4% of all pregnancies in the United States, or 135,000 pregnancies each year. According to a new study, however, many women are not screened for this condition, with potentially damaging effects on their babies. Furthermore, current standards for diagnosing gestational diabetes mean that many pregnant women with somewhat elevated blood glucose levels do not meet the diagnosis threshold, yet there may still be negative effects on the baby. And having gestatinal diabetes raises a woman’s risk of developing Type 2 diabetes later in life, yet many women who have had gestational diabetes are not screened for Type 2 diabetes as recommended.

The study — published in the January 2011 issue of the journal Obstetrics and Gynecology — sought to estimate both the initial screening rate for gestational diabetes and the follow-up diabetes screening rate among women with gestational diabetes once they had given birth. Using the records of a laboratory services company, the researchers found that 32% of pregnant women ages 25–40 were not screened for gestational diabetes. Of those who did undergo screening, 5% were found to have the condition. Yet only 19% of women with confirmed gestational diabetes were screened again for diabetes within six months after giving birth. According to an article on the study in USA Today, follow-up screening is recommended for women with gestational diabetes between 6 and 12 weeks after giving birth. As many as half of women with gestational diabetes continue to have diabetes after their pregnancy.

Undertreatment of gestational diabetes may be even more of a problem than the study’s 68% screening rate suggests, given the results of a 2008 study called Hyperglycemia and Adverse Pregnancy Outcomes (HAPO). This study sought to determine the results of impaired glucose tolerance during pregnancy on a variety of outcomes, including high birth weight, caesarean section delivery, high umbilical-cord C-peptide levels, and hyperglycemia (high blood glucose) in the newborn. HAPO used an oral glucose tolerance test of 75 grams of glucose, rather than the gestational-diabetes standard of 100 grams, and correlated participants’ blood glucose levels before and one and two hours after ingesting the glucose with outcomes in the baby. Lower glucose tolerance at any level — even below the current medical threshold for gestational diabetes — was found to raise the risk of negative outcomes in the baby. A medical conference was convened to discuss these results, leading to the release of recommendations earlier this year based on the principle that any elevated blood glucose level that raises the risk of negative outcomes beyond 1.75 times the average level — using the 75-gram oral glucose tolerance test — should be treated as gestational diabetes. Under this more stringent standard, the new study found, the number of women considered to have gestational diabetes would double.

If you have been pregnant, were you screened for gestational diabetes? If you had gestational diabetes — or another type of diabetes during pregnancy — did you find it difficult to manage your blood glucose levels? Did you or your baby experience any negative effects that might have been diabetes-related? Were you given a follow-up test for diabetes in the months following your pregnancy? Should there be stricter standards for screening and/or diagnosis of gestational diabetes in light of the new study? Leave a comment below!

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