What Is The Evidence On Different Ways To Diagnose Gdm
The Cochrane review on this topic included seven trials , and the researchers found disappointing results . The studies in the review were of poor quality, had small sample sizes, did not study the best time during pregnancy to test for GDM, and often did not report important infant or maternal outcomes, such as higher birth weight. Because the evidence was so limited, the Cochrane reviewers could not recommend one strategy over another. They concluded that large, randomized trials are needed before we can establish the best way to identify people with GDM.
About Diabetes In Pregnancy
Whenever we eat, a hormone called insulin helps move the sugar from our food through our blood and into our muscles, where it is turned into energy to help us move.
When you are pregnant, your body produces lots of other hormones to help your baby grow. Some of these hormones can stop insulin working well. This causes sugar to build up in your blood because it cant get to your muscles. You have diabetes when you have too much sugar in your blood.
Pregnancy diabetes generally goes away after your baby is born, though it leaves you with more chance of developing diabetes again later in life.
Other Glucose Test Alternatives
In case youre curious, here are some other alternatives to the glucose test that I discussed with my doctor, along with why she doesnt recommend them:
A1c Blood Test. This blood test can give you a look at your blood sugar level average over the last 3 months or so, which is great for testing for diabetes in non-pregnant people. The reason why my doctor doesnt like this test for determining gestational diabetes, is that this condition typically wont show up until much later in pregnancy. In fact, thats why she didnt even want me to test my blood sugar until I was 30 weeks along, because gestational diabetes might not make an appearance until the last 8 to 10 weeks of pregnancy. So, it doesnt really matter what my blood sugar average has been over the last 3 months I could still develop diabetes and it could go undiagnosed if we relied on the A1c test.
Eating an equivalent amount of glucose in food or fresh juice. Ive heard that some midwives will let their clients eat a certain amount of grapes, orange juice, or jelly beans to get to the 50g of glucose found in the standard orange drink. My doctor wasnt comfortable with that idea, because she felt there were too many variables involved. Since food can vary, she was afraid Id be eating too much or too little sugar and wind up with an inaccurate result which could potentially lead to undiagnosed diabetes, or falsely diagnosed diabetes, neither of which is ideal.
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Antenatal And Postnatal Care
NICE recommends that GPs, midwives and other primary care professionals should advise pregnant women with any form of diabetes to maintain their capillary plasma glucose below certain target levels, if these are achievable without causing problematic hypoglycaemia.
Recommended target levels are 5.3 mmol/litre for fasting, and 7.8 mmol/litre 1 hour after meals, or 6.4 mmol/litre for 2 hours after meals.
Further updated recommendations cover women with gestational diabetes whose blood glucose levels have returned to normal after birth.
NICE says these women should be offered lifestyle advice that includes weight control, diet and exercise, and a fasting plasma glucose test 613 weeks after the birth to exclude diabetes.
NICE recommends that a 75 g 2-hour oral glucose tolerance tests should not be routinely offered for women who were diagnosed with gestational diabetes and whose blood glucose levels returned to normal after birth.
In addition, women were diagnosed with gestational diabetes who have a negative postnatal test for diabetes should be offered an annual HbA1c test.
Elsewhere NICE recommends that women with type 1 diabetes who are planning to become pregnant should be offered blood ketone testing strips and a meter. Women should be advised to test for ketonaemia if they become hyperglycaemic or unwell.
What Is Being Tested
Glucose is the primary energy source for the bodys cells and the only energy source for the brain and nervous system. A steady supply must be available for use, and a relatively constant level of glucose must be maintained in the blood. Glucose tolerance tests help diagnose gestational diabetes, which is high blood glucose that develops during pregnancy.
Women diagnosed with gestational diabetes and their babies can receive
Glucose is the primary energy source for the bodys cells and the only energy source for the brain and nervous system. A steady supply must be available for use, and a relatively constant level of glucose must be maintained in the blood. Glucose tolerance tests help diagnose gestational diabetes, which is high blood glucose that develops during pregnancy.
Women diagnosed with gestational diabetes and their babies can receive appropriate treatment during pregnancy as well as after delivery. If untreated, mothers with gestational diabetes can pass more glucose to their developing babies than they need, and their fetuses may gain a lot of weight. These mothers may give birth to large babies , which can cause complications for the mothers and their babies, such as difficult labor and delivery, heavy bleeding after delivery, or need for a cesarean delivery. Women with gestational diabetes are more likely to have other conditions, such as high blood pressure. There is an increased risk of preeclampsia for women with gestational diabetes.
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Adoption Of Iadpsg Criteria By Various Scientific Bodies
Though the IADPSG recommendations for first trimester diagnosis of GDM have been questioned, their recommendations for diagnosing GDM at 2428 weeks are based on evidence that correlate maternal glucose concentrations to fetal outcomes. These recommendations also reflect a consensus view and have been accepted by a large number of scientific bodies. In 2011, the ADA endorsed the IADPSG criteria . ADA recommended that all pregnant women not known to have prior diabetes undergo a 75 g OGTT at 2428 weeks. Although the thresholds recommended by IADPSG are only minimally different from the ADA criteria, the prevalence of GDM would still be higher, if IADPSG criteria were used. This is because while the ADA uses 100 g OGTT, requires 2 elevated readings, the IADPSG uses the 75 g load and requires only one abnormal value.
As already mentioned, in 2013, the WHO also accepted the IADPSG criteria . Other organizations like the Endocrine Society and the Australian Diabetes in Pregnancy Society and recently the International Federation of Gynecology and Obstetrics have also accepted the IADPSG criteria.
How To Lower Your Blood Glucose Levels
Even if you have a normal glucose screening and never test positive for glucose in your urine, its still important to follow a healthy diet during pregnancy, which can help stabilize your blood sugar levels.
Here are some tips on what to eat to keep blood sugar spikes at bay, plus other smart strategies:
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When Is It Ordered
Pregnant women are usually screened for gestational diabetes between their 24th and 28th week of pregnancy. You may be screened earlier in your pregnancy if you have signs and symptoms of diabetes or have had gestational diabetes with a previous pregnancy.
You may also be tested earlier in your pregnancy if you are at risk of type 2 diabetes . You may be at risk if you:
- Are overweight, obese, or physically inactive
- Have a first degree relative with diabetes
- Delivered a baby weighing 9 pounds or more or had gestational diabetes with a previous pregnancy
- Have polycystic ovary syndrome
- Are of a high-risk race or ethnicity, such as African American, Hispanic, Native American, Asian American, Pacific Islander
- Have high blood pressure or taking medication for high blood pressure
- Have heart disease
**Some labs may use different numbers.
What Is The Gestational Diabetes Test
First of all, when I understood what this test was for, the whole experience seemed less scary. Thats pretty typical though- the more prepared you feel, the less scary pregnancy is!
Basically, during pregnancy, you can develop temporary diabetes depending on how your placenta develops. It has nothing to do with how healthy you eat or your genetics- it seems to be pretty random actually.
Its pretty common as well- The American Diabetes Association said that pregnant women affected by it could be as high as 9%. If you have gestational diabetes, that means you have insulin resistance and you likely just have to change the way you eat for the remainder of your pregnancy After the baby is born your body should go back to normal!
The Gestational Diabetes Test simply is to track how your body handles a high dose of sugar. Thats it.
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How To Pass The Glucose Tolerance Test For Pregnancy
If you have no choice but to take the glucose test, Ill pass on this tip that my doctor shared with me: Rather than eating a low-carb meal before you take the test, as so many doctors recommend, she actually recommends eating a low-fat, higher-carb meal because the body seems to respond to the test better that way.
Since false positives are fairly common with the one-hour glucose test, I wonder if this tip might help to avoid that. Also, its not uncommon for fasting numbers to be higher than post-meal numbers, so if I had to do it again, I would definitely eat something 2 hours before taking the one-hour test. I fasted for my one-hour test the last time, and failed it by one or two measly points, but went on to pass my 3-hour test with flying colors.
Reader Feedback: If youve ever been pregnant, did your doctor offer you an alternative to the glucose test? Id love to hear if there are any other options available!
Living With Gestational Diabetes
Many women with gestational diabetes are able to control their blood sugar levels with lifestyle changes, including diet and physical activity however, some women will need to inject insulin for better control.
Ask your doctor to refer you to a registered dietitian to learn about healthy eating during pregnancy. Physical activity during pregnancy can also help control your blood sugar level.
Sometimes healthy eating and physical activity are not enough to manage blood sugar levels. In this case, your health-care provider may recommend insulin injections or pills for the duration of your pregnancy. Medication will help keep your blood sugar level within your target range.
Your health-care team will teach you how to check your blood sugar with a blood glucose meter to better track and manage your gestational diabetes. This will help to keep you and your baby in good health.
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How Does Gestational Diabetes Develop
Your body makes a hormone called insulin to help keep your blood glucose at the right level. Your blood glucose levels become higher if your body doesnt make enough insulin or if your insulin does not work as well as it should.
During pregnancy, hormones are made by the placenta to help the baby develop and grow. These hormones, however, can stop the mothers insulin from working properly. This is called insulin resistance. As the pregnancy develops and the baby grows bigger, the mothers body has to make more insulin to keep her blood glucose in the recommended glucose range.
Later in pregnancy the amount of insulin needed to keep blood glucose levels in the optimal range is 2 to 3 times higher than usual. If the mother is unable to produce enough insulin to meet this demand then her blood glucose levels rise and gestational diabetes develops.
International Association Of Diabetes And Pregnancy Study Groups Criteria
On the basis of the HAPO data, the International Association of Diabetes and Pregnancy Study Groups panel suggested a single step 75 g OGTT to be done in all pregnant women at 2428 weeks of gestation . Glucose values which yielded an odds ratio of 1.75, i.e., which had a 75 % increase in risk of developing 3 combined primary outcomes . The diagnosis was to be made if any one of the values for fasting plasma glucose, 1-h glucose, or 2-h glucose equaled or exceeded the diagnostic threshold as shown in Table .
Table 3 IADPSG criteria for diagnosis of GDM and overt diabetes in pregnancy
IADPSG criteria also recommended the threshold for the diagnosis of GDM as well as overt diabetes at first trimester. Following the IADPSG recommendations, several other guidelines now recommend screening in early trimester to detect overt diabetes especially in high-risk groups .
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Treatment For Gestational Diabetes
You can do a lot to manage your gestational diabetes. Go to all your prenatal appointments and follow your treatment plan, including:
- Checking your blood sugar to make sure your levels stay in a healthy range.
- Eating healthy food in the right amounts at the right times. Follow a healthy eating plan created by your doctor or dietitian.
- Being active. Regular physical activity thats moderately intense lowers your blood sugar and makes you more sensitive to insulin so your body wont need as much. Make sure to check with your doctor about what kind of physical activity you can do and if there are any kinds you should avoid.
- Monitoring your baby. Your doctor will check your babys growth and development.
If healthy eating and being active arent enough to manage your blood sugar, your doctor may prescribe insulin, metformin, or other medication.
What Are The Complications Of Untreated Gestational Diabetes
- shoulder dystocia, which occurs when the babys shoulders to get stuck in the birth canal during delivery
- slightly higher rates of fetal and neonatal death
Untreated gestational diabetes can also result in the baby having a high birth weight. This is called macrosomia. Macrosomia may result in shoulder damage during birth and can require a cesarean delivery. Babies with macrosomia have a higher likelihood of childhood obesity and type 2 diabetes.
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What Happens During The Oral Glucose Tolerance Test
The oral glucose tolerance test involves quickly drinking a sweetened liquid , which contains 50g of glucose. The body absorbs this glucose rapidly, causing blood glucose levels to rise within 30 to 60 minutes. A blood sample will be taken from a vein in your arm about 60 minutes after drinking the solution. The blood test measures how the glucose solution was metabolized .
Fasting Blood Sugar Test
Screening with a fasting blood sugar test would be quick, cheap, and help people avoid side effects such as vomiting. However, researchers are uncertain about the fasting plasma glucose tests potential for a GDM screening test . The U.S. Preventative Services Task Force reviewed the evidence and concluded that screening with a FPG test after 24 weeks of pregnancy may be useful to rule out people who do not have GDM however, the 50-gram glucose screening test is better at identifying those who have GDM with fewer false positives . In a recent review , researchers talked about one interesting idea for using FPG screening in the third trimester. The FPG test could be used to rule out GDM in people with lower blood sugar levels and to rule in, or diagnose GDM in people with higher levels . They point out that in the HAPO study, health and birth outcomes were much better when the FPG was < 80 mg/dL. Screening with an FPG test this way using a two-cutoff approachcould cut the need for a diagnostic OGTT in half, since only people with FPG levels between 80 mg/dL and 92 mg/dL would need the OGTT for a diagnosis. For everyone else, no other testing would be needed. This FPG approach has potential, but it needs research before it can be recommended. Its also possible that relying on this approach could miss people who have normal fasting blood sugar but abnormally high post-meal blood sugar.
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How To Prepare For The Gestational Diabetes Test
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Most pregnant Mamas loathe the diabetes test. No one in their right mind enjoys fasting before smashing 75gm of glucose.
BUT, unfortunately the Glucose Tolerance Test is here to stay. Unless some genius comes up with a fool-proof cure for Gestational Diabetes.
So weve laid out exactly what you need to do to make the test not only easier, but also more likely to be successful, ie not have to be repeated.
Oral Glucose Tolerance Test
The OGTT measures blood glucose after you fast for at least 8 hours. First, a health care professional will draw your blood. Then you will drink the liquid containing glucose. You will need your blood drawn every hour for 2 to 3 hours for a doctor to diagnose gestational diabetes.
High blood glucose levels at any two or more blood test timesfasting, 1 hour, 2 hours, or 3 hoursmean you have gestational diabetes. Your health care team will explain what your OGTT results mean.
Your health care professional may recommend an OGTT without first having the glucose challenge test.
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Glucose Drinks: The One
One trial in the review compared the one-part diagnostic method with the two-part screening and diagnostic method . They did not measure maternal or infant outcomes, but rates of GDM diagnosis only. They found that the one-part diagnostic method resulted in more diagnoses of GDM compared to the two-part screening and diagnostic method.
Although the evidence was low quality due to problems with the study design, the finding that more people are diagnosed with GDM using the 75-gram OGTT is supported by other research and widely accepted . In fact, this is the primary reason that ACOG has refused to adopt the one-part, 75-gram OGTT for diagnosis at this timethey state it would lead to a much higher number of people diagnosed with GDM, and an enormous increase in health care costs without clear evidence that it results in improvements to maternal and infant health that match the treatment costs .